Category: eNews

PRESIDENT’S MESSAGE Dr. Malcolm Reid

February 24, 2017 Volume 17 Number 8

Dear Colleagues:

On February 17, CMS awarded approximately $20 million to 11 organizations for the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 clinicians or fewer. These local, experienced, community-based organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas, including rural areas, health professional shortage areas, and medically underserved areas.

The training and education resources will be available immediately, and will be provided at no cost to eligible clinicians and practices. CMS also launched a new telephone helpline for clinicians seeking assistance with the Quality Payment Program at 866-288-8292 or qpp@cms.hhs.gov. For more information, visit the Quality Payment Program website. IPRO, with whom we have partnered with on several projects in the past, is one of the 11 recipient organizations. Questions can be sent to IPRO at email address: NY-QPP@atlanticquality.org  or you can call IPRO at 1-866-333-4702.

We will keep you apprised of exactly how this will roll out and really assist physicians who, to date, have not gotten on board with Quality Payment Program.

National Advocacy Conference in DC

Next week is the AMA’s National Advocacy Conference in Washington. Due to a prior commitment, I cannot attend, but we have excellent representation from our MSSNY leadership that includes President Elect Dr. Charles Rothberg, Past Presidents Dr. Robert Goldberg and Dr. Robert Hughes, and Speaker Dr. Kira Geraci, as well as Executive Vice President of Government and Regulatory Affairs Moe Auster and our Executive Vice President Phil Schuh.

We will be meeting with our Senators Schumer and Gillibrand to outline our issues and identify how they can directly help MSSNY. At the actual conference we will be discuss medicine’s “big issues,” including prescription drug pricing, which has been a consistent concern for patients and their physicians. This problem has caught the bipartisan attention of Congress. The panel will discuss the rising costs and projected growth in spending on pharmaceuticals, the impact they have on patient access and adherence to medically necessary prescription drugs and suggested solutions. The AMA’s health care reform objectives highlight key elements that will guide continuing discussions with Congress and the Trump Administration.

Among these objectives are ensuring that low/moderate income patients are able to secure affordable and adequate coverage and ensuing that Medicaid, CHIP and other safety net programs are adequately funded. This week, Governor Cuomo warned that an ACA repeal could cost the state $3.7 billion in funding and throw 2.7 million New Yorkers off the healthcare rolls. Clearly, the potentially devastating impact this would have on health care delivery in New York State will certainly be raised by our leadership.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

MSSNY Lobby Day (3/8) is Quickly Approaching! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8^th in the Lewis Swyer Theatre in the Egg, located at the Empire State Plaza, Albany NY.  The program begins at 8 AM. If you have not already, please register here:. Joint hundreds of your colleagues from across the State who are coming to Albany on this day to meet with their local Senators and Assembly members, as well as hearing from New York’s top health care policymakers including:

• Senate Majority Leader John Flanagan;
• Assembly Majority Leader Joseph Morelle;
• Senate Health Committee Chair, Kemp Hannon; Assembly Health Committee Chair, Richard Gottfried: Senate Insurance Committee Chair, James Seward; Assembly Insurance Committee Chair, Kevin Cahill;
• Jason Helgerson, NYS Medicaid Director;
• Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services

Come meet with your legislators to urge that they:

• REJECT burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the Governor’s proposed State Budget;
• REJECT inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners;
• REJECT changes to increase burdensome physician prior authorization requirements contained in the proposed State Budget;
• SUPPORT legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
• SUPPORT legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up costs; and
• REJECT legislation that would impose costly and time consuming mandates on physician delivery of patient care.

A brief informal luncheon to which members of each House are invited to speak with their constituents will follow the morning program. In addition to registering here please contact your local county Medical Societies who will be scheduling appointments for physicians to meet with their elected representatives. If you have any questions/comments, please contact Carrie Harring at charring@mssny.org or call 518-465-8085.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Please Contact Your Legislators To Express Concerns With Several State Budget Proposals
The month of March brings with it an intensification of negotiations between the Assembly, Senate and Governor to meet the April 1 State Budget deadline. As these negotiations ensue, physicians are urged to continue to contact their elected officials regarding a number of State Budget proposals listed below.   While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  For example:

• We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  Send a letter to your legislators here.
• Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or who have not met clinical goals of therapy. While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  Send a letter to your legislators here.

• “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements. To send a letter to your legislators, click here.

• The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.

• The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including “modernizing” Certificate of Need laws, and changing scopes of practice for non-physicians. Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval. Over a dozen specialty societies have joined MSSNY in a letter to the entire Legislature to urge that this proposal be removed from the budget, or remove the provision that enables these demonstration programs.
• Giving overbroad discretion to state officials to drop physicians and other prescribers from the Medicaid program based upon the “inappropriate prescribing of opioids”. (DIVISION OF GOVERNMENTAL AFFAIRS)

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

MSSNY OFFERS 3 Hour CME Program on Pain Management, Palliative Care and Addiction; NYS Requires Every Prescriber to Take 3 Hour Course By July 1, 2017
The Medical Society of the State of New York announces a series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers holding a DEA license to complete three hours of coursework no later than July 1^st, 2017.   These webinars are being offered FREE OF CHARGE to MSSNY members with a discount code.  The discount code has been provided to MSSNY members.  Non-MSSNY members will be charged $150 for the series.  The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services in the development of this program.   Following the webinars, the course will be offered on-line on the MSSNY CME site.

The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series. The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Webinars will be held on:

Thursday, March 9, 2017—7:30-8:30am

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Trishia Allen, Esq.

Educational Objectives:

Understand New York State and Federal Requirements for Prescribing Controlled Substances

Discuss Guidelines for Chronic Pain. Register for this webinar here. 

Tuesday, March 14, 2017—7:30-8:30am

Rational Opioid Prescribing for Chronic Pain Conditions

Faculty: Charles Argoff, MD & Patricia Bruckenthal, PhD, APRN-BS, FAAN

Educational Objectives:

Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation. Describe palliative medical care and end-of-life care. Register for this webinar here. 

Tuesday, March 21, 2017—7:30-8:30am

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Charles Morgan, MD & Frank Dowling, MD

Educational Objectives:

Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral. Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed.Describe Strategies for Treating Pain in Patients with Substance Use Disorders.Register for this webinar here. 

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.

Additional information or assistance with registration may be obtained by contacting Pat Clancy at pclancy@mssny.org.
(CLANCY)

New York Physician Leaders to Head to Nation’s Capital Next Week
Several MSSNY physician leaders from across New York State will travel to Washington DC next week to join thousands of physicians across the country meeting with their Representatives and Senators fighting for needed improvements in health care delivery, and in opposition to proposals that would jeopardize health care access and coverage for their patients. The Hill visits are in conjunction with the AMA’s Annual National Advocacy Conference.

Specifically, physicians will be urging the enactment of legislation to ease some of the burdens associated with the new Medicare Merit-Based Incentive Payment System (MIPS), and to reduce hassles associated with Medicare audits initiated by Recovery Audit Contractors.

MSSNY will also be advocating for carefully considered reforms to the Affordable Care Act (ACA). Last month, MSSNY President Dr. Malcolm Reid wrote to New York’s entire Congressional delegation to express concern with efforts to repeal funding for coverage expansions authorized under the ACA without simultaneously specifying how it will be replaced.

Dr. Reid’s letter acknowledged the many concerns physicians have expressed with the impact of the ACA, but also noted that “the ACA has provided the opportunity for hundreds of thousands of New Yorkers to obtain affordable health insurance coverage that previously was not available to them” and that “elimination of the funding currently provided to New York State through these programs could drive a huge hole in our State Budget, and prompt untenable cuts affecting millions of more New Yorkers.”    Therefore, he urged “that any legislation that threatens the availability of affordable health insurance options for our patients simultaneously specifies how these currently available coverage options will be replaced with improved coverage options”.
(AUSTER)

DFS Announces Comprehensive Investigation Into Insurer Contraceptive Coverage Compliance
Superintendent Maria Vullo announced this week that the New York State Department of Financial Services (DFS) is conducting a comprehensive investigation of health insurer compliance with contraceptive coverage requirements under New York Insurance Law, following an undercover sting of 15 insurers.  The press release, noted a report that describes how DFS discovered that certain New York health insurers are providing consumers with incorrect information about contraceptive coverage.

The press release notes that, in its undercover sting, DFS identified 11 New York health insurers that had provided consumers with incorrect information about contraceptive coverage.  Some health insurers were incorrectly telling callers that the consumer must pay for contraceptive drugs and devices, when both New York law and the ACA mandate such coverage.  In addition, several health insurers incorrectly stated that a particular contraceptive drug or device is not covered, or that co-payments are required when they are not. The press release further noted that, as part of this comprehensive investigation, DFS will take several steps to correct any violations they find, including:

• Taking all necessary action to ensure that all health insurers in New York cover the full range of FDA-approved contraceptive delivery methods at no cost-sharing;
• Requesting a corrective action plan and related relief from health insurers found to have failed to provide accurate or complete information;
• Requesting information and documentation from health insurers regarding their coverage and reimbursement of contraceptive drugs and devices under health insurance policies.  Specifically, DFS will be requesting information about contraceptive claims submitted and whether the claims were appropriately paid, with no cost-sharing imposed.  DFS will also be requesting information about complaints and appeals involving contraceptive coverage.
  (AUSTER, CLANCY)

AG Settles Case with Oxford for Improper Denial of Infusion Services
New York Attorney General Eric Schneiderman announced an agreement with Oxford Health Plan this week requiring Oxford to provide refunds to hundreds of small group plan members in New York State for improperly denying coverage of infusion services, including necessary supplies and nurse visits, since November 2015.  According to the press release, the investigation began after an Oxford enrollee complained to the Attorney General’s Health Care Bureau Helpline that she began to receive bills from a provider of infusion supplies, when the infusion supplies had been previously covered by her plan.  As a result of the AG’s inquiry, Oxford acknowledged that hundreds of other members’ infusion services claims were also improperly denied as well as claims for nurse home healthcare visits for the administration of infusion medication.

Specifically, Oxford identified a total of 2,587 claims that were improperly denied, totaling nearly $500,000.   The agreement requires Oxford to mail letters to members notifying that they may have paid too much for infusion services, and setting forth the steps to secure a full refund; Re-examine all infusion claims from October 1, 2015; and pay $35,000 to New York State.
(AUSTER)

Register Now For Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, March 15, 2017 at 7:30 a.m. with Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise. 2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. MSSNY 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.                                                                                                                           (Clancy, Hoffman)

Register Now For Upcoming Veterans Matters CME Webinars
The Medical Society of the State of New York encourages you to register for its upcoming Veterans Matters webinars. These programs include CME presentations on PTSD and TBI, as well as Substance Use Disorders. Faculty for these programs are Frank Dowling, MD and John McIntyre, MD. Registration for all of these programs is open.  Just click on any of the presentation dates below.

Substance Use Disorders (SUDs): Friday, March 3 at 7:30 a.m.

Faculty Presenter: Frank Dowling, MD

The educational Objectives for the SUDs program are:

1) Explain substance use disorders (SUDs), symptoms, warning signs, comorbidities.

2) Explore treatment options for veterans including evidence-based practices in psychotherapy and pharmacotherapy.

3) Identify barriers to identification and treatment, including those unique to military culture, and how to overcome them.

PTSD and TBI: Friday, March 10 at 8 a.m.

Faculty Presenter: John McIntyre, MD

The educational Objectives for the PTSD program are:

1) Describe the symptoms of PTSD and TBI.

2) Describe the treatment modalities of PTSD and TBI.

3) Describe military culture & how to overcome unique barriers to treatment intrinsic to military culture

Additional information or assistance with registration may be obtained by contacting Greg Elperin at gelperin@mssny.org.

Veterans Matters is a CME series made possible through a grant from the New York State Office of Mental Health. 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 each 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.             
(Elperin)

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

For Your Patients: MY DRUG IS NOT COVERED. NOW WHAT?
With the rising cost of healthcare today, families are in need of assistance.  The New York Rx Card can help with those prescription costs and is a free program available to all New York residents.  No eligibility requirements or forms to fill out, simply take the card into the pharmacy to receive savings of up to 75% on prescription medications for the whole family.  New York Rx Card is a proud supporter of Children’s Miracle Network. A donation will be made to your local CMN hospital each time a prescription is processed through the New York Rx Card.  Go to www.newyorkrxcard.com and print your free card today. 

January 2018: New Paid Family Leave Regulations in New York
On February 22, Governor Andrew M. Cuomo announced that the state has filed regulations for the implementation of New York’s paid family leave program, the most comprehensive paid family leave program in the nation. The new regulations provide guidance to employers, insurance carriers and employees about their rights and responsibilities under the law. New York’s Paid Family Leave Law will provide for 12 weeks of paid leave when fully phased-in for employees who seek to take care for a new child, a close relative with a serious health condition or relieve the pressures created when a family member is called to active military service.

The Governor launched a new helpline (844) 337-6303 and a new website to answer questions and provide New Yorkers with more information about the new program. The state also issued a Request for Information to solicit information from potential vendors and develop a leave plan for state employees. The new policy will be phased in over a four-year period, beginning on January 1, 2018.

Beginning January 1, 2018, the state’s paid family leave program will provide employees with wage replacement during time away from their job in order to bond with a child, care for a close relative with a serious health condition, or to help relieve family pressures when someone is called to active military service. Employees are also entitled to be reinstated to their job when their leave ends, as well as the continuation of their health insurance. The regulations filed today provide regulatory guidance to employers, insurance carriers, and employees to clarify their rights and responsibilities under the program so that they can plan accordingly when the new law goes into effect.

