Tag: Physician Advocacy Day in Albany March 4

PRESIDENT’S MESSAGE Arthur Fougner, MD MSSNY President MSSNY eNews January 24, 2020 Vol. 23  Number 4

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Colleagues:

No doubt you’re heard that the Governor’s proposed budget legislation is out.  In the Health and Mental Hygiene Section, there are many helpful proposals, among them reducing maternal mortality, regulation of PBMs, and removing flavored tobacco products. There are some that are unhelpful such as requiring more information in the physician profiles. Ironically, in the fiscal year 2015 budget, the Governor had actually proposed eliminating the profile website altogether. Quite a turnaround, no? 

But then we come to the poison pill –  Section L. Here, the Office of Professional Medical Conduct (OPMC) is further empowered to allow for “immediate publication of charges upon investigative requests.” Let that sink in for a moment. As if that isn’t enough, the powerful position of OPMC Executive Secretary is now removed from the Board Chair’s oversight and now overseen by the Commissioner directly. This similarly could shred due process.  

As I’ve previously shared, less than 3% of complaints to OPMC result in significant actions. Publication of charges prior to thorough investigation would effectively end a physician’s career. In 1976, Richard Jewell found a suspicious package in the Atlanta Olympic Park and alerted police, saving countless lives. For his effort, Jewell was hounded by the press and he became a person of interest. His life was ruined while attention was diverted from the real bomber.  Perhaps we could ask our Governor, as Raymond Donovan famously asked, to which office do physicians go to get their reputations back?  

I don’t know about you, but I feel that an MD or DO degree is a badge of honor. Section L of the Budget could turn your badges of honor into Scarlet Letters.  

Concerned? Upset? Outraged? Then, go here right now and tell Governor Cuomo and your legislators how you feel. Also, Lobby Day is March 4. Albany believes it’s a crisis ONLY when physicians act like it’s a crisis. Physicians, make no mistake – this IS a crisis. We need to pack the house. We need you. 

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

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Capital Update

The Week’s Legislative Podcast

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Please Plan to Be in Albany for: MSSNY‘s Annual “Physician Advocacy Day” (3/4)
As we begin to unpack the Governor’s budget proposal and the legislative work at the Capitol continues, the need for physician advocacy and grassroots involvement is greater than ever. With the Governor’s budget proposal teeing up items for potential concern such as Medicaid cuts, legalized marijuana and changes to the physician disciplinary process, while also supporting reforms such as regulating PBMs and a flavored tobacco ban, it is imperative that physicians be in contact with their local legislators to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 4th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click here to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program.  Please work with your County Medical Societies to schedule appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Raza Ali at rali@mssny.org.       (ALI)

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Governor Announces Proposed Budget
Governor Cuomo this week released his proposed $178 Billion Budget for the 2020-21 State Fiscal year, including measures to close a $6.1 billion Budget deficit, through creating a new Medicaid Redesign Team (MRT) to recommend $2.5 Billion in Medicaid savings, assuming an additional $2 billion in new tax revenue, and $1.8 billion in reduced payments to localities.  While we are still poring through the tens of thousands of pages of Budget bills, among the most notable items for physicians upon initial review:

Items of Significant Concern Include:

• As previously announced, expanding the ability of the Commissioner of Health to notify the public that a physician is under investigation and to make it easier for the Commissioner to summarily suspend a physician license during a disciplinary investigation.  Send a letter to your legislators here: Please click here
• Expanding the information on the physician profile to include office hours, whether accepting new patients, insurance participation information, and mandatory completion of a workforce survey.
• Legalizing, regulating and taxing the production, distribution, transportation, and sale of recreational or “adult-use” marijuana.
• Expanding the list of adult immunizations that can be provided by pharmacists to all those recommended by the ACIP.
• Expanding the existing physician-pharmacist collaborative drug therapy program to include nurse practitioners and physician assistants 

