MSSNY eNews: June 11, 2021 – MSSNY Victories in Albany Fight for Physicians and Patients
MSSNY Victories in Albany Fight for Physicians and Patients
As the Legislature concluded the 2021 session overnight into early this morning, MSSNY has been actively fighting for physicians to continue to be able to deliver the quality and timely care our patients expect. Among many issues, MSSNY worked to:
- Pass a Bill to Prevent Mid-Year Prescription Plan Formulary Changes, protecting patients from unexpected and prohibitive increases in out-of-pocket costs when insurers move medications to a higher cost tier.
- Pass a Bill to Regulate PBMs, providing far greater oversight over a largely unregulated industry that has a significant role in developing health insurer formularies, and the challenging rules physicians must follow to ensure patients receive the medications they need.
- Stop Huge New Med Mal Liability Costs through a bill pushed by the trial lawyers’ lobby that would have grossly expanded damages awardable in a wrongful death action, increasing medical liability costs for physicians by almost 50%.
- Preserve the Right of Physicians to Bill Independently. MSSNY supported the intent of the Patient Medical Debt Reduction Act to ensure that patients receive clear, concise, and timely bills. However, we objected to parts of the bill that would have barred a physician from billing a patient separate from the hospital without guarantees that hospitals will pay physicians fully and timely. Without such guarantees, physicians would have had a significant additional challenge remaining in practice, thereby harming patient access to specialized care in hospitals.
- Stop a Series of Scope of Practice Expansions. Working together with the affected specialty societies, MSSNY successfully opposed bills that would have jeopardized patients through inappropriate expansion of the scope of practice for several professions, including allowing pharmacists to perform lab tests, podiatrists to treat up to the knee, nurse anesthetists to practice independently, and physician assistants to serve as primary care providers under Medicaid managed care. Another defeated bill would have removed required collaboration of nurse practitioners with physicians.
For those bills that passed which we supported, we now need to work with allies to convince the Governor to sign. Conversely, there are other nuisance bills that MSSNY objected to that we will be urging the Governor to veto. Please stay tuned for how you can be helpful.
These successes follow a series of victories in this year’s State Budget process – where MSSNY worked to stop bad proposals to allow Department of Health publication of any allegations against physicians without due process and to cut funding for medical malpractice excess coverage, the Committee for Physician Health, and Medicaid.
We will continue to work with other patient care advocates to fight for physicians on these and other issues such as telehealth payment parity, breaking down prior authorization barriers by insurers, and due process for physicians when an insurer non-renews a network participation contract.
Our success in Albany is the direct result of a team effort by MSSNY staff, leaders, and physician members. Patients—and the entire population of the state—are better off because of this advocacy.
Troy J. Oechsner
MSSNY Executive Vice President
Things You Need to Know About the End of Legislative Session
Legislative Session Wraps Up
The New York State Legislature wrapped its regular scheduled 2021 Legislative Session overnight Thursday into Friday, with the New York State Assembly gaveling out at 4:22 AM. It produced many successful outcomes as noted below.
MSSNY thanks the many physicians who took the time to send a letter or a tweet to their legislators on these issues, as well as the tremendous partnership with the county medical societies and specialty societies to help achieve our successful results. We will continue to need advocacy over the next many months to urge the Governor to sign various bills that were passed that we support and to urge him to veto bills that passed which we oppose. (DIVISION OF GOVERNMENTAL AFFAIRS)
Legislature Passes Bill to Provide Greater Transparency & Accountability for PBMs
Legislation (A.1396, Gottfried/S.3762) was passed by the Senate and Assembly that would if signed into law 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 the Governor’s veto message. The bill would require PBMs to be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS.
It also requires disclosure of all possible revenue streams and 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 interfering with patients obtaining needed medications. Please remain alert for further information regarding how you can urge the Governor to sign this bill into law. (CARY)
Legislature Passes Bill to Restrict Mid-Year Formulary Changes and Protect Patients
The Senate and Assembly passed legislation (A.4668, People-Stokes/S.4111, Breslin), which would if signed into law by the Governor 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 the Governor, to address concerns raised in the veto message.
In particular, 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. Other mid-year formulary changes could still occur.
