MSSNY eNews: June 18, 2021 – Physicians’ Offices Preferred COVID Vaccine Sites for Unvaccinated Americans
Physicians’ Offices Preferred COVID Vaccine Sites for Unvaccinated Americans
We celebrated an important milestone earlier this week when New York State reached 70 percent adult COVID-19 vaccination rate. As the news hit, I was reminded of the important work accomplished by MSSNY and my predecessor, MSSNY’s Immediate Past President Dr. Bonnie L. Litvack—who serves as a member of the Governor’s Vaccine Distribution and Implementation Task Force.
But the fight is not over. We must get as close to 100 percent vaccination as we can. And it’s now more important than ever for us—our patients’ trusted physicians—to instill confidence in the safety and efficacy of the vaccine.
Just this week in my office, I was reminded of the important role physicians play in continuing to get New Yorkers vaccinated. I had three patients with three distinct barriers preventing access to the healthcare system—one with limited health literacy, one with impaired mobility, and one with substance abuse issues. In our office—a healthcare setting they trust—we were able to counsel each patient and get them all vaccinated.
In fact, results of a new national poll of more than 12,000 people conducted jointly by the African American Research Collaborative and the Commonwealth Fund show that more than half of unvaccinated Americans would prefer to get a COVID-19 vaccination at their physicians’ office. The preference to be vaccinated in a medical office was three to five times higher among unvaccinated Americans than were other options like retail pharmacies, community health centers, public health clinics, and large public vaccination sites.
As new variants of COVID-19 continue to emerge, we need to be prepared and ready to prevent a resurgence. Let’s get as close to 100 percent vaccination as we can by instilling vaccine confidence in our patients.
We, as our patients’ trusted physicians, are uniquely qualified to accomplish this goal.
MSSNY Press Statement in Support of US Supreme Court Decision to Uphold the ACA in California v. Texas
Statement from Joseph Sellers, MD
President, Medical Society of the State of New York
“We appreciate that the US Supreme Court has—once again—upheld the legality of the Affordable Care Act. We hope this case once and for all stops these lawsuits which unnecessarily endanger health insurance coverage for millions of patients across New York and across the country.
“While MSSNY continues to pursue reforms to the law that would help to better ensure patients can obtain comprehensive first-dollar health insurance coverage, the ACA has importantly set the stage for millions across New York State to obtain health insurance coverage that they previously they were unable to afford.
Longtime MSSNY Member Dr. Erick Eiting Receives AMA Excellence in LGBTQ Health Award
The AMA Foundation presented the Excellence in LGBTQ Health Award to Erick Eiting, MD, MPH, MMM at the 16th Annual Excellence in Medicine Awards Ceremony on Sunday, June 13.
The award honors a physician who has demonstrated outstanding work, innovation and leadership in LGBTQ policy, advocacy, patient care, academics, workforce diversity, or health care administration.
Dr. Eiting has been a tireless advocate for the care of underserved and vulnerable populations, particularly in the LGBTQ+ community in New York City where he serves as the vice chair of operations for emergency medicine at Mount Sinai. He has also served as the vice chair for the AMA Advisory Committee on LGBTQ Issues and helped establish the LGBTQ Honor Fund at the AMA Foundation.
An active member of MSSNY, Dr. Eiting currently serves as co-chair of the Committee on Health Equity and has served on several other committees, including as a member of the Task Force on Medical Student Tuition and Debt and the Committee on Medical Education.
MSSNY Joins Legislative Champion on Telehealth in Letter Questioning Department of Financial Services (DFS) Decision to Eliminate Cost-Sharing Waiver for Patients
MSSNY and several specialty societies have joined a joint letter to the New York Department of Financial Services (DFS) initiated by Assemblywoman Carrie Woerner (D- Saratoga Springs), raising concerns with DFS ending its policy adopted in March 2020 exempting patients from out-of-pocket expenses including co-pays, coinsurance, and deductibles for in-network Telehealth services. It should be noted that the latest DFS extension of emergency coverage is valid through July 4, 2021 and continues to ensure that commercial health insurers must cover audio-only Telehealth services. Assemblywoman Woerner is also the lead sponsor of legislation (A.6256/S.5505) strongly supported by MSSNY to require insurer payments for services provided using Telehealth are on par with in-office visits.
Early on in the pandemic, with the support of MSSNY and many other patient advocacy organizations, DFS and the state Department of Health (DOH), adopted critically important policies to better enable patients to obtain health care services via telemedicine, including waiving cost-sharing requirements for services delivered via telemedicine, expressly permitting coverage for health care services via audio-only, and allowing delivery of telemedicine services through basic smartphone video technologies. Medicare also followed this path, waiving the federal statute that limits Medicare coverage for Telehealth to rural areas and significantly increased the payments for video and audio-only Telehealth services.
Even as a significant portion of the population begins to be immunized against COVID19, public health experts anticipate that Covid-19 will remain a public health threat for the foreseeable future, making continued expanded patient access to Telehealth services all the more important. Therefore, MSSNY has raised concerns to DFS that it may still be premature to re-instate otherwise applicable patient cost-sharing requirements when many immuno-compromised patients still may be more comfortable receiving ongoing care where appropriate via telehealth. Moreover, MSSNY will continue to advocate for measures that remove barriers to patients receiving Telehealth services from their physicians, including fair payments for these services.
