MSSNY eNews: April 29, 2022

Message from MSSNY President Dr Joseph Sellers:
Measles Cases on the Rise Worldwide

Colleagues:
This week, UNICEF and WHO warned of a “perfect storm” of conditions for measles outbreaks in children. As physicians, we know—and as I told Fox News in an interview—the concern is that when measles cases rise, we worry not only about measles outbreaks. I explained to the reporter that physicians worry that the children who are not vaccinated against measles are likely not vaccinated against other childhood illnesses as well. Measles—which is so contagious—is the first sign of an under-vaccinated population.

The UNICEF and WHO report is concerning indeed. Worldwide measles cases increased by 79 percent in the first two months of 2022, compared to the same period in 2021. Almost 17,338 measles cases were reported worldwide in January and February 2022, compared to 9,665 during the first two months of 2021.

There are so many contributing factors to this situation, including pandemic-related disruptions and increasing inequalities in access to vaccines. In addition, conflicts and crises around the world that cause disruptions in immunizations and lack of clean water and sanitation increase the risk of vaccine-preventable disease outbreaks.

MSSNY has been a leader in immunization campaigns and is a strong proponent of individual vaccinations in both children and adults. Vaccination has been—and continues to be—the most important public health measure of our lifetime.

Joseph Sellers, MD, FAAP, FACP
MSSNY President

Hassles with Insurance Companies? MSSNY’s Director of Physician Practice and Payment Can Help!
Following is a note we received recently from a member:
Twice over the past few months I have asked MSSNY’s Director of Physician Payment and Practice Heather Lopez for help resolving issues that my staff and I were unable to resolve on our own.  The first was regarding my need to get clarification of an ambiguous general billing policy of an insurance company, which she was able to get the answer for me rather quickly.  The second problem she solved for me was a miracle.  For over a year now, my staff and I have been fighting an insurance company, which denied payment for a rendered service for a reason that was completely unfair, but despite all our arguments and pleas, we could not get the insurance company to reverse their non-payment decision.  I contacted Ms. Lopez about this case and she went to work on it promptly and got the insurance company to reverse their decision and make payment to me—all within a month. 

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

Do You Have Unanswered Questions for CMS? Join Open Forum
On the second Tuesday of each month, CMS holds a monthly call for physicians—an opportunity to bring your questions to an open forum. The next call is Tuesday, May 10 at 6 pm.

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MSSNY Member’s Letter to the Editor Published in Wall Street Journal
Ms. Finley’s op-ed (California’s Medical ‘Misinformation’ Crusade Could Cost Lives)  understates the danger of California’s legislation. Every innovation in medicine goes against existing standards of care. Today’s standard becomes substandard as new treatments develop. Medicine progresses when doctors have the freedom to practice their profession without interference from political agendas.

In my field of ophthalmology, millions of patients undergo the implantation of an intraocular lens. These surgeries often result in better vision than patients had before developing their cataracts. Yet until the mid-1970s, inserting a foreign body inside the human eye was considered well outside the standard of care. Without innovative surgeons willing to go against accepted thinking, patients would not have benefited from these lenses.

Any proposed law against innovation will end progress. California’s law must be defeated.

Michael T. Goldstein, M.D.

Senate Insurance Committee Advances Three Bills to Increase Patient Access
At its most recent committee meeting on Monday, April 25^th, the Senate Insurance Committee reported to the Senate floor three bills strongly supported by MSSNY that will remove barriers and increase patient access to the most appropriate treatment.

The first, S.8299 (Breslin)/A.9908-A (McDonald), establishes a “Gold Card” program in which physicians, and other care providers will be exempted from Prior Authorization requirements from a health insurer for a specific health care treatment if they receive at least 90% approval for their prior authorizations for that treatment. The legislation is similar to a law enacted last year in Texas, which was designed to prevent unnecessary roadblocks to patient care and reward the following of evidence-based treatment guidelines.  Physicians are urged to a letter in support here: Take Action (p2a.co)

The second bill S.5299 (Rivera)/A.1741 (Gottfried) prohibits insurers from preventing patients from using a copay card or coupon to cover count towards their out-of-pocket deductibles.  Many patients rely on financial assistance programs, such as a copay coupon or card, to reduce the cost of their medication. However, insurers are employing this new tactic to undermine these financial assistance programs by preventing their application towards meeting the enormous deductibles patients face. Physicians can send a letter in support here: Take action!

