Category: eNews

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THIS IS THE LAST ENEWS PUBLICATION BEFORE THE HOLIDAY.
WE WILL RETURN ON WEDNESDAY, JANUARY 5.

WISHING ALL OF OUR MEMBERS A HAPPY AND HEALTHY 2022!

COVID-Related Stress and Work Intentions in a Sample of U.S. Health Care Workers
A new Mayo Clinic Proceedings article led by the American Medical Association explores the relationship between COVID-related stress and work intentions of U.S. health care workers. The article found that physicians, nurses, and advanced practice providers are at the highest risk of reducing clinical work hours or leaving their practice, with one in five physicians and two in five nurses intending to leave their practice altogether.

Factors associated with a greater intention to reduce work hours or leave a practice include higher levels of burnout, stress, workload, fear of infection, anxiety or depression due to COVID-19, and the number of years in practice. The article concluded that organizations should implement measures to enhance health care workers’ sense of value, create supportive environments, and reduce work overload through better teamwork to reduce stress and prevent turnover.

Federal Law Restricting Patient Surprise Bills Takes Effect January 1:
Be Prepared
As reported in recent MSSNY eNews articles, the New York Department of Financial Services has issued a lengthy advisory letter detailing how it intends to reconcile potentially conflicting provisions between the federal No Surprises Act that takes effect January 1, and New York’s surprise bill law provisions.  The letter discusses that New York’s law will now:

• Ensure that that the provisions of New York’s surprise bill law will apply to all out of network providers, not just hospitals and physicians;
• Clarify that the “visit” subject to patient protection under New York’s surprise bill law includes: equipment and devices, telemedicine services, imaging services, laboratory services, preoperative and postoperative services, and other such services as HHS may specify;
• Clarify that New York’s surprise bill law applies to all safety net hospitals;
• Clarify that previously exempted CPT codes 99281 – 99285, 99288, 99291 – 99292, 99217 – 99220, 99224 – 99226, and 99234 – 99236 are no longer exempted from NY’s surprise bill law;
• Clarify that the insured’s cost-sharing will be calculated based upon the health insurer’s initial payment amount to the physician, hospital or other care provider
• Clarify that patients cannot be asked to waive protections for both emergency and surprise out of network bills
• Clarify that, even if a patient does not sign an assignment of benefits form, upon receipt of a claim from a provider for a surprise bill or for emergency services, an issuer must send the initial payment or notice of denial of the payment directly to the provider
• Remind health care providers of the federal NSA requirement to post on their website and in their practice location a New York-specific model form advising their insured patients of their legal protections against surprise medical bills.

This is just one of numerous federal patient protections that will become effective on January 1.  Litigation has been filed by various medical and hospital associations against one aspect of the federal No Surprises Act relative to the consideration of various data points during an independent dispute resolution between an out of network health care provider and health insurer.

MSSNY’s General Counsel, Garfunkel Wild, P.C., has announced the creation of a Federal Surprise Bill Working Group that has developed a particular level of expertise in addressing client questions about the new Federal No Surprises Act law.

Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact info@garfunkelwild.com.

Governor to Sign Legislation to Limit Formulary Adjustments
Governor Hochul will be signing into law legislation (S.4111, Breslin/A.4668, People-Stokes) advocated for by MSSNY and several other patient advocacy groups that will greatly limit the ability of health insurers to implement prescription formulary changes or cost-sharing tier changes for medications during the middle of a policy year.  Based upon some technical amendments agreed to by the State Legislature, the law will take effect for policy years that begin January 1, 2023 and after.

We thank the many physicians who took the time to send a letter to Governor Hochul urging her to sign this bill into law.  Still pending before Governor Hochul is legislation also supported by MSSNY that would regulate the practices of Pharmaceutical Benefit Managers (PBMs).

Governor Hochul has signed into law another bill (A.1677, Gottfried/S.2008, Jackson) supported by MSSNY that requires health insurers to provide greater details to a physician or hospital when a claim has been partially approved, as opposed to being denied.

UnitedHealthcare Offers New Process to Expedite Claims
UnitedHealthcare is now offering a new process to better serve care providers in a more responsive and efficient way.  It will expedite both the handling and accuracy of claims.  They now have a dedicated team of individuals that includes claims processors assigned to handle all open claims issues.

With this new process, your unresolved claims issues will be quickly resolved by a dedicated and experienced claims reviewer who will respond with the resolution or a status usually within 2 days.   When you have a claims question or dispute that was not resolved to your satisfaction through the service model (e.g., LINK reconsideration, call center or appeal) you now can utilize their dedicated team to handle your escalated issues by sending an email to NewYork_PR_Team@uhc.com.   By sending issues as soon as they are identified, your issues will be resolved without further delay.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | hlopez@mssny.org.