Positive Items Under the Proposed Budget

• Require the regulation of Pharmaceutical Benefit Managers (PBMs) with the Department of Financial Services (DFS) and to disclose financial incentives they receive
• A comprehensive anti-smoking package including: prohibiting the sale or distribution of e-cigarettes or vapor products that have a characterizing flavor; prohibiting the sale of tobacco products  in all pharmacies; expanding the definition of “place of employment” to define indoor space and limit second hand smoke exposure;  restricting the advertising of vapor products;  requires manufacturers of vapor products to disclose to the DOH Commissioner and the public, information regarding the ingredients, by-products, or contaminants in vapor products; bans coupons and manufacturer discounts and displays in shops; and increases penalties for illegally selling tobacco products to minors.
• Creating an administrative simplification work group to address health insurance hassles and to expedite physician credentialing applications.
• Establishing the Behavioral Health Parity Compliance Fund for the collection of penalties imposed on insurance carriers who violate New York’s Behavioral Health Parity laws, which will be used to support the Substance Use Disorder and Mental Health Ombudsman program
• Significantly reduce the interest rate on medical malpractice and other court judgments, from 9% to a market-based rate
• Reduce the business income tax rate from 6.5% to 4% for businesses with 100 or fewer employees and with net income below $390,000 that file under Article 9-A.
• $14.2 million in funding to ensure access to a full array of reproductive services for women due to the loss of Title X funding.
• $8 million to improve maternal health outcomes and for the implementation bias training and incentives for an expansion of community health workers related to Maternal Mortality.
• Continuation of funding for the Excess Medical Malpractice Insurance Program
• Continuation of funding for the Committee for Physicians’ Health

Other Items of Note

• Expanding the scope of New York surprise bill law to include in-patient services following an emergency admission.
• Convene a new Medicaid Redesign Team (MRT) to come up with $2.5 billion in savings
• DFS will be authorized to investigate pricing of any prescription drug if the price of such drug has increased by more than 100% within a one-year time period.
• Capping the co-payments required of insured patients at $100 for a one-month supply of insulin.
• Development of “NYHealthCareCompare”, a website that will allow New Yorkers to look up charges for medical services, the quality of services provided, and access information about financial assistance programs, as well as what to do about a surprise medical bill.
• Local governments will be required to stay within 2% property tax increase, or be held accountable for excess growth in Medicaid costs

Several items of concern from previous Budgets, proposed but rejected, such as cuts to Medicaid payments for treating dual eligible patients, elimination of “prescriber prevails” under Medicaid, and expansion of CRNA scope of practice WERE NOT included (but could be brought up under the new MRT).
(DIVISION OF GOVERNMENTAL AFFAIRS)

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Marijuana Legalization Gains Additional Support in State Senate; MSSNY Continues to Raise Strong Concerns with Public Health Impacts
In a press conference held on Thursday Senator Pete Harckham (D-Westchester County) announced his support behind an amended recreational or ‘adult use” marijuana legalization bill sponsored by Senator Liz Krueger (D- Manhattan). Senator Harckham, thought to be one of the Senators that had previously opposed the legalization of marijuana, explained his support is the result of a key provision of the bill which would allocate roughly 25% of the revenue generated from the legalization to mental health and substance abuse prevention and treatment. Senator Harckham is the chair on the Senate Alcoholism and Substance Abuse committee.

Senator Krueger also indicated during the press conference that, if a consensus was not reached between lawmakers and the governor, she would be willing to put the issue aside until after the budget was passed.

MSSNY continues to oppose the legalization of recreational marijuana and we urge our members to send a letter to the legislature and to the governor opposing this legislation (please click here).  Last week, MSSNY joined with the New York State Association of County Health Officials in a statement (please click here ) re-iterating our groups opposition to the legalization of recreational or “adult use” marijuana given the recent CDC report confirming a direct link between legally obtained adult use cannabis and the nation’s outbreak of vaping related illnesses and deaths.   (ALI)

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MSSNY Statement by Dr. Art Fougner on the Release of the State Budget
“The proposed Budget importantly advances several positive steps to promote public health, including restricting the sale of flavored tobacco products, regulating PBMs, and facilitating the ability of physicians to be more quickly approved into plan networks.

However, we are extremely concerned about the scope of the Budget proposals that would essentially strip physicians of important due process rights when a complaint has been filed with the Office of Professional Medical Conduct. We agree with the importance of acting quickly when it is imperative, but these proposals would completely undermine important and longstanding due process protections. Given that most complaints are dismissed without any sanction or action, this series of proposed changes to bypass these rights would create a substantial possibility of unfairly destroying an innocent physician’s career.

Due to our enormous liability costs and excessive regulations, New York already has the dubious reputation of being the worst state in the country to be a physician. Proposals like this will make it even more unattractive for physicians to choose New York to deliver patient care.

