MSSNY eNews: February 9, 2022 – Empire Plan Drastically Cutting Some Payments
NYS Empire Plan Drastically Cutting Some Payments
MSSNY has received very concerning reports from some practices (primarily anesthesiologists) regarding the New York State Empire Plan drastically cutting payments since January 1 for out-of-network care delivered to state employee patients at in-network hospitals.
This is likely the result of a health plan taking advantage of the implementation of the federal No Surprises Act enacted by Congress that took effect 1/1/22. Of further concern is that we have been advised that in some cases practices are being informed they must wait 30 days to seek relief through New York’s Independent Dispute Resolution (IDR) process to appeal these low payments. Staff at the New York Department of Financial Services (DFS) has confirmed that statement is incorrect, in that New York law enables a physician to immediately bring a payment dispute with a health plan to IDR.
Bring a dispute to New York’s IDR process here.
Physicians should continue to provide examples of these tactics to MSSNY staff, which will assist in our advocacy efforts with various government officials. MSSNY has raised concerns to DFS that this tactic being used by the Empire Plan is going to result in unnecessary delays to the IDR process.
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 | firstname.lastname@example.org
The Physicians Foundation’s Fellowship Program Announces Call for Applicants
The Physicians Foundation today opened a Call for Applicants for its Fellowship Program, which advances physicians’ leadership skills to strengthen the physician-patient relationship, support medical practices’ sustainability and navigate the changing health care system. The Fellowship Program is open to physicians who are new or mid-career in their practice, and have experience with or interest in addressing social drivers of health (SDOH), improving physician wellbeing and lifting physician perspectives in health policy discussions. Applications are due Friday, March 25, 2022.
The Fellowship Program provides physician participants with the tools and knowledge necessary to improve practice environments and fulfillment within the profession. The Program offers physicians the opportunity to:
- Expand leadership skills to be equipped to address barriers to physician wellbeing, improve practice environments and build understanding of SDOH implications for patients and physicians;
- Contribute to the research, education and innovative grant making happening nationally that seeks to shape the future of health care;
- Connect and learn from SDOH experts and leaders through mentorship opportunities;
- Share perspectives in the ongoing media and policy discourse on how to improve health care delivery; and
- Advance research on the SDOH and their impact on all aspects of the health care environment.
The Fellowship Program will last for 12-months beginning July 1, 2022 through June 30, 2023, and participating fellows will receive a stipend of $24,000 as well as reimbursement for program related travel and lodging expenses. This fellowship requires approximately 10 to 15 hours monthly for project development and implementation, along with external thought leadership activities. Interested physicians must submit an application with a current resume/CV, two letters of recommendation, one of which is recommended to be from their state or county medical society, and a statement of intent that briefly describes how participation in the Fellowship Program will prepare you to make positive, constructive contributions to the medical profession.
The Decline of Independent Practice: Wall Street Journal Publishes Opinion Piece by MSSNY Member
In an opinion piece in the Wall Street Journal, MSSNY member Dr. Michael Goldstein writes the following:
The three factors most responsible for the decline of independent practice are burdensome regulations, obsolete antitrust laws and economic benefits of consolidation to hospital systems.
Physicians spend about 20 uncompensated hours a week entering data into electronic records and complying with other regulations. This distracts from and compromises patient care and is a major factor in the high incidence of physician burnout.
Under obsolete antitrust laws, independent practitioners are viewed as competitors and therefore prohibited from bargaining collectively with insurance companies. Large healthcare systems, which are viewed as single entities, have been able to negotiate fees that are up to 300% higher than what independent practices get. The lower fees have forced many independent practices to go out of business or consolidate.
Higher reimbursement levels enable healthcare systems to afford physician salaries. They also benefit from downstream revenues generated by employed physicians, including laboratory tests, physical therapy, radiology, outpatient surgery and inpatient hospital admissions. Our healthcare system works best when there is competition and choice in how physicians practice and patients receive care. Private practice remains a cost-effective, high-quality component of our healthcare system. Its survival depends on regulatory and antitrust reform.
Federal No Surprises Act – One Month In: What Have We Learned? What Questions Remain?
Garfunkel Wild’s February 1, 2022 webinar, “Federal No Surprises Act – One Month In: What Have We Learned? What Questions Remain?” is now available for those that were unable to attend the live webinar. The presentation to available to download here. You can also listen to and view the full webinar on Garfunkel Wild’s YouTube channel here.
For more information, access the detailed CMS explanation of how the QPA is to be calculated and access the Federal IDR Initiation Form.