Mark Your Calendars: MSSNY’s Virtual Lobby Day is on March 8th
Please plan to put aside Tuesday, March 8^th for MSSNY’s Annual Physician Advocacy Day. To view the flyer, click here: MSSNY 2022 Lobby Day. To register, click here: Physician Advocacy Registration

The format will be similar to previous years, 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).

With COVID cases on the rise across NYS, we will be advocating for policies that encourage vaccination and support fair payment for telehealth care. We will also advocate for proposals that reduce prior authorization hassles. At the same time, we will voice our opposition to policies that would inappropriately expand the scope of practice for non-physicians and mandate how physicians provide care to their patients.

Please plan to join hundreds of colleagues from around the state on March 8^th!

New CPT Modifier 93: Audio-Only Services
At the September 2021 CPT Editorial Panel Meeting, a new Modifier was accepted to describe real-time telemedicine services between a patient and a physician or other qualified health care professional rendered via audio-only.  This new modifier is effective January 1, 2022.
Modifier 93 – Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System:
Synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. The totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction.

The official release information can be found on the AMA website.

AMA Updated Specialty Impact Analysis
The American Medical Association’s updated specialty impact analysis factors in the Protecting Medicare & American Farmers from Sequester Cuts Act, which avoided a 4% statutory cut from the PAYGO provisions, extended the moratorium on the 2% Medicare payment sequester, and mitigated the 3.75% Medicare physician payment cut. Note, the analysis is focused on the impact at the beginning of the year.

CMS Releases Updated CFs
CMS has now released the new 2022 PFS conversion factor of $34.6062 and Anesthesia CF of $21.5623. The updated CFs were included in newly updated spreadsheets on cms.gov.

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 

Wishing Each of You a Joyful Holiday Season and a Happy, Healthy 2022

Colleagues: 

As we come to the end of 2021 and look forward to 2022, I am filled with hope for the future. Despite huge challenges for physicians in the face of this historic pandemic, we have dug deep, persevered, and helped our patients navigate extraordinary challenges.  My hope is that 2022 will bring an end to this pandemic.

2021 has been a busy year for MSSNY. The improvements and changes underway give me a renewed sense of hope that our future—and the future of all organized medicine—is bright. We started the year by conducting a nationwide search for a new MSSNY EVP and were thrilled to hire Troy Oechsner, who hit the ground running. After extensive research, MSSNY is getting ready to implement a new database service to replace our present database dinosaur and is in the process of developing a plan for a complete overhaul of the MSSNY website. Troy hired Valerie Cammiso as our new VP of Membership and Heather Lopez as Director of Physician Payment and Practice. Troy, Valerie, and Heather each possess a sense of optimism and confidence—and all three have a wealth of experience in their respective fields that I’m confident will bring renewed value to MSSNY membership. They join an existing stellar MSSNY staff that continues to produce excellent work on behalf of all of us.

And our voice in Albany and Washington, DC remains strong. Here are just a few highlights of MSSNY’s work this year:

• Rejected Physician Responsibility for 50% Excess Insurance Cost-Share
• Protected Physician Due Process During OPMC Investigations
• Protected Physician Confidentiality When a Complaint Has Been Filed Against Them With OPMC
• MSSNY Advocacy resulted in the recent announcement that claims submitted to liquidated health insurer Health Republic would be paid
• MSSNY worked with the NY Congressional Delegation, the American Medical Association (AMA) and the Federation of Medicine to prevent implementation of a 2% sequester cut until at least 2022 and to mostly prevent implementation of a 10% cut to Medicare physician payment conversion factor while continuing to move forward with payment increases to E&M codes.

As the year winds down, I wish each of you a joyful holiday season and a wonderful 2022 filled with good health and happiness.

Joseph Sellers, MD, FAAP
MSSNY President

Provider Relief Fund Reporting Period 1 Portal Open Until December 20 @ 12 PM
The Provider Relief Fund Reporting Period 1 portal will be reopened from 9:00 a.m. ET on December 13, 2021 through 11:59 p.m. ET on December 20, 2021. During this time, PRF recipients may register, request corrections, and/or submit their report on PRF payments received prior to June 30, 2020. This will be the final opportunity for providers to report on Reporting Period 1 payments.  Providers who submitted their reports before November 30, 2021 may request to have their report reopened for revisions by contacting the Provider Support Line (866-569-3522). All reports must be finalized and submitted before December 20, 2021 at 11:59 pm ET to be compliant with the terms and conditions of the PRF program.

To access the PRF reporting portal, please click here.
For additional information about PRF reporting, please visit the PRF webpage.

