Category: eNews

PRESIDENT’S MESSAGE Arthur Fougner, MD MSSNY President MSSNY eNews November 1, 2019 Vol. 22  Number 41

Colleagues:

Do you recall the days when physicians dictated every manner in which Medicine was practiced?

I do. Today, those days seem just a lovely dream – like Disney World in the rear view. It feels as if every new day brings some new aggravation. EHRs, Billing, Coding, RVUs, MOC, I-STOP occupy a larger portion of a physician’s day than does family dinner. Each year brings with it the promise of a new unfunded mandate. Patient care was once the physician’s raison d’etre. Now, it’s an inconvenient truth.

Physicians are always the good guys, the nice guys, the ones who, when reimbursements are cut, are reduced to plaintively requesting, as Oliver Twist once did, “Please sir, I want some more.“ Medicine is the only US enterprise that regularly receives a cost of living decrease. I’ve said it before— that everyone thrives on the indulgence of physicians’ good will.

If you’re older like me, you’ll remember that moment in every Popeye cartoon when our Sailor, finally at his limit, reached for his spinach, exclaiming, “That’s all I can stand ‘cause I can’t stand no more.”

Physicians are notorious whiners, which usually results in our not being winners. So if you want to start winning, I’ll make one suggestion. Your Medical Society’s annual Lobby Day is March 4, 2020. It’s time to take that passion to Albany. Let those that would make laws affecting your practice, your family and your patients hear your voices, your concerns, your angst.

Or would you rather just settle into Kubler-Ross’ Acceptance and simply shuffle off to watch the sunset?

Your call.

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

Arthur Fougner, MD
MSSNY President

NYCMS Testifies at Legislative Single Payor Hearing
On October 23, New York County Medical Society Past-President and MSSNY Legislative Committee member Dr. Scot Glasberg testified at a Bronx NYS Assembly-Senate Health Committees hearing examining proposals to create a single payor system in New York State. To view Dr. Glasberg’s testimony and Q&A with Committee Chairs Richard Gottfried and Gustavo Rivera, click here and scroll to the 1:25 mark.

While MSSNY and NYCMS continue to support a multi-payor health insurance system and oppose a single payor system, both MSSNY and NYCMS have engaged with legislators to highlight the positives of such legislation but also the many areas of concern effecting patient care delivery with moving to such a system.  During the hearing, Assemblyman Gottfried praised NYCMS and MSSNY for engaging in a constructive dialogue, including highlighting specific areas of concern in the far-reaching proposal.

As a result, changes were made to the legislation including limiting prior authorization requirements and providing stronger collective negotiation rights for physicians.  During the hearing Q&A, Dr. Glasberg highlighted that, even with the changes to the legislation, deep concerns still remain including with the ambiguity of the bill’s patient care payment standard, as well as the risk of steep cuts that could be needed to address Budget constraints.

There have been multiple hearings around the State examining the single payor issue, with the testimony overwhelmingly in favor of legislation.  Earlier this year, MSSNY President Dr. Art Fougner testified at an Albany hearing on this issue (click here and here.)
Dr. Fougner’s testimony noted that while there are aspects of a single payor system that are appealing, such as the potential for administrative simplification, MSSNY remains concerned that the good intentions of the sponsors of this proposal may not be how the NY Health system will ultimately operate, particularly when they must respond to situations where anticipated tax revenues do not meet spending projections.

He also noted that continued promotion and expansion of the varied programs to provide health insurance coverage for New York’s uninsured and underinsured is MSSNY’s preferred approach. This legislation will be a major source of discussion during the upcoming 2020 Legislative Session.

Bill Enacted to Provide Greater Clarity to Medical Record Disbursement When Physicians Retire
The Governor this week signed into law a bill (S.5367/A.2349) that sets forth procedures to follow when a physician or other health care practitioner ceases delivering patient care in New York State. The goal of the legislation is to address the often-asked question of where patient records should be sent when a physician or other care provider retires from medical practice or moves to another state.

Specifically, the legislation requires the practitioner, at least 30 days prior to ending their practice, to make a good faith effort to notify the practice’s “current patients” of the impending closure and of the patient’s right to request their patient information or medical records be sent to the health care provider, facility, or practitioner of their choice or returned to the patient.  It also clarifies that the provisions of the bill do not apply to situations where a physician’s practice is acquired or merged with another entity, and the physician continues to deliver care to their patients.

It also notes that the bill does not affect the application of other relevant statutes regarding medical record retention such as provisions that set forth the time periods that physicians are required to retain patient medical records, and provisions that require physicians to provide copies of medical records to other medical practitioners in response to a patient request.

However, MSSNY pointed out to the Governor’s office that the bill does contain an ambiguity in that, as written, it could be interpreted to require retiring health care practitioners to provide patients with the original medical records rather than providing copies of the medical records.  That would be in conflict with the laws noted above instructing physicians to provide patients with copies of medical records and retaining the original records.  MSSNY will work with the New York State Department of Health to assure there is clear guidance to physicians as to how this is to be applied.

