MSSNY eNews: April 30, 2021 – The Passing of the Baton

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Colleagues:

This week’s column will be my last as MSSNY President. I would like to take this opportunity to say thank you to all of you for all you have done to further our profession, for all the sacrifices you have made in order to care for your patients, and for all your heroic efforts to pull this country out of the greatest public health crisis in a century.

Every MSSNY committee this year was active and exceedingly productive.  Thanks to the strong leadership of our committee chairs, our dedicated MSSNY staff and the selfless, hard work of our committee members as well as our MSSNY officers, councilors, and Board of Trustees we have together made tremendous strides forward.  We have enacted our P2P peer program to support one another in times of stress, launched the Practice Transformation Initiative to get at the root cause of physician burnout and demoralization and provided webinars/guidance and advocacy on all things COVID from treatment, testing, reopening and funding, to vaccines.

We listened closely and worked quickly to find solutions to problems such a lack of PPE and cost prohibitive PPE (with sourcing where we could and partnering wherever possible) and a long-term answer through a new MSSNY Member benefit option with the Group Purchasing Organization, Premier Inc. Our telehealth committee leaped into action at the start of the pandemic with “how to” YouTube videos and ultimately a new MSSNY Member benefit through CareClix that offers the option of remote patient monitoring.

This year we faced an Executive Budget like none that I can remember. Proposals included a cut to funding for MSSNY’s Committee on Physician Health, provisions that threatened physician due process within the Office of Professional Medical Conduct, cost shifting to physicians for funding of the excess medical malpractice fund, scope of practice expansion for non-physicians, and more.  However, thanks to the great work of MSSNY’s legislative team and to all of you that heeded our calls to Grassroots action, the detrimental provisions nearly across the board were not enacted. Here is the detailed summary.

This year marks the retirement of some of our long-time MSSNY staff, our EVP Philip Schuh, our MSSNY Membership VP Eunice Skelly, our MSSNY Communications VP Christina Southard and our Sociomedical Economics VP Regina McNally.  Their contributions to our organization and the field of medicine are enormous and we owe them a debt of gratitude and wish them well in retirement.  They have set the stage for our new EVP, Troy Oechsner who has hit the ground running to move us forward.

Our MSSNY Office of the President guides our organization from day-to-day and this year’s physician team was extraordinary.  Those exiting the Office of the President, MSSNY Immediate Past President Dr. Arthur Fougner and MSSNY BOT Chair Dr. Andrew Kleinman, have contributed greatly to the success of our organization. I treasure their friendship and cannot thank them enough for their leadership and mentorship.

In the game of life, our MSSNY is set up as a relay and not an individual event.  Every year we get stronger and more effective as we learn from the past and add brainpower to the team. It is with forward momentum that I pass the baton to my good friend, the charismatic and dynamic Dr. Joseph Sellers, who I have every confidence will take us to and through our next milestones.

Thank you all for the honor and a privilege of serving as MSSNY President.

Bonnie Litvack, MD
MSSNY President

MSSNY Weekly Podcast

Assembly and Senate Advance Key Patient Prescription Coverage Bills
The New York State Senate passed important patient protection legislation (S.4111, Breslin) this week that would significantly restrict the ability of healthcare plans to move a prescription medication to a higher-cost tier on a formulary during the enrollment year.  The same-as legislation (A.4668, People-Stokes) was also advanced this week from the Assembly Insurance Committee to the Ways & Means Committee.  MSSNY has worked with several patient and physician advocacy groups to support this legislation.

Importantly, the legislation has been revised from a version that was passed by the State Legislature in 2019 but vetoed by the Governor.  These new provisions would permit an insurer in some instances to revise a formulary during the contract year provided that such formulary revision would not be applicable to a patient already using the medication subject to the formulary change or diagnosed with a condition that is treated by the medication subject to the formulary change.