Federal No Surprises Act Takes Effect in 15 Days: Are You Ready?
On January 1, 2022, a new and complex set of rules enacted by the federal government regarding “surprise bills” goes into effect. The statute is broad and sweeping and will have significant effects on any health care provider who renders services to out-of-network or uninsured patients. While many jurisdictions, including New York, New Jersey, Connecticut and Florida already have rules addressing surprise bills, the Federal law varies from the state laws in many ways, including having a far wider application.

The penalties for violating the Federal No Surprises Act law can be substantial. If you are uncertain about an aspect of the new law—whether you are covered, what aspects of your practice are covered, and how to comply—the GW Federal Surprise Bill Working Group can provide unmatched expert guidance.

Garfunkel Wild, P.C., a law firm dedicated to the health care industry, is pleased to announce the creation of a Federal Surprise Bill Working Group that has developed a particular level of expertise in addressing client questions about the new Federal No Surprises Act law.

Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.

DFS Develops Model Form for Physicians to Share with Patients Regarding Protections from Surprise Billing
The New York Department of Financial Services has finalized a New York-specific model form that physicians, hospitals and other health care providers will need to post on their website and in their practice location advising their insured patients of their legal protections against surprise medical bills.  The form developed by the DFS is a modified version of the template form developed by the US Department of Health and Human Services.  As noted in an upcoming DFS Circular letter, “Beginning January 1, 2022, each health care provider and facility must make publicly available, post on their public websites, and provide to insureds, a one-page notice in clear and understandable language containing information on:  the requirements and prohibitions of such provider or facility under 42 U.S.C. §§ 300gg-131 and 300gg-132 (relating to prohibitions on balance billing for emergency services and surprise bills); any other applicable state law requirements on such provider or facility prohibiting out-of-network balancing billing (including any state laws that provide consumer protections that go beyond the NSA); and information on contacting appropriate state and federal agencies in case an individual believes that such provider or facility has violated any state or federal prohibitions on balance billing for emergency services and surprise bills.

45 C.F.R. § 149.430(c) provides clarification regarding the methods for this disclosure.  When posting on the provider’s or facility’s website, the information or link to the information must appear on a searchable homepage of the provider’s or facility’s website.  If a provider or facility does not have a website, this requirement does not apply.  Additionally, for the information to be publicly available, the provider or facility must include the information on a sign posted prominently at the provider’s or facility’s location.  A sign is posted prominently if the sign is posted in a central location, such as where insureds schedule care, check in for appointments, or pay bills.  If the provider does not have a publicly accessible location, this requirement does not apply.  Lastly, the notice provided to the insured must be a one-page (double-sided) notice, using print no smaller than 12-point font.

The provider or facility must provide the notice in person or through postal mail, or if the insured consents, through electronic mail.”

MSSNY Podcast: Omicron, Medicare and Surprise Bills
Listen to today’s MSSNY podcast as MSSNY Senior VP and Chief Legislative Counsel Moe Auster updates physician members on Omicron, Medicare, and Surprise Bills.

MSSNY in the News
WSYR LocalSyr.com (News 9) – 12/14/21
President of the Onondaga County Medical Society discusses the strain of COVID-19
(Interview with Dr. Robert Dracker,  President of the Onondaga County Medical Society)

PoliticsNY – 12/14/21
PoliticsNY Power Players in Health Care
(MSSNY President-Elect Parag Mehta named PoliticsNY Power Player)

CBS WRGB News 6 Albany  12/10/21
Capital Region hospitals not concerned over elective surgery postponements
(MSSNY President Dr. Joseph Sellers quoted) 

The Journal News (LoHud) – 12/06/21
Some NY counties lagging behind in COVID-19 vaccinations for ages 5 to 11. Here’s where
(MSSNY President Dr. Joseph Sellers quoted)

Also ran in:
Daily Messenger
Wayne Post
Genesee Country Express
Democrat and Chronicle
Observer-Dispatch
Times Telegram
Star-Gazette
Poughkeepsie Journal
The Steuben Courier Advocate
Irondequoit Post
The Evening Tribune
Wellsville Daily Reporter
Yahoo News
The Leader

Rochester First (WROC) – 12/03/21
Free rapid take-home tests and booster shots coming to Monroe County
MSSNY President Dr. Joseph Sellers Interviewed

The Hill – 11/29/21
Time to think beyond the vax? Reflections from a COVID-stricken doc
Op-ed by MSSNY Member, Dr. Frank Contacessa

LoHud.com – 11/22/21
As COVID surges, New York’s flu season is off to a troubling start. Will ‘twindemic’ hit?
(MSSNY President Dr. Joseph Sellers quoted)