Please Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
As reported in MSSNY e-news last week, the State 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 liability insurance costs for many physicians particularly in downstate New York. 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 – Expanding the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal.
- A8040/S7093 – Changing a long-standing rule that heretofore excluded a “hearsay” statement made by a defendant’s employee.
- A8041/S7052 – Imposing excessive insurance disclosure requirements on defendants during litigation.
As MSSNY works together with other aligned organizations to urge the Governor to veto these bills, physicians are urged to send a letter or tweet to the Governor from here Urge Governor Cuomo to VETO Regressive Liability Bills also asking him to veto these bills.
Please Urge Governor to Sign into Law Two Bills to Assist Patients to Receive Needed Medications
Physicians are urged to contact Governor Cuomo to urge that he sign into law 2 bills that are critical to helping patients to be able to receive the medications they need as well as to ensure greater oversight over pharmacy benefit formulary development practices. A letter or tweet can be sent here: Urge Gov. Cuomo to SIGN two RX bills-Regulating PBMs and Restricting Mid-Year Formulary Changes.
The first bill (A.1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices of Pharmacy Benefit Managers (PBMs). The bill was significantly revised from the version that passed the Legislature in 2019, but vetoed, to address concerns raised in your veto message. The bill would require that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. The bill would also provide for the 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 that interfere with patients obtaining needed medications.
The second bill, A.4668, People-Stokes/S.4111, Breslin, would significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. The bill was revised from the version that passed both chambers two years ago, but was vetoed. To address concerns raised in your veto message in 2019, the legislation would prohibit the applicability of a mid-year formulary change for those patients who were on the medication at the beginning of the policy year, or suffer from a condition for which the medication is part of a treatment regimen, for that condition. However, other mid-year formulary changes could still occur.
Several New York Congressional Members Urge Federal Surprise Bill Law Implementation to Ensured Balanced Consideration of Factors
Eleven members of New York’s Congressional delegation signed on to a letter to the Secretaries of several federal agencies urging an implementation of the No Surprises Act (NSA) that ensures “a balanced process to settle payment disputes between health plans and providers.” It was designed to push back against aggressive efforts by the insurance and business industries that want to distort the federal Independent Dispute resolution (IDR) process to resolve surprise out of network medical bills to essentially have a presumption in favor of insurer payments.
The Center for Consumer Information and Insurance Oversight (CCIIO) is developing regulations over the next several months implementing the NSA with the law operative beginning January 1, 2022.
The letter was initiated by Rep. Tom Suozzi (D-Long Island) and Brad Wenstrup (R-OH), and whose bi-partisan list of 93 signers including Rep. Adriano Espaillat (D-Bronx and Manhattan), Rep. Andrew Garbarino (R-Long Island), Rep. Brian Higgins (D-Erie and Niagara counties), Rep. John Katko (R-Central New York), Rep. Sean Patrick Maloney (D-Hudson Valley) Rep. Grace Meng (D-Queens), Rep. Joe Morelle (D-Monroe County), Jerrold Nadler (D-Kings and Manhattan), Rep. Tom Reed (R-Western New York) and Rep. Nydia Velasquez (D-Kings, Manhattan and Queens).
The Suozzi-Wenstrup letter notes that “the No Surprises Act instructs the certified IDR entity to consider each of these listed factors, as well as any allowable information brought by either party or requested by the certified IDR entity. To match Congressional intent, your implementation of the law should ensure an IDR process that captures the unique circumstances of each billing dispute and does not cause any single piece of information to be the default one considered.”
The letter further notes that the IDR process established in the No Surprises Act prevents artificially low payment rates that would incentivize insurance companies to keep providers out of their networks. Providers and payors are able to bring relevant information with the exception of billed charges and public payor information for consideration, and the certified IDR entity shall consider:
- Median in-network rates
- Provider training and quality of outcomes
- Market share of parties
- Patient acuity or complexity of services
- Teaching status, case mix, and scope of services of the facility
- Demonstrations of previous good faith efforts to negotiate in-network rates
- Prior contract history between the two parties over the previous four years.
Health and Human Services (HHS) Issues Important New Information for Provider Relief Fund (PRF) Recipients
HHS held a call on Tuesday, June 16th with health provider associations across the country to provide education for recipients of COVID-related emergency funding regarding information about new deadlines, auditing, and reporting requirements. Recipients include those who received funding from the CARES Act and the Paycheck Protection Program (PPP), among others. More than $186 billion dollars were distributed through these programs, throughout the COVID crisis, and provided relief to healthcare providers, hospitals, businesses and a range of others.
All information is available through the HHS and Health Resources and Services Administration (HRSA) websites and includes key details like an extension for the period to complete reporting from 30 to 90 days, allowable expenditures, who is required to report, and a host of other important details. All changes supersede previous information.
To learn more, please use the following links:
Provider Reporting Portal
Deadlines for Recipients
Examples of Allowable Expenditures
COVID-19 Vaccines: Expiration and Beyond Use Dates (BUDs)
Determining when a vaccine expires is a critical step in proper storage, handling, and reporting. The expiration date should always be checked prior to preparing or administering vaccine. Expired vaccine should NEVER