Also, this week the Assembly Insurance Committee advanced to the floor legislation (A.1741, Gottfried) that would require financial assistance from third parties to count towards a patient’s deductible or out of pocket maximum requirements imposed by a health insurer.  The same-as legislation (S.5299, Rivera) is also on the floor of the State Senate.  MSSNY has signed on to a letter with nearly 50 other patient and physician advocacy organizations in support of this legislation. (AUSTER, CARY)

Prior Authorization Reform Legislation Re-Introduced
Assembly Health Committee Chair Richard Gottfried and Senate Insurance Committee Chair Neil Breslin introduced legislation this week (A.7129 and S.6435) that would enact a number of reforms to address prior authorization hassles impacting patient care.  These proposed changes would: limit the ability of a health insurer to require a physician and patient to repeat a previously obtained prior authorization, require that health insurer utilization review criteria be evidence-based and peer-reviewed; and reduce the time frames for an insurer to respond to a request for prior authorization.

According to a recent survey from the American Medical Association, almost 70% of 1,000 practicing physicians surveyed in Dec. 2020 reported that health insurers had either reverted to past prior authorizations policies or never relaxed these policies in the first place. More than nine in 10 physicians (94%) reported care delays while waiting for health insurers to authorize necessary care, and nearly one-third (30%) of physicians reported that prior authorization requirements have led to a serious adverse event for a patient in their care.       (AUSTER, CARY)           

NYS DOH Guidance for New York State COVID-19 Vaccination Program
The NYS Department of Health has issued guidance this past week that all individuals that reside, study, or work in New York 16 years of age and older are eligible to be vaccinated in New York State. The guidance also allows all providers enrolled in the NYS vaccine program to vaccinate any eligible individual.

Effective April 19, Executive Order 202.102 eliminated the enhanced civil penalty for failure of a provider to administer its allocated COVID-19 vaccine within seven days of receipt.

The elimination of this enhanced penalty is intended to give all providers flexibility in scheduling vaccination appointments if they need more than seven days to use a vaccine allocation. This flexibility is being given to providers at a time where the State has vaccinated more than half the adult population with at least one dose and demand for the vaccine begins to steady. All vaccine providers in New York State, including those located in the City of New York and those participating in federal programs, must follow New York State Department of Health (NYSDOH) guidance and directives, including the requirement to report to the NYS COVID-Vaccine Tracker on Mondays and Thursdays.

Read more on New York State COVID-19 Vaccination Program               (CLANCY)

US Department of Health and Human Services Eases Restrictions on Buprenorphine Prescribing
This week, the US Department of Health and Humans Services issued new guidelines to make it easier for physicians and other health care health-care practitioners to prescribe the drug buprenorphine to treat opioid addiction and will automatically allow various clinicians to administer the MAT drug buprenorphine to up to 30 patients at a time. Eligible practitioners include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives who are licensed under state law and possess a valid DEA registration.

The new requirements ensure that physicians will not have to complete extra hours of training in order to be able to administer buprenorphine, potentially expanding the number of MAT prescribers nationwide and making it easier for people to access the gold-standard OUD treatment.  The American Medical Association’s Opioid Task Force last year encouraged that HHS take steps to eliminate and ease the barriers to patients’ access to buprenorphine.   MSSNY is a member of the AMA’s Opioid Task Force and is represented on the task force by Frank Dowling, MD and Pat Clancy, Sr. VP for MSSNY’s Public Health and Education Division.  A copy of the statement by the AMA Opioid Task Force can be found here: AMA Statement  A copy of the guidelines can be found here: Guidelines (CLANCY)

Please Contact Your Legislators to Urge Revisions to “Consolidated Billing” Legislation
Physicians should continue to contact their Assembly members and Senators to urge them to substantially revise A.3470-A/S.2521-A, “The Patient Medical Debt Reduction Act”. Click here to contact your legislators today! Click Here.

The bill is currently in the Assembly Ways & Means Committee, and the Senate Health Committee.  While there are many components to this well-intended legislation, there is a seriously problematic component which would prohibit a physician with a “financial or contractual relationship” with a hospital from separately billing a patient for a course or episode of treatment in the hospital.

While it doesn’t appear to prohibit continued separate billing to insurance companies or other payers, a single hospital-physician bill would be required when a bill is sent to a patient for costs not covered by the patient’s insurance, such as collection of a deductible. It would also require such consolidated bill to be sent within 7 days of a patient’s discharge from the hospital, before there is any clarity as to what expenses will actually be covered by a patient’s insurance.