Also ran in:
Daily Messenger
Democrat and Chronicle
Genesee Country Express
Star-Gazette
The Evening Tribune
The Leader
The Poughkeepsie Journal
The Steuben Courier Advocate
Times Telegram
Wayne Post
Wellsville Daily Reporter
Yahoo news           

InsuranceNewsNet – 11/21/21
Stakeholders Praise 4 House Members Letter to Admin Regarding Surprise Billing Interim Final Rule
(MSSNY President Dr. Joseph Sellers quoted)

Buffalo News – 11/12/21
Covid cases are rising in younger people. So are urgent calls to get them vaccinated
(Former MSSNY President Dr. Thomas Madejski quoted)

Harlem World Magazine – 11/03/21
Attorney General James Defends New York State’s Gun Licensing Protection Law At Supreme Court
(MSSNY President Dr. Joseph Sellers quoted)

Crain’s Health Pulse – 11/3/21
Labor costs driving up expenses for hospitals, physician practices
MSSNY Past Presidents Dr. Thomas Madejski and Dr. Charles Rothberg interviewed)

Podcast on Omicron and Antivirals with MSSNY Infectious Diseases Committee Chair Dr. William Valenti Available Now
Questions about the Omicron COVID Variant and the newly developed antivirals for COVID-19?  Listen to MSSNY’s latest podcast on Omicron and antivirals here.  Chair of MSSNY Infectious Diseases Committee, Dr. William Valenti offers insight on the latest COVID variant, Omicron, and provides information on the newly developed COVID antivirals.  Also be sure to check out all MSSNY’s other podcasts on topics ranging from Emergency Preparedness to Veterans Matters to Legislative Updates.  And go to https://cme.mssny.org  to explore all of MSSNY’s CME programs.

COVID-19 Exacerbating Physician Stress: MSSNY is Here to Help
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.

MSSNY understands that with the Holiday season, comes a great deal of stress for many.

If someone you know is struggling with life stressors, encourage them to reach out to the P2P program to connect them to a peer supporter!

Email: P2P@mssny.org or call 1-844-P2P-PEER (1-844-727-7337) to request to be connected with a peer supporter.

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.

If you wish to become a trained peer supporter, please reach out to Cayla Lauder, MPH, Program Coordinator, at clauder@mssny.org.

MSSNY Calls on Governor Hochul to Sign Bill to Increase PBM Transparency & Limit Insurers’ Mid-Year Formulary Changes: Members Urged to Take Grassroots Action
Physicians are again urged to send a letter asking Governor Hochul to sign two bills into law that are critical to helping patients access the medications they need and to ensuring greater oversight of pharmacy benefit formulary development practices.  Physicians can send a letter or tweet from here.

The first piece of legislation, (A.1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices of Pharmacy Benefit Managers (PBMs). The bill was amended from the version that passed the Legislature in 2019, but vetoed, to address concerns raised in Governor Cuomo’s veto message two years ago.

The bill requires that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. It also calls for disclosure of all possible revenue streams, terms, and conditions, that they place on their networks of pharmacies. MSSNY has supported greater oversight and regulation of PBMs as one manner to address restrictive formularies and excessive prior authorization requirements that interfere with patients obtaining needed medications.

The second bill, A.4668, People-Stokes/S.4111, Breslin, would significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. The bill was revised from the version that passed both chambers two years ago, but was vetoed by then Governor Cuomo. To address concerns raised in his veto message, the legislation now prohibits the applicability of a mid-year formulary change to a patient who was on the medication at the beginning of the policy year, or suffers from a condition for which the medication is part of a treatment regimen, for that condition. However, other mid-year formulary changes could still occur.

Physicians can send a letter to ask Governor Hochul to sign both bills here.

MSSNY Tip of the Week: Time-Based Billing for E/M Guide
Effective January 1, 2021, the new time-based billing for E/M codes went into effect and should be used now. This will allow you to bill a higher-level CPT code in the event certain time metrics are met. To ensure you are receiving the most appropriate reimbursement for your time, please take a moment to review this document.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice Heather Lopez at 518.465.8085 X332 | hlopez@mssny.org.

The Telehealth Initiative
As part of the Telehealth Initiative project, MSSNY and the AMA will work together to develop relevant educational content, resources, measurement tools, and evaluation support to help practices with telehealth implementation. MSSNY will be part of a national network to establish and maintain strong relationships with physicians, practices, and health systems interested in implementing, optimizing, or sustaining telehealth. In addition to providing ongoing support, this year’s program will emphasize the importance of realizing the true value of virtual care. MSSNY has secured four signed statements of interest: C DOC, Mount Sinai, Northwell TeleICU/Telehealth, and Eger Healthcare and Rehabilitation Center.

