Tag: MSSNY eNews November 2017

PRESIDENT’S MESSAGE Charles Rothberg, MD November 17, 2017 Volume 17 Number 43

Dear Colleagues:

Longtime MSSNY member, Dr. Pat Bomba, has been working enthusiastically on end-of-life issues for well over two decades. The champion of “the tough conversation” has earned  her national recognition for her work; other states have followed New York’s lead. Dr. Bomba created and promoted the end-of-life-care document called MOLST (Medical Orders for Life Sustaining Treatment) for people who are in good health and those who are seriously ill.  MOLST helps fill in the gaps of a living will, and makes sure everyone in the health care system is guided by the patient’s own preferences for care.

According to a recent editorial Dr. Bomba wrote, her family has a Thanksgiving tradition dating back to 1992 that has nothing to do with food or football. Her message is something you may want to think about for yourself, your family, your patients and your practice.

As a health plan medical director with an expertise in geriatrics, palliative care and end-of-life issues, Dr. Bomba knows opening this topic leads to difficult but meaningful conversation. She recommends that everyone 18 years and older complete a Health Care Proxy and then, should share copies with their physician, lawyer and most importantly, their families.

At the Bomba’s annual family turkey dinner, they have an advance care planning discussion whereby they “focus on what makes life worth living at this point in our lives. I encourage every family to embrace our Thanksgiving tradition. Our Thanksgiving and thoughtful MOLST discussions helped our family honor our mom’s wishes at the end of her life.”

As she writes, “Advance care planning is a gift to yourself and your family. Choose the person you trust to make medical decisions if you lose the ability to make medical decisions and share your values, beliefs and what matters most with your family and loved ones.

While at first you might think it’s morbid to discuss such issues at a festive gathering, we’ve found sharing our wishes for end-of-life care actually brings us closer. We gain peace of mind knowing our own wishes will be understood and honored in the event we can’t speak for ourselves.”

As she succinctly puts it, “No pumpkin pie, until you tell me how you want to live until you die.” After dinner, “the adults in our family stay at the table and talk about what matters most in our lives. We review our advance directives to make sure they reflect our current feelings.”

The New York eMOLST Registry is an electronic database centrally housing MOLST forms and CDFs to allow 24/7 access in an emergency. eMOLST allows for electronic completion of the current New York State Department of Health-5003 MOLST form.  By moving the MOLST form to a readily accessible electronic format and creating the New York eMOLST Registry, physicians and EMS professionals, can have access to MOLST forms at all sites of care including hospitals, nursing homes and in the community.

Discussing and documenting each family member’s wishes when they are well will save family turmoil in the future.

For physicians, you can download the doctor-specific information here.

This is not just for your patients. This information is for you and your family.

I wish you and your families a Happy Thanksgiving.

Sincerely,

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

MSSNY Phone Number for Garfunkel Wild
Our new law firm, Garfunkel Wild, has established a phone number for exclusive use by MSSNY members: 516-393-2230.  We also have a group of attorneys dedicated to receiving the phone calls to ensure that any MSSNY member who calls will receive prompt service.

They want to hear from you!

DFS Imposes $2 Million Fine on Cigna for Selling Unapproved Health Insurance Policies
This week, New York Department of Financial Services Superintendent Maria Vullo announced the imposition of a $2 million fine on Cigna for violations of New York State Insurance Law involving the illegal sale of stop-loss insurance and unapproved health insurance policies that would otherwise have been part of New York’s small-group market.

According to a consent order entered into with Cigna, DFS found that Cigna improperly sold stop-loss and fully insured health insurance policies outside of New York to New York-based small groups with employees in New York State.  The press release noted that Cigna sold 81 group health insurance policies in violation of New York Insurance Law, including 38 stop-loss insurance policies to New York small groups seeking to self-insure and 43 fully insured health insurance policies to small groups as if they were selling to non-New York small groups.

To read the full press release, click here.

Governor Again Vetoes Legislation to Permit Prescription Refills Longer than Original Prescription
Recently, Governor Cuomo vetoed legislation (A.6731-B/S.5171-B) that would have authorized pharmacists to refill non-controlled substance prescriptions in a quantity greater than that set forth in the prescriber’s original prescription. In effect, it would have enabled pharmacists to provide 90-day refills of particular prescription medication even if the original prescription called for a shorter refill duration, such as 30 days.