We welcome discussions to improve our disciplinary system to address gaps to help protect the public. However, these proposed changes are startling. We urge the Senate and Assembly to take a critical eye towards these overreaching proposals to assure patients can continue to receive the care they need.”                                                       (AUSTER)

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Forum Examines Prescription Drugs & Health Care Costs
On Wednesday, January 22, MSSNY Albany staff attended a forum hosted by the New York Health Plan Association (HPA), at the Empire State Plaza Convention Center, in Albany. The event, “Access to Innovation: How are States Addressing Prescription Drug Costs?”, looked at current spending trends associated with prescription drugs, and health care, and outlined potential policy options to address a range of issues. Among them were the use of comparative effectiveness in measuring the value and pricing of prescription drugs.

Leading the discussion was HPA”s President & CEO, Eric Linzer, who was joined by panelists Sarah Emond, from the Institute for Clinical and Economic Review (ICER), Assemblyman Daniel Rosenthal, Chair of the Subcommittee on Intergenerational Care, Helen Schaub from 1199SEIU, Charles Bell with Consumer Reports, and Eileen F. Wood, representing Capital District Physicians’ Health Plan.

Governor Cuomo has introduced several proposals in his budget for 2021 related to prescription drugs, which the MSSNY Albany staff is reviewing, including a requirement that Pharmaceutical Benefit Managers (PBMs) disclose financial incentives received to the Department of Financial Services (DFS) and giving the Department of Financial Services power to investigate sudden large jumps in drug prices. We will update members as budget discussions move forward in the coming weeks.         (CARY)

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Partial Fill Prescribing on Senate Calendar
A measure that would enable the dispensing of a partially filled controlled substances prescription, is now on the Senate calendar for a vote.  The measure, S. 7115/A.9034, sponsored by Senator Gustav Rivera and Assemblymember John McDonald, would allow a prescriber to issue a partially filled prescription for a Controlled Substance II, III, IV, V to a patient.

The prescription would be recorded in the same manner as a refill and the remaining quantity of the prescription may be dispensed separately.   In 2016, Congress passed legislation that would enable partial fill prescription under the Comprehensive Addiction and Recover Act (CARA).  This state measure would allow New York State to conform to what is allowable under federal law.

A similar measure had passed during the 2019 legislative session, but was vetoed by Governor Andrew Cuomo.  This new bill addresses concerns expressed by the administration.  The Medical Society supports this measure and believes that it will help to reduce the amount of unused pain medication that can accumulate in home medicine cabinets and will allow prescribers to help patients balance the need to relive pain with an adequate supply of medication.    (CLANCY)

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NYS DOH Issues Guidance on 2019 Novel Coronavirus (2019-nCoV)
The New York State Department of Health issued guidance on the 2019 novel coronavirus (2019-nCoV) and this includes healthcare providers and facilities collecting a travel history for patients presenting with febrile illness and remain aware of current outbreaks overseas. Patients who meet either of the following criteria should be evaluated as a person under investigation (PUI) in association with the 2019-nCoV outbreak.

Fever AND symptoms of lower respiratory illness (e.g., cough, shortness of breath) and in the last 14 days before symptom onset had:

▪ A history of travel from Wuhan City, China OR  Close contact with a person who is under investigation for 2019-nCOV while that person was ill. Fever OR symptoms of lower respiratory illness (e.g., cough, shortness of breath) and in the last 14 days before symptom onset:

▪ Had close contact with an ill laboratory-confirmed 2019-nCoV patient. A copy of the NYS DOH guidance is here.

MSSNY is planning to conduct a webinar on 2019 Novel Coronavirus (2019-nCov) in March.  More information will be available shortly.          (CLANCY)

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Registration Now Open for Steps to Physician Wellness and Resiliency
MSSNY is proud to announce our first webinar entitled Steps to Physician Wellness and Resiliency on February 25^th from 7:30-8:30am. Jeffrey Selzer, MD will serve as faculty for this webinar.

Educational Objectives are:

• Review the warning signs that stress, depression, anxiety or substance use may impact work or personal life
• Identify strategies to increase personal empowerment toward making positive change, including self-assessment tools
• Recognize self-monitoring strategies for stress related problems and know when to seek professional assistance

Register by clicking here.