Legislature Passes Bill to Require Greater Transparency in Claim Approvals/Denials
Legislation (A.1677, Gottfried/S.2008, Jackson) passed the Assembly and Senate that would require health insurers to, within the time frames set forth under the Prompt Payment law, conspicuously state whether a claim or a bill has been partially approved or entirely denied.
Specifically, it would require that a partial approval of claim or payment to state at the top of such written notice with at least 14-point type bold: “NOTICE OF PARTIAL APPROVAL OF MEDICAL COVERAGE”. A denial of claim or payment would need to state at the top of such written notice with at least 14-point type bold: “NOTICE OF DENIAL OF MEDICAL COVERAGE”. (AUSTER)
Legislation to Require Consolidated Hospital/Physician Billing Does Not Pass
The Session ended without the State Legislature taking action on legislation (A.3470/S.2521) under serious consideration which would have among other components required hospital-based physicians to jointly submit consolidated bills with their hospitals. 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 where they practice since the legislation does not specify how payments to hospitals from this “single bill” would then be distributed to these physicians. MSSNY thanks the many physicians who sent a letter or a tweet raising concerns with this proposal.
In the last week of Session, the Senate passed a significantly revised version of this bill (S.2521-B) that would have required notice to patients prior to hospitals, health systems and health care providers charging patients for so-called “facility fees” (distinct from professional fees), including whether the patient’s health coverage will cover the facility fee.
MSSNY does not object to the concept of this legislation to require greater transparency of these fees, but together with several specialty societies wrote to the Legislature to raise concerns with a specific provision that would have required a health care provider to notify the patient of a facility fee that could be charged by the health system with whom the physician is employed or affiliated. MSSNY had recommended that this required notice be instead placed on the entity that is charging the facility fee, not the physician. The Assembly did not pass this legislation prior to adjournment, so this discussion will carry over into next Session. (AUSTER)
Legislature Does Not Pass Massive Liability Expansion Bill; Multiple Pro-Trial Lawyer Tactical Bills Pass, Requiring Vetoes
Despite an aggressive push by the trial lawyer lobby, the Legislature ended its regular 2021 Legislative Session without passing legislation (S.74-A/A.6770) strongly opposed by MSSNY and many other groups that could have prompted untenable increases in New York’s already excessive medical liability costs by greatly expanding the types of damages awardable in “Wrongful Death” actions.
One recent actuarial estimate indicated that passage of legislation such as this could have required a liability premium increase of nearly 50%, which could have meant tens of thousands of dollars in new costs for many physicians who are already paying tens to hundreds of thousands of dollars per year in their insurance costs. We thank the many physicians who took the time to send a letter or tweet reminding legislators of the devastating impact this legislation could have on patient access to care in their communities.
However, in the Session’s final days, the State Legislature did pass 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. These bills include:
- A2199/S473 – in cases where a plaintiff’s request for summary judgment was not granted, but then overturned on appeal, requiring interest to run from the date the original decision was rendered;
- A8040/S7093 – revising the common law exclusion of a hearsay statement of a party’s agent or witness, provided that such statement was on a matter within the scope of that employment relationship;
- A8041/S7052 – Imposing on defendants a requirement to provide plaintiffs with complete disclosure of all relevant insurance information within 60 days after the filing of answer during litigation.
MSSNY will be working together with specialty societies, MLMIC and hospital associations to request vetoes by the Governor on each of these bills. (AUSTER)
Numerous Scope of Practice Expansion Bills Under Consideration Do Not Pass
The Legislative Session adjourned for the summer without passing legislation (S.3056-A/A.1535-A), strongly opposed by MSSNY that could lead to uncoordinated, siloed care by eliminating any statutory requirements for nurse practitioners to maintain collaborative arrangements with a physician practicing in the same specialty. The legislation would also have eliminated the requirement for a newly practicing nurse practitioner to maintain a written collaborative agreement with a physician.
MSSNY joined with a dozen other specialty societies in a letter to Senators raising strong objections to this bill, and in support of protecting physician-led team care. The bill had advanced to the Senate floor.
During the State Budget adopted in early April 1, there was a provision enacted that extended for another year – until June 30, 2022 – the existing law that permits nurse practitioners with more than 3,600 hours of experience to practice without a written collaborative agreement provided they maintain evidence of “collaborative relationships” with a physician in the same specialty practiced by the NP.