While there were some changes to a similar bill that was vetoed last year, Governor Cuomo noted in the veto message his concerns that “the bill retains the provisions that would risk contributing to the distribution of larger quantities of prescription medications than may be necessary for a specific patient”.  Moreover, he noted his concern that “it would still allow the pharmacist to infringe on the physician-patient relationship” because the notification to the prescriber would not occur until after the prescription is filled.

Promo Code: MSSNY

AHA and ACC Redefine High Blood Pressure Reading
Acting for the first time in 14 years, the American Heart Association, the American College of Cardiology and nine other groups redefined high blood pressure as a reading of 130 over 80, down from 140 over 90.” This “change means that 46 percent of US adults, many of them under the age of 45, now will be considered hypertensive.” The Post points out that “under the previous guideline, 32 percent of US adults had” hypertension.

On its front page, the New York Times (11/14) reports that “under the guidelines…the number of men under age 45 with a diagnosis of high blood pressure will triple, and the prevalence among women under age 45 will double. The guidelines presented at a heart association meeting and published in the Journal of the American College of Cardiology, also spell out exactly how health care providers and people at home should check blood pressure.” For instance, physicians “and nurses are urged to let patients rest five minutes first and then to average at least two readings over two visits.” Meanwhile, “patients are urged to take regular readings at home, with a device checked out by their health care providers.”

Click here to read the AMA statement on the updated guideline for measuring blood pressure.

Tip of the Week: Is it Appropriate to Report Kinesio Taping with Strapping Codes?
By Jacqueline Thelian, CPC, CPC-I, CHCA, Medco Consultants, Inc.

As per Current Procedural Guidelines (CPT), the CPT Assistant and the Centers for Medicare and Medicaid Services (CMS) Local Coverage Determination (LCD) L33631 it is inappropriate to report Kinesio taping with any of the CPT codes for strapping (29200, 29240, 29260, 29280, 29520, 97799, 97039, 29799).

Strapping may be used to treat strains, sprains, dislocations, and some fractures. The strapping codes are intended to be used when the desired effect is to provide total immobilization or restriction of movement.”

Kinesio taping is not utilized for immobilization; rather its function is to provide support and stability to joints and muscles without affecting circulation and range of motion.

The CPT Assistant goes on to state the Kinesio taping is considered to be an inclusive part of neuromuscular re-education or therapeutic exercise and would not be separately reported.

The Centers for Medicare and Medicaid Services (CMS) Local Coverage Determination (LCD) L33631 Outpatient Physical and Occupational Therapy Services under the General Guidelines for Strapping also considers the Kinesio taping to be considered inclusive to CPT codes 97110 and 97112.

Source:

• National Government Services Inc. Local Coverage Determination (LCD) L33631
• CPT Assistant March 2012, Surgery Musculoskeletal System

If you have a coding or compliance question you would like to have answered please send your question to MSSNY at eskelly@mssny.org, and complete the subject line with Tip of the Week.

Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!

Help Us Advocate Legislation to Prevent Mid-Year Prescription Formulary Changes
Concerned about changes to health insurer prescription drug formularies that may adversely impact your patients? MSSNY has been working collaboratively with several patient advocacy groups to support legislation (A.2317, People-Stokes/S.5022-A, Serino) that would prohibit health insurers from moving a drug to a higher-cost tier or removing a prescription drug from a formulary during a policy year.  To help facilitate advocacy in support of this legislation, the group New York Health Works has developed a survey to enable physicians and patients to better document the full extent of this problem.  Please take just a few minutes to respond to the survey by clicking here.

Share Your Personal Stories about Challenges You Face as a Physician
MSSNY wants legislators to hear directly from New York Physicians about the challenges they face as medical practitioners.  Personal stories are vital for enhancing our messages on issues of concern to the medical professionals, particularly to legislators who represent the area where those professionals practice.

We plan to gather personalized stories from physicians and medical students to print as flyers and articles that can be distributed to legislators and journalists. Opting in to share your stories is entirely voluntary. We value and respect your privacy, which is why your permission is needed for us to share these stories. Please click here to fill out the brief Physician Questionnaire.