Updated Return-to-Work Protocols for Healthcare Personnel with SARS-CoV-2 Infection or Exposure to SARS-CoV-2
The NYS Department of Health (NYSDOH) released updated guidance on return-to-work protocols for healthcare personnel, which supersedes the January 4, 2022 return-to-work guidance. Updated CDC guidance will be reviewed by NYSDOH as it is released and additional requirements may be added.
OnBoard Update from WC Board
Last week, we reported details regarding OnBoard, the Workers’ Compensation Board’s new online business information system. It will eventually replace the Board’s legacy paper-based claims systems and the eCase system with a single, web-based platform, providing stakeholders with increased accuracy, paperless transactions and a user-friendly interface for interacting with the Board.
The GovDelivery notification provides additional OnBoard information, training webpages and webinar training links. As a reminder, OnBoard: Limited Release, the first phase of OnBoard, will be implemented on March 7, 2022.
For more details, please visit the OnBoard project website and refer to the frequently asked questions and project resources, which includes stakeholder-specific fact sheets, FAQs, and recorded webinars. To have project updates and webinar information sent directly to you, please subscribe for emailed updates.
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
For the MSSNY 2022 Ad Rate Sheet, please click here.
Opportunity: Medical Director- Long Term Care (RiverSpring Living)
The Medical Director is responsible for the quality assurance program for RiverSpring, formerly known as ElderServe Health (a division of Hebrew Home), in the NYC area. This individual will be the most senior level physician in the organization and report directly to the EVP and President of the business. They will work with an interdisciplinary team of administrative and clinical staff who are highly experienced in the care of the frail elderly and disabled individuals to develop care plans and guidelines and assess quality. S/he will chair the Quality Assurance Committee, appoint its members, and set the agenda. In addition, this position provides an exciting opportunity for a forward-thinking physician to build a PACE program and ensure members receive the highest quality care. Internal Medicine, Family Practice, Geriatrics preferred. Please inquire at Lisa.email@example.com.
Rendr- Transforming Healthcare – Leadership Opportunity: Associate Chief Medical Office, SVP of Population Health, Bilingual English and Chinese (Mandarin or Cantonese) preferred Job Position: Associate Chief Medical Office, SVP of Population Health in this role, you will lead and provide a wide range of support through population health, quality measures, practice transformation, Rendr360 department, House Calls, and other projects. Please send resumes firstname.lastname@example.org. We are offering leadership opportunities to Physicians who are interested in providing high-quality clinical care to our patients in the diverse communities that we serve. As a rapidly growing network, we provide a supportive environment for our physicians to practice medicine under the guidance of dedicated medical leadership. www.rendrcare.com.
Rendr- Transforming Healthcare – Primary Care Opportunity: Internal or Family Medicine Physician, Bilingual English and Chinese (Mandarin or Cantonese)
Job Position: Internal Family Medicine Physician please send resumes to: email@example.com. We are offering employment opportunities to Internal or Family Medicine Physicians who are interested in providing high-quality clinical care to our patients in the diverse communities that we serve. As a rapidly growing network, we provide a supportive environment for our physicians to practice medicine
under the guidance of dedicated medical leadership. www.rendrcare.com.
Job Position: Clinical Operations Medical Director in this role, you will provide clinical oversight and help lead our team of providers to assure high standards of care for our patients. The ideal candidate will be dedicated to improving the health of the communities we serve and will be a practicing physician as well as an established medical leader with proven experience improving clinical operations and building strong teams. Please send resumes firstname.lastname@example.org. We are offering leadership opportunities to Physicians who are interested in providing high-quality clinical care to our patients in the diverse communities that we serve. As a rapidly growing network, we provide a supportive environment for our physicians to practice medicine under the guidance of dedicated medical leadership. www.rendrcare.com.
Healthcare Tech Investment Opportunity
Kalypsys (www.heykaly.com) is a healthcare tech startup that integrates patient appointment booking, telemedicine, and practice growth, with additional leveraged, validated, and lucrative revenue sources available downstream. We are a 100% physician-owned and operated company seeking $2.5MM in seed investment via SAFE agreement from the physician community. This is a rare and unique opportunity to invest on the ground floor in a ready-to-launch tech startup in an industry that is ripe for disruption. If you are frustrated with the $35-$110 per booking fee of our competitors, please contact us immediately to review our investor deck! We are also looking for board-certified physicians to add to our growing medical advisory board. Great opportunity to break into the healthcare tech space. Please inquire at email@example.com!
NYS Department of Health is looking for a licensed, board-eligible /board certified physician to serve as the Medical Director for the Medicaid State Disability Review Unit (SDRU). Interested candidates: Submit resume and cover letter preferably in PDF format, to firstname.lastname@example.org, or by fax to (518) 473-3395 with Reference Code SC/PHP2HS/15223 included in the subject line. View Full Listing