The regulations also address eligibility, coverage, the phase-in schedule of the new program, and more information on how employees, employers, and insurance carriers will interact to pay out benefits. The full Workers Compensation Board regulations are available here. DFS regulations for insurance companies are available here.  Eligibility: To be eligible for paid family leave, employees must have been employed full-time for 26 weeks or part-time for 175 days by a covered employer, at the time they apply for benefits.

The proposed paid family leave regulations are subject to a 45-day notice and public comment period following the publication in the New York State register before its final issuance.   New York’s Paid Family Leave website, found at www.ny.gov/paidfamilyleave, has also been updated to reflect information based on the draft regulations. Information on the site will be regularly updated. The public is also encouraged to call the Paid Family Leave helpline at (844) 337-6303 with any questions.

To be eligible, employees must present certification from a health care provider treating the family member. For adoption and foster care of child, documentation is also required. Coverage: The program is included under an employer’s disability policy that all private employers must carry, and will be fully funded by employees through payroll deductions—beginning in July 2017. The program is mandatory for all private employers, and public employers may opt-in to the program.

 SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details

United Accused of Overcharging Medicare through Medicare Advantage Program
UnitedHealth Group, one of the nation’s largest health insurers, is accused in a scheme that allowed its subsidiaries and other insurers to improperly overcharge Medicare by “hundreds of millions — and likely billions — of dollars,” according to a lawsuit made public at the Justice Department’s request. The accusations center on Medicare Advantage, a program through which people 65 or older agree to join private health maintenance organizations, or HMOs, whose costs the government reimburses.

The program was created in 2003 after UnitedHealth and other insurers said that managed care could help contain the overall cost of Medicare. Instead of slowing Medicare costs, UnitedHealth may have improperly added excess costs in the billions of dollars over more than a decade, according to the lawsuit, which was unsealed in Federal District Court in Los Angeles.

A spokesman for UnitedHealth disputed that assertion, saying it was based on faulty interpretations of Medicare rules.

GOP Aims to Push HSAs to Consumers to Lower Healthcare Costs
The AP http://apne.ws/2mfijET reports the Federal government may begin pushing consumers to help reduce healthcare costs. While the fate of the Affordable Care Act remains uncertain, “Republicans indicated last week that they will encourage wider use of insurance that comes with a health savings account aimed at pushing patients to save and shop for care.” They are convinced that when consumers’ “money is on the line – and not the insurance company’s” – they will shop around for the best value and do their “part to curb national health care spending.”

CMS Streamlines ICD-10 Resources
To streamline your access to resources, CMS has merged all up-to-date content from our Road to 10 website to our main ICD-10 site, cms.gov/ICD10.

We are now phasing out the Road to 10 site, with an anticipated completion date of April 3.

Please be sure to update all your bookmarks and links for Roadto10.org to point to cms.gov/ICD10.

After the successful transition to ICD-10, we noted that:

• Visits to the Road to 10 website dropped sharply
• Most users were opting to visit cms.gov, not Road to 10, for ICD-10 information

CMS has made cms.gov/ICD10 your one-stop site for official CMS ICD-10 resources.

MSSNYPAC – The Political Voice for New York’s Physicians
Significant victories have been hard won by physicians.  Numerous administrative simplifications have been achieved.  E-prescriptions will soon be permitted to be transferred from pharmacy to pharmacy! Reporting to the DOH is no longer necessary when you have to write a paper prescription!  Health insurer step therapy medication protocols can be more readily overridden!

Health insurer credentialing times have been shortened!  These and the many other victories the physician community achieves are possible when physicians work collectively on the three important fronts of advocacy – Lobbying, Grassroots and Political.  If any one area lacks, all areas are weakened.  Like joining MSSNY, or sending letters or making calls in support of important measures, Your support of MSSNYPAC is essential to our collective advocacy successes.  Help pave the way for more victories!
Join or increase your support and participation today at www.mssnypac.org/contribute. 

REMINDER: THERE IS A MARCH 17 DEADLINE FOR MEANINGFUL USE EHR ATTESTATION AND THE DEADLINE FOR PQRS HAS BEEN EXTENDED UNTIL MARCH 21, 2017.

CDC Report: Season’s Flu Vaccine Has Been 48% Effective So Far
According to a report from the Centers for Disease Control and Prevention, the flu vaccine has been 48% effective so far this season.

Weekly Charting Tip: What is the cause of the vast majority of social media poor reviews? Poor patient service; NOT poor patient care. Return phone calls and attempt to realistically appoint your patients. If the physician is delayed due to an emergency, immediately explain this to the people waiting. Perhaps, proactively call the later patients that will be affected by the delay; like some airlines are now doing.

If you have any questions, please contact Kern Augustine, P.C. at 1-800-445-0954 or via email at info@DrLaw.com.

CLASSIFIEDS

PRESIDENT’S MESSAGE Dr. Malcolm Reid

February 17, 2017 Volume 17 Number 7

Dear Colleagues:

Several physician leaders of the Erie County Medical Society and MSSNY met with the Buffalo News editorial board this week to express concerns about the impact to patient care as a result of statements made by various prosecutorial agencies regarding their intention to prosecute more physicians for inappropriate prescribing of opioids. The participants included: MSSNY Vice President Dr. Thomas Madejski, Erie County Medical Society President Dr. Timothy Gabryel, former MSSNY House of Delegates Speaker (and former AMA President) Dr. Nancy Nielsen and Medical Society of Erie County Executive Director Christine Nadolny.

The physicians emphasized the extensive efforts of the medical community to respond to the opioid abuse crisis. They also recognized the appropriateness of criminal prosecution in certain instances where prescribers are intentionally writing prescriptions for diversion purposes.  However, they also emphasized that it is wrong to prosecute physicians for medical decision-making, as such efforts could intimidate physicians into greatly limiting their prescriptions for necessary medications, which in turn would greatly narrow treatment options for patients.

It is yet another reason for physicians to come to Albany for MSSNY’s Physician Advocacy Day on March 8 to make sure their legislators are aware of the possible narrowing of treatment options for patients due to potentially overly aggressive efforts to prosecute.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

MSSNY Lobby Day Scheduled for March 8^TH – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8^th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.

Physicians are urged to come to Albany to participate in MSSNY’s lobby day to give firsthand accounts on the current needs in health care, lobby for the positive provisions included in the proposed state budget and stop several proposals that could have an adverse impact on physician care delivery.

If you plan to attend, please register here.

The morning program will begin at 8 AM, after which physicians will have the opportunity to have meetings with their local Senators and Assemblymembers.   A full slate of legislators and key policymakers have been confirmed to participate in the morning program including:

• NYS Senate Majority Leader John Flanagan;
• Jason Helgerson, NYS Medicaid Director;
• Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and top health care staff at DFS have been invited.

A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.   In addition to registering here please contact your county medical societies, as they will be scheduling appointments for physicians to meet with their local Assemblymembers and Senators.
(DIVISION OF GOVERNMENTAL AFFAIRS)                                                      

MSSNY Testifies at Health Budget Hearing
Division of Governmental Affairs’ Senior Vice President / Chief Legislative Counsel Moe Auster testified at a joint public hearing on the health care budget this week.

MSSNY stressed the need for lawmakers to reduce burdensome prior authorization hassles and not increase already overwhelming overhead costs borne by physicians.  In this regard, the testimony included support for the continued funding for the Excess Medical Liability Insurance program while stressing our opposition to the proposed tax clearance obligation as a condition for Excess coverage which could serve as an impediment to timely issuance of the Excess policy.

MSSNY also expressed support for budget proposals that call for the regulation and taxation of E-cigarettes in the same manner as tobacco cigarettes, and the registration and regulation of Pharmaceutical Benefit Manager (PBMs).

MSSNY outlined concerns with a proposal that would allow pharmacists to enter into “comprehensive medication management protocols” with nurse practitioners to manage, adjust and change the medications of certain patients. While similar collaborative drug therapy programs exist in the hospital environment, only physicians are currently permitted to enter into these protocols.

Additionally, MSSNY expressed concerns regarding the Health Care Regulation Modernization team proposal that would be empowered to review and propose fundamental restructuring of statutes, policies and regulations including certificate of need rules and clinician scope of practice laws.  Of greatest concern, the proposal appears to allow various state agencies the ability to implement “demonstration programs” to test and evaluate procedures and processes for organizing, financing and delivering health care services that are not permissible under current statute or regulation.

MSSNY also urged that outstanding Health Republic claims be paid in full.  DFS Superintendent Maria Vullo gave a presentation at the hearing regarding her extensive efforts to oversee the liquidation of HR including the possible initiation of litigation to collect “Risk Corridor” payments as other states have done.

To read MSSNY’s full testimony, please click here.                                           (DIVISION OF GOVERNMENTAL AFFAIRS STAFF) 

MSSNY OFFERS 3 Hour CME Program on Pain Management, Palliative Care and Addiction; NYS Requires Every Prescriber to Take 3 Hour Course By July 1, 2017
The Medical Society of the State of New York announces a series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers holding a DEA license to complete three hours of coursework no later than July 1^st, 2017.   These webinars are being offered FREE OF CHARGE to MSSNY members with a discount code.  The discount code has been provided to MSSNY members.  Non-MSSNY members will be charged $150 for the series.

The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services in the development of this program.   Following the webinars, the course will be offered on-line on the MSSNY CME site.   The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series.

The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Webinars will be held on:

Thursday, March 9, 2017—7:30-8:30am

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Trishia Allen, Esq.

Educational Objectives:

Understand New York State and Federal Requirements for Prescribing Controlled Substances

Discuss Guidelines for Chronic Pain

Register for this webinar here.  

Tuesday, March 14, 2017—7:30-8:30am

Rational Opioid Prescribing for Chronic Pain Conditions

Faculty: Charles Argoff, MD & Patricia Bruckenthal, PhD, APRN-BS, FAAN

Educational Objectives:

Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation

Describe palliative medical care and end-of-life care

Register for this webinar here.  

Tuesday, March 21, 2017—7:30-8:30am

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Charles Morgan, MD & Frank Dowling, MD

Educational Objectives:

Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral.

Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed.

Describe Strategies for Treating Pain in Patients with Substance Use Disorders.

Register for this webinar here.  

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.

Additional information or assistance with registration may be obtained by contacting Pat Clancy at pclancy@mssny.org
(CLANCY)

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

Physician Uproar Over Kinney Drugs’ New Strep and Flu Testing Program
This week MSSNY alerted state Department of Health and State Education Department officials to the concerns raised by several physicians regarding a new program from Kinney Drug Stores in 10 Onondaga County locations to conduct “rapid tests” of customers for strep and influenza and facilitate telemedicine treatment for these customers if these initial tests are positive.  These physicians’ concerns were extensively documented on a local Syracuse television station this week.

Several physicians have been in contact with Kinney officials directly questioning whether Kinney has legal authority to do this, as well as whether this could adversely impact patient health because of the possibility of “false positives” and “false negatives”.  These initial conversations have resulted in Kinney increasing from 13 to 18 the minimum age of customers who could be rapid tested for strep and flu.  Kinney representatives have noted that its actions are legal because these sites have been approved by New York State to perform rapid strep and flu tests under the supervision of a physician medical director as these are “CLIA waived tests”.

MSSNY staff has also been in touch with Kinney representatives, and will be facilitating dialogue between local county medical society physician leaders and Kinney representatives to discuss how best to assure patients’ health.
(AUSTER, CLANCY)

Details on Federal Health Care Changes Start to Emerge
House Republicans have released an outline of how they would repeal and replace the Affordable Care Act.  Their plan would include giving states the power to design their own plans, increasing the amount individuals can put in their Health Savings Accounts and allows individuals and families to spend money from their HSA on “over-the-counter” health care items.  Their plan also includes a monthly portable tax credit that can be used to buy a health insurance plan that would be based on age. Of greatest significance to New York State, it would phase out the Medicaid eligibility expansion contained in the ACA.

The Centers for Medicare & Medicaid Services (CMS) also issued a proposed rule this week that would make the following changes, with the goal of helping to stabilize the individual and small group market.

• Expand Pre-Enrollment verification of eligibility
• Allowing an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year’s plan with the same issuer.
• Provide greater flexibility to insurers to offer varying coverage options.
• Give states the authority to assess issuer network adequacy.
• Shorten the upcoming annual open enrollment period for the individual market.
  (Belmont)

Aetna-Humana Calls off Its Merger and Cigna Sues to End Merger with Anthem
While Aetna and Humana announced that they were ending their proposed merger this week, a federal judge temporarily blocked Cigna from immediately terminating its proposed merger agreement with Anthem, after Cigna earlier this week sued Anthem seeking to end the agreement.  These actions follow recent rulings blocking these proposed mergers from moving forward.  These proposed mergers had been challenged by several patient advocacy and physician advocacy organizations including the American Medical Association and MSSNY because of the very significant market impact the mergers would have had in various regions across the country, and in New York.  Last fall, MSSNY President Dr. Malcolm Reid and AMA representatives testified at a New York Department of Financial Services (DFS) hearing to express strong concerns with the proposed merger of Anthem and Cigna.                        (AUSTER)

DOH Provides Information on New Breast Cancer Screening and Diagnostic Imaging
In July 2016, Governor Andrew M. Cuomo signed legislation to help more women get breast cancer screening and diagnostic imaging. The legislation prohibits insurers in New York from requiring cost-sharing for women who get these services. A copy of the letter that the New York Department of Financial Services sent to insurers about the new requirements can be found here.