MSSNY to Implement National Diabetes Prevention Program; Physicians Encouraged to Take Diabetes Awareness Survey
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York.  MSSNY has developed a short survey to sample physician’s knowledge of the National Diabetes Prevention Program (DPP) and the Prevent Diabetes STATTM program.  This survey can be taken by clicking here.

The AMA previously rolled out the program through partnerships with state medical societies in California, Michigan and South Carolina. New York is one of eight states where the AMA is extending the program. The DPP model encourages physicians to screen patients for prediabetes, a condition in which blood glucose levels are higher than normal but below the threshold for a diabetes diagnosis. Patients identified as pre-diabetic are referred to diabetes prevention programs that meet certain criteria established by the Centers for Disease Control and Prevention.

This initiative will help bridge the gap between the clinical care setting and communities to reduce the incidence of type 2 diabetes by educating and connecting more patients to evidence-based lifestyle change programs that are available in their communities, including programs offered where they work, through community and faith-based organizations, and online.

“MSSNY’s partnership with the AMA is a key step towards making an immediate impact on the health of New Yorkers,” said Dr. Geoffrey Moore, Chair of MSSNY’s Preventative Medicine and Family Health Committee and a lifestyle medicine physician based in Ithaca, NY. “The Centers for Disease Control and the American Medical Association have developed a great educational toolkit and, through our partnership, we seek to extend the benefits of these tools to all physicians and patients throughout New York State.”

In the coming year, MSSNY will be developing education sessions and articles outlining important information about diabetes in the MSSNY Daily and E-News.  Educational webinars and podcasts tailored to both physicians and patients on prediabetes and diabetes are also being developed. MSSNY’s website includes a Diabetes webpage and physicians are encouraged to visit for more information about Type 2 Diabetes and to learn more about MSSNY’s partnership with the AMA.

Please Urge Governor Cuomo to Veto Disastrous Liability Expansion Bill and Work for Comprehensive Reform Instead
With just a few weeks left in 2017, please help us to urge Governor Cuomo to veto legislation (S.6800/A.8516) that would significantly expand the time to bring a medical malpractice lawsuit, in circumstances based upon an “alleged negligent failure to diagnose a malignant tumor or cancer.”  If signed into law it would likely prompt a double digit increase in physician and hospital malpractice premiums.  You can send a letter to the Governor here and call 518-474-8390.

The bill will likely be delivered to Governor within the next few weeks, upon which he will have 10 days to decide to sign it or veto it.  While many physicians have contacted the Governor to urge a veto of this legislation, we need an overwhelming demonstration from physicians regarding how this bill will harm access to care in their communities if this bill is not paired with needed tort reforms to bring down the exorbitant costs of medical liability insurance in New York.

Physicians have been active in warning the public about the patient care access problems this bill will exacerbate if it is signed into law.  Recently Albany radiologist and MSSNY member and Albany radiologist Dr. Robert Rapaport had a commentary published in the Albany Times-Union urging that the Governor veto this bill and instead work for comprehensive reform.  Moreover, a letter to the Editor from MSSNY’s Dr. Rothberg urging a veto was also recently published in the Albany Times-Union (letter).   Similar letters from regional and statewide physician leaders have also appeared in:

• Buffalo News 
• Syracuse Post-Standard
• Rochester Business Journal
• Poughkeepsie Journal

Share Your Personal Stories about Challenges You Face as a Medical Student
MSSNY wants legislators to hear directly from medical students about the challenges they face as future physicians.  Personal stories are vital for enhancing our messages on issues of concern to the medical professionals, particularly to legislators who represent the area where those professionals practice.

We plan to gather personalized stories from physicians and medical students to print as flyers and articles that can be distributed to legislators and journalists. Opting in to share your stories is entirely voluntary. We value and respect your privacy, which is why your permission is needed for us to share these stories. Please click here to fill out the brief Medical Student Questionnaire.

CME Webinar on December 6: An Unusual and Highly Resistant Fungus in NYS: An Update on Candida auris for the Practicing Physician:
Upcoming in MSSNY’s Medical Matters continuing medical education (CME) webinar series is: An Unusual and Highly Resistant Fungus in NYS: An Update on Candida auris for the Practicing Physician.  This webinar will take place on Wednesday, December 6, 2017 at 7:30 a.m.  Emily Lutterloh, MD, MPH, Director, Bureau of Healthcare Associated Infections, from the New York State Department of Health will conduct this presentation.  Register for this webinar here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are:

• Provide an update on the emerging multi-drug resistant yeast, Candida auris ( auris), globally and in New York State
• Describe the risk factors for auris infection and the recommended diagnostic approach
• Review the recommendations for auris, including infection prevention and control measures

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. 