Physician Action Needed on Health Bills to be Considered by Governor
As of today, there were still nearly 500 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just a few months left in the year, the flurry of bill signings/vetoes has begun.

Physicians can quickly and easily send a letter to the Governor here on the following:

• Support Ending Mid-year formulary changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law https://p2a.co/jPbHbaC

• Support Partial prescription fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking https://p2a.co/YRf6CsU

• Oppose Liability expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills https://p2a.co/HPhmZqB
  

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High Rate of Thyroid Cancer in New York is on Staten Island
The rate of thyroid cancer on Staten Island is 67% higher than other boroughs and 69% higher than rates across the rest of the state, according to data released by the state health department this month. Thyroid cancer is the most common cancer among women aged 20-34 in New York State and on Staten Island, and it is also the most common cancer among women aged 35-39 on Staten Island. The state could not determine why the rate is higher for Staten Island residents than other New Yorkers, and ruled out exposure from the terror attacks on the World Trade Center and its aftermath. The summary found that the number of responders — mostly men — made up a small portion of the population and could not explain the elevation in thyroid cancer among women. Other environmental tests proved inconclusive or not significant to the uptick in thyroid cancer rates. (Politico, Oct. 30)

Medicare Fraud Could Mean More Deaths/Hospitalizations
A retrospective study finds that patients who receive care from physicians who commit Medicare fraud or patient abuse have a higher rate of mortality and hospitalization than those who are treated by doctors without those records. Looking at data from more than 8,200 patients who were treated by those who would turn out to have been defrauding Medicare or engaging in other harmful behavior, researchers found that these patients had between a 13%-23% higher risk of dying during the study follow-up period than those who were not treated by physicians who engaged in risky behavior. Patients treated by those found to be engaging in some kind of illegal activity also had between 11%-30% higher rates of emergency hospitalizations. In addition to the financial savings to Medicare, identifying perpetrators could also improve patients’ health, the authors suggest. (STATMorning Rounds News Oct. 29

Legislation Will Provide $100M for ED Suicide Prevention
Reps. Eliot Engel and Gus Bilirakis on Monday introduced legislation to curb the country’s rising suicide rate. The law would allocate $100 million in federal funding over a five-year period to emergency departments to help identify and treat individuals at a high risk of suicide.

The money would be earmarked for training emergency department clinicians to identify high-risk individuals and developing programs to coordinate care and follow-up services, Engel’s office said. It also would go toward supporting the recruitment and retention of behavioral health professionals who specialize in treating those experiencing suicidal ideation and the development of telehealth and other approaches.

Suicide rates in New York have increased by about 30% since 2000, Engel, a Democrat who represents New York’s 16th congressional district, encompassing parts of the Bronx and Westchester County, said in a statement. The legislation created with Bilirakis, a Republican from Florida, would “leverage the skills of nurses and emergency department professionals who are trained in identifying and treating at-risk individuals to help end this crisis and save lives.”

Suicide is the 10th leading cause of death in the country and was responsible for about 47,000 deaths in 2017, according to the Centers for Disease Control and Prevention. Suicides and suicide attempts cost the country about $70 billion per year in lifetime medical and work-loss costs. — Health Pulse Oct.29

New York’s MRT 1115 Waiver: Downstate & Upstate Public Comment Day
The Department of Health (DOH) recently held two public comment days—one in NYC and one in Syracuse – regarding its application to the federal government to extend until 2024 the existing DSRIP waiver.  You can view the webcast of both Public Comment Days here.

Phil Alotta from DOH gave a grief summary of the 1115 Waiver as well as the concept paper that was submitted for the DSRIP waiver extension. The 1115 waiver is designed to permit New York to use a managed care delivery system to deliver benefits to Medicaid recipients, create efficiencies in the Medicaid program, and enable the extension of coverage to certain individuals who would otherwise be without health insurance.

Greg Allen from DOH highlighted that potentially preventable admissions (PPA) were reduced by 21%, potentially preventable readmissions (PPR) were reduced by 17% and PPR/PPA costs per member were reduced by 14%.   Mr. Allen also highlighted future DSRIP goals which include; the expansion of medication-assisted treatment into primary care and emergency department settings, partnerships with the justice system, primary care and behavioral health integration and addressing social determinants of health through community partnerships.

Additionally, he emphasized the need to expand practices to high need areas and populations that includes an effort in reducing maternal mortality, bettering children’s population health and focusing on long-term care reform. He emphasized the departments need for continued improvements and investments in workforce flexibility, addressing the opioid epidemic and having interim access insurance fund.  He added that these efforts must be seen through a multi-payer lens and by continuing New York’s investment in the Social Determinant of Health (SDH) Networks as well as aligning performance based measures with value-based payment models.

The vast majority of public comments came from individuals representing different Community Based Organizations (CBO’s) who voiced their support for DSRIP and also urged the department to invest more in the social determinates of health as improving children’s behavioral health and developing a better infrastructure for CBO’s when working with DSRIP.  While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as physician practices, MSSNY and many other groups have raised concerns that there is still insufficient funding being made available to physicians and other community care providers who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.