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

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.     (HOFFMAN)

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Registration Now Open for Medical Matters: Virtual Drill: Incident Command System & Crisis Communications
MSSNY’s next Medical Matters will feature a Virtual Drill on the Incident Command System and Crisis Communications on February 19^th from 6:00-8:00pm. Faculty for this program are: Arthur Cooper, MD; Pat Anders, MS, MEP; William Valenti, MD and Lorraine Giordano, MD.

Educational Objectives are:

• Obtain information about local, state and national chain of command in a public health emergency and learn how to access resources
• Understand the importance of planning for medical surge and triage of patients, as well as staff and family considerations, in the office-based practice setting during a health emergency
• Develop an understanding that all public health emergencies can potentially have mental health implications for survivors and others connected with the event
• Acquire skills for the management of patients in a public health emergency

Please note that there are recommended pre-course materials to be viewed prior to this virtual drill. You will be sent a link with your registration confirmation. We encourage all participants to examine these prior to the Virtual Drill.  Register by clicking here:  please click here

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

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™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.   (HOFFMAN)                                                                                                                                                                                                  

pschuh@mssny.org	mauster@mssny.org	pclancy@mssny.org	zcary@mssny.org
rali@mssny.org

eNews

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Transplant Policy That Will Help New Yorkers Clears Legal Hurdle 
A federal judge has denied a second motion for a preliminary injunction that would have halted a new liver transplant policy from taking effect. The policy, which could now be implemented in as soon as days barring an appeal from the plaintiffs, prioritizes the sickest patients over geographic location when it comes to organ allocation.  

“This is a big deal because it allows patients all over the country to be prioritized based on how sick they are, not on where they live,” said Motty Shulman, a partner at Boies Schiller Flexner, who has championed fair-organ allocation and spearheaded litigation to that end. “It’s consistent with the law, but it’s also fair. It removes any barriers for equitable allocation.” Plaintiffs that have challenged the policy’s implementation include a number of major hospitals and transplant centers in the South and Midwest that have benefited from the existing system.  

The court’s order denying the plaintiffs’ motion for a preliminary injunction noted that the Organ Procurement and Transplantation Network, which put forth the new policy, is not an agency subject to the Administrative Procedure Act. The act oversees federal agencies’ issuance of regulations.  

Proponents have remained steadfast that the new policy is a much-needed reform that helps to ensure every patient in need of an organ stands an equal chance of receiving one. A 2018 lawsuit that was led by Shulman and spurred the new policy included a plaintiff who lived in New York City and lacked the financial means to travel outside the area to transplant centers that historically have had much shorter wait times.
(Crain’s Health Pulse, Jan. 2)

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One More Vaping Death: Now, There Are Four
The NYSDOH has confirmed two more deaths in New York from vaping-associated illness: a woman in her 20s from the city and a woman in her 50s from Ontario County. To date, Gov. Andrew Cuomo said in a statement, that brings the number of vaping-related deaths in New York to four. He added that the department and its Wadworth Center Laboratory are working to get to the bottom of the situation, and that the state “will continue using every tool at our disposal until these illnesses and deaths stop.”

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Deadline for abstract submission is 4 pm, Monday, February 3, 2020
MSSNY is very pleased to announce the 15th Resident/Fellow/Medical Student Poster Symposium. 

When:   Friday, April 24, 2020
Where:  Westchester Marriott, Tarrytown, New York
Time:     1:30 pm – 4:00 pm 

Click here for detailed guidelines.  

We welcome the participation of residents and fellows. Participants must be MSSNY members, and membership is free for first-time resident members. Join online.

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Many Physicians Would Give Up $20K+ for Better Work-Life Balance
Almost half of physicians would take a pay cut to work fewer hours, according to a survey conducted by Medscape. The top three factors physicians cited as contributing to burnout were bureaucratic tasks like charting and paperwork; spending too many hours at work; and lack of respect from administrators, employers, colleagues or staff. The online survey was conducted among more than 15,000 physicians in 29 specialties. Respondents represented three main age groups: millennials (ages 25-39), Generation X (ages 40-54), and baby boomers (ages 55-73). More than a quarter of physicians in each age group would give up between $20,000 and $50,000 per year in salary to work 20 percent fewer hours. Another third in each age group said they would give up $10,000 to $20,000 a year to work fewer hours.  

Medscape writes that these results are “a powerful statement” on behalf of physicians, suggesting that they want greater balance.  

This desire for more balance may partially contribute to the relatively high rates of burnout in the profession, experienced by 42 percent of survey respondents. Burnout was highest among Generation X physicians (48 percent), compared to millennials (38 percent) and baby boomers (39 percent). Read more here.  