Educate Your Patients About the Flu
It’s flu season!  New York State Department of Health has had reports of seasonal influenza in nearly every county. Encourage your patients to listen to MSSNY’s brief and informative podcast on influenza vaccine here.

MSSNY also has a podcast on the pneumococcal vaccine for patient’s 60 and older here. Or click here listen to all 13 of MSSNY’s podcasts on topics such as the Zika virus, emergency preparedness and a variety of adult vaccines.

Buprenorphine Training to be held in Sullivan County December 2^nd
The NYSDOH AIDS Institute and the Sullivan County Public Health Department are hosting a Buprenorphine Eligibility Waiver Training for Clinical Providers on Saturday, December 2,

from 8:00AM to 1:00PM at Catskill Regional Medical Center, 68 Harris-Bushville Rd, Board Room, Harris, NY 12742.

This training is for physicians, nurse practitioners, physician assistants, pharmacists, and medical residents. Sullivan County has some of the highest rates of opioid overdose in New York State. In just the first seven months of 2017, Sullivan County has experienced a reported 20 overdose deaths.  From 2013-2016, there were approximately 75 reported opioid overdose deaths.

DOH is seeking to increase the volume of providers in and around the county that are able to offer medication assisted treatment (MAT) to people using opioids whom could benefit from buprenorphine (or “suboxone”).  Attached is a flyer with further information, including location, online registration, and more details. Further information will be sent out to confirmed attendees. Light refreshments will be provided. Registration closes on November 29^th at 5pm.Trainers: Sharon Stancliff, MD, Harm Reduction Coalition, New York, NY; Bruce Trigg, MD, Harm Reduction Coalition, New York, NY

Please Note: CME Credits will be made available. This is the first half of the minimum required 8 hours of training, and the second half must be completed online after attendance to the live training. Currently NPs & PAs are required to take an additional 16 hours of online training which is available on the PCSS-MAT website (Part 2). For more information about buprenorphine related trainings, mentoring, coaching, technical assistance and more, please contact us at buprenorphine@health.ny.gov or 1-800-692-8528.

Want to Learn More about New York’s New Step Therapy Override Law?
Please click here to view a webinar discussing New York’s new law that gives physicians a stronger ability to override a health insurer’s step therapy protocol when seeking to assure their patients can receive coverage for necessary prescription medications. Among the faculty for the program are MSSNY President-elect Dr. Thomas Madejski and MSSNY Senior Vice President Moe Auster. The webinar, sponsored by the National Psoriasis Foundation, will provide physicians with 0.5 hours of CME credit.

The new law will be applicable to all NY-regulated health plans as of January 1, 2018.  However, since the law applies to health insurance plans “delivered, issued for delivery issued or renewed” after January 1, 2017, many group health insurance plans across the State are already required to follow the new law.

MSSNY has created a template for physicians and their support staff to use in requesting a step therapy protocol override, available here.

Enforcement is the key to assuring that the law is working as intended.  Therefore, please let us know if you see instances where health insurers are not following the law.  Moreover, you can file a complaint with the State here.

You Must Enroll In Medicaid FFS to Treat MMC Patients
In September, MSSNY alerted the membership of a new federal regulation resulting from the 21^st Century Cures Act.  The regulation requires that any physician treating Medicaid recipients in a Medicaid Managed Care (MMC) plan must now enroll in Medicaid Fee-for-Service (FFS) in order to continue treating MMC patients.  By now, you should have received letters from your MMC plan explaining this requirement.

Some of our members raised concerns about the requirement.  To research the matter, Regina McNally, VP of SME, called the Director of Medicaid provider enrollment at the NYS DOH.  Based on that contact, we have been advised of the following:

Regarding Medicaid Managed Care physicians who want to continue treating Medicaid Managed care recipients, the DOH has no intention of terminating any physician who has his/her application on file before the deadline.  So, if the provider enrollment application is submitted before January 1, 2018, the DOH will work with the physician(s) to ensure that the information is properly on file.  Since the application is submitted to CSC, the Medicaid Intermediary, first for scanning into their system and then forwarded to the NYS DOH for review to ensure accuracy, it would be advisable to have the application filed by December 1, 2017.  This should give sufficient time to ensure that the application is on file.