In addition, numerous other pieces of legislation opposed by MSSNY and affected specialty societies did not pass, including:
- A1837/S1591 – would have permitted physician assistants to perform fluoroscopy.
- A2294/S2019 – would have expanded ability of podiatrists to perform wound care unrelated to foot care.
- A3033/S2529 – would have permitted pharmacists to perform various lab tests without referral from a physician.
- A4358/S1319 – would have greatly increased the scope of practice for chiropractors.
- A6035 – would have created licensure for the profession of naturopathic medicine.
- A7268/S5435 – would have created independent practice for nurse anesthetists. (AUSTER)
Legislature Passes Modified Scope Expansion Bill for Optometrists
The Assembly and Senate passed legislation (S1519/A1921), opposed by MSSNY and the NYS Ophthalmological Society (NYSOS) that will grant optometrists prescriptive privileges for a limited range of oral medications for patients. While the final version of the bill is narrower than the prior version, it is still broader than the version negotiated in good faith with the NYS Optometric Association more than three years ago, insofar as it:
- Requires additional training for optometrists to prescribe these oral medications but reduces the agreed-upon number of additional hours required.
- Requires that optometrists take a certification course and final examination to prescribe these oral medications but does not require them to retake the course if they have failed the final examination three times.
- Eliminates a proposed requirement that optometrists furnish evidence that they have completed required continuing education courses when they submit an application for license renewal; and
- Eliminates an important oversight element that had required that, for the first 5 years following the implementation of the law, prescribing optometrists must provide information to the State Education Department concerning their prescribing activities, and such information must be reviewed by a committee comprised of an ophthalmologist, optometrist, pharmacist, and an expert in the public health field and cross-checked against existing records to ensure compliance with applicable requirements. (AUSTER)
Bill to Mandate Documentation of Consideration of Opioid Alternatives Does Not Pass Assembly; Co-Prescribing Requirement Passes Both Houses
The New York State Assembly adjourned without passing A.273, legislation opposed by MSSNY that would have placed a mandate in the law for physicians and other prescribers before prescribing an opioid medication to a patient for neuromuscular pain to consider, to discuss with the patient and refer or prescribe alternative services such as chiropractic, massage therapy or behavioral therapy. The legislation had passed the State Senate last week.
MSSNY raised concerns that this legislation is repetitive of existing state law requiring physicians and other prescribers to use the CDC Guideline for Chronic Pain when assessing patients for opioid use, which direct prescribers to discuss benefits and risks and the availability of non-opioid therapies with the patient. MSSNY also raised concerns that, by listing off so many possible alternatives in the legislation, it could potentially create significant new documentation requirements to demonstrate that a physician has considered each of the enumerated suggested alternatives in the legislation to prove compliance with the legislation. By creating these additional unnecessary administrative burdens, it would further disincentivize physicians from prescribing needed pain control patients to those who truly need them.
At the same time, the Legislature did pass S.2966-A/A.336-A, which requires physicians and other prescribers, for the first opioid prescription of each year to a patient receiving 90 MME or more, to also co-prescribe an opioid antagonist with the prescription. Importantly, however, the bill was amended prior to passage to increase the threshold from 50 MME to 90 MME, to be applicable to a far smaller cohort of patients who are more at risk for overdose.
MSSNY has raised concerns that even this more limited proposed co-prescribing requirement could cause some patients taking these medications to address their chronic pain to inappropriately feel stigmatized as a “drug addict”. Moreover, many physicians are already co-prescribing an opioid antagonist to certain patients based upon the physician’s clinical judgment of the risks the patient may face. Furthermore, with New York’s mandatory e-prescribing law, the co-prescription will automatically go to the pharmacy and essentially remove the choice of the patient to have the co-prescription filled, as would be the case if such prescriptions were still on paper. Certainly, such a mandate could result in significant new cost-sharing responsibilities for patients and may result in a windfall for those manufacturers of the drug. (CLANCY, AUSTER)
Bill to Prevent Harmful & Unfair Copay Accumulator Policies Fails to Pass Assembly in Final Hours of Session
Despite a persistent advocacy campaign by a number of patient and physician advocacy groups including MSSNY, the Assembly did not pass legislation (A.1741, Gottfried) that would have ensured that third party financial assistance programs can count towards patient deductible and other health insurer-imposed cost-sharing requirements. The same-as bill (S.5299, Rivera) passed the Senate earlier in the session.