No cost-sharing means that women who have health insurance policies covered by this law do not have to pay any out-of-pocket costs for breast cancer screening and diagnostic imaging. This means that insurers cannot apply the services against annual deductibles and also cannot charge patients a co-payment or coinsurance.  Important note: no cost-sharing applies only when services are delivered by a provider in your health plan’s network. Services may not be covered at all if delivered by a provider outside of your health plan’s network. The law removes cost-sharing for mammograms, including:

a single, baseline mammogram for women 35 to 39 years old, yearly mammograms for women 40 years of age or older, and mammograms for women at any age who are at an increased risk of breast cancer because they have a prior history of breast cancer, or they have a first degree relative (e.g., parent, sibling, child) with breast cancer. The law also removes cost-sharing for women in need of imaging tests other than standard mammograms – such as diagnostic mammograms, breast ultrasounds, and breast magnetic resonance imaging (MRI) for the detection of breast cancer.  Additional information can be found here.  (CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, March 15, 2017 at 7:30 a.m. with Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

MSSNY 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.  (CLANCY, HOFFMAN)

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

MSSNYPAC – The Political Voice for New York’s Physicians
Supporting MSSNYPAC with a financial contribution is an important investment in the preservation of our noble profession.   You can help to strengthen the physician’s political voice to help direct the shape of healthcare policy.  Physicians face opposition on many fronts.  Therefore, we need to be prepared with a well-funded MSSNYPAC to support the candidates who truly understand the concerns of physicians trying to assure their patients receive the best possible care.  In light of what’s at stake, isn’t it time you lent your voice to our efforts?  Join or increase your support and participation today at www.mssnypac.org/contribute. 

SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details

New York Investigating Three Cases of Leptospirosis in Bronx Neighborhood
The New York Times (2/14) reported that the NYC Department of Health and Mental Hygiene “is investigating three recent cases” of the rare disease leptospirosis “that have occurred in the Grand Concourse neighborhood of the Bronx.” Leptospirosis “infections commonly occur through exposure to rat urine,” and the city has “taken ‘immediate measures’ to reduce the rat population in the area and” educate residents about the disease.


FOR YOUR PATIENTS: MY DRUG IS NOT COVERED. NOW WHAT?
With the rising cost of healthcare today, families are in need of assistance.  The New York Rx Card can help with those prescription costs and is a free program available to all New York residents.  No eligibility requirements or forms to fill out, simply take the card into the pharmacy to receive savings of up to 75% on prescription medications for the whole family.  New York Rx Card is a proud supporter of Children’s Miracle Network.  A donation will be made to your local CMN hospital each time a prescription is processed through the New York Rx Card.  Go to www.newyorkrxcard.com and print your free card today.

Travel Ban Creates Uncertainty for Upcoming Match Day
The Chicago Tribune (2/11) reported that the “continuing uncertainty surrounding” President Trump’s travel ban “has international medical school graduates and teaching hospitals on edge.” According to the national Resident Matching Program, “about 14 percent of residents who matched through the main matching program – more than 3,700 people – were non-U.S. citizens who graduated from medical schools outside the U.S.” The article points out that the American Medical Association “has asked the Trump administration for guidance on Trump’s order to ensure it doesn’t keep out qualified med school grads or leave hospitals with unfilled training spots.”

AMA President Andrew W. Gurman said, “International medical graduates have been a resource to provide medical care to areas that don’t otherwise have access to physicians. With the current uncertainty about those physicians’ immigration status, we don’t know whether or not these areas are going to receive care.”

Over 65: Taking At Least Three Psychiatric Meds More Than Doubled in Nine Years
“The number of retirement-age Americans taking at least three psychiatric” medications “more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers” found after analyzing “data from annual government surveys of office-based” physicians. In particular, investigators “focused on office visits by people 65 or older that resulted in the prescribing of at least three of a list of psychiatric, sleep and pain medications.” The findings were published online Feb. 13 in a research letter in JAMA Internal Medicine.

Two Upstate New York Medical Groups to Merge
The Schenectady Daily Gazette (2/9) reports that Community Care Physicians and CapitalCare Medical Group are planning to merge. When combined, the two “will offer urgent care, primary care and care in 30 specialties at more than 50 locations across the Capital Region.” The article reports that additional details will be released Friday “when Dr. Shirish Parikh, CEO of Community Care, and Joan Regan Hayner, CEO of Capital Care, make a formal announcement of the plans at a news conference.”

Pediatrics: Drunk Driving Contributes To More than One in Four Crashes among Young
Research suggests that drunk driving “contributes to more than one in four motor vehicle fatalities for children, teens and young adults [in the United States] – and nearly half of these deaths happen at night or on weekends.” Researchers “analyzed crashes that occurred from 2000 to 2013 and involved at least one driver with a blood alcohol level of at least 0.08 percent, the legal limit in most states.” People killed in motor vehicle crash fatalities involving alcohol were “predominantly male (73 percent) and most were at least 18 years old.” The findings were published in the journal Pediatrics.

CLASSIFIEDS

PRESIDENT’S MESSAGE Dr. Malcolm Reid

February 10, 2017 Volume 17 Number 6

Dear Colleagues:

As you may be aware, some of our physicians in the Central New York and Adirondack area have received letters from the Medicaid Fraud Control Unit (MFCU) of the NYS Attorney General’s Office.

These letters are the result of investigations conducted by MFCU concerning billing agents (and the providers that utilize their services). Our physicians are being asked to refund money based on MFCU’s decision of fraudulent billing stemming from contracts that are perceived to be allowing fee splitting.

MFCU points out that billing services that charge medical professionals a percentage of costs for claims submitted is in violations of Medicaid rules. MFCU also mentions that this form of billing is in violation of NYS Education Law. MSSNY is advising our member physicians to review their billing vendor service contracts. If your contract appears to allow this type of percentage billing, it is urged that you share these two documents with your billing service:

• EXCERPT from the March 2001 Medicaid Update
• Redacted Medicaid Fraud Unit Repayment Demand Letter

It is important that you seek to amend the fees you pay your biller for Medicaid claim submissions to either payment based on time or a flat fee for claims submitted.

Again, these letters are coming from MFCU and are not generated by NYSDOH, OMIG, NYS Education Department or OPMC. From our understanding, this recovery activity will impact fee for service and Medicaid fee for service and managed care.

If you have questions, please call Regina McNally at 488-6100 ext. 339.

Anthem Cigna Merger Blocked

Wednesday’s decision to block the mega-merger between insurance giants Anthem and Cigna is an important development for patients and their physicians. While many regions of New York State and across the country continue to be dominated by a few large insurers, this proposed merger would have made this problem even worse. Indeed, many patient and physician advocacy organizations raised concerns regarding the potential impact of this merger proposal on patient care, including MSSNY and the American Medical Association during a public hearing (where I testified) held by the New York Department of Financial Services (DFS) last September. We thank New York DFS Superintendent Maria Vullo for publicly articulating the huge market impact of this proposed merger had it been permitted to go forward, and New York Attorney General Eric Schneiderman for joining the US Department of Justice’s action to block the merger.

The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds.

As expected, the day after the decision, Anthem Inc. appealed the federal judge’s decision to block its acquisition of Cigna, but the future of the deal was unclear amid discord between the two partners.

Apparently, it’s not over yet.

As a personal endnote, my family and I would like to sincerely thank everyone for the outpouring of sympathy regarding the death of my mother last Sunday.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

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

Please Contact Your Legislators to Express Concerns with Several State Budget Proposals
Physicians are urged to continue to contact their elected officials regarding a number of State Budget proposals listed below.   While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made.  For example:

• We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  To send a letter to your legislators, click here.

• Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  To send a letter to the Legislature, click here.

• “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.  To send a letter to your legislators, click here.

• The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.

• The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including “modernizing” Certificate of Need laws, and changing scopes of practice for non-physicians. Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval.

• Giving overbroad discretion to state officials to drop physicians and other prescribers from the Medicaid program based upon the “inappropriate prescribing of opioids.

MSSNY will be testifying at a Joint Legislative Hearing this Thursday to examine concerns with the proposed Health Budget.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Court Ruling Blocks Anthem-Cigna Merger from Moving Forward
A US Federal court issued a ruling this week blocking the proposed merger between health insurance giants Anthem and Cigna.  The proposed merger had been challenged by several patient advocacy and physician advocacy organizations including the American Medical Association and MSSNY because of the very significant market impact the merger would have had in various regions across the country, including in Long Island and New York City.  Last fall, MSSNY President Dr. Malcolm Reid testified at a New York Department of Financial Services (DFS) hearing to express strong concerns with the proposed merger.

The judge found that the merger would have substantially lessened competition for the sale of health insurance to national employers resulting in higher prices and diminished prospects for innovation. In a historic, stunning affirmation of the position urged by the AMA and consequently adopted by the government, Judge Jackson concluded that an enhanced ability to coerce physicians to accept lower reimbursement is not a merger efficiency defense.  She determined that it would not benefit consumers and “would erode the relationship between insurers and providers” and “reduce the collaboration” that is essential to innovation in payment and delivery.

In response to the court’s ruling, Dr. Reid gave the following statement.

Yesterday’s decision to block the mega-merger between insurance giants Anthem and Cigna is an important development for patients and their physicians.  While many regions of New York State and across the country continue to be dominated by a few large insurers, this proposed merger would have made this problem even worse.  Indeed, many patient and physician advocacy organizations raised concerns regarding the potential impact of this merger proposal on patient care, including the Medical Society of the State of NY (MSSNY) and the American Medical Association (AMA) during a public hearing held by the New York Department of Financial Services (DFS) last September.

We thank New York DFS Superintendent Maria Vullo for publicly articulating the huge market impact of this proposed merger had it been permitted to go forward, and New York Attorney General Eric Schneiderman for joining the US Department of Justice’s action to block the merger.

Anthem Has announced that it will appeal the decision.                              (AUSTER)

Several Health Insurance Reform Initiatives Advanced to Assembly Floor
Several bills supported by MSSNY to address inappropriate health insurer practices were favorably reported from various Assembly committees to the Assembly floor this week:

• Legislation (A.2704, Lavine) to assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company is non-renewed, similar to protections provided when a physician is terminated from network participation;
• Legislation (A.2539, Gottfried) to prohibit a health insurer from denying care unless it is reviewed by a physician in the same or similar specialty, and licensed in New York State.
• Legislation (A.2389, Gottfried) to require health insurers to use uniform credentialing forms for reviewing applications to participate in a health insurer’s network; and
• Legislation (A.2370, Gottfried) to prohibit health insurers from imposing certain requirements on their participating providers, including prohibiting referrals to out of network physicians, and “Most Favored nation” clauses                                                                         (AUSTER)

Physicians Action Needed  March 8^th
MSSNY’s Annual Physician’s Advocacy Day – physician’s Urged to Attend and Wear Your White Lab Coats
Join MSSNY and your colleagues to lobby your elected leaders at this year’s annual “Physician’s Advocacy Day” on March 8^th! Encourage your Senators and Assembly members to support legislation that is crucial to your practice and oppose the bills that place restrictions and add unreasonable burdens.  This year’s event will be held at the Lewis Swyer Theater at The Egg in Albany from 8am to 12noon, ending with a catered lunch and the opportunity to speak more directly with your legislators.  If you are interested in attending, please register here  or contact Carrie Harring at charring@mssny.org.

The morning program will begin at 8 AM, after which physicians will have the opportunity to have meetings with their local Senators and Assemblymembers.   A full slate of legislators and key policymakers have been confirmed to participate in the morning program including: NYS Senate Majority Leader John Flanagan;Jason Helgerson, NYS Medicaid Director;Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and top health care staff at DFS have been invited. A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.

County medical societies will be scheduling appointments for physicians to meet with their elected representatives. Come meet with your legislators to urge that they:

• Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
• Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into “medication management protocols” with nurse practitioners;
• Reject changes to increase physician prior authorization requirements contained in the proposed State Budget;
• Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
• Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
• Reject legislation that would impose costly and time consuming mandates on physician practices.

Do not leave it to the “other guy”.  Please plan to come to Albany to advocate on behalf of your profession, your community and your patients!
(DIVISION OF GOVERNMENTAL AFFAIRS)

Dr. Tom Price Confirmed as HHS Secretary
By a 52-47 vote, the US Senate this week confirmed Dr. Tom Price to become the next Secretary of the US Department of Health and Human Services (HHS).  Dr. Price, an orthopedic surgeon from Georgia, was a Congressman and a Georgia delegate to the AMA House of Delegates.

Dr. Price was the long time sponsor of the Medicare Patient Empowerment Act, legislation supported by many organizations that would enable seniors to have partial coverage to receive care from a physician who does not participate in Medicare program.  He has also opposed various Medicare bundled payment demonstration programs, such as for joint replacement and cardiac surgery, that have been implemented by CMS in several regions across the country. (AUSTER)                                                                                                                                      

Assembly Health Committee Advances Retail Clinic Legislation to Codes Committee
Assembly Bill 958, sponsored by Assemblywoman Amy Paulin, passed out of the Assembly Health Committee to the Codes Committee.   This legislation would authorize the establishment of clinics in corporate-owned retail stores.   MSSNY believes that by permitting this practice, NYS will infringe upon the independence of medical decision-making and the integrity of the doctor-patient relationship.

Furthermore, many are concerned that corporately owned and operated retail clinics will open the floodgates to conflicts of interest  as retail clinics could directly profit from the very prescriptions that are written there , and treatments they recommend—all under the very same roof.   Voting against this measure was: Assembly members Kevin Cahill, Aileen Gunther, Ellen Jaffe, Thomas Abinanti and Edward Ra. The measure now goes to the Assembly Codes Committee for its consideration. To send a letter in opposition, click here.
(CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.

