Tag: MSSNY eNews – October 14

PRESIDENT’S MESSAGE Dr. Malcolm Reid

October 14, 2016 Volume 16, Number 36

Dear Colleagues:

On Friday, September 30, I had the pleasure of meeting with MSSNY’s Committee on Continuing Medical Education, chaired by E. Kenneth Freiberg, DO.  The CME Committee oversees MSSNY’s dual role as both a Recognized Accreditor of 33 CME providers in New York State and an Accredited Provider of CME activities.

In order to support these two roles, there are two CME subcommittees:  the Subcommittee on Surveys (chaired by Pauline Hecht, MD) and the Subcommittee on Educational Programs (chaired by Sheldon Putterman, MD).  MSSNY couldn’t ask for a more dedicated, passionate, and hard-working group.  The Subcommittee on Surveys and the full CME Committee meet quarterly (in March, June, September, and December), while the Subcommittee on Educational Programs meets monthly to approve both directly and jointly provided activities and analyze the results of activities that have occurred.

MSSNY is in the process of revising its CME website http://cme.mssny.org  to incorporate all of MSSNY CME programming.  It is anticipated that the revisions will be completed early in 2017.   In the meantime, the cme.mssny.org site offers over 50 CME programs, which include the Opioid Webinar series, public health topics such as Zika, Ebola, influenza, and pertussis, and others.  Additionally, there are courses related to bioterrorism, emergency preparedness, and mental health.

If you are new to the site, you will have to register as a new user with a log on and password.   Please go here to see the array of programs MSSNY has to offer.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org

Physicians Required to Comply with “Non-Discrimination” Reporting
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which include most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.

According to the AMA, the rule does not apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court.

Covered physicians must comply with the following requirements:

• Post a notice of nondiscrimination and taglines in multiple languages
• Develop and implement a language access plan
• Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)

To help reduce burden and costs, the HHS Office of Civil Rights (OCR) has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rule, factsheets on key provisions and a list of frequently asked questions.

To read a comprehensive summary prepared by Donald Moy, Esq. from the firm of MSSNY’s General Counsel, Kern Augustine P.C., click here. 

CMS Finalizes the New Medicare Quality Payment Program
Today, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program.

While the program begins January 1, 2017, CMS has laid out different time frames for when physicians can begin to participate to avoid penalties in Medicare payment in 2019. CMS also raised to $30,000 the Medicare revenue threshold that enables a physician to be exempted from the MIPS program.

The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.

Accompanying today’s announcement is a new Quality Payment Program website, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.

To see the press release and obtain more information about today’s announcement, including a fact sheet, please click here.

To learn more about the rule, click here.

AMA and MSSNY evaluation of the final rule is ongoing and further updates will be provided.

ICD-10 Updates for 10-01-16
In reference to the ICD-10 diagnosis code updates that were scheduled to be effective on October 1, 2016, Excellus has advised us that the ICD-10 codes are in their claim processing system.  However, Excellus is currently updating their clearinghouse to accept these codes electronically. Excellus expects that the clearinghouse will be updated by 10/19/16.  These delays will cause rejections/denials if you are submitting with the updated ICD-10 diagnosis codes. Since the claims will be rejected from the Clearinghouse, the claims would not have entered the Excellus system so you will have to resubmit the claims for payment.
Other payers might be experiencing some delays with their ICD-10 updates, as well.

OSCAR Health Insurance Narrowing Physician and Hospital Network
Oscar Health Insurance has begun to notify its participating provider network physicians that their contract participation will be amended effective January 1, 2017.  Please see the attached communications. As you should know, Oscar Health Insurance began their services utilizing the Magna Care network of physicians.  Now, Oscar plans to reduce its network and contract directly with their own network of physicians.

Two letters are attached.  One letter was sent out to providers who will continue to be in network, by direct contract, with Oscar in 2017, and the other letter was sent out to providers who will not be participating in the Oscar 2017 network. Both letters have information on Oscar’s continuity of care policy.  Both letters advise the physicians that their Magna Care contract remains intact and unaffected by this change.

http://www.mssnyenews.org/wp-content/uploads/2016/10/MagnaCare-Letter-1.pdf

http://www.mssnyenews.org/wp-content/uploads/2016/10/MagnaCare-Letter-2.pdf

Based on additional contact with Oscar Health Insurance, MSSNY has been advised that Oscar is conducting a comprehensive outreach to all Oscar members/patients impacted by the network change. Oscar has processes in place to support their members in continuity of care as well as finding in network providers.

Informed sources report that Oscar will reduce its provider network in New York, by half.  This may impact 20,000 doctors.  Its hospital network will decrease from 77 facilities to just 31.