The third bill, S.5909 (Kaminsky)/A.3276 (Gunther), would exempt mental health medications from health insurer step therapy requirements.

Physician Associations Team Together to  Advocate that Medical Residents and Fellows Are Eligible for Bonuses
MSSNY is working together with several specialty societies and medical residents to urge the Commissioner of Health to exercise her discretionary authority to ensure that physician residents and fellows are deemed eligible for the frontline health care worker bonuses established as part of the recently enacted State Budget.  A letter and tweet in support can be sent from the MSSNY Grassroots Action Site here: Allow Residents and Fellows to be Eligible for Frontline Healthcare Worker Bonuses (p2a.co)

The issue arises from the fact that the State Budget included a provision that funds one-time bonus payments of up to $3,000 for front line health care workers employed by hospitals and certain other Medicaid enrolled health care providers, who have a base salary of less than $125,000, and have worked for 6 months straight for one employer during the “vesting” period.  It included several types of health care job titles, but importantly also gave discretion to the Commissioner to add additional job titles.

As a result, several thousand medical residents across the State of New York joined in a communication to Governor Hochul asking for their inclusion in the bonus pool.

MSSNY also joined together with several specialty societies in submitting a letter to Commissioner of Health Dr. Mary Bassett stating that the lack of express inclusion of residents and fellows in the bonus pool is inconsistent with the stated goal of the bonuses.  In urging the Commissioner to include residents and follows, the letter notes the Legislature’s intent that the bonuses apply generally to all members of the health care workforce who “…have seen us through a once–in–a–century public health crisis and turned our state into a model for battling and beating COVID–19.  To attract talented people into the profession at a time of such significant strain while also retaining those who have been working so tirelessly these past two years, we must recognize the efforts of our health care and mental hygiene workforce and reward them financially for their service…”

Please remain alert for further updates on this important issue.

Several Categories of Physician Medicaid Fees Being Increased Starting July 1
Physician Medicaid fees for Evaluation & Management and Medicine CPT codes will be increased to 70% of Medicare, for services July 1, 2022, and after, as announced by the NYS Department of Health during a webinar this week detailing changes enacted in the. While this is low when compared to the growth in the costs of delivering patient care, many of these patient services provided by physicians are currently paid at below 50% of Medicare.

As part of the webinar, the DOH also announced that the enacted Budget  removed the requirement for physicians and other care providers to request DOH to increase beneficiary benefit limits.  DOH indicated the reason for the change was to reduce some of the administrative burdens that physicians and other care providers have with the Medicaid program.

The DOH webinar also discussed several other important changes arising from the recently enacted State Budget, including expanded eligibility for the State Essential Plan and increasing eligibility for no-cost Child Health Insurance Plus coverage.

Numerous Physician Mandate Bills Under Consideration in the Final Weeks of Session
As we head into the final 5 weeks of the legislative session, there are numerous bills under active consideration in the Senate and Assembly that would impose requirements on physicians (and other providers) delivering care to their patients, in addition to the other countless mandates on medical practice in New York.  MSSNY has been working together with the affected specialty societies to highlights its concerns to the Legislature that, while each of these proposals may have good intentions, in totality they are creating significant new documentation requirements that place the physician’s licensure in jeopardy if there is an instance where they fail to document that they completed a task.  This could have a significant impact on decisions made by physicians including whether or not to practice in New York. Some of these bills include:

• 67/A.3298 – Would require physicians treating a patient for epilepsy to provide information regarding the risk of Sudden Unexpected Death in Epilepsy.
• 213/A.1615 – Would require physicians to obtain the school attended by their pediatric patients.
• 2521-C/A.3470-C – Would require employed health care providers to disclose if their employer health system is charging a facility fee.
• 2736/A.217 – Requires physicians and other maternal care providers to provide information to pregnant patients with information regarding the risks of a caesarean section to patients scheduled to have a C-section.
• 4640/A.273 – Would require physicians and other care providers to document that they considered and discussed numerous alternatives to opioid treatment prior to writing an opioid prescription for a patient.
• 6287-B/A.7560-A – Would require O-GYNs to provide information to their pregnant patients regarding the risks of cytomegalovirus (CMV).
• 7865/A.5976-A – Would require physicians and other maternal care providers providing pre- and post-natal care or pediatric care to invite the mother to fill out a questionnaire to detect maternal depression.
• 8455/A.9380 – Requires physicians and other maternal care providers to provide information to patients about the potential consequences of an episiotomy.

Please remain alert for further updates on these issues.

MSSNY, Family Physicians Raise Concerns with Legislation to Permit PAs to Directly Bill Medicaid Managed Care
MSSNY, the  NYS Academy of Family Physicians, and the NY Chapter of the American College of Physicians have written to the NYS Assembly to raise strong objections with legislation that would permit physician assistants (PAs) to be designated as a primary care practitioner under Medicaid Managed Care.  While the bill does not in and of itself change statutory supervision requirements for PAs, it would potentially give them the ability to directly bill insurers for patient health care services, despite the fact that PAs typically practice as an employee in a hospital or in a physician practice.  Since PAs do not practice independently, they should not be allowed to bill an insurance company independently from their employer.

The bill advanced from the Assembly Ways & Means Committee to the Assembly floor this week.  The legislation passed the State Senate earlier this session.  Physicians can send a letter to their
Assembly members Preserve Physician-led, Team-based Healthcare (p2a.co) to express concerns with legislation (A.6056/S.5956).

While they are essential components of the health care team, including in the delivery of primary care, PAs are not authorized under law to practice without physician supervision. Current executive orders have provided for a temporary waiver of some supervision requirements (which MSSNY has strongly opposed).  However, the goal of these EO provisions was to provide greater flexibility in hospitals for the management of excess patient load due to COVID-19, not to provide independent practice on a permanent basis.

In its memo, MSSNY raised concerns that this legislation was creating a potential pathway for PAs to practice independently without physician oversight, which has been rejected in numerous states because of the need to protect physician-led team-based care for patients.  Furthermore, numerous studies have shown that advanced care practitioners provide more costly care, including.

MSSNY Raises Concerns with Legislation to Require Health Care Employee Disclosure of Health System Facility Fees
Last year, legislation which would have required hospitals and hospital-based physicians to submit consolidated bills was significantly revised to delete this very concerning provision.  This was a significant development, as MSSNY together with several other specialty societies, had raised significant concerns to the Senate and Assembly that this joint billing requirement would have put non-employed physicians at the mercy of the hospitals since the legislation does not specify how payments to hospitals from this “single bill” would then be distributed to these physicians.

This week, the pared-down legislation (S.2521-C/A.3470-C) was reported from the Senate Health Committee to the Senate floor.  This version would require a health care provider who enters into “a business relationship with a hospital or health system that will result in the provider’s patients being subject to facility fees”, to notify its patients of the change and that facility fees will now be applicable to services received from the health care provider. MSSNY, together with several specialty societies, submitted a letter raising concerns with this revised legislation, urging that this disclosure requirement should be placed on the health system charging the facility fee, instead of the physician providing the service.  The letter notes the concern is that these types of charges imposed by a health system are often not known by the physician employee delivering patient care.  

NYS Department of Health Updates County Health Indicators by Race and Ethnicity
The NYS Department of Health has announced updates to  three major dashboard applications, as well as the County Health Indicators by Race and Ethnicity and the County Perinatal Data Profiles. These resources present data at the state, county, and sub-county level where available. They  mark the completion of updates for county-level dashboards and resources intended to assist in planning and use for the current round of County Health Assessments.