The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from an active shooter/bombing event in the healthcare setting.  2) Identify means by which members of the healthcare team can address  stress before,  during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.

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.

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

MSSNY 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.  (CLANCY, HOFFMAN)

Assemblyman Schimminger Introduces Proposals Strongly Supported by MSSNY
Assemblyman Schimminger introduced two bills strongly supported by MSSNY. 

• 5648 – The “medical liability reform act” would implement a number of important reforms to the medical liability adjudication system to reduce the exorbitant and rapidly rising cost of medical liability insurance.  This bill would require an attorney for a plaintiff in a medical, dental or podiatric malpractice case to include with the certificate of merit, an affidavit from a physician stating that there is a reasonable basis for such malpractice action.  The failure to file would result in the dismissal of the suit. The bill also limits noneconomic damages in such causes of action to $250,000 has been adopted by several other states.  Additionally, the bill requires enhanced and comprehensive disclosure of expert witnesses to be used by any party in medical, dental and podiatric malpractice cases.

• 4914 – would prohibit a hospital from requiring board certification as a condition of having staff privileges, and prohibit a health insurance company from requiring board certification as a condition of being a participating physician in such plan. The legislation is designed to alleviate some of burdensome costs & time demands associated with Maintenance of Certificate (MOC) requirements.
  (BELMONT)

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

BMJ: IMGs Seem to Perform At Least as Well as U.S.-Trained Physicians
Hospitalized patients in the U.S. who are treated by attending physicians who received their medical training abroad fair just as well — and in some cases better — than those treated by domestically trained physicians, suggests a study in The BMJ.

The authors examined data on 1.2 million Medicare beneficiaries who were admitted from 2011 to 2014 and treated by 44,000 general internists. Roughly 44% of the internists were international medical graduates.

After multivariable adjustment, patients of international medical graduates had significantly lower 30-day mortality rates than those of U.S. graduates (11.2% vs. 11.6%). The mortality differences were similar across numerous clinical conditions. However, international graduates had higher costs of care ($1145 vs. $1098). Readmission rates were similar between the groups.

The authors write: “Taken together, our findings should reassure policymakers and the public that our current approach to licensing international medical graduates in the US is sufficiently rigorous to ensure high quality care.” The BMJ article

Weekly Charting Tip:

Remember when you were bad in 2nd grade and your teacher told you it was going on your permanent report card? Well, your National Practitioner Data Bank profile is that permanent report card for health care professionals. Most any malpractice settlement or judgment, hospital privilege loss, being terminated by a managed care company, being disciplined by your state board; all of these and more can be found in your NPDB profile. Request a copy via going on line to the NPDB and initiate a “self-query.” It is only a few dollars. Don’t you want to know what every inquiring entity knows about you? You also want to make sure it is accurate. While patients and plaintiff attorneys cannot access this, a hospital where you applied for privileges, a medical group doing a due diligence prior to hiring you or a managed care company, can certainly access it. Also be warned that if you settle a case, your state board will have access to this information if they want to investigate the matter. Forewarned is forearmed!  – Larry Kobak, Esq., Kern Augustine

Governor Announces $20 Million Fund to Expand/Upgrade Healthcare Facilities
The AP (2/3) reports New York Gov. Andrew Cuomo announced the creation of the Community Health Care Revolving Fund, which aims to “help community health organizations that might not be able to expand otherwise.” The state has set aside almost $20 million for the fund in order “to assist local health care providers looking to expand or upgrade their facilities.” The money will be awarded in the form of low-cost loans.

CDC: 40,000,000 Have Some Hearing Loss Due To Noise Outside Workplace
In a Feb. 7, 2017, media briefing with Anne Schuchat, MD, acting director, U.S. Centers for Disease Control and Prevention regarding the Feb. 7, 2017, Morbidity and Mortality Weekly Report, “40,000,000 American adults have lost some hearing because of noise, and half of them suffered the damage outside the workplace, from everyday exposure to leaf blowers, sirens, rock concerts and other loud sounds.” Researchers found that “24 percent of adults had ‘audiometric notches’ – a deterioration in the softest sound a person can hear – in one or both ears.” The data “came from 3,583 people who had undergone hearing tests and reported the results in the 2011-2012 National Health and Nutrition Examination Survey.
The report is available at http://bit.ly/2kAsqlQ

Jan 28 NYSDOH Report: Four Deaths This Influenza Season
The NYS Department of Health (NYSDOH) reports in their Influenza Surveillance Report for the week ending January 28, 2017 that  influenza activity level was categorized as geographically widespread:

• This is the sixth consecutive week that widespread activity has been reported.
•  There were 5,235 laboratory-confirmed influenza reports, a 20% increase over last week. Of the 1,873 specimens submitted to NYS WHO/NREVSS laboratories, 406 (21.68%) were positive for influenza.
• Of the 66 specimens tested at Wadsworth Center, 41 were positive for influenza. 31 were influenza A (H3), 2 were influenza A (Not Subtyped), 4 were influenza B (Yamagata) and 4 were influenza B (Victoria).
• Reports of percent of patient visits for influenza-like illness (ILI3 ) from ILINet providers was 9.19%, which is above the regional baseline of 3.00%.
• The number of patients hospitalized with laboratory-confirmed influenza was 961, a 4% increase over last week.

There was one influenza-associated pediatric death reported this week. There have been four influenza-associated deaths this season. https://www.health.ny.gov/diseases/communicable/influenza/surveillance/2016-2017/flu_report_current_week.pdf

SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details

NY State of Health Report on Number of Insured by County
Nearly one-quarter of New York City residents have purchased health insurance on New York State of Health, the exchange created by the Affordable Care Act. See the county results here.

Obese People May Be Less Likely To Receive Hospice Care, Research Suggests
Research suggests that obese people are less likely receive hospice care “and more likely to die at home.” The study authors “tracked the experiences of almost 5,700 Medicare beneficiaries who died between 1998 and 2012.” The investigators “looked at weight levels and whether or not someone died in hospice care.” Overall, about “35 percent of those in the study received hospice care, but just 23 percent of the severely obese did. In addition, the severely obese spent four fewer days in hospice care than those with a BMI of 20.” The findings were published online Feb. 6 in Annals of Internal Medicine.

Attest to 2016 EHR Incentive Requirements by March 13 to Avoid Pay Adjustment
The Centers for Medicare & Medicaid Services (CMS) has extended the attestation deadline for providers participating in the Medicare EHR Incentive Program to Monday, March 13, 2017, at 11:59 p.m. PT.

Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by March 13, 2017 to avoid a 2018 payment adjustment.  If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.

Attestation Resources

• Registration and Attestation System
• Eligible Professional (EP) and Eligible Hospital and Critical Access Hospital (CAH) Attestation Worksheets
• EP and Eligible Hospital and CAH Attestation User Guides
• EP and Eligible Hospital and CAH Registration Use Guides
• Attestation Batch Upload Webpage

For More Information
For questions about the Registration and Attestation System, contact the EHR Information Center at 1-888-734-6433 (press option 1). The EHR Information Center is open Monday through Friday from 6:30 a.m. to 5:30 p.m. ET, except federal holidays

CLASSIFIEDS

PRESIDENT’S MESSAGE Dr. Malcolm Reid

January 27, 2017 Volume 17 Number 4

Dear Colleagues:

This week, in a landmark win for organized medicine and the nation’s patients, federal judge John D. Bates blocked the proposed Aetna-Humana merger. The judge found that the merger would have substantially lessened competition in Medicare Advantage and commercial health insurance markets. This is a comprehensive, fact-based ruling that acknowledges that meaningful action was needed to preserve competition and protect high-quality medical care from unprecedented market power that Aetna would acquire from the merger deal. The decision is a historic, stunning affirmation of the position urged by the American Medical Association (AMA) and the 17-state medical association antitrust coalition members of which MSSNY is an active member. The court’s ruling sets a notable legal precedent by recognizing Medicare Advantage as a separate and distinct market that does not compete with traditional Medicare.

MSSNY was vigorously opposed to this merger and joined with stakeholders, various patient coalitions, and the National Association of Attorneys General. The coalition presented physician surveys that gauged physician concerns about the merger and presented the compelling survey results to DOJ and state regulators; testified in or submitted memoranda in state insurance department hearings and/or attorney general investigations, and secured outside experts to demonstrate how the merger would harm patients and physicians.

We want to take this opportunity to thank our physicians and, all of our coalition partners for helping to achieve this historic victory on behalf of our physician members and their patients. Our collective work on these mergers is, without a doubt, a model for future advocacy success.

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

Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

Please Contact Your Legislators to Express Concerns in Proposed State Budget
As noted last week, Governor Cuomo released his proposed $152.3 billion spending plan for the 2017-18 Fiscal Year.   While the proposed Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made.  For example,

• We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  To send a letter to your legislators, click here.

• Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  To send a letter to the Legislature, click here.

• “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.  To send a letter to your legislators, click here.

• The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic.  To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.

Other Items of Note in the State Budget

• Funding for MSSNY’s Committee for Physicians Health would be continued at past levels;
• Re-appropriating $300,000 for MSSNY’s Veterans Health Care Initiative.
• E-cigarettes would be taxed in the same manner as tobacco cigarettes.
• Requiring the registration and regulation of Pharmaceutical Benefit Manager (PBMs)
• Creating a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including: modernizing Certificate of Need laws; “creating more flexible rules on licensing and scope of practice for clinicians and caregivers” and “increasing flexibility of state agency regulations governing the delivery of and reimbursement for telehealth programs;
• Making the “inappropriate prescribing of opioids” an unacceptable provider practice in the Medicaid program, giving the State discretion to remove a physician or other prescriber from the program.
• Reducing prescription drug costs by making drug companies pay a surcharge when costs exceed a certain benchmark to be determined by a Drug Utilization Review Board within the NYS Department of Health;
• Requiring the testing of public water systems every 3 years for contaminants

The state Senate and Assembly have scheduled a February 16 public hearing to receive comments regarding concerns with the proposed Health Budget, at which MSSNY will testify.
(DIVISION OF GOVERNMENTAL AFFAIRS)

MSSNY LOBBY DAY SCHEDULED FOR MARCH 8^TH – PHYSICIANS URGED TO ATTEND AND WEAR YOUR WHITE LAB COATS
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8^th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.  Please register here  if you plan to attend.

A full slate of legislators and key policymakers have been invited to dialogue with Advocacy Day participants including:

• Jason Helgerson, NYS Medicaid Director;
• Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
• Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program.   County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Come meet with your legislators to urge that they:

• Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
• Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners
• Reject changes to increase burdensome physician prior authorization requirements contained in the proposed State Budget;
• Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
• Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
• Reject legislation that would impose costly and time consuming mandates on physician delivery of patient care

Please come to Albany to make your legislators aware of these challenges!                   (GOVERNMENTAL AFFAIRS STAFF)

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

ACA Discussions Continue in Washington
This week, several Senators proposed different pieces of legislation to repeal and replace pieces of the Affordable Care Act (ACA).

Under the Cassidy-Collins bill, called the Patient Freedom Act, states could enroll people who would otherwise be uninsured in health plans providing basic coverage and would allow consumers to buy additional coverage.  States could stay with the ACA, or they could receive a similar amount of federal money, which consumers could use to pay for medical care and health insurance.  The bill would eliminate the individual coverage mandate and the requirements for larger employers to offer coverage to full-time employees, but allow some protections to remain in place. Parents would still be allowed to keep children on their insurance until the age of 26, and insurers could not impose annual or lifetime limits on benefits.

Additionally, Senator Rand Paul announced the “Obamacare Replacement Act” which would eliminate several provisions of the ACA, including the individual mandate and minimum standards for care. It would also provide a two-year window for people with preexisting conditions to sign up for care.  It also allows insurers to sell plans in multiple states and a $5,000 tax credit that people can put toward a health savings account.

As reported previously, MSSNY has written to New York’s Congressional delegation to urge that the funding mechanism for ACA health insurance coverage programs not be repealed unless such proposals also specify how the current available coverage options will be repealed with improved coverage options that will increase the availability of comprehensive health insurance coverage.             (Belmont)

Governor Cuomo Announces Regulatory Action to Preserve Women Access to Reproductive Health Care
Governor Andrew M. Cuomo announced this week a series of New York State actions to protect access to women’s reproductive rights in New York State.  The Governor announced that New York State will take regulatory action to provide that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles regardless of the future of the Affordable Care Act.

He also proposed that contraceptives are available in amounts exceeding one month’s supply at a time; and all medically necessary abortion services are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles. The announcement coincided with the Women’s Marches in Washington D.C., across New York State and across the country, as well as the 44^th anniversary of the landmark United States Supreme Court ruling in Roe v. Wade.  Further information can be obtained HERE and HERE.

The Governor’s action followed action by the New York State Assembly. The Assembly passed the Reproductive Health Act, (A.1748), sponsored by Assemblymember Deborah Glick,  which amended the public health law and placed the abortion procedure in the public health law rather than the penal law.   Additionally, the Assembly also passed A. 1378, the Comprehensive Contraception Coverage Act (CCCA), sponsored by Assemblymember Kevin Cahill.  This measure would require New York State insurers to cover all FAD approved contraceptive methods without out-of-pocket costs, and would ease the multiple barriers experienced by women in obtaining contraceptives and from using them effectively and consistently.                                                                          (CLANCY)

Advocates for Aid in Dying Legislation Hold Press Conference
This week, advocates for “aid in dying” legislation, along with members of the New York State Legislature, held a press conference to push for legislation that would allow a terminally ill patient in New York State to request and use medication to aid in dying.   Advocates from Compassion and Choices joined with Assembly members Amy Paulin and Richard Gottfried and Senator Diane Savino, sponsors of the bill A. 2383/S3151, at the January 23 press conference.  Susan Rahn, who has Stage IV breast cancer, spoke about advocating for the right to “die with dignity.”  The legislation is currently in the Assembly Health Committees.  A similar measure S. 2045 has also been introduced by Senator John Bonacic and is in the Senate Health Committee.

