MSSNY eNews: February 4, 2022 – MSSNY Fights Back Against Insurer Tactics
MSSNY Fights Back Against Insurer Tactics
Colleagues:
As we reported on Wednesday, the trial in the action Medical Society of the State of New York et al. v. UnitedHealth Group Inc. et al, began this week in the Southern District of New York federal court.
This lawsuit is just one example of the countless ways MSSNY fights back against insurer tactics that impose unnecessary claim hassles, payment delays and interference with our patients getting the treatment and medication they need.
Our Division of Physician Payment and Practice helps our physician members—on a daily basis—to navigate the complexities of insurance company reimbursement. And our Division of Government Affairs is in regular contact with the NYS Department of Financial Services and continually advocates for insurance-related legislation that is fair for both physicians and for the patients we care for every day. And, when necessary, MSSNY will take to the courts to fight for patients and physicians through litigation—as evidenced by this week’s trial.
The United class action lawsuit—which reflects the outgrowth of policies adopted at numerous House of Delegates meetings to ensure that the enormous costs of obtaining and maintaining an accredited office-based surgery location should be reimbursed by health insurers because it provides another option for patient care—was originally filed in 2016. It argues that United’s failure to pay facility fees to out-of-network office-based surgery providers is contrary to the terms of United’s health benefits plans and the requirements of ERISA.
MSSNY fights for you—our member physicians—every day. As I like to say, “Membership doesn’t cost, it pays.” If you are not already a member and would like to join, please contact MemberResources@mssny.org.
Joseph Sellers, MD, FAAP
MSSNY President.
MSSNY Podcast: Advocacy Efforts Beyond (and Including) the Legislature and the Importance of Physician Advocacy Day
Listen to MSSNY’s February 4th podcast with Senior Vice-President & Chief Legislative Counsel Moe Auster as he looks at advocacy efforts beyond (and including) the legislature and the importance of Physician Advocacy Day.
Micro Masterclass on Filing Formal Complaints Now Available
MSSNY’s first Micro Masterclass, Filing Formal Complaints with the Appropriate Agency, is now available to members under the “Resources” tab on the MSSNY website. Micro Masterclasses are short educational sessions with focused content shared in 15 minutes or less. The information in these sessions can be consumed quickly and requires only a small amount of time. In this Micro Masterclass, Heather Lopez, MSSNY’s Director of Payment and Practice describes the steps needed to file a formal complaint against an insurer, including the documentation needed for filing your complaint and how long you should wait for a response to your filing. For questions or comments about the Micro Masterclass sessions, please contact MSSNY at MemberResources@mssny.org.
Workers’ Comp Board New “On-Board” Web-Based Platform
The Workers’ Compensation Board is in the process of building a new online business information system, OnBoard, which will eventually replace the Board’s legacy paper-based claims systems and the eCase system with a single, web-based platform. OnBoard will provide stakeholders with increased accuracy, paperless transactions and a user-friendly interface for interacting with the Board.
OnBoard: Limited Release, the first phase of OnBoard, will be implemented March 7, 2022. Health care providers should be aware of some key dates and updates ahead of the phased launch.
If you have questions, contact the OnBoard Project Team at onboard@wcb.ny.gov.
MSSNY Continues to Advocate on Key State Budget Items
Governor Hochul’s proposed Budget for FY 2022-23 includes a significant number of investments in New York’s health care system, and its health care workforce. While many items would enhance the ability of patients to access care from their physicians, other provisions would add to the extraordinary burdens already faced by our State’s dedicated physicians and increase levels of burnout. Next Tuesday, February 8, MSSNY President Dr. Joseph Sellers will be delivering testimony to legislative leaders on many of the State Budget items below.
MSSNY Supports
- Requiring health insurers to pay for Telehealth Services at a level similar to in-person services. Send a letter of support to your legislators here: Support Payment Parity for Telehealth Services
- Increasing from $9M to $15M funding for the Doctors Across New York Program to provide loan forgiveness for physicians who agree to work in underserved areas for three years.