If this bill were to pass and this provision not amended, it would put these non-employed physicians at the complete mercy of the hospitals where they practice since the legislation does not specify how payments to hospitals from this “single bill” would then be distributed to these physicians.  What would happen if only partial payments were made?  How can a physician verify what payments were received by the hospital?  Would complaints about the payment process from the hospital to the physician place the physician at risk of losing hospital privileges?  In an era when patients’ insurance policies regularly impose enormous deductibles, it would likely force even more physicians to sell their practices and become employees of hospitals in response to the helpless position many physicians would find themselves.  Other physicians may leave the state altogether.  The impact of this prohibition will fall most adversely on physicians who are on the front lines of the pandemic, many of whom are facing an enormous drop in patient volume due to a significant amount of delayed care.

In an effort to address one concern with our health care system, a whole new problem affecting patient access to necessary specialized care could be created.  Please urge your legislators to make necessary revisions to this bill.            (AUSTER)

Food and Drug Administration to Issue Rule Banning Menthol Cigarettes
The Food and Drug Administration (FDA) announced that it will promulgate a rule banning menthol cigarettes.  This action came in response to a Citizen Petition submitted to the agency in 2013 by nineteen public health organizations, including the American Medical Association.  The FDA’s response to the petition was prompted by a lawsuit filed by the African American Tobacco Control Leadership Council (AATCLC), Action on Smoking and Health (ASH), the American Medical Association (AMA), and the National Medical Association (NMA).

It is expected that the Food and Drug Administration will seek to ban menthol and other flavors in mass-produced cigars, including small cigars popular with young people. Public health advocates, including the Medical Society of the State of New York, have long sought the removal of “menthol” flavored tobacco products.  A copy of the statement Action on Smoking and Health (ASH) can be found here.      (CLANCY)

Registration Now Open – Veterans Matters CME: Substance Use Disorders (SUDs) in Veterans Webinar

Wednesday, May 12^th @ 7:30 am

The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: Substance Use Disorders (SUDs) in Veterans live webinar on Wednesday, May 12, 2021 at 7:30 am.

Click HERE to register for the program! View the program flyer HERE

When:                 May 12, 2021 at 7:30 am
Faculty:               Thomas Madejski, MD 

Educational Objectives:

• Identify Substance Use Disorders (SUDs) in veterans
• Discuss evidence-based psychosocial strategies to treat veterans with SUDs
• Discuss Medication Assisted Treatment (MAT) for veterans with alcohol or opioid use disorders
• Identify barriers to diagnosis and treatment of SUDs in veterans and methods to overcome them  

For more information, contact Jangmu Sherpa at jsherpa@mssny.org or call (518) 465-8085

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             (SHERPA)

MSSNY Announces New Podcast Episodes on COVID Pandemic
MSSNY has recently published three new podcasts related to the COVID pandemic.

Newly added: Mental Health of Patients & COVID-19 offers a discussion with Dr. Craig Katz, co-vice-chair of MSSNY’s

Committee on Emergency Preparedness and Disaster/Terrorism Response, on the mental health impact the COVID pandemic has had on patients.  Click here to listen.

How to Talk to Patients About Vaccine Hesitancy includes a discussion on the history of vaccine hesitancy and offers sage advice from Dr. William Valenti to listeners on talking to vaccine hesitant patients.  Listen to this podcast by clicking here.

A Discussion on COVID Vaccine for Patients is MSSNY President, Dr. Bonnie Litvack, President-elect, Dr. Joseph Sellers and Dr. William Valenti, Chair of MSSNY’s Committee on Infectious Diseases discussing vaccines currently available for COVID-19. This podcast answers many questions patients may have about the vaccines.  Tell your patients to go to -Discussion on COVID Vaccine to listen.

Click here to select from all 100+ of MSSNY’s podcasts: https://www.buzzsprout.com/51522                                     (HOFFMAN)

MSSNY’s Physician Wellness and Resiliency Committee: Peer to Peer Program
If you or someone you know is struggling with everyday life stressors, reach out to the P2P program to be connected with a peer supporter to help! 