MSSNY position on Physician Assisted Suicide and Euthanasia 95.989 states: “Patients, with terminal illness, uncommonly approach their physicians for assistance in dying including assisted suicide and euthanasia. Their motivations are most often concerns of loss of autonomy, concerns of loss of dignity, and physical symptoms which are refractory and distressing. Despite shifts in favor of physician-assisted suicide as evidenced by its legality in an increasing number of states, physician-assisted suicide and euthanasia have not been part of the normative practice of modern medicine. 

Compelling arguments have not been made for medicine to change its footing and to incorporate the active shortening of life into the norms of medical practice. Although relief of suffering has always been a fundamental duty in medical practice, relief of suffering through shortening of life has not.  Moreover, the social and societal implications of such a fundamental change cannot be fully contemplated. MSSNY supports all appropriate efforts to promote patient autonomy, promote patient dignity, and to relieve suffering associated with severe and advanced diseases.  Physicians should not perform euthanasia or participate in assisted suicide.”            (HARRING, CLANCY)

NYS Assembly Codes Committee Approves Expedited Partner Therapy Bill
The New York State Assembly Codes and Health committees approved legislative (A.313, Bichotte) supported by MSSNY, which would allow expedited partner therapy for sexually transmitted infections that the Centers for Disease Control and Prevention (CDC) recommend for the sexual partner or partners of someone having been diagnosed with the disease. Currently, the CDC has recommended the use of EPT for Chlamydia Trachomatis and in November 2012 also recommended EPT in cases of gonorrhea.

In 2005, the New York State passed a law to allow health care providers to provide EPT for Chlamydia infection.  This law was made permanent, along with immunity protections for prescribers as part of the 2013-14 NYS budget process.   This bill will expand the current law to include other sexually transmitted infections that the CDC recommends for expedited partner therapy. EPT helps physicians and other health care providers decrease rates of sexually transmitted infections. While expedited partner therapy in no way replaces a face to face interaction with a health care provider, it can help patients who otherwise would not reach out for treatment.

The CDC has found through randomized controlled tests that EPT has the potential for the same success that it has shown with Chlamydia with other sexually transmitted infections (STIs).  EPT can be highly effective in decreasing infection rates with other STIs that can be cured by taking antibiotics by mouth, such as gonorrhea.  The bill is expected to go to the Assembly floor for a vote and its companion measure, S. 2545, sponsored by Senator Kemp Hannon, is in the Senate Health Committee.                                      (CLANCY) 

AG Schneiderman Announces Settlement with Cigna to Resolve Mental Health Coverage Investigation
New York Attorney General Eric Schneiderman announced a settlement with Cigna this week to require the health insurer to eliminate a written ban on coverage for claims for neuropsychological testing of psychiatric conditions and autism spectrum disorder.

According to the press release the AG’s Health Care Bureau launched an investigation into Cigna’s administration of mental health benefits following a complaint about its written policy for neuropsychological testing. The policy said that “Cigna does not cover neuropsychological testing” for psychiatric conditions and autism spectrum disorder “because such testing is considered educational in nature and/or not medically necessary.”

Under the terms of the settlement, the company agrees to comply with Timothy’s Law, which requires New York group health plans provide “broad-based coverage for the diagnosis and treatment of mental, nervous or emotional disorders or ailments … at least equal to the coverage provided for other health conditions.”   The settlement also requires Cigna to revise its policies, pay autism claims previously rejected, and pay a penalty of $50,000.  Cigna also clarified its policy regarding concussion and mild cognitive impairment.                                                                            (AUSTER)

MSSNY, AMA and Others Release Principles Urging Reduction in Prior Authorization Burdens
Noting that 75% of surveyed physicians described prior authorization burdens as “high or extremely high”, the American Medical Association released a document this week calling on health insurers and benefit managers to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.  The document, entitled “Prior Authorization and Utilization Management Principles” lists 21 principles where prior authorization hassles could be reduced.  MSSNY was one of a handful of state medical societies to assist I the development of the principles.

While some of the principles that are already imposed on health insurers under New York law, many other principles listed, if implemented, would help reduce some of the PA burdens faced by New York physicians and their staff.  These suggested reforms include:

• Utilization review entities should offer an appeals system for their utilization management programs that allows a prescribing/ordering provider direct access, such as a toll-free number, to a provider of the same training and specialty/subspecialty for discussion of medical necessity issues;
• A drug or medical service that is removed from a plan’s formulary or is subject to new coverage restrictions after the beneficiary enrollment period has ended should be covered without restrictions for the duration of the benefit year;
• Eligibility and all other medical policy coverage determinations should be performed as part of the prior authorization process.

• If a utilization review entity requires prior authorization for non-urgent care, the entity should make a determination and notify the provider within 48 hours of obtaining all necessary information. For urgent care, the determination should be made within 24 hours of obtaining all necessary information.   (AUSTER)

CMS Again Institutes Audits to Check Physician & Home Care Compliance with Medicare Face to Face Requirements
All physicians should be aware that CMS is again instructing its Medicare Administrative Contractors (MACs), including National Government Services (NGS) covering New York, to conduct Home Health “Probe-and-Educate” medical review audits relating to claims submitted by home health agencies (HHAs) for Medicare home health services including the face-to-face (F2F) requirement.

As many physicians know, the F2F provision requires a certifying physician to document that he or she, or a non-physician practitioner (NP or PA) working with the physician, has seen the patient, as a condition of eligibility for Medicare home health services.  Many home care agencies and physicians have noted that the CMS regulations implementing this provision have created unnecessary and overly burdensome documentation requirements that are delaying or denying coverage for needed home care services.  MSSNY has been working the Home Care Association of New York State (HCA) on efforts to eliminate or reduce the hassles in Medicare and Medicaid associated with this requirement.  Dr. Evelyn Dooley-Seidman chairs a MSSNY-HCA working group that also has the participation of Suffolk County geriatrician Dr. Jay Slotkin.

Specifically, CMS is directing MACs to sample five claims for pre-payment review from each HHA within their jurisdictions.  Based on the results of these reviews, MACs will conduct provider-specific educational outreach. CMS will instruct MACs to deny each non-compliant claim and to outline the reasons for denial in a letter to the HHA, which will be sent at the conclusion of the probe review portion of the process. CMS will also instruct the MACs to offer individualized phone calls/education to all providers with errors in their claim sample. During such calls, the MAC will discuss the reasons for denials, provide pertinent education and reference materials, and answer questions.  For those providers that are identified as having moderate or major concerns (two to five denials out of five), the MACs will repeat the probe-and-educate process for dates of services occurring after education has been provided.

The “probe and educate” initiative, in turn, will likely result in increased efforts to assure physicians are providing the necessary certification.  It is another example of the burdensome paperwork hassles associated with complying with the F2F requirement for physicians and home care agencies. As such, MSSNY will continue to work with HCA to convince New York’s Congressional Delegation to work towards repeal or substantial modification of this rule.  Moreover, we are hopeful that the new Trump Administration Executive Order to reduce regulatory burdens on health care providers and patients will provide a new opportunity to revisit this rule.  With the requirement also slated to go into effect for Medicaid patients as of July 1, 2017, MSSNY is also working with HCA to advocate to the NYS Department of Health to reduce the burdens associated with complying with this rule.                           (AUSTER)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1)  Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event.  2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2) Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

MSSNY 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.                                               (Clancy, Hoffman)

Activism Matters
The New York Times published an article highlighting the importance of activists to call and meet with legislators. Several lawmakers and staff indicated the value that a large volume of calls on an issue can have on legislator’s positions.  Even if you don’t speak directly to the lawmaker, staff members often pass the message along in one form or another.  From our firsthand experience, lawmakers have always expressed the importance that phone calls and meetings with their constituents can have on their position.

How can I help?
Your participation in the legislative and political process remains critical.  We need to make sure our elected officials know where we stand when their positions helps or hurts you.  MSSNY’s input is valued by many of our elected officials.  Throughout our website, MSSNY provides various resources to make sure you have the tools to fight back when harmful proposals are introduced.

Proposals are constantly introduced that directly affect you and your family.  As many know, physician activism is essential to making a difference in Albany.  MSSNY needs resources and activist like you to so that we will be a united force to be reckoned with.   Every MSSNY member has an opportunity to get involved in one form or another.  Becoming a member of MSSNY allows you to receive the latest information on legislative and budgetary proposals that impact you.

MSSNY is an important avenue to make sure our collective voices are heard.  Every physician should be a part of MSSNY and MSSNYPAC in order to be able to continue our efforts.  And please avail yourself of our resources that make it easier for you to contact your elected officials.                                                                  (BELMONT)

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

Council Notes: January 19, 2017

• Council approved the Board of Trustees report, which included the pricing policy for the opioid training modules that MSSNY has developed in accordance with the regulations set by the Bureau of Narcotics. The course will be free to MSSNY members. The cost for Non-Members will be $150 for the 3 Module course. However, this $150 will be applied towards deferring the cost of MSSNY membership dues in the event that non-members decide to join MSSNY.

• Michael R. Privitera, MD, presented a report of MSSNY’s Physician Burnout Task Force. In 2015, the MSSNY House of Delegates passed resolution 2015-200, titled “Physician Health Programs and Membership Recruitment” to develop a series of programs to assist physicians in early identification and management of stress. Council approved the following recommendations from the Task Force:

1. Development of CME programs on physician stress and burnout, as well as the peer support model and recruitment of a cadre of doctors to do such CME presentations and presentations to leaders and other stakeholders.
2. Seeking grants or other funding to support CME, burnout study and program activities in an enduring way.
3. Continued collaboration with other organizations on burnout reduction and wellness efforts.
4. Seek grants or other funding to help develop a peer support model to all county societies, hospitals and hospital systems and practices in an ongoing way.

• Council approved the following mission and vision statements from MSSNY’s Committee to Eliminate Health Care Disparities:
  Mission Statement:
  The mission of the Committee to Eliminate Healthcare Disparities is to increase awareness of how factors such as race, ethnicity, culture and religious beliefs, sexual orientation, gender and gender identity contribute to both health and healthcare disparities.

Vision Statement:
The vision of the Committee to Eliminate Health Care Disparities is a New York State healthcare system that bridges gaps and identifies potential bias in order to provide the highest quality care to all people throughout the state with respect for their race, ethnicity, culture and religious beliefs; sexual orientation, gender and gender identity.

• Speaker Dr. Kira Geraci-Ciardullo announced that Health Commissioner Howard Zucker, MD, JD, will address the 211^th House of Delegates on Friday morning, April 21.
• Don Moy, Esq. spoke briefly about the Overtime Pay Final Rule that was effective on December 31, 2016. Click here for more information.

MSSNYPAC – The Political Voice for New York’s Physicians
Advocating for our profession is both a duty and an honor and physicians are a force for change in New York State healthcare. Our patients deserve excellent care and we strive to provide that in our practices and in policy formation. Participation in MSSNYPAC is an important step in helping to elect physician-friendly candidates, and MSSNYPAC’s President’s Circle and Chairman’s Club help to develop the strong relationships that are necessary for effective political action.  It is essential that physicians not only have a seat at the discussion table but speak with a strong united voice. Join or increase your support and participation today at www.mssnypac.org/contribute. 

AARP Medicare Complete Is Not AARP Medicare Mosaic
For physicians who participate in a Medicare “Advantage” plan called AARP Medicare Complete, there is another plan called AARP Medicare Complete – Mosaic.

They are not the same and if a physician participates in AARP Medicare Complete, he/she does not necessarily participate in the Mosaic product.

When a patient calls for an appointment and says they have AARP Medicare Complete, the practice’s office staff should confirm if the patient is enrolled in the AARP Medicare Complete or the Mosaic product. UHC’s Mosaic plan is a limited language network for patients who speak Chinese, Korean, or Spanish.

The practice will only be paid for services from their contracted plan.

                                    From Regina McNally, VP of MSSNY Socio-Med Division

Nonmedical Vaccine Exemptions on the Rise in NY, Other States, CDC Data Show
STAT (1/20l7) reported that nonmedical vaccine exemptions are on the rise in some states, even as they decline nationally, according to data from the Centers for Disease Control and Prevention. The number of children not being vaccinated for nonmedical reasons in 11 states – Connecticut, Florida, Iowa, Kentucky, Maryland, New York, North Carolina, North Dakota, Ohio, Oklahoma, and Virginia –”is higher than at any point in the past five years.”

Deadline for Abstract submission Is Tuesday, Jan. 31 for Poster Symposium

Resident/Fellow/Medical Student

The Annual Poster Symposium will be held on:

Friday, April 21, 2017
Westchester Marriott
Tarrytown, New York
2 pm – 4:30 pm

In the words of past participants, the MSSNY symposium is an “excellent networking opportunity,” a place to “meet fellow residents and attendings” and “learn from other presentations” that they “would highly recommend.” 

Click here for detailed guidelines.

Check out last year’s Abstract Book here.

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

SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details

Health Care Coalition Calls for Prior Authorization Reform
Releases new principles to improve timely access to care and reduce administrative burdens

CHICAGO – Responding to unreasonable hurdles for patients seeking care, a coalition including the American Medical Association (AMA) and 16 other health care organizations this week urged health plans, benefit managers and others to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.

The coalition, which represents hospitals, medical groups, patients, pharmacists and physicians, says that requiring pre-approval by insurers before patients can get certain drugs or treatments can delay or interrupt medical services, divert significant resources from patient care and complicate medical decisions.

Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved by applying the principles’ common-sense concepts grouped in five broad categories:

• Clinical validity,
• Continuity of care,
• Transparency and fairness,
• Timely access and administrative efficiency, and
• Alternatives and exemptions.

The data entry and administrative tasks associated with prior authorization reduce time available for patients. According to a new AMA survey, every week a medical practice completes an average of 37 prior authorization requirements per physician, which takes a physician and their staff an average of 16 hours, or the equivalent of two business days, to process.

The AMA survey illustrates that physician concerns with the undue burdens of preauthorizing medical care have reached a critical level. Highlights from the AMA survey include:

• Seventy-five percent of surveyed physicians described prior authorization burdens as high or extremely high.

• More than a third of surveyed physicians reported having staff who work exclusively on prior authorization.
• Nearly 60 percent of surveyed physicians reported that their practices wait, on average, at least 1 business day for prior authorization decisions—and  more than 25 percent of physicians said they wait 3 business days or longer.
• Nearly 90 percent of surveyed physicians reported that prior authorization sometimes, often, or always delays access to care.

The AMA and other coalition organizations welcome the opportunity to work collaboratively with health plans and others to create a partnership that lays the foundation for a more efficient prior authorization process. In addition to the AMA, the coalition includes the: American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology, American Academy of Family Physicians, American College of Cardiology, American College of Rheumatology, American Hospital Association, American Pharmacists Association, American Society of Clinical Oncology, Arthritis Foundation, Colorado Medical Society, Medical Group Management Association, Medical Society of the State of New York, Minnesota Medical Association, North Carolina Medical Society, Ohio State Medical Association and Washington State Medical Association.

CMS: New Participants Join Several CMS Alternative Payment Models
CMS announced over 359,000 clinicians are confirmed to participate in four of CMS’s Alternative Payment Models (APMs) in 2017. Clinicians who participate in APMs are paid for the quality of care they give to their patients. APMs are an important part of the Administration’s effort to build a system that delivers better care and one in which clinicians work together to have a full understanding of patients’ needs. APMs also strive to ensure that patients are in the center of their care, and that Medicare pays for what works and spends taxpayer money more wisely resulting in a healthier country.

“By listening to physicians and engaging them as partners, CMS has been able to develop innovative payment reforms that bring physicians back to the core practice of medicine – caring for the patient,” said Acting Administrator Andy Slavitt. “By reducing regulatory burden and paying for quality, CMS is offering solutions that improve the quality of services our beneficiaries receive and reduce costs, to help ensure the Medicare program is sustainable for generations to come.”

The Medicare Shared Savings Program (Shared Savings Program), Next Generation Accountable Care Organization (ACO) Model, Comprehensive End-Stage Renal Disease (ESRD) Care Model (CEC) and Comprehensive Primary Care Plus (CPC+) Model all apply the concept of paying for quality and effectiveness of care given to patients in different health care settings.

CLASSIFIEDS

PRESIDENT’S MESSAGE Dr. Malcolm Reid

January 20, 2017 Volume 17 Number 3

Dear Colleagues:

This week, our Government Affairs Division outlines Governor Cuomo’s proposed budget for 2017-2018 highlighting items that relate to New York State physicians.

Malcolm Reid

Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

Governor Proposes $152 Billion Budget for 2017-18
This week Governor Cuomo released his proposed $152.3 billion spending plan for the 2017-18 Fiscal Year.  The Budget proposed is to address a $3.5 billion budget deficit and a proposed increase of $1 billion in education aid in part by retaining the “millionaires’ tax” for an three additional years. At the same time the Governor proposes to reduce income taxes for those with incomes of $300,000 or less.  The budget would also extend for an additional three years the health financing mechanisms of the Health Care Reform Act (HCRA) for a variety of public good programs.

Among the positive provisions in the proposed Budget:

• Funding for the Excess Medical Malpractice program would be continued at its historic level of $127,400,000;
• Funding for MSSNY’s Committee for Physicians Health would be continued at its historic level of $990,000;
• Re-appropriating $300,000 for MSSNY’s Veterans Health Care Initiative.
• E-cigarettes would be taxed in the same manner as tobacco cigarettes.
• Requiring the registration and regulation of Pharmaceutical Benefit Manager (PBMs)

Some of the items of significant concern in the proposed budget include:

• Physicians would be required to receive a “tax clearance” as a pre-condition to receiving Excess Medical Malpractice Insurance coverage;
• “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements;
• Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage and adjust the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.
• Creating a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including: modernizing Certificate of Need laws; “creating more flexible rules on licensing and scope of practice for clinicians and caregivers” and “increasing flexibility of state agency regulations governing the delivery of and reimbursement for telehealth programs;
• Making the “inappropriate prescribing of opioids” an unacceptable provider practice in the Medicaid program, giving the State discretion to remove a physician or other prescriber from the program.

Other items of note within the proposed Budget include:

• Reducing prescription drug costs by making drug companies pay a surcharge when costs exceed a certain benchmark to be determined by a Drug Utilization Review Board within the NYS Department of Health;
• $150 million for a life sciences laboratory public health initiative;
• Increase cost-sharing for certain enrollees in the State’s Essential Plan;
• Requiring the testing of public water systems every 3 years for contaminants

MSSNY staff is continuing its review of the thousands of pages of budget documents and will follow up with further information.  The state Senate and Assembly have scheduled a February 16 public hearing to receive comments regarding concerns with the proposed Health Budget, at which MSSNY will testify.
 (DIVISION OF GOVERNMENTAL AFFAIRS) 

MSSNY Lobby Day Scheduled for March 8^TH – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8^th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.  Please register here  if you plan to attend.

A full slate of legislators and key policymakers have been invited to dialogue with Advocacy Day participants including:

• Jason Helgerson, NYS Medicaid Director;
• Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
• Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program.  County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Shifts in Medicare and Medicaid payment methodologies are producing enormous changes in our health care delivery system that is affecting how patients receive care.  These changes are profoundly affecting the daily lives of physicians and the patients they serve.  At the same time, actions are being taken by the health insurance industry to greatly shrink their networks at the expense of long-standing physician-patient relationships, and increasing burdensome prior authorization requirements.

Adding to this uncertainty are the consequences to New York State’s extensive health insurance coverage programs if proposals under consideration by Congress to repeal the Affordable Care Act were to be enacted.

Please come to Albany to make your legislators aware of these challenges!
(DIVISION OF GOVERNMENTAL AFFAIRS STAFF)

Bill Introduction Update
Over the last several weeks, the State Legislature has introduced thousands of bills.  The Governmental Affairs team will continue to monitor and advocate where legislation will  have an impact on physicians and medical services in New York State. Several scope of practice bills have been introduced that MSSNY opposes:

• Licensing of genetic counselors (A.2275 Rosenthal / S.1323 LaValle)

This bill would allow the licensing of genetic counselors and providing them with a scope of practice, which includes communication to and education of clients, their families, other health care professionals and the general public with regard to genetic testing, individual family histories, or other genetic, medical, and technical information associated with the occurrence , risk of occurrence or recurrence, of a genetic or hereditary condition or birth defect in a comprehensive, understandable, ethical manner.  The Medical Society believes that there should be a connection to a physician required, such as requirement of a referral from the physician or other health care provider who is treating the patient, specifying the reason for the referral.  

• Certification of certified registered nurse anesthetists (CRNAs) (A.442 Paulin / S.1385 Gallivan)

This measure would provide for the certification by the education department of certified registered nurse anesthetists (CRNAs).  This bill fails to define a scope of practice consistent with existing New York State standards.  Under NYS Health Code (10 NYCRR 700.2), CRNAs are already required to register with the NYS Education Department and are prohibited from practicing nurse anesthesia without meeting specific education and testing requirements.

• Podiatric scope of practice (A.1880 Pretlow)

This bill would expand the scope of practice of podiatrists to allow podiatrists to “diagnose, treat, operate or prescribe for cutaneous conditions of the ankle to the level of the distal tibial tuberocity” (knee). The bill would eliminate existing law that currently limits a podiatrist’s treatment of wounds to those relating or originating on the foot.

Several other reform bills have been introduced that MSSNY supports: 

• Continuity of Care (A.256 Dinowitz)

This bill would extend the time period which health plan enrollees may continue to receive services from a health care provider who is not a member of the plan’s network from 60 or 90 days to one year, or in the case of terminal illness, until the time of the enrollee’s death within three years.

• Coverage for “Dually Eligible”(A.1435 Cahill)

This proposal ensures health care services are accessible to the elderly and people with developmental disabilities that are dually eligible for Medicaid and by restoring full “crossover” payments.  The bill provides Medicaid reimbursements for 100% of any Medicare deductible and co-insurance amounts for services and items provided to individuals “dually eligible” for Medicaid and Medicare.

Restores “Prescriber Prevails”(A.700 Rodriguez / S.2919) Carlucci This bill would require Medicaid managed care (MMC) and Child Health Plus plans to adopt the procedures of the Preferred Drug Program and restores “prescriber prevails” for all drugs.              (BELMONT)

AG Announces Settlements to Resolve Inappropriate Prior Authorization and Drug Price Change Allegations
Attorney General Eric Schneiderman announced the following settlements with various health care entities this week:

• A settlement with Anthem, the parent of Empire BlueCross BlueShield, to end prior authorization requirements for Medication Assisted Treatment (MAT) for opioid use disorders. According to the press release, Anthem required providers to submit a prior approval form for MAT coverage requests, which required the providers — who had already received specific training regarding MAT and federal authorization to prescribe these drugs — to answer numerous questions about the patient’s current treatment and medication history.   This subsequently caused significant delays in patients obtaining treatment for addiction – or patients never obtaining the treatment at all.  The press release noted that, in contrast to its policy for drugs to treat opioid use disorder, Empire does not require prior authorization for the majority of drugs it covers for medical conditions.

Under the agreement, Empire will also launch an initiative to expand access to MAT for members in its New York service area. Empire BCBS will conduct provider outreach and education regarding the benefits of MAT, informing qualified health care providers how they can obtain certification from the Substance Abuse and Mental Health Services Administration (“SAMHSA”) to prescribe buprenorphine and buprenorphine/naloxone as part of MAT for opioid dependence. Empire BCBS will provide the Attorney General with a list of MAT providers who have joined its network as a result of this initiative.

• A $100 million settlement with drug manufacturer Mallinckrodt and its U.S. subsidiary, formerly known as Questcor Pharmaceuticals (“Questcor”), to resolve allegations of preventing competition for its drug H.P. Acthar Gel, which is typically used as a last resort to treat certain life-threatening diseases, including infantile spasms and multiple sclerosis.   To read the press release, click here.
  (AUSTER)

House Advances Resolution to Consider ACA Repeal Legislation
By a 227-198 vote, the US House of Representatives approved a resolution to enable the consideration of legislation that would repeal much of the funding mechanisms under the Affordable Care Act (ACA).  The resolution, which enables the repeal to be considered via the process of “reconciliation”, had been passed by the US Senate the week before.  All but 9 House Republicans voted in favor of the resolution, with eight of the nine republicans from the New York Congressional delegation voting in favor.   All 189 Democrats in the US House voted against the measure, including 18 Democrats from New York Congressional delegation as well as Rep. John Katko (R-Syracuse).

Last week, President Donald Trump said that Republicans will introduce proposals to repeal and replace the ACA as soon as Health and Human Services secretary, Tom Price, is approved.  MSSNY recently wrote to the New York Congressional delegation to express concerns with proposals that would repeal ACA funding streams for insurance coverage without simultaneously specifying what they will be replaced with, as well as concerns with the impact to New York patients and the New York State Budget.
(AUSTER)

Free Buprenorphine Training for Provides to Be Held February 25 on Long Island
The New York State Department of Health’s  AIDS Institute is sponsoring a free buprenorphine waiver training for clinical providers.  The training will be held on Saturday, February 25, 2017 from 8 a.m. to 1 p.m. at the Farmingdale State College, 2350 Broadhollow Road, Roosevelt Hall, Room 111; Farmingdale NY 11735.

On-line registration is required here.

Physicians, nurse practitioners and physician assistants are welcome and highly encouraged to attend this training.   Five hours of Continuing Medical Education (CME) will be provided.

Under current regulations, physicians are required to obtain a ‘waiver’ to prescribe buprenorphine. Physicians can acquire this waiver by attending and completing standardized and required 8-hour training. This training is offered in a half-and-half format [4 hours of online training followed up by 4 hours of in-person training]. NPs and PAs are required to complete an additional 16 hours of training. Upon completion, providers will meet the requirement of the DATA 2000 to be qualified to prescribe buprenorphine for opioid-dependent patients. (Prerequisite: additional information about required online training will be sent out to registrants). 

Faculty for the training is Sharon Stancliff, MD, from the Harm Reduction Coalition, New York, NY and Ray Harvey, MD, Institute for Family Health, Kingston NY.  Directions to Farmingdale State College can be found at here.

More information on this program can be found here:(CLANCY)                                                                                                                                                            

Register Now for a January 26 Lunchtime Program to Discuss the Medicare MIPS Program
The Medicare MACRA/MIPS program has now gone into effect.  Do you and your staff want to learn more regarding what you need to know to comply with this new program that could have a significant impact on your revenue from Medicare?  Please join us for a webinar this Thursday January 26, from 12:30 – 1:30, where you will hear from Frank Winter of New York Regional Office for CMS present important information about this new program for physicians and their staffs.  To register Click Here. 

Upon your registration, you will receive a confirmation e-mail with instructions for joining this session either by webinar or conference call.                                                                                                                (AUSTER)

Register Now for Medical Matters 2017 CME Webinar Series Upcoming
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.  