In spite of New York State’s strong record in providing affordable access to health insurance, many New Yorkers still struggle to pay for their prescription drugs and for those battling chronic illnesses like cancer, diabetes, multiple sclerosis, and others, the burden is often overwhelming. To help with high out-of-pocket costs, there are a range of copay assistance, discount, and coupon programs, that help patients pay for their medications. However, patients must also contend with what insurers refer to as “cost utilization tools”, which are used by health plans to curb spending on the more expensive drugs.
These include prior authorization, step therapy and a more recent one known as “Copay Accumulators”, which prevents patients from using a copay card, or coupon, to cover their out-of-pocket expenses. Copay Accumulators are particularly unfair to patients as any payment from a copay coupon or card goes directly to the health plan, but the amount of the support provided by the coupon/card does not count towards the patient’s maximum out of pocket limit. This unreasonable practice can be especially challenging for patients that have health insurance plans with high deductibles or high copayment requirements.
MSSNY will continue to work with patient advocacy organizations who championed this effort such as the American Cancer Society, New York State Bleeding Disorders Coalition and the National Multiple Sclerosis Society, to push for passage of this bill as well as other needed health insurance reforms should the Legislature return to Albany later this year and/or during the 2022 legislative session. (CARY)
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 (email@example.com) 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 an email or phone call away! (LAUDER)
MSSNY Medical Matters Program on Long COVID
Registration now open
Medical Matters: The Lingering Pandemic: Long COVID Symptoms & Treatments
Date: June 16, 2021 @ 7:30am
A growing number of COVID survivors are experiencing a multitude of ongoing effects for months after initial recovery. Learn more about Long COVID and how to recognize and treat it by registering for Medical Matters: The Lingering Pandemic: Long COVID Symptoms & Treatments. This webinar will take place on Wednesday, June 16th at 7:30 am. William Valenti, MD, chair of MSSNY’s Infectious Diseases Committee, will serve as faculty for this program. Click here to register for this webinar.
- Recognize the symptoms associated with long COVID
- Identify referral options to treat long COVID
- Examine CDC guidelines for caring for patients with long COVID symptoms
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)
MSSNY Member Dr. Monica Sweeney to Receive the Dr. Debasish Mridha Spirit of Medicine Award on Sunday, June 13
The AMA Foundation will present the Dr. Debasish Mridha Spirit of Medicine Award for the Selfless Elimination of Human Suffering to M. Monica Sweeney, MD, MPH, FACP at the 16th Annual Excellence in Medicine Awards Ceremony. The awards will be presented via Zoom on Sunday, June 13 at 6 p.m. ET. Click here to view the ceremony.
The award recognizes the work of a U.S. physician who has demonstrated altruism, compassion, integrity, leadership, and personal sacrifice while providing quality health care to a destitute, distressed, or marginalized population in an impoverished community.
“I am humbled and honored by this award,” said Dr. Sweeney. “Medicine is a calling for me, especially to serve the underserved. My life has been enriched by my profession.”
In her notification to Dr. Sweeney of her Dr. Debasish Mridha Spirit of Medicine Award, Dr. Jacqueline A. Bello, the AMAF President, stated:
“This annual awards program honor physicians who represent the highest values of altruism, compassion and dedication to patient care. The caliber of our nominees was awe-inspiring, and your selection from such an impressive group speaks volumes in recognizing your dedication to the profession of medicine. As an Excellence in Medicine Awards recipient, you will be honored during an awards ceremony hosted by the AMA Foundation in 2021 (date TBD). In addition, this award comes with an AMA Foundation grant of $2,500 to the organization of Dr. Sweeney’s choosing.”
Dr. Sweeney has been an active member of MSSNY since 1989. She currently serves on MSSNY’s Committee to Eliminate Health Disparities, Infectious Diseases Committee, Task Force on End-of-Life Care, and Women Physicians Committee. She previously served as a delegate to MSSNY’s House of Delegates and on the Preventative Medicine and Family Health Committee and the Rural Subcommittee.
Join CareClix on June 23 @ Noon for Overview of Virtual Care Management Program
MSSNY Members receive a discounted rate for implementing CareClix, a virtual telehealth platform that enables you to put your patients first.