Note:  Physicians do not have to treat Medicaid fee-for-service recipients even though they have enrolled in the program.  However, physicians do need to enroll in order to continue treating Medicaid Managed care recipients.

New Deadline: Participate in Field Testing of Episode-Based Cost Measures by November 20
The Centers for Medicare & Medicaid Services (CMS) has extended the deadline for feedback on its cost measures field test to November 20, 2017.

As a reminder, CMS is conducting a field test for eight episode-based cost measures before consideration of their potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program. During the field test, clinicians may access confidential feedback reports with information about their performance on these new measures. All stakeholders are also invited to comment on the measures and supplemental documents.

The eight episode-based cost measures are:

1. 1. Elective Outpatient Percutaneous Coronary Intervention (PCI)

1. Knee Arthroplasty
2. Revascularization for Lower Extremity Chronic Critical Limb Ischemia
3. Routine Cataract Removal with Intraocular Lens (IOL) Implantation
4. Screening/Surveillance Colonoscopy
5. Intracranial Hemorrhage or Cerebral Infarction
6. Simple Pneumonia with Hospitalization
7. ST-Elevation Myocardial Infarction (STEMI) with (PCI) 

Participate in Field Testing through November 20, 2017
The field test is a voluntary opportunity for stakeholders to comment on the measure specifications and the report template for the eight measures in their current stage of development. This feedback will be considered in refining the measures and for future measure development activities.

If you or your clinician group perform(s) or manage(s) the care for one or more of the procedures or medical conditions represented in the measures above, you might have a confidential Field Test Report on the CMS Enterprise Portal. For group practices, reports are available for the TIN of the group practice. Please refer to the “2017-10-cost-measure-field-test-access-guide.pdf” in the zip file linked below for instructions on setting up or activating your EIDM account. The supplemental documentation listed below is included in a zip file on the MACRA page under the “What’s new” section and “Episode-based cost measures” subsection. To download the zip file directly, please click here.

• Field Test Mock Report
• Draft Cost Measure Methodology
• Draft Measure Codes List

Please provide comments through this online survey by 11:59 PM ET on November 20, 2017.

For More Information. You may refer to the fact sheet or FAQs
document for additional information. If you have any questions, please contact QPPCostMeasureTesting@ketchum.com.

New Medicare Card: Provider Ombudsman Announced
The Provider Ombudsman for the New Medicare Card serves as a CMS resource for the provider community. The Ombudsman will ensure that CMS hears and understands any implementation problems experienced by clinicians, hospitals, suppliers, and other providers. Dr. Eugene Freund will be serving in this position. He will also communicate about the New Medicare Card to providers and collaborate with CMS components to develop solutions to any implementation problems that arise. To reach the Ombudsman, contact: NMCProviderQuestions@cms.hhs.gov.

The Medicare Beneficiary Ombudsman and CMS staff will address inquiries from Medicare beneficiaries and their representatives through existing inquiry processes. Visit Medicare.gov for information on how the Medicare Beneficiary Ombudsman can help you.

Summary and Statement: 2018 QPP Final Rule
Last week, CMS issued the long-awaited Medicare Quality Payment Program final regulation for 2018.  PAI’s comments discussed the need for continued physician flexibility and greater simplicity to allow physicians to transition to the program successfully.

The final regulation’s impact on physician practices is a mixed bag, as discussed in PAI’s statement, released earlier this week. PAI applauds CMS for finalizing its policy to increase the low-volume threshold and include an interim final rule to support the needs of those impacted by recent natural disasters.

However, PAI is disappointed that the final regulation includes certain policies that could unintentionally put some patients, physicians, and practices at a disadvantage. One policy of concern will increase the weight of the cost category from 0% in 2017 to 10% in 2018, utilizing the Medicare Spending per Beneficiary (MSPB) and total per capita cost measures, while new episode-based cost category measures that more accurately assess health care service utilization and appropriately attribute costs are still under development and not part of the scoring.

A summary of the final rule provisions is available here; a CMS Fact Sheet is available here. Blood Eosinophil And Neutrophil Concentrations May Predict Lung Function Declines In WTC-Exposed Firefighters, Research Suggests.

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