MSSNY is hoping to have close to 10 practice sites in total. As a collaborating partner, team leaders will participate in a “kick-off” meeting with leaders from practice sites in New York and in other states. Each practice site will be involved in dissemination of a telehealth survey assessing practice/physician experience using telehealth. In addition to participation in the Telehealth Survey, the project team will collect baseline, mid- point, and final data points to measure the impact of telehealth in their practices using the Return on Health framework. Access to educational resources from the AMA and expert mentoring to discuss optimization and sustaining telehealth into practice, virtual events and discussions which provides a network for physicians and care teams to share experiences will be provided to all participants.

If you or someone you know is interested in joining this initiative, please reach out to Cayla Lauder, MPH, Program Coordinator at clauder@mssny.org.

Please Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
With just a few weeks left in the year, physicians are again urged to contact Governor Hochul’s office to encourage her to veto multiple problematic pro-trial lawyer bills that if signed could have the effect of significantly disadvantaging defendants generally in litigation in New York State, including physicians and hospitals defending against malpractice claims.

While these bills do not have the same gargantuan premium impact as other legislation sought by the trial bar that would expand lawsuits and awards against physicians, they would continue to make New York’s already dysfunctional medical liability adjudication system even more unbalanced and add to New York’s notorious outlier status with regard to medical liability payouts.  These bills include:

• A8041/S7052 (“The Comprehensive Insurance Disclosure Act”) – Imposes excessive insurance disclosure requirements on defendants during litigation, which has been strongly opposed by many groups. Business groups urge Hochul to veto insurance bill (nystateofpolitics.com)
• A2199/S473 – Expands the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal.
• A8040/S7093 – Changes a long-standing rule that heretofore excluded a “hearsay” statement made by a defendant’s employee.

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

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Colleagues:

This week, MSSNY extended a warm welcome to Dr. Mary Bassett as she begins her tenure as New York State’s Health Commissioner. We look forward to working closely with her to address the health needs of all New Yorkers.

As I said in my press statement, Dr. Bassett joins New York State at a uniquely challenging time in history and we are confident that her wealth of knowledge and experience in the field of public health will help her to guide New Yorkers through to the end of the COVID-19 pandemic—and future public health challenges.

At the moment, the greatest challenge is the concerning rise of COVID positivity and hospitalizations in parts of New York. There are nearly 40, mostly upstate, hospitals whose bed capacity is less than 10 percent. And just yesterday we received news that several cases of the Omicron variant have been reported in New York State.

This week, I—along with MSSNY President-Elect Dr. Parag Mehta and Vice-President Dr. Paul Pipia—met with top officials to Governor Hochul to discuss aspects of her recent emergency order that will give the NYS Department of Health the authority to limit elective procedures at hospitals that have less than 10% bed capacity, and cannot safely coordinate patient services with a nearby hospital who does not face similar capacity limitations.  While this may be a necessary step for some hospitals based upon their current capacity challenges, we also urged caution in blanket restrictions on “elective” surgeries to ensure patients continue to have the ability to receive urgently needed care, such as necessary cancer screening tests (mammograms, colonoscopies, etc.) and surgeries that address patient health issues that substantially impact patients’ ability to live without pain and go to work. See the first article below for specific guidance on limiting elective surgeries set forth today by Governor Hochul and the Department of Health. Determinations as to which hospitals are subject to the limitations will be made this Monday 12/6; procedures at these hospitals to be delayed starting on Thursday 12/9.

Earlier this week, the CDC strengthened its recommendation on booster doses to indicate that everyone 18 years of age and older should get a booster shot either 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine. If you are a physician COVID vaccine provider, click here to view Guidance for The New York State COVID-19 Vaccination Program.

Let’s do all we can to encourage our patients to get their vaccinations and boosters so we can all look forward to enjoying a safe and healthy holiday season with family and friends.

Joseph Sellers, MD, FAAP, FACP
MSSNY President

Governor Hochul and DOH Set Forth Guidance for Limiting Elective Surgery at Certain Hospitals
The New York State Department of Health sent a “Dear Administrator” Letter (DAL) today to hospitals across the state detailing the framework when facilities must, upon DOH review and determination, limit non-essential elective procedures and/or implement other actions to coordinate services as determined by DOH to ensure New York State health systems and Impacted Facilities can address potential capacity constraints.  Governor Hochul had announced last week that such restrictions would be forthcoming in response to the big jump in COVID hospitalizations in several regions of the State, and the unknown impact of the Omicron variant.

As noted in our e-news article earlier this week, as part of a meeting with MSSNY President Dr. Joseph Sellers, President-elect Dr. Parag Mehta and Vice-President Dr. Paul Pipia, key health staff to the Hochul Administration indicated that a key goal in implementing such a policy is that it be far more nuanced and limited than previous iterations of elective surgery restrictions. A few of the notable components of the DAL include:

• Determinations of which hospitals will need to restrict elective procedures will be on Monday, December 6, to apply to procedures scheduled to occur on or after Thursday, December 9.