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Poor Glycemic Control in Childhood May Be Tied to T1D-Related Premature Death in Young Adulthood
Medwire News (1/23) reports, “People who die in young adulthood from acute complications of type 1 diabetes [T1D] are characterized by poor glycemic control during childhood,” researchers concluded in a study of 12,652 patients. The study revealed that “overall, people with diabetes were nearly three times more likely to die before the age of 30 years than those without.” The findings were published online in Pediatric Diabetes. 

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Unhealthy LCD/LFD Scores May Be Associated with Higher Total Mortality in US
Clinical Endocrinology News (1/22) reports, “The health consequences of diet don’t largely depend on whether a person eats a high or low level of carbohydrates or a diet high or low in fat,” research suggests. What appears to be “more important is where the carbs and fats come from, according to an analysis that related diet and mortality rates in more than 37,000 American adults.” The study revealed that “unhealthy low carbohydrate diet [LCD] and low-fat diet [LFD] scores were associated with higher total mortality, whereas healthy LCD and LFD scores were associated with lower total mortality.” The findings were published online in JAMA Internal Medicine.  

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CMS

New Medical Narrative Report Template for Form CMS-1500 Submissions
To further assist medical providers in the implementation of the CMS-1500 for workers’ compensation patients, the Board has created a medical narrative report template that can be used to create the medical narrative that must accompany all CMS-1500 submissions. 

The top of the template includes the three elements most narratives require: the patient’s work status, the causal relationship of the injury to the patient’s work activities, and the patient’s percentage of temporary impairment. A medical narrative report may be found legally defective if these elements are missing. Medical providers must also include examination findings within their narrative, including the history of the injury/illness, objective findings based on the clinical evaluation, the patient’s plan of care and the diagnosis(es)/assessment of the patient. 

A link to the new template, as well as line-by-line instructions, can be found on the CMS-1500 section of the Board’s website at http://www.wcb.ny.gov/CMS-1500/requirements.jsp. A chart outlining the specific narrative requirements for each specialty is located on the same page.  

If you have any questions regarding use of the medical narrative report template, please write to the CMS-1500 mailbox at CMS1500@wcb.ny.gov.(  Jan.22,2020)

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New 2019 Data Submission Resources Now Available on QPP Resource Library
CMS has posted the following new Quality Payment Program (QPP) resources to the QPP Resource Library to help eligible clinicians submit their 2019 Merit-based Incentive Payment System (MIPS) data until the submission period closes at 8:00 p.m. EDT on March 31, 2020.  

• 2019 Data Submission FAQs – Answers commonly asked questions about data submission for the 2019 performance period. 
• 2019 Data Submission Demonstration Videos:  

• Introduction and Overview of 2019 Data Submission – Provides an overview of how to submit MIPS data through the QPP website for the 2019 performance period. 
• File Upload and Quality Scoring – Explains how to upload and review MIPS Quality data in the QPP portal and how Quality data is scored during the 2019 MIPS data submission period. 

• Manual Attestation of Improvement Activities – Provides an overview of how a third-party intermediary can report MIPS data on behalf of a group within the QPP portal and how to modify the Improvement Activity score by manually attesting to measures. 
• Manual Attestation of Promoting Interoperability Measures – Shows how a third-party intermediary can submit MIPS data on behalf of a group within the QPP portal and how to modify the Promoting Interoperability score by manually attesting to measures. 

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SIGN UP TO RECEIVE ALERTS FROM MSSNY’S GRASSROOTS ACTION CENTER 

When you subscribe to the Medical Society of the State of New York Grassroots Action Center, the Division of Governmental Affairs will alert you when legislation and issues of importance to physicians and patients, either in the NYS legislature or in Congress, are at critical stages.

Accordingly, contact from constituents would be vital to influencing the path and future of that legislation or issue.

Alerts will be accompanied by recommended actions you or your designee can take to have maximum impact such as calling, tweeting and emailing a customizable letter to your legislators.

If you are concerned with health care policy formation in New York State, please subscribe today by texting MSSNY to 52886 and you will be prompted to enter your email address.  When you sign up, it is best to use your NY-based voting address or practice address (if you do not reside in NY) for your alerts.

Contact the Division of Governmental Affairs at 518-465-8085 or albany@mssny.org if you have questions or comments.  Thank you.
(WILKS)

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