The educational objectives are: 1) Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event.  2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2) Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

MSSNY 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.
(Clancy, Hoffman)

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

MA Insurers Warned of Fines if They Don’t Correct Provider Directory Errors
Kaiser Health News (1/18) http://bit.ly/2jDycTs reports Federal officials warned earlier this month “21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face heavy fines or have to stop enrolling people if the problems are not fixed by Feb. 6.” The warning comes after the first in-depth review by the government “of the accuracy of Medicare Advantage provider directories, which consumers and advocates have complained about for years.”

MSSNYPAC – The Political Voice for New York’s Physicians
The Governor’s proposed budget includes many provisions which impact physicians.  Advocacy on these and a myriad other health care reform proposals will be necessary.  Your voice and support matter as they enable physicians as a group to have political power.  It is critically important for the physician to have a meaningful seat at the table in shaping these proposals. Through MSSNYPAC, physicians are a force for change in New York State healthcare policy.   Join or increase your support and participation today at www.mssnypac.org/contribute. 

Physician Judges Needed for HOD Poster Symposium
Doctors: If you’re coming to the House of Delegates in Westchester– or just live in the neighborhood – and are free on Friday afternoon, April 21, from 2 – 4:30 pm, please consider participating as a judge at the MSSNY Resident and Fellow Section Poster Symposium. It’s always an exciting, lively event! Please contact sbennett@mssny.org or 516-488-6100 extension 383 if you’re interested.  

Governor Cuomo Discusses Potential Impact of Repealing ACA with Trump
Reuters (1/18) http://reut.rs/2kaRX67 reports Gov. Andrew Cuomo said that he discussed how the potential repeal of the Affordable Care Act could impact residents of New York with President-elect Donald Trump. Cuomo said the repeal of the law could leave 3 million New Yorkers without health insurance.

Study Identifies New Zika Proteins That Explain Fetal Brain Abnormalities
A study published in the Proceedings of the National Academy of Sciences http://bit.ly/2iT04Ps “could contribute to Zika treatment efforts” by identifying two new Zika proteins that may help explain how the virus actually causes fetal brain abnormalities. The study builds on previous research using fission yeast that identified seven possible proteins. The earlier study had used a strain of the virus from 1947.

MLMIC: Monitoring Management Changes at PRI
On January 17, the Albany Times Union reported a new development in the struggles for one of New York’s major malpractice insurance carriers. You can access the article here under the Times Union headline, “Amid scandal and fiscal woes, insurance mogul steps aside.”

Instability of a large provider creates some uncertainty for the entire market, of course, but we want to assure MLMIC policyholders that their coverage is not at risk. By adhering to responsible underwriting practices from our beginning, MLMIC continues to demonstrate sound financial condition and is able, once again, to offer a policyholder dividend (20% for those insured by May 1 and continuously insured through July 1).

We’ll keep monitoring the situation in the market on your behalf and will apprise you of further developments. In the meantime, if you have questions, please call 1 (888) 488-9253.

One in Three Adults Diagnosed with Asthma – May Not Have It
An article published in JAMA suggests “as many as one in three adults diagnosed with asthma may not actually have the” condition. The study’s 613 participants, all of whom “had been diagnosed with asthma in the previous five years,” underwent “multiple tests and examinations to determine if they had signs of asthma.” Investigators “determined that 203 participants, or” about “33 percent, did not have baseline symptoms of asthma after the initial examination.”  LiveScience (1/17) reports, “When the participants without asthma were evaluated by the study” physicians, approximately “60 percent were diagnosed with other conditions, such as seasonal allergies, acid reflux or breathing difficulties that were due to obesity.”

Attest to 2016 Program Requirements by February 28
The Centers for Medicare & Medicaid Services Registration and Attestation System is now open. Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by February 28, 2017 at 11:59 p.m. ET in order to avoid a 2018 payment adjustment. The EHR reporting period was any continuous 90 days between January 1 and December 31, 2016.

If you are participating in the Medicaid EHR Incentive Program, please refer to your states deadlines for attestation information.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.

Reminder: Remember to visit the registration tab in the Registration and Attestation system to ensure your personal information is accurate. For more information on registration, visit the Registration & Attestation page of the EHR Incentive Programs website.

Payment Adjustments and Hardship Exceptions

In January 2018, CMS will begin to apply payment adjustments for providers that did not successfully demonstrate meaningful use of EHR technology or apply for and receive a hardship exception for the 2016 program year. CMS will send a separate announcement with more information on the hardship exception application process, once available.

Attestation Resources

Eligible Professional (EP) and Eligible Hospital and Critical Access Hospital (CAH) Attestation Worksheets

EP and Eligible Hospital and CAH Attestation User Guides

EP and Eligible Hospital and CAH Registration User Guides

Attestation Batch Upload Webpage

For More Information

For questions about the Registration and Attestation System, contact the EHR Information Center at 1-888-734-6433 (press option 1). The EHR Information Center is open Monday through Friday from 6:30 a.m. to 5:30 p.m. ET, except federal holidays.

SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details

CLASSIFIEDS

PRESIDENT’S MESSAGE Dr. Malcolm Reid

January 13, 2017 Volume 17 Number 2

Dear Colleagues:

I know that many of you like me are keeping a close eye on the activities in Washington DC regarding Congress’ consideration of legislation to repeal much of the Affordable Care Act (ACA).

Physicians of every specialty and every part of the State can identify various shortcomings with the ACA.  Over the last several years, we have raised concerns to our Congressional delegation as well as to the media that the ACA has encouraged the proliferation of insurance plans with huge patient cost-sharing responsibilities and plans with less choice of physicians. This, in turn, has accelerated the trend of physicians feeling forced to leave private practice and becoming part of large health care systems.

At the same time, the ACA has provided the opportunity for hundreds of thousands of our patients in New York to obtain affordable health insurance coverage that previously was not available to them.  Understandably, many are concerned about losing this coverage altogether if the ACA were to be repealed without a suitable replacement. Moreover, there could be huge budget consequences to New York State if funding were to be repealed, which could prompt untenable cuts affecting millions of more New Yorkers.

Given these concerns, MSSNY has urged that any legislation that threatens the availability of affordable health insurance options for our patients must simultaneously specify how these currently available coverage options will be replaced with improved coverage options.

According to news reports, it appears that an increasing number of Congress members, including many in New York’s Congressional delegation representing both parties, have publicly articulated the importance of Congress specifying with what the ACA would be replaced before voting on its repeal.

However, it is still unclear what will happen over the next few weeks and months.  Please be assured that MSSNY will continue to work closely with medical societies across the country as well as the AMA to be a strong advocate for our patients.  Our foremost request is that any proposal to replace the ACA enhance, not reduce, the availability of affordable and comprehensive health insurance options for our patients.

Anything less is unacceptable.

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

Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

Governor Advances Numerous Health Reform Measures for 2017 Session
Governor Cuomo is expected to release his full 2017-18 Executive Budget proposal this Tuesday 1/17 after releasing a 380-page book this week that outlined many of the proposals he intends to pursue in the State Budget and the legislative session.

Among the proposals highlighted include measures that would:

• Combat heroin and opioid abuse and addiction (see related article);
• Contain rising prescription drug prices (see related article);
• Work with business and labor “to come together…on legislation that will deliver a workers’ compensation system that works for everyone”;
• Expand efforts to “end the AIDS epidemic by 2020” (see related article);
• Improving the healthcare system in eastern and Central Brooklyn (see related article) and
• Launching a comprehensive agenda to promote health and wellness through interconnected strategies (see related article).(AUSTER, CLANCY, BELMONT)

MSSNY Lobby Day, March 8 – Plan Now to Be in Albany
MSSNY’s 2017 Annual Physician Legislative Advocacy Day is Wednesday, March 8.  Please hold that day open to join hundreds of your colleagues from across the State in Albany to hear from New York State’s legislative leaders and top health policymakers and to meet with your local legislators to urge that they fix the challenging issues that are confronting our health care delivery system.  To register, click here.
(DIVISION OF GOVERNMENTAL AFFAIRS) 

Governor Announces Proposal to Regulate PBM Practices and Drug Prices
Among the proposals announced by Governor Cuomo that he will pursue during the 2017 Legislative Session was a three-pronged approach to addressing rising prescription drug prices.  The measures would:

• Require Pharmacy Benefit Managers (PBMs) to be regulated in New York beginning in 2019, as well as requiring them to disclose financial incentives or benefits for promoting the use of certain drugs, and other financial arrangements affecting customers.
• Increase drug company rebates to New York State when the price for a particular medication exceeds a certain benchmark for Medicaid; and
• Impose a “surcharge” on companies when prices exceed a certain benchmark, to be dedicated to lowering health insurance premiums.  (AUSTER, BELMONT)

Governor’s Proposal to Combat Heroin/Opiod Abuse Would Require ER I-Stop Checks and Improved Insurance Coverage for Outpatient Treatment
Among the proposals announced by Governor Cuomo in his “State of the State” tour across New York was a 6-point plan to further combat heroin and opioid abuse in New York State. The proposal includes:

• Eliminating prior authorization requirements for insurance coverage of outpatient substance use disorder treatment;
• Adding fentanyl analogs to the New York controlled substances schedule to subject emerging synthetic drugs to criminal drug penalties;
• Increasing access to life-saving buprenorphine treatment by recruiting physicians, physician’s assistants and nurse practitioners to become prescribers;
• Establishing 24/7 crisis treatment centers to ensure access to critical support services;
• Requiring Emergency Department prescribers to consult the Prescription Monitoring Program registry prior to writing controlled substance prescriptions; and
• Creating New York’s first recovery high schools to help young people in recovery finish school
  (AUSTER, CLANCY, BELMONT)

Cuomo Announces the Brooklyn Community Health and Wellness Transformation Initiative
Governor Cuomo proposed a three-point plan to dramatically improve the health care delivery system in central and eastern Brooklyn:

1. Creating affordable healthy foods opportunities and other health
2. Three existing not-for-profit hospitals in the area will work closely with community-based organizations and community health workers to provide non-clinical interventions that increase health, such as mold remediation programs to eliminate environmental triggers of asthma and programs to improve chronic disease management, promote access to healthy food, and create opportunities for physical activity
3. Build new capacity for primary and ambulatory care.

• The Governor is proposing to develop a large primary and ambulatory care network supported by an integrated state-of-the-art health information technology system with a common electronic medical record platform through a community-based healthcare delivery-system.
• The proposal will develop a total of 36 primary and ambulatory care facilities to be built, increasing primary care visits from 300,000 annually to 800,000 annually.

4. Create a new healthcare system by bringing together three independent not-for-profit hospitals in the area into a regional system that will leverage significant operating efficiencies and address the serious life and safety infrastructure issues at each of these hospitals, while restructuring and improving healthcare delivery in the communities of central and eastern Brooklyn. The new health system will also collaborate closely with Downstate University Hospital.  (BELMONT)

Governor’s State of the State Announces Several Proposals on HIV Testing and Treatment
Governor Andrew Cuomo announced several proposals to enhance testing and treating of HIV including the development of new regulations to allow minors to give informed consent for HIV treatment and prophylaxis.   Under current state law, minors can consent to STD and HIV testing and for treatment for STDs without parental consent.   Parental consent for HIV treatment is not permitted in the statute.

Additionally, as part of the Governor’s Efforts to End the AIDS Epidemic by 2020, the governor will propose, through legislation, to require emergency department and urgent care facilities to provide emergency non-occupational Post Exposure Prophylaxis (nPEP )following a potential non-occupational exposure to HIV.   The governor will alsoadvance legislation requiring the electronic reporting of filled HIV antiretroviral therapy prescriptions dispensed with New York State to monitor the number of persons who are taking prescribed antiretroviral therapy.               (CLANCY)

Governor’s State of the State Advances “Health Across All Policies” Initiative
To make New York the healthiest state in the nation, Governor Andrew Cuomo will advance a “Health Across All Policies” initiative where each state agency is directed to take into account how agency actions can have a positive impact on public health.   The State of the State message specifically highlights the NYS Prevention Agenda and calls on the Public Health and Health Planning Council and the Ad Hoc Committee to Lead the Prevention Agenda to work together to advance a Health Across All Policies initiative.

Physicians from the Medical Society of the State of New York have worked with the NYS Department of Health in setting the Prevention Agenda.   Kira Geraci-Ciardullo, MD, MPH,  is the MSSNY representative on the Ad-Hoc Committee for the Prevention Agenda.   Also involved in helping develop the Prevention Agenda are MSSNY Preventive Medicine and Family Health Committee chair, Geoffrey Moore, MD; and committee members Nina Huberman, MD, vice chair; Frank Dowling, MD; Sheila Bushkin, MD.   At the November meeting, members of the Ad-Hoc Committee discussed with DOH Commissioner Howard Zucker, MD, and with Deputy Secretary for Health Paul Francis, the need to implement this type of initiative to improve the health of all New Yorkers.  (CLANCY)

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

$50 Million Investment in Montefiore Health System to Expand Affordable Healthcare
Governor Cuomo proposed investing $50 million in Montefiore Health System.  According to the Governor’s press release, the funding will be used to “extend its healthcare delivery model to other parts of the Bronx and lower Hudson Valley.”                                   (Belmont) 

President-Elect Trump Promises Swift Repeal and Replacement
In a news conference this week, President-Elect Donald Trump said that Republicans will introduce proposals to repeal and replace Obamacare as soon as Health and Human Services secretary, Tom Price, is approved.  His confirmation hearings will begin next week.  “We’re going to be submitting — as soon as our secretary’s approved, almost simultaneously, shortly thereafter, a plan. It’ll be repeal and replace. It will be essentially simultaneously,” Trump said. “Probably the same day, could be the same hour.”  As reported last week, MSSNY wrote to the New York Congressional delegation  to express concerns with proposals that would repeal ACA funding streams for insurance coverage without simultaneously specifying what they will be replaced with, as well as concerns with the impact to New York patients and the New York State Budget.