• The restrictions on elective surgeries do not apply to procedures performed at specialty facilities (such as a cancer treatment facility), non-hospital owned ambulatory surgery centers, office-based surgery practices, or free-standing diagnostic and treatment centers.

• The limitations will apply to only those facilities that are in regions of the State considered to be high risk (as defined in the DAL) AND have less than 10% bed availability. While not stated in the DAL, it would appear that those regions currently considered “high risk” are: North Country, Capital District, Mohawk Valley, Finger Lakes and Western New York

• Impacted Facilities may be required to limit non-essential elective procedures at a hospital-owned ambulatory surgery centers if the Impacted Facility has an occupancy of 95% or higher based on the previous 7-day average.

• The following procedures are considered essential, and not subject to the restrictions.
  • Cancer, including diagnostic procedure of suspected cancer
  • Neurosurgery
  • Intractable Pain
  • Highly symptomatic patients
  • Transplants
  • Trauma
  • Cardiac with symptoms
  • Limb threatening vascular procedures
  • Dialysis Vascular Access

Moreover, there is an important “catch all” provision to provide flexibility to physicians and their patients to enable procedures not listed above at these restricted facilities where “Patients are at a clinically high risk of harm if their procedures are not completed”

MSSNY staff is continuing to review this document and will be discussing with allied groups to assess the impact to patient access to needed care. MSSNY will also continue to stay in regular communication with the Governor’s office and the DOH about where patient access gaps exist to ensure necessary flexibility to this policy.

MSSNY Legislative Podcast
Rising COVID Cases, the Omicron Variant & Elective Surgery Restriction Policies

MSSNY Micro Masterclass Webinar:  Submitting Formal Insurer Complaints to the Appropriate Agency
Do you have unresolved claims payment issues with an insurer? Not sure how to pursue a resolution? Settle in with your lunch and join Heather Lopez, Director of MSSNY’s Payment and Practice Division, at 12:15 pm on December 9 for a 15-minute masterclass on filing and following up on insurer complaints. Heather will share information on how to determine the proper agency for the complaint as well as providing contact information for each of the agencies. Please register to join us for the webinar at https://bit.ly/31j1fUt 

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges
The Kaiser Family Foundation released an analysis examining Medicare spending per person for beneficiaries in Medicare Advantage (MA), relative to traditional Medicare. The number of people enrolled in Medicare, along with its spending, has increased since its inception. In the last decade, there has also been a significant increase in MA enrollment – with enrollment doubling in the last decade. Publicly available data from CMS was used in this study. Findings include:

• Medicare spending for MA enrollees was $321 higher per person in 2019 than if enrollees had been covered by traditional Medicare. This difference in spending contributed to an estimated $7 billion in additional spending in the Medicare program in 2019.
• The growth in MA enrollment only explains half of the projected increase in total MA spending between 2021 and 2029, while half is attributable to growth in Medicare payments per MA enrollee (adjusting for inflation).
• Using Medicare Payment Advisory Commission protections and recommendations for MA plan payments could save $82 billion between 2021 and 2029. If Medicare payments for MA plans grew at the same rate as is projected for traditional Medicare spending (per person), total Medicare spending would be $183 billion lower between 2021 and 2029.

More Than Half of Global Telehealth Providers Have Patients Who Declined Telehealth Over Privacy, Data Concerns, Survey Says
mHealth Intelligence reports that while “the popularity of telehealth has grown over the course of the COVID-19 pandemic,” 52% of “global telehealth providers have experienced cases where patients refused to participate in a virtual visit either because they do not trust the technology or due to privacy or data concerns, according to” a new Kaspersky survey (PDF).

In addition, clinicians “have concerns, with 81 percent saying that they are uncertain about how patient data will be used and shared from these virtual sessions. They also expressed concerns about data security and the personal penalties that may arise if data is leaked.”