In New York, Oral HPV Fairly Common in Sexually Active Adolescent Girls
Oral human papillomavirus (HPV) is not uncommon among sexually active adolescent females, and the vaccine appears to be protective, suggests a JAMA Network Open study.

Nearly 1300 sexually active females aged 13 to 21 in New York City had oral samples tested for HPV at baseline. Roughly 6% tested positive for oral HPV. Nearly 2% were positive for oncogenic types, while 0.2% had types included in the quadrivalent vaccine. Risk for oral HPV decreased with increasing time since their first sexual experience, “potentially reflecting the highlight transient nature of HPV infection,” the authors write.

Patients who received at least one dose of the vaccine had an 80% lower risk for oral HPV types included in the quadrivalent vaccine, relative to unvaccinated participants, although the authors note that few patients were unvaccinated. In addition, the presence of cervical HPV was associated with oral HPV.

The authors conclude: “This study’s findings suggest that … HPV vaccination is associated with a significant decrease in detection of HPV types in the oral cavity.”

Commentators say the results are similar to what is observed in adult patients.

JAMA Network Open article
JAMA Network Open commentary
Background: NEJM Journal Watch Women’s Health coverage of evidence of herd immunity against oral HPV (NEJM Journal Watch subscription required)

TO: New York State Residents, Fellows, and Medical Students
MSSNY Announces the 15^th 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. Deadline for abstract submission is 4:00 pm, Monday, February 3, 2020. We welcome your participation. Participants must be MSSNY members, and membership is free for first-time resident/fellow members, and for all medical students.  Join online.

Research Suggests Gender Discrimination Contributes to Burnout Among Female Surgical Residents, Physicians
A study published in the New England Journal of Medicine indicates “sexual harassment, gender discrimination and verbal abuse are contributing to high rates of burnout among female physicians.” A survey study of over 7,400 surgical residents, 40 percent of which were female, showed “approximately 42% of female surgical residents reported burnout, compared to 36% of male surgical residents.”

Reuters (10/28) reports in a separate study of 26 primary care physicians, nurse practitioners, and clinical directors in a rural part of California, researchers found “women and minority health professionals are sometimes driven out of rural communities by the discrimination and harassment from colleagues.” The interview-based study showed “many of the healthcare professionals who were female, nonwhite and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment and hostility from their colleagues.” The findings were published in JAMA Network Open.

Former JUUL Exec Claims Company Knowingly Sold Tainted Nicotine Pods
The New York Times (10/30) reports Siddharth Breja, the former senior vice president for global finance at JUUL Labs, has filed a federal lawsuit claiming the company knowingly “sold at least one million contaminated mint-flavored nicotine pods – and refused to recall them when told about the problem.” Breja “claims he was fired on March 21 in retaliation for whistle-blowing and objecting to the shipment of the contaminated and expired pods and other illegal and unsafe conduct.”

The Washington Post (10/30) reports the lawsuit “comes as Juul announced the layoffs of 500 employees, among them a handful of executives, including chief financial officer Tim Danaher.”

On its website, NBC News (10/30) reports Breja claims JUUL CEO Kevin Burns once said, “Half our customers are drunk and vaping,” in response to concerns that customers would notice the poor quality of the tainted pods. Breja also said the company has a culture of “disregard for the law, public safety, and public health.”

Docs Laud E/M Proposal, Blast Pay Cuts in Physician Fee Schedule Rule
As the comment period for the proposed 2020 Medicare Physician Fee Schedule rule drew to a close on Friday night, CMS received over 30,000 comments, including letters from major industry groups commending the agency for proposing to do away with a policy that would collapse evaluation and management (E/M) payment rates.

CMS decided in the 2019 Medicare Physician Fee Schedule final rule to consolidate E/M levels 2 through 5 into a single payment rate by 2021 to reduce the administrative burden associated with Medicare documentation requirements. Facing staunch industry criticism, the federal agency proposed earlier this year to walk back on the policy, which many industry groups are now praising. “CMS recognized that its earlier plan for E/M visits would have disrupted care patterns and may have created other unintended consequences. Having the separate codes helps acknowledge the difference in resources in treating patients with more complex care needs,” the American Medical Group Association’s (AMGA) president and CEO Jerry Penso, MD, MBA, said in a statement.

Finalizing the proposal to keep separate E/M payment rates would also avert unintended consequences, such as forcing “medical practices to reduce their Medicare patient volume or limit the medical issues addressed during one office visit due to lower reimbursement rates for more complex visits,” MGMA stated in its comments. ( RevCycle Intelligence, September 30, 2019)

Heavy Soda Consumption Associated with Hip Fracture after Menopause
Older women who drink more soda may be more likely to suffer hip fractures than their counterparts who consume little to no soda,” researchers concluded after examining “data on soda consumption, bone health and fractures for more than 70,000 women who were 69 years old on average.” The findings were published online in the journal Menopause.

“When is the Flu not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? on November 20^th at 7:30am.  This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  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.  Please click here to view the flyer for this program.

Educational objectives are:

• Recognize the distinction between types of influenza and other similarly presenting illnesses
• Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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.