The County Health Indicators by Race/Ethnicity (CHIRE):
These tables use the most recent data from NYS Vital Statistics, SPARCS and the Cancer Registry, and from the US Census, to present 46 indicators about general population description, birth, death, hospitalization, and cancer, by race/ethnicity, for New York State, New York City, and for each county. Each region and county have their own set of tables.

The Leading Causes of Death Dashboard: 
NYS vital statistics data was used to produce ten-year trends of deaths and death rates for leading causes of death and leading causes of premature death, in New York State, New York City, and in counties. For the state, data is  available by gender, age and race/ethnicity. For the regions, data is  available by gender and age. For the counties, data is available by gender. The dashboard also includes ten-year trends in life expectancy, for the state by gender.

The Maternal and Child Health dashboard:
Federal and statewide data systems were analyzed to update maternal, infant, child, and

adolescent health at the state and county-level, on the Maternal and Child Health dashboard. This dashboard is an interactive visual presentation of indicators tracking maternal, infant, and child health data at state and county levels. The state dashboard homepage displays a quick view of the most current data for 41 indicators and compares them with data from previous time periods to assess progress. State level historical (trend) data can be easily accessed, and data for many state level indicators is  also available by socio-economic status. County data (maps, tables and bar and trend charts) is  also available for 13 indicators.

The Asthma Control Program Data Dashboard:
The state asthma dashboard homepage displays a quick view of the most currently available data as compared to the previous year for the 40 tracking indicators. It provides users with easily accessible historical (trend) data, drill-down data to county and sub-county (ZIP code) levels, and visualizations for major socio-demographic factors (e.g., age group, race/ethnicity, sex, region, income, education). Each of the 62 counties have

their own dashboard with data for 31 indicators, including sub-county (ZIP code) level data for 8 indicators.

An export tab has been added to easily output data at the state, county, and subcounty levels, and by demographic group.

The County/ZIP Code Perinatal Data Profiles:
Vital statistics data from a three-year period is  used to produce ZIP Code based tables of commonly requested perinatal data, such as total births, premature births, low birth weight births, births to unmarried parents, infant deaths, teen birth, and pregnancy rates. The tables are available for the state, regions, county, and ZIP Codes within each county. NYSDOH has worked diligently to update and improve these applications and resources, which make data easily accessible to program partners, practitioners, health officials, and the public. Please direct questions and requests for additional information to phiginfo@health.ny.gov.

NYS Arthritis Program to Host Webinar on Improving Arthritis Management
The NYS Department of Health Arthritis Program will conduct a webinar, “Prescribing Physical Activity to Improve Arthritis Management” on Monday, May 9, 2022 from 9-10 a.m. The webinar can be viewed at https://livestream.com/wmht/phl0509. Handouts and the link for the evaluation and post-test for continuing education credits are located at the School of Public Health website.  Email coned@albany.edu or call 518-402-0330 if assistance is needed.

Join MSSNY in Kicking Off Wellness
MSSNY will be hosting a series of physician wellness webinars covering various topics within the realm of wellness over the next few months.
Women in Medicine 2022: Up the Down Staircase: May 20, 8:40-9:40am
Carol Bernstein, MD will serve as faculty. Register now!

Educational objectives:

• Identify significant stressors contributing to burnout as they specifically impact women physicians in the era of Covid.
• Increase knowledge of potential strategies that can be used to support women physicians, especially when working in dynamically changing and stressful clinical environments.
• Identify potential systemic solutions as well as practical techniques that promote growth and resilience in women physicians.

Additional information or assistance with registration may be obtained by contacting Cayla Lauder at clauder@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.

Peer to Peer (P2P) Program
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. With the advent of the COVID-19 pandemic, some of the emotional issues related to this event, may also be troubling for our colleagues.

MSSNY has established a confidential helpline phone number (1-844-P2P-PEER) and an email address (p2p@mssny.org) so that physicians may be connected with a peer24/7 . 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!

A training session to become a peer supporter will be scheduled for the coming month. If you wish to become a trained peer supporter, please reach out to Cayla Lauder, MPH, Public Health Associate, at clauder@mssny.org.

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

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 RateSheet, please click here.

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 medicineunder 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.