Obituaries
BAYARRI, Vincent; White Plains NY. Died September 18, 2021, age 94. Suffolk County Medical Society
BROWN, Howard Raymond; Williamsburg VA. Died August 25, 2021, age 88. New York County Medical Society
CUTLER, Leonard; Pittsboro NC. Died September 15, 2021, age 92. Medical Society County of Westchester
CUTROFELLO, Paul Joseph; Jamaica NY. Died July 24, 2021, age 88. Medical Society County of Queens
DAVIS, Paul Harvey; Staten Island NY. Died May 15, 2021, age 82. Richmond County Medical Society
DREYER, Ronald William; Scarsdale NY. Died November 18, 2020, age 92. Medical Society County of Rockland
FRIEDMAN, Norman Elliot; Scarsdale NY. Died November 07, 2020, age 91. Medical Society County of Westchester
GOLDMAN, Mitchell Barry; Oakdale NY. Died April 19, 2020, age 88. Suffolk County Medical Society
HEITZMAN, E. Robert Jr.; Syracuse NY. Died November 04, 2020, age 93. Onondaga County Medical Society
KATYAL, Inderjit; Medford NY. Died September 14, 2021, age 84. Suffolk County Medical Society
KORMAN, Elise H.; Moorestown NJ. Died August 17, 2021, age 84. Suffolk County Medical Society
MENDELOW, Joseph; Boca Raton FL. Died May 11, 2020, age 92. Erie County Medical Society
MUCCIA, John Richard; Liberty NY. Died October 03, 2019, age 78. Medical Society County of Sullivan
UEHLBAUER, Peter F.; Somers NY. Died November 09, 2020, age 81. Medical Society County of Westchester
NAUMANN, Ronald A.; Hilton Head Island SC. Died May 04, 2021, age 86. Onondaga County Medical Society
PARKER, Albert Cushman; Port Chester NY. Died July 11, 2021, age 88. Medical Society County of Westchester
PRIEBE, Cedric Joseph Jr.; East Setauket NY. Died January 19, 2019, age 88. Suffolk County Medical Society
RESZEL, Thaddeus F.; Massena NY. Died September 20, 2018, age 90. Medical Society County of St. Lawrence
SHAPIRO, Robert T.; Smithtown NY. Died August 20, 2020, age 82. Suffolk County Medical Society
WANLASS, Stanley A.; Columbus NC. Died January 06, 2012, age 89. Medical Society County of Westchester
WEI, Wen-Chen; New Hartford NY. Died November 21, 2021, age 87. Medical Society County of Oneida
WEIR, William H. Jr.; Wading River NY. Died June 22, 2017, age 87. Suffolk County Medical Society

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

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MSSNY Physician Leadership Meets with Governor Hochul’s Team to Discuss Elective Surgery Limitations
MSSNY physician leaders and staff met with top officials to Governor Hochul this week to discuss aspects of her recent emergency order that will give the NYS Department of Health the authority to limit elective procedures at hospitals that have less than 10% bed capacity.

MSSNY President Dr. Joseph Sellers, President-Elect Dr. Parag Mehta, and Vice-President Dr. Paul Pipia emphasized MSSNY’s ongoing strong support for Governor Hochul’s efforts to ensure that all health care workers be vaccinated against COVID and offered the physician community’s assistance to help tackle the enormous challenges facing our healthcare system currently due to rising COVID hospitalizations across the State. At the same time, they urged caution in restrictions on “elective” surgeries to ensure that such restrictions do not unduly interfere with patients’ ability to receive urgently needed care, such as necessary cancer screening tests (mammograms, colonoscopies, etc.) and surgeries that address patient health issues that substantially impact patients’ ability to live without pain and go to work.

The elective procedure limitations will begin on Friday December 3 and be re-evaluated by January 15. They will be implemented on a hospital-by-hospital basis, not based on cumulative numbers in the county or the region of the State. Hospitals with less than 10% bed capacity could be able to continue to perform elective procedures if patients can be safely moved and/or directed to other facilities not facing similar bed capacity limitations.  As of now, 37 facilities across the State, mostly in Western NY, Central NY, the Mohawk Valley and the Capital Region have reached the threshold of less than 10% bed capacity and some of these facilities have already paused elective procedures.

As of this writing, it is unclear how the restrictions on elective procedures could apply to procedures to be performed at ambulatory surgery centers that are part of health systems containing hospitals facing these capacity limitations. The NYS DOH is developing a document that will set forth how the elective procedure limitations would be implemented in hospital systems, as well as the medical procedures that will be subject to these limitations. MSSNY will share that information with our members when it becomes available.

MSSNY Welcomes Mary Bassett, MD, MPH  as NYS Department of Health Commissioner
MSSNY sent the following statement to the press today:

Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York

“MSSNY extends a warm welcome to Dr. Mary Bassett as she begins her tenure today as New York State’s Health Commissioner. Our member physicians look forward to working closely with Dr. Bassett to address the health needs of all New Yorkers.

“Dr. Bassett joins New York State at a uniquely challenging time in history and we are confident that her wealth of knowledge and experience in the field of public health will help her to guide New Yorkers through to the end of the COVID-19 pandemic—and future public health challenges.

“During her years as commissioner of the NYC Department of Health and Mental Hygiene, Dr. Bassett worked to tackle racial, ethnic, and economic health inequities. We look forward to working with her to address those needs throughout the State in our shared fight for quality, accessible, and affordable health care for all New Yorkers.”