- Expanding the SUNY Pre-Medical Opportunity Program and the Diversity in Medicine Program
- Restoring the FY 2020-21 1.5% Medicaid cut & a 1% increase across the board
- Expanding eligibility of New Yorkers for health insurance with minimal or no cost-sharing requirements
- Requiring all New York-regulated health insurers to follow the 60-day deadline for reviewing physician credentialing applications, and to limit their excessive medical record requests.
- Reducing the statutory interest rate on judgments from 9% to a market rate.
MSSNY Opposes
- Imposing enormous new costs on the 17,000 physicians with Excess Medical Malpractice Insurance Coverage by requiring them to purchase the coverage themselves, and then hope to be reimbursed by the State in 2 yearly installments. This could thrust tens of thousands of dollars in new costs on our healthcare heroes still trying to recover from the pandemic. Send a letter of opposition here: Keep Excess Medical Liability Insurance Intact.
- Eliminating the statutory requirement for primary care nurse practitioners to practice in collaboration with a physician. Send a letter of opposition here: Protect Physician-Led Team-Based Care for Patients (p2a.co)
- Allowing pharmacists to perform dozens of limited services lab tests authorized by FDA without coordination with the patient’s physician.
- Eliminating “prescriber prevails” protections in Medicaid and Medicaid managed care.
Items of Concern/Under Review
- Conforming New York’s “Surprise Billing” law with new federal law protections (many of these provisions were synthesized into New York law through previous DFS Circular letters). This would eliminate the requirement that a physician obtain an Assignment of Benefits from a patient to proceed to an Independent Dispute Resolution (IDR). However, it would also expressly permit an IDR entity’s consideration of insurer median payments even though not required by the federal law
- Adding New York to the list of states who have joined the Interstate Medical Licensure Compact.
- Transferring to DOH oversight of all Education Law regulated health care providers.
- Placing limitations on the use of Restrictive Covenants by employers. While this is generally positive, the proposal may not go far enough in preventing excessive post-employment limitations often placed on employed physicians that could harm continuity of care for patients.
MSSNY Joins Other Groups to Fight for Fair Telehealth Payments and Loan Repayment
On Tuesday, February 1st, MSSNY DGA staff joined other provider organizations for a legislative advocacy day to push for several important items included in Governor Hochul’s proposed budget for FY2022-23. The event was organized by the Workforce Advocacy Group (WAG) and participating organizations included the Healthcare Association of New York State (HANYS), the Greater New York Hospital Association (GNYHA), the New York chapter of the American College of Physicians (ACP), the Center for Health Workforce Studies (CHWS), New York State Health Education Center System (AHEC), the Community Health Care Association of New York State, and Health Workforce NY.
Among the issues discussed were support for payment parity for Telehealth services and increased state funding for physician access programs like Doctors Across New York State (DANYS), Diversity in Medicine, Area Health Education Centers (AHEC), and others. The issue of payment parity for Telehealth services has been a top priority for MSSNY the last two legislative sessions and has been included in the Executive budget.
Since the beginning of the pandemic, steps have been taken to enhance patient access to Telehealth services, but none have addressed the gross disparity in payment for care delivered virtually, compared to in-office visits. Establishing fair payments to providers will help ensure that patients have access to timely and necessary healthcare.
Join Us for MSSNY’s Virtual Lobby Day on March 8th
The $216 Billion dollar budget proposed by Governor Hochul last month will have a profound impact on all New York physicians. It’s more important than ever that leaders in Albany listen to the concerns of physicians. To make their voices heard, physicians should plan to attend MSSNY’s Virtual Physician Advocacy Day on Tuesday, March 8th. Register Now!
The format will follow last year’s format, where assembled physicians and allies will hear from legislative leaders in the morning (via Zoom), and then have virtual visits with their respective legislators in the afternoon (coordinated by their county medical societies).
In her budget, Governor Hochul articulated support for a number of measures advocated by MSSNY such as: support for telehealth payment parity, significant increases in loan repayment programs for physicians, and increased eligibility for subsidized health insurance coverage for patients. However, she also indicated support for measures where physicians have raised strong concerns, such as eliminating statutory collaborative agreement requirements for nurse practitioners to practice in collaboration with a physician and potentially significant new costs for Excess Medical Liability Insurance coverage.