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

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 peer 24 hours a day/7 days a week. 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!          (LAUDER)

MSSNY Medical Matters Program on Triage in a Disaster Event – May 26

Registration now open
Medical Matters: Triage in a Disaster Event
Date: May 26, 2021 @ 7:30am

There have been innumerable disaster events taking place all around us on a regular basis.  Learn more about how to perform triage when you find yourself in proximity to different types of disaster by registering for Medical Matters: Triage in a Disaster Event.  This webinar will take place on Wednesday May 26^th at 7:30am.  Arthur Cooper, MD and Zackary Hickman, MD will serve as faculty for this program.  Click here to register for this webinar.

Educational objectives

• Describe the importance of immediate bleeding suppression during a disaster event
• Describe the SALT methodology for triage and where to access SALT training
• Recognize the importance of both mass casualty and bio-event triage

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.     (HOFFMAN)         

Join MSSNY for Social Media in Medicine on Wednesday, May 5 at 6 PM ET
MSSNY Vice President Parag H. Mehta, MD and MSSNY YPS Immediate Past Chair Daniel E. Choi, MD present Social Media in Medicine: A Beginners Guide for Physicians.
Register now for Virtual Webinar

When: May 5, 2021 at 6:00 PM Eastern Time

After registering, you will receive a confirmation email containing information about joining the meeting.

Topics Include:

• Introduction to popular social media physician communities: #MedTwitter,
  Instagram, YouTube, TikTok
• How to establish a social media presence and grow your audience.
• Common terminology e.g., Twitter handle, hashtag
• Scheduling posts
• How social media can be harnessed for effective patient education, practice growth, and advocacy.
• Best ways to connect with patients and colleagues on social media.
• Pitfalls of social media as a physician
• What not to do on social media

CareClix Discounted Telemedicine Platform for MSSNY Members: Explore Staff Load Balancing
CareClix provides comprehensive, integrated telehealth applications, technology, and services for MSSNY members with out-of-the-box support for the most popular telemedicine carts, EHRs, and over 200+ medical devices.

Explore how staff load balancing can be attained with virtual health and how better balancing the workload virtually can rapidly help with coverage shortage and load imbalances. CareClix incorporates staff load balancing into its system to realize key benefits for patients and providers, including but not limited to:

• Shortened patient wait-times
• Better provider utilization
• Reduced physician burnout
• Increased cost savings

What Is Staff Load Balancing?
Staff load balancing is the process of efficiently distributing staff across a provider network to promote optimal staffing and enhanced provider capacity. Hospital administrators are often aware that some staff are very busy and others have capacity, yet it is difficult to find a long-term solution of balance.

An enterprise telehealth network allows for both geographic and time-based load balancing, which in turn provides an efficient utilization of providers across the region and country. Telemedicine enables primary and specialty care physicians to be virtually distributed through the health system for on-demand consults with both on and off-site patients. In fact, leading telehealth providers regularly achieve an average response time of less than three minutes. 

How to Effectively Accomplish Staff Load Balancing
A comprehensive plan outlining your treatment routing decisions and protocols must be developed. CareClix’s platform includes load balancing capabilities that help monitor current usage and re-direct physicians to where they are needed.

In addition, CareClix’s platform includes support for all major telemedicine carts for over 200+ associated peripherals. This enables you to leverage the telemedicine equipment you may have already purchased and put it to work to help load-balance your staff. If you currently do not have telemedicine carts at your organization, CareClix provides a variety of carts, kiosks, and mobile cases.

To learn more about CareClix: careclix.com/for-providers/
To implement telemedicine for your practice visit: careclix.com/provider-signup/
Have questions? Contact sales@careclix.com

Info Blocking Rule Examples Needed: Take the AMA Survey
The AMA is conducting an informal survey to collect members’ perspectives, stories, and examples of patient harm as it relates to the release of protected health information (PHI). This information will inform AMA’s policy and advocacy efforts. The Office of the National Coordinator for Health Information Technology (ONC) recently implemented regulations that require physicians to make available a variety of medical information (e.g., lab tests, clinical notes, medications, etc.) to entities or individuals requesting that information for or on behalf of the patient. Physicians interfering or imposing any delays in the access, exchange, or use of that information would likely implicate new rules aimed to prevent information blocking.