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

Beware of “Seamless Conversion” for Your Medicare Patients
A policy known as seamless conversion allows insurance companies to move members of their commercial or Medicaid managed-care plans over to Medicare Advantage plans if they first ask permission from the CMS. The Medicare Advantage plans mean more revenue for insurers, but it often means patients’ doctors will be considered out of network. The CMS believes the transition to Medicare Advantage should be implemented to ensure continuity of care and recently issued a memo to insurers reminding them about seamless conversion as a way to transition enrollees.

The concern among many physicians is that the CMS’ seamless conversion is not as advantageous to patients as it is to its insurers and financial interests. Physicians nationwide have been critical of the secrecy of the plan as well and some groups are pushing for the CMS to publicly release information on which Medicare Advantage plans have been approved.

The goal of assuring a continuity of care seems contradicted when a patient’s non-Medicare insurance has been covering their care at a practice but the practice is not in the Medicare Advantage plan’s network. It has been rumored that Aetna, Humana and UnitedHealthcare have asked for permission to participate in seamless conversion. Patient advocacy groups are also pushing against this policy and requesting that the CMS require insurers to get confirmation from a beneficiary that they understand their network may have changed and allow for a special enrollment period in case their doctors are not in network.

In response to the criticism, the CMS countered that beneficiaries should be more vigilant in opening and reviewing all mail from their current insurer. The CMS further shifted the onus on enrollees to make sure to ask about provider and pharmacy networks and noted that patients can opt out of Medicare Advantage plans. The CMS has also said that it will make public which insurers use seamless conversion later this year.

Click here to download a MSSNY flyer for your patients to inform them that they may be switched into a Medicare Advantage Plan without their knowledge.

“When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.

Democrat (Psychiatrists 76%) or Republican (Surgeons 67%)?Physicians in certain specialties are much more likely to be registered as Democrats or Republicans, according to analysis by the New York Times’ “The Upshot.” For instance, the analysis found that 67 percent of surgeons in the study sample identified as Republican, while 76 percent of psychiatrists were registered as Democrats. (New York Times’ “The Upshot,” (10/6).

PQRS Negative Payment Adjustment Notification
PQRS participants are now being notified by letter regarding the 2017 negative payment adjustments. If you did not participate in PQRS in 2015, or did not satisfactorily participate in 2015, all of your 2017 Medicare Part B reimbursement will be subject to a -2.0% adjustment.

If you think that this negative payment adjustment has been applied incorrectly, you can request an informal review — but you must request a review on or before November 30, 2016 at 11:59 pm. CMS will investigate the merits of your request and issue a decision within 90 days of receipt.

Start with these steps:

Review your Feedback Report and 2015 AQRUR

Request an informal review (note: there are no hardship exemptions for the PQRS negative payment adjustment)

Register for the live CSMS AQRUR webinars

Download the CSMS on-demand PQRS webinars

Questions? Please contact theQualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or qnetsupport@hcqis.org. They are available from 7 am – 7 pm Central Time, Monday through Friday. 

RFP for Office of Temporary and Disability Assistance

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

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

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

Nursing Home Residents: Ventilators Not Increasing Life Expectancy
The “number of nursing home residents with advanced dementia” connected to ventilators has increased significantly in recent years although it “doesn’t appear to help them live longer,” according to a new study published in JAMA Internal Medicine, researchers found that in 2000 only 39 of every 1,000 nursing home residents with dementia who were hospitalized were connected to ventilators, but in 2013 that had increased to 78 of every 1,000.

CMS Website to Review Resources on 2016 Program Requirements
The Centers for Medicare & Medicaid Services (CMS) has created the following materials to help providers attest successfully to the Medicare and Medicaid EHR Incentive Programs in 2016.

• Eligible Professionals (EPs) and Eligible Hospitals/Critical Access Hospitals (CAHs) What You Need to Know for 2016 Tip sheets
• EPs and Eligible Hospitals/CAHs Specification Sheets
• Alternate Exclusions Fact Sheet
• Health Information Exchange Fact Sheet
• Broadband Access Exclusions Tip Sheet
• Security Risk Analysis Tip Sheet
• Patient Electronic Access Tip Sheet
• EPs and Eligible Hospitals/CAHs Public Health Reporting in 2016 Tip Sheets
• Guide for EPs Practicing in Multiple Locations

CMS is encouraging EPs, eligible hospitals, and CAHs to use the relevant resources to prepare for attestation.

For More Information
Visit the EHR Events page and listen to previous webinars for EPs and eligible hospitals/CAHs to learn more about the EHR Incentive Programs in 2016.

Price of Insulin Increases, Along With Rebates to PBMs
The Wall Street Journal (10/7) reported that while the list price of top-selling insulins have doubled since 2011, most of the revenue has gone to pharmacy-benefit managers (PBM), rather than drugmakers. Experts say that PBMs have demanded higher rebates to include the drugs on their preferred lists.

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