Moreover, MSSNY President-Elect Charles Rothberg, MD, was interviewed about these concerns on News 12, Long
Island.                                                                                                                (BELMONT, AUSTER)

Let’s Make Sure They Hear Us
MSSNY will continue to work elected officials and leaders of any party to enhance the availability of affordable and comprehensive health insurance options for patients and prevent cuts to critical federal funding provided to New York State.  At this time, it is not clear what legislation will be enacted by Congress to replace the ACA but we have to make sure our voices and health care expertise are heard.                                                                             (BELMONT)

Help Us Fight by Joining MSSNYPAC and becoming a MSSNY Member Today

AG Schneiderman Propsosed Expanded Insurance Coverage for Contraceptives
New York Attorney General Eric Schneiderman this week announced his development of draft legislation to protect and enhance New Yorkers’ access to cost-free contraception. The stated purpose of the legislation is to ensure the continuation of insurance coverage for contraception in New York were the ACA to be repealed.  To read the AG’s press release, click here. 

Among the provisions in the draft legislation:

• Require state-regulated health insurance policies to provide cost-free coverage for all FDA-approved methods of birth control, including emergency contraception;
• Prohibit insurance companies from “medical management” review restrictions that can limit or delay contraceptive coverage.
• Require coverage of men’s contraceptive methods and bring their insurance coverage in line with the benefits enjoyed by women; and
• Permit the provision of a year’s worth of a contraceptive at a time.

The press release included statements of support from several state legislators and advocacy groups, including ACOG.                                                                                                      (AUSTER, CLANCY)

Register Now For A January 26 Lunchtime Program to Discuss the Medicare MIPS Program
The Medicare MACRA/MIPS program has now gone into effect.  Do you and your staff want to learn more regarding what you need to know to comply with this new program that could have a significant impact on your revenue from Medicare?  Please join us for a webinar on Thursday January 26, from 12:30 – 1:30, where you will hear from Frank Winter of New York Regional Office for CMS present important information about this new program for physicians and their staffs.  To register Click Here.

Upon your registration, you will receive a confirmation e-mail with instructions for joining this session either by webinar or conference call.  (AUSTER)

MSSNY Attends Forum on the Future of Health Care
The Empire Center for Public Policy hosted a forum to discuss New York’s Health Care Reform Act, the future of the Affordable Care Act and the impact on New York’s state budget. Speakers and panelists included Assembly Health Committee Chairman Gottfried, the New York State Medicaid Director Jason Helgerson, and Tom Wickham, the top health care policy staff  to the Senate Majority.  There was also a panel discussion regarding the future of HCRA that included representatives of health plans and hospital associations.  Robert Hinckley, Senior Vice President and Chief Strategy Officer, Capital District Physicians’ Health Plan (CDPHP), noted that more is spent on pharmacy than on doctors under their health insurance plans.  (BELMONT) 

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York will continue its Medical Matters webinars this coming Wednesday, January 18, 2017 at 7:30 a.m. with Triage in a Disaster Event.   Arthur Cooper, MD, vice-chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee and Zachary Hickman, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Register for this webinar here then click on “Upcoming”.

Educational objectives are: 1) Describe the importance of immediate bleeding suppression during a disaster event; 2) Describe the SALT methodology for triage and where to access SALT training; 3) Recognize the importance of not just general triage training, but triage training for bio-events as well.

Medical Matters continues on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.

The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event; and 2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event; and 3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

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.  

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  

MSSNY 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.           (CLANCY, HOFFMAN)

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

State Expanding Clinicians’ Course Offerings for Marijuana Program
New York is expanding its course offerings for clinicians and pharmacists who want to participate in the state’s medical marijuana program. The state has awarded a two-year contract to TMCI Global to offer an alternate version of the 4.5-hour online course that’s required for clinicians to register to prescribe cannabis in New York. It will become available in mid-2017. The state also secured a two-year contract with the current course vendor, the Answer Page.

On a related topic, Vireo Health is planning to start home delivery service of medical marijuana to consumers in New York City, Long Island and Westchester County within the next 90 days.

AMA: Five Issues Physicians Will Take to State Legislators in 2017
A survey of more than 65 state and specialty societies revealed the top issues to be addressed in 2017 include Medicaid, the nation’s opioid epidemic, private payer reforms, and numerous public health issues.

The annual AMA State Legislative Strategy Conference was held in Amelia Island, Fla., where physician leaders met to discuss state legislative and regulatory issues that will occupy their efforts in the months to come. Five issues rise to the top of the queue.

·    Strengthening Medicaid

Many states are preparing for debates this year over the future of Medicaid expansion. Also, on the agenda for state medical associations will be advocating for responsible Medicaid reforms that improve patient access and quality of care.

• Reducing the nation’s opioid epidemic

Physicians across the nation will keep up their efforts to reverse the opioid misuse, overdose and death epidemic. Much of the legislation focuses on mandated prescription drug monitoring program (PDMP) use (New York’s program is a model), physician education, substance-use disorder treatment, guidelines or restrictions on prescribing controlled substances.

• Advancing physician-led team-based care

The AMA’s Advocacy Resource Center tracked more than 450 scope-of-practice bills last year and included in those bills were provisions to establish a framework for physician-led team-based care. Several states will consider AMA model state legislation, which encourages flexible, innovative health care teams under a framework of physician leadership. The AMA’s STEPS Forward™ collection of practice improvement strategies offers several modules to help physicians move their practices toward physician-led team-based care, including instructions on the implementation of team meetings, team documentation and strengthening team culture.

• Provider network issues

As provider networks continue to narrow and patients’ financial responsibility for their health care continues to increase, the issues of network adequacy and out-of-network care will continue to be a focus in many state legislatures in 2017. Physicians are having discussions with key stakeholders across the country about how to ensure access to quality and affordable care for their patients while maintaining their ability to enter into fair contract negotiations.
Improving public health State legislatures continue to debate highly politicized issues, such as vaccines, firearm safety, reproductive health and many others. Assaults on the patient-physician relationship will continue in many states with legislation that attempts to decide what can and cannot be discussed in the exam room.

State and national medical societies will be targeting a long list of additional issues such as diabetes prevention, decreasing cardiovascular disease, infectious disease prevention, obesity, student-athlete concussion and cardiac laws, women’s reproductive rights, tanning restrictions for minors and many others.

The top issues that will affect physicians in 2017
Health insurance coverage and access
Implementation of new Medicare pay system
Reversing the opioid epidemic
Prescription drug pricing
EHR interoperability
Regulatory relief

SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details

MLMIC: Latest Developments in NY’s Medical Malpractice Marketplace
As reported by Politico New York, one of New York’s major malpractice insurance carriers “continues to struggle financially, reporting significant losses through the end of the third quarter.” This news, along with disciplinary action from the Joint Commission on Public Ethics, has raised legitimate concerns.

Instability of a large provider creates some uncertainty for the entire market, of course, but we want to assure MLMIC policyholders that their coverage is not at risk. By adhering to responsible underwriting practices from our beginning, MLMIC continues to demonstrate sound financial condition and is able, once again, to offer a policyholder dividend (20% for those insured by May 1 and continuously insured through July 1).

We’ll keep monitoring the situation in the market on your behalf and will apprise you of further developments. In the meantime, if you have questions, please call 1 (888) 488-9253.

Fourth and Fifth District Retreat on January 27 -29 at Lake Placid
Third and Fourth  District Retreat on Friday (8am) January 27 to Sunday (9am) January 29 at the Mirror Lake Inn in Lake Placid. Call for reservations (518) 523-2544. More information here.

BREAKING: ICD-10 Glitch Leads CMS to Relax Physician Quality Penalties
The CMS issued a two-year pass to physicians and group practices because of a glitch with quality reporting measures based on a recent update to the ICD-10 diagnosis and procedure codes.

Note, this is not across the board.  Only certain specialties and procedures will be impacted by this waiver of negative payment adjustments.  The majority of ICD-10-CM coding changes that impacted 2016 PQRS measures were related to diabetes, pregnancy, cardiovascular, oncology, mental health and eye disease diagnosis.

In addition, it will be up to CMS to decide if the payment adjustment should or should not be applied.  CMS will perform an analysis after the close of the 2016 PQRS reporting period and CMS will review the submissions to determine which group practices and EPs were negatively impacted by the ICD-10-CM coding changes. The group practices and EPs affected by the impact of the ICD-10-CM code updates will be removed from the PQRS payment adjustment prior to the release of feedback reports.

Registries, Qualified Clinical Data Registry (QCDR) and Electronic Health Record (EHR) vendors should calculate the measures as defined in the 2016 measure specifications and utilize the calculated measures data in their submission on your behalf. CMS determined that there has been minimal impact to the Group Practice Reporting Option (GPRO) Web Interface measures due to the assignment and sampling process. Therefore, those PQRS group practices and Accountable Care Organizations (ACOs) reporting via the GPRO Web Interface will not be impacted by the ICD-10-CM code updates. If you receive a payment adjustment and believe it is due to ICD-10-CM code updates, you have the option to submit a request for an informal review of the payment adjustment.

For more information, please click here. Please be sure to review the FAQs referenced on the bottom of this website.

Save the Date: Annual Joint Meeting of YPs, Resident/Fellow, Medical Students

When:  Saturday, February 11, 2017

Where: Marriott Courtyard, 1800 Privado Road, Westbury NY 11590.

Presentations will include “Telemedicine/Telehealth: Tools for Clinical Practice and Patient Engagement.” Gain a better understanding of and appreciation for the use of telemedicine as part of a patient management strategy that will improve and increase access to treatment, lower costs, and more effectively engage patients.

We will also present important financial planning strategies and tips specifically for younger physicians, including Student Loan Management, Main Financial Issues to Address in Residency and as you Transition to Practice, Asset Protection Strategies and Risk Management, and more. Click here for agenda.

Policy will be created, elections will be held.

YPS and RFS register at sbennett@mssny.org; MSS register at mreyes@mssny.org. 

CMS Releases 2017 QPP Quality Measure Benchmarks
If a physician or practice plans to participate in 2017 Quality Payment Program (aka MIPS) with the goal of receiving a bonus in 2019 it is highly recommended that they review the recently released 2017 QPP Measure Benchmark information. The 2017 quality benchmark information does not apply to physicians who only plan to participate in 2017 to avoid a 2019 penalty (submit one measure, one time in 2017). 

The 2017 CMS QPP benchmark information was released late last week and posted to the CMS QPP website. The benchmark calculations for the 2017 performance year use data that was submitted for PQRS in 2015 by clinicians that were a Quality Payment Program provider type eligible for MIPS and were not newly enrolled in 2015, or groups with at least 1 such clinician. When a clinician submits measures for the QPP Quality Performance Category, each measure is assessed against its benchmarks to determine how many points the measure earns. A clinician can receive anywhere from 3 to 10 points for each measure (not including any bonus points).

Benchmarks are specific to the type of submission mechanism: EHRs, QCDRs/Registries, CAHPS and claims. For CG-CAHPS, the benchmarks are based on two sets of data, 2015 PQRS CAHPS and 2015 ACO CAHPS data. Submissions via CMS Web Interface will use benchmarks from the Shared Savings Programs.

CMS Releases Patient Facing Encounter Codes
Late last week CMS released and posted to the QPP website the list of patient-facing encounter codes. The list is used to determine the non-patient facing status of MIPS eligible clinicians. Given the flexibility in program requirements for non-patient facing clinicians, the encounter codes are critical for CMS to identify MIPS eligible clinicians. A non-patient facing MIPS eligible clinician is:

• An individual MIPS eligible clinician that bills 100 or fewer patient-facing encounters (including Medicare telehealth services defined in section 1834(m) of the Act) during the non-patient facing determination period, and
• A group provided that more than 75 percent of the clinicians billing under the group’s TIN meet the definition of a non-patient facing individual MIPS eligible clinician during the non-patient facing determination period.

The list of patient-facing encounter codes are categorized into three overarching groups of codes (Evaluation and Management Codes; Surgical and Procedural Codes, and Visit Codes). The utilization of Evaluation and Management Codes, Surgical and Procedural Codes, and Visit Codes classifies MIPS eligible clinicians as non-patient facing and patient-facing.

AMA-IMG Section Governing Council Nominations Due Feb. 17
Nominations are being accepted for the 2017 AMA-IMG Section Governing Council election to fill two vacancies.

Consider nominating a colleague or, if you have leadership experience, consider nominating yourself for this important upcoming governing council election.

The AMA-IMG Section Governing Council positions carry three-year terms. Council nominees must be:

• An AMA member
• Able to attend the AMA Annual Meeting in June, Interim Meeting in November and a separate meeting in the spring
• Committed to their governing council service, able to participate in evening teleconferences and have proficient computer knowledge
• Available to serve as chair of an AMA-IMG Section committee

Nominations are being accepted now through Friday Feb. 17. Be sure to submit your nomination form, bio sketch and photo (JPEG format) to img@ama-assn.org by midnight Friday, Feb. 17.  Submission of a letter of support from an organization is optional.

Visit https://www.ama-assn.org/about-us/international-medical-graduates-sectionimgs-leadership-opportunities to obtain your nomination and bio sketch forms. If you have questions, contact carolyn.carter-ellis@ama-assn.org for assistance.

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