ONC’s guidance is directing physicians to immediately release information to patients—in many cases, prior to the physician reviewing the information and without regard to whether such release could be mentally or emotionally distressing to the patient. For example, a radiology report of a CT scan indicating a “malignancy could not be ruled out” must be sent to the patient’s portal or smartphone application even if the oncologist has yet to view the study or read the report. If this report were sent to a parent of an infant ahead of a holiday weekend, the parent could unnecessarily spend days in deep emotional distress before being able to talk to the infant’s physician.

Another example pertains to adolescent medical records, particularly in states where minors do not have specific privacy protections, allowing parents to access their adolescent’s health information. Adolescents often confide in their clinicians as a “safe space” and the release of information against their wishes could provoke significant emotional or psychological distress, even in scenarios where the adolescent may not fear physical abuse. While patients accessing their medical information is an important part of patient-centered care and the AMA strongly supports patient access and engagement, there are a verity of ethical, professional, and practical concerns with automatically and immediately releasing all reports and office notes.

The AMA is interested in real-world examples, scenarios, and instances where the release of reports or notes without vital physician context or review with the patient could or has caused emotional or mental harm. The AMA is advocating for OCR to revise its subregulatory guidance on “harm” to include emotional and mental distress. This would facilitate ONC’s ability to create additional flexibility. Your information will help inform the AMA’s efforts to address unintended consequences of OCR’s current policy and ONC’s information blocking regulations. Please send your examples to Ela Cameron Ela.Cameron@ama-assn.org.

Early Results from Federal Price Transparency Rule Show Difficulty Estimating Cost of Care
Under federal rules issued by the Trump Administration, beginning in 2021 hospitals are required to publish the price of health services they provided by payer. The goal of these rules is to improve price transparency to foster competition. The rules require hospitals to publish their 1) gross charge; 2) payer-specific negotiated charge; 3) minimum de-identified negotiated charge; 4) maximum de-identified negotiated charge and 5) discounted cash price for 300 common services, presented in a consumer-friendly online tool.

• Price variation within a hospital for the same services is substantial, depending on the payer.
• While 3 out of 4 hospitals provided some pricing information (such as the gross charge), the vast majority of hospitals (97%) did not provide the public with payer-specific negotiated rates for their services.
• Implementation has been thwarted by lack of standardization in reporting, partial reporting and inconsistencies in hospital reporting of the same charges.

Click here to view the full report.

Do You Know an Outstanding Physician? MSSNY Now Accepting Nominations for the Albion O. Bernstein, MD Award

“…the physician, surgeon or scientist who shall have made the most widely beneficial discovery or developed the most useful method in medicine, surgery or in the prevention of disease in the twelve months prior to December, 2020.”

This award was endowed by the late Morris J. Bernstein in memory of his son, a physician who died in an accident while answering a hospital call in November, 1940.

The $2,000 award will be presented to the recipient during a MSSNY Council Meeting.

Nominations must be submitted on an official application form and must include the nominator’s narrative description of the significance of the candidate’s achievements as well as the candidate’s curriculum vitae, including a list of publications or other contributions.

Deadline for applications is June 9, 2021. To request an application, please contact: 

Committee on Continuing Medical Education
 Miriam Hardin, PhD, Manager, Continuing Medical Education
Medical Society of the State of New York
99 Washington Avenue, Suite 408
Albany, NY 12210
518-465-8085
mhardin@mssny.org

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 516-488-6100 x302 • fax 516-488-2188

For the MSSNY 2021 Ad Rate Sheet, please click here.

.Two Offices Available for Rent in Established SoHo Primary Care Practice
Newly constructed loft space. Dedicated private waiting area available.  This space is ideal for individual psychiatry, psychology, social work, physical therapy, or acupuncture services. Potential to work with existing Primary Care Practice as a referral source. Centrally located in the heart of SoHo, close to all subways. Available 7 days/week.
Contact: SpringPrimaryCare@gmail.com.

Medical Office and Medical Practice (Upper East Side)
79th St near Lexington / Park. 750 sq Ft beautiful, street entrance, medical office for sale with a 25 + yr internal medical practice for sale. Office is in move in condition. Physician retiring. Waiting room. Secretarial area for 3. 1 Consult room. 2 exam Rooms 2 Toilets. Please contact: 917-770-8700 / email drklein@att.net

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