Join CareClix for a brief overview of the platform followed by a Q&A session with CareClix’s CEO to answer any questions.
Date: June 23rd, 2021
Time: 12 pm EST
Presenter: Dr. John Korangy, MD, MPH, CEO of CareClix
CareClix’s all-in-one platform lets you deliver an exceptional patient experience that’s convenient for your patients and efficient for you. Allow patients – new and old – to chat straight from your website or mobile app. Increase appointment bookings and capture patient demand 24/7.
Key features that will be demonstrated in the webinar:
- Provider Dashboard
- Virtual Waiting Room
- 3rd Party Invite
- Account Settings
- Setting Up Clinic
- Setting up Fee and Specialties
AMA Joins Opposition to ‘Physician Associate’ Rebrand
Physician assistants’ recent move to change their title to “physician associate” will create confusion for patients about who is providing their care, American Medical Association President Susan R. Bailey, MD, said in a June 2 statement to Becker’s.
On May 24, the American Academy of Physician Assistants voted to adopt “physician associate” as the official title for the PA profession. The change comes about three years after the academy hired a healthcare marketing research and branding firm to determine the best title and marketing strategy for the profession.
“AAPA’s effort to change the title of physician assistants to rebrand their profession will undoubtedly confuse patients and is clearly an attempt to advance their pursuit toward independent practice,” Dr. Bailey said. “Given the existing difficulty many patients experience in identifying who is or is not a physician, it is important to provide patients with more transparency and clarity in who is providing their care, not more confusion.”
The AMA believes this effort is “incompatible with state laws” regarding truth in advertising and is prepared to work with other medical societies to block efforts to implement the title change in state or federal policy, Dr. Bailey said in the statement.
The medical association’s stance echoes that of the American Osteopathic Association, which released a statement opposing the proposed title change on May 28.
Soaring Private Equity Investment in the Healthcare Sector: Consolidation Accelerated, Competition Undermined, and Patients at Risk
American Antitrust Institute and Petris Center at University of California, Berkeley | May 2021
This detailed analysis looks at the explosion in private equity investments in healthcare, finding it a threat to both the structure and the goals of the healthcare system. The authors indicate that the lack of transparency surrounding private equity investment is deeply concerning and that private equity business practices have caused significant harm to individual healthcare companies, to patients, and to markets. There are strong reasons to suspect that additional transparency and further study will reveal deeper and more serious problems. The surge in private equity investment in healthcare also threatens to undermine the already fragile competition in healthcare markets.
- Private equity investment in the healthcare sector ballooned over the past decade, growing from $41.5 billion in 2010 to $119.9 billion in 2019, totaling approximately $750 billion in investments, primarily in the outpatient care and home health markets. Private equity investments are largely unreported and unregulated, making it difficult to fully capture the scope of these investments.
- The economic incentives inherent to private equity investments drive policies aimed at maximizing profits by cutting costs and engaging in anticompetitive billing and business practices over the short-term. These companies also benefit from consolidation in the industry regardless of whether the integration achieves efficiencies, eroding competition and innovation.
- The authors call for increased regulatory scrutiny over private equity investments in healthcare to mitigate certain practices that undermine the health of the overall system. In particular, the authors call on the Department of Justice to rescind recent guidance allowing private equity firms to be preferred buyers in divestitures.
- Click here to view the full report.
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
Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / firstname.lastname@example.org.
340 E. 49TH St. (Ground Floor -Handicap Accessible) 1-3 Lanes Wed/Fri/Sat/Sun Full use of: VF / OCT /Pachymeter/ Autorefractor /Autolensometer / Argon / YAG Lasers
Please contact Scott Weissman MD. email@example.com. 914-772-5581
Professional Office Space For Sale – Albany, NY
319 S. Manning Blvd, Suite 308A. Albany NY. Located on the St. Peter’s Hospital Campus. 2000 SF. Bright, 3rd floor location. Office is in move in condition. Waiting room, front reception area for 3 staff, 2 consult rooms, 4 exam rooms, 1 large procedure room, eat in break room, storage room, walk in storage closet. 369K. Contents negotiable. Please contact 518-222-4956 / email firstname.lastname@example.org
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 email@example.com