Health Equity from an Actuarial Perspective
The American Academy of Actuaries published a discussion brief exploring if and how methodologies or approaches actuaries use to develop financial models and identify physicians for network participation may contribute to health disparities. Health plans contract with physicians and other health care providers to develop networks to serve their members.

These contracts establish a health plan’s reimbursement for services and other terms of network participation. However, these methodologies do not typically account for physicians’ patient mix, putting physicians who treat high risk patients at a disadvantage. This thoughtful report on how these methodologies for evaluating reimbursement levels and network participation may impact health equity or health care disparities focuses on the following areas/questions:

• How do overall health plan spending goals or other outcome goals and considerations affect network development and physician contracting, and do they have effects on access to care and health disparities?
• How do alternative payment models (APMs) and cost targets for risk-bearing contracts affect physician incentives and disparities in health care access and outcomes?
• Are quality provisions and outcome measures in APM contracts aligned with achieving equitable health outcomes?
• How do the risk adjustment methods used in physician
  contracting and network development affect access to care outcomes?

Patients to be Held Harmless for Inaccurate Health Plan Provider Directories
Reliance on inaccurate information provided in a health insurer’s provider directory would become a basis for a patient to receive protection from out of network bills under New York’s surprise bill law, pursuant a regulation recently proposed by the New York Department of Financial Services. Payment for care in those instances would be determined through New York’s Independent Dispute Resolution process.

The regulation will help to conform New York’s law to the provisions of the federal No Surprises Act enacted by Congress last December and which takes effect in January. It requires health plans to ensure provider directories are current and accurate, with regular verification of provider contract status and updates required at least once every 90 days, and for the updated information to be posted within 2 business days of the receipt of the information. The federal NSA law also requires a health care provider to have a process in place to provide updated practice information to the health plan to help ensure that the health plan’s provider directory information remains accurate. No Surprises Act: Three Ways to Address New Provider Directory Requirements – Healthcare Business Today.

For more information regarding other important new requirements physicians need to be aware of regarding the implementation of the NSA, please review our e-news article from November 19.

MSSNY Micro Masterclass Webinar:  Submitting Formal Insurer Complaints to the Appropriate Agency
Do you have unresolved claims payment issues with an insurer? Not sure how to pursue a resolution? Settle in with your lunch and join Heather Lopez, Director of MSSNY’s Payment and Practice Division, at 12:15 pm on December 9 for a 15-minute masterclass on filing and following up on insurer complaints.

Heather will share information on how to determine the proper agency for the complaint as well as providing contact information for each of the agencies. Please register to join us for the webinar at https://bit.ly/31j1fUt.

MSSNY Tip of the Week: Current Guidance on Medicare Revalidation Process
Medicare revalidation is due every 5 years and there are multiple scenarios that can influence how yours is processed. Click here to view the most current information from the CMS manual to ensure you are following guidelines to help save time.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | hlopez@mssny.org.

Guidance for Physicians: CDC Recommends COVID Boosters for 18 and Older
On November 29, 2021, the CDC strengthened its recommendation on booster doses to indicate that everyone 18 years of age and older should get a booster shot either 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine. Click here to view Guidance for The New York State COVID-19 Vaccination Program.

Vaccinations and boosters continue to protect and are critical to enjoying a safe and healthy holiday season with family and friends. New Yorkers are strongly encouraged to get vaccinated to help prevent the spread of the deadly COVID-19 virus.

Contact Your Representatives of Congress to Prevent Staggering Medicare Cuts in 2022
Physicians are just 31 days away from a disastrous 10% Medicare payment cut unless Congress acts to stop this cut. Please contact Senators Schumer, Senator Gillibrand and your Congressional Representative today. Tell Congress to cancel Medicare cuts today!

The 2022 Medicare payment rule reduces the conversion factor by approximately 3.75% resulting from the expiration of an increase to the conversion factor enacted by Congress last December. In addition, there is a 2% cut resulting from the scheduled re-implementation of the previously delayed Medicare sequester provisions, and imposition of a 4% Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act.

Earlier this fall, Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) circulated a “Dear Colleague” letter highlighting the financial uncertainty within the Medicare payment system and the dangers facing patient care if Congress fails to enact legislation to prevent this staggering cut. Within a matter of weeks 245 of their colleagues showed their support for fixing the problem of these extreme Medicare cuts by co-signing the letter, including many of the members of the New York Congressional delegation. This strongly supported letter was an important advocacy building block towards stopping these cuts, but we need our Representatives to strongly push leadership to ensure that funding to prevent these cuts is included in a year end package.

Please urge Congress to act to protect care for our seniors! Tell Congress to cancel Medicare cuts today!

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