There are countless other items that will be under discussion this legislative session as well, including further proposals to change scope of practice of various non-physician practitioners, proposals to reduce health insurer prior authorization hassles, and proposals to address various public health threats. We urge all physicians to join their colleagues in advocacy to their legislators to protect access to quality care for their patients.
MSSNY Seeks NYS Funding for the Veterans Mental Health Training Initiative
For several years, the Veterans Mental Health Training Initiative (VMHTI) was funded through a legislative add-on to provide skills, development, and education to those working in the mental health field with service members and their families. This initiative is a partnership between the Medical Society of the State of New York, The New York State Psychiatric Association, and the National Association of Social Workers-New York State.
These associations work to deliver free training to service providers across New York. They also work with counties implementing the NYS Joseph P. Dwyer Veterans Peer Support programs, which provide holistic care for returning veterans. Through this initiative, MSSNY has been able to provide seminars, webinars, and other online programming to county medical societies and hospitals. Please send a letter on the VMHTI through the Grassroots Action Center (GAC) to ensure that this funding is included in the state budget.
Join Monroe County Medical Society in Upcoming Wellness Symposium:
Register to join the physician community for a symposium on Well-Being and Burnout Prevention on Wednesday, February 16, 2022, from 8:30 AM – 1:00 PM.
This symposium is co-sponsored by the Monroe County Medical Society, the Rochester Academy of Medicine, and the University of Rochester Medical Center.
This virtual symposium will bring together academics, educators, and practitioners from a variety of fields for a collaborative, multidisciplinary exploration of the ways to support the well-being of clinicians, faculty, and learners, and to share best practices. In addition, MSSNY secretary Frank Dowling, MD, will be giving a presentation on the Peer to Peer (P2P) Program and Physician Wellness.
Peer to Peer (P2P) Program
Stress and burnout among physicians have been well documented for years. The COVID-19 pandemic is exacerbating the public health problem of physician burnout in New York state. Throughout the pandemic, physicians and other health professionals have faced concerns about safety, overworking, and feelings of loss. Without an intervention, it is possible that a high number of physicians over the next few years may develop chronic stress reactions, anger, clinical depression, substance abuse, post-traumatic stress disorder, and suicidality.
The Medical Society of the State of New York now offers to physicians, residents, and medical students a completely confidential and anonymous opportunity to talk with a peer about some of life stressors. MSSNY’s Physician Wellness and Resiliency Committee launched a Peer 2 Peer (P2P) program to assist their colleagues who are need of help in dealing with work and family stressors.
MSSNY has established a confidential helpline (1-844-P2P-PEER) and an email address (p2p@mssny.org) so that physicians may be connected with a peer 24/7. In addition to offering a trained, empathetic ear, peer supporters may provide information on specific resources that can offer further support, provide positive coping skills, or connect physicians to professionals for more focused assistance when needed. MSSNY has nearly 50 trained peer supporters across NYS who are just a phone call away!
If someone you know is struggling with life stressors, reach out to the P2P program to connect them to a peer supporter!
Email: P2P@mssny.org and request that you be connected with a peer supporter
Phone: 1-844-P2P-PEER (1-844-727-7337) and request that you be connected with a peer supporter
If you wish to become a trained peer supporter, please reach out to Cayla Lauder, MPH, Public Health Associate, at clauder@mssny.org.
Registration Now Open – February 16, 2022 @ 7:30 am Medical Matters CME Webinar The Impact of the COVID-19 Pandemic on Racial and Ethnic Minorities
The COVID-19 pandemic has cast a spotlight on health inequities that lead to inequitable health outcomes amongst racial and ethnic minorities. Learn more about the impact of the COVID-19 pandemic on racial and ethnic minorities by registering for “The Impact of the COVID-19 Pandemic on Racial and Ethnic Minorities” on Wednesday February 16, 2022, at 7:30 A.M. Yvette Calderon, MD, MS will serve as faculty for this program. Register now.
Educational objectives are:
- Outline some social determinants of health that put racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19
- Identify the ways in which
racial and ethnic minority groups have been disproportionately impacted by the COVID-19 pandemic - Describe strategies to improve COVID-related health outcomes for racial and ethnic minorities
Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.
The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Classified Ads Available for:
Physicians’ search services • allied medical placements • locum tenens • practice valuation • practice brokerage • practice consulting • real estate
For help, information or to place your ad, call Roseann Raia at 516-488-6100 ext. 302
For the MSSNY 2022 Ad Rate Sheet, please click here.
Opportunity: Medical Director- Long Term Care
The Medical Director is responsible for the quality assurance program for a long-term care center in NYC. This individual will be the most senior level physician in the organization and report directly to the EVP and President of the business. They will work with an interdisciplinary team of administrative and clinical staff who are highly experienced in the care of the frail elderly and disabled individuals to develop care plans and guidelines and assess quality. S/he will chair the Quality Assurance Committee, appoint its members, and set the agenda. In addition, this position provides an exciting opportunity for a forward-thinking physician to build a PACE program and ensure members receive the highest quality care. Internal Medicine, Family Practice, Geriatrics preferred. Please inquire at Lisa.mooney@kornferry.com.
Rendr- Transforming Healthcare – Leadership Opportunity: Associate Chief Medical Office, SVP of Population Health, Bilingual English and Chinese (Mandarin or Cantonese) preferred Job Position: Associate Chief Medical Office, SVP of Population Health in this role, you will lead and provide a wide range of support through population health, quality measures, practice transformation, Rendr360 department, House Calls, and other projects. Please send resumes careers@rendrcare.com. We are offering leadership opportunities to Physicians who are interested in providing high-quality clinical care to our patients in the diverse communities that we serve. As a rapidly growing network, we provide a supportive environment for our physicians to practice medicine under the guidance of dedicated medical leadership. www.rendrcare.com.
Rendr- Transforming Healthcare – Primary Care Opportunity: Internal or Family Medicine Physician, Bilingual English and Chinese (Mandarin or Cantonese)
Job Position: Internal Family Medicine Physician please send resumes to: careers@rendrcare.com. We are offering employment opportunities to Internal or Family Medicine Physicians who are interested in providing high-quality clinical care to our patients in the diverse communities that we serve. As a rapidly growing network, we provide a supportive environment for our physicians to practice medicine under the guidance of dedicated medical leadership. www.rendrcare.com.
Job Position: Clinical Operations Medical Director in this role, you will provide clinical oversight and help lead our team of providers to assure high standards of care for our patients. The ideal candidate will be dedicated to improving the health of the communities we serve and will be a practicing physician as well as an established medical leader with proven experience improving clinical operations and building strong teams. Please send resumes careers@rendrcare.com. We are offering leadership opportunities to Physicians who are interested in providing high-quality clinical care to our patients in the diverse communities that we serve. As a rapidly growing network, we provide a supportive environment for our physicians to practice medicine under the guidance of dedicated medical leadership. www.rendrcare.com.
Healthcare Tech Investment Opportunity
Kalypsys (www.heykaly.com) is a healthcare tech startup that integrates patient appointment booking, telemedicine, and practice growth, with additional leveraged, validated, and lucrative revenue sources available downstream. We are a 100% physician-owned and operated company seeking $2.5MM in seed investment via SAFE agreement from the physician community. This is a rare and unique opportunity to invest on the ground floor in a ready-to-launch tech startup in an industry that is ripe for disruption. If you are frustrated with the $35-$110 per booking fee of our competitors, please contact us immediately to review our investor deck! We are also looking for board-certified physicians to add to our growing medical advisory board. Great opportunity to break into the healthcare tech space. Please inquire at invest@kalypsys.com!
NYS Department of Health is looking for a licensed, board-eligible /board certified physician to serve as the Medical Director for the Medicaid State Disability Review Unit (SDRU). Interested candidates: Submit resume and cover letter preferably in PDF format, to resume@health.ny.gov, or by fax to (518) 473-3395 with Reference Code SC/PHP2HS/15223 included in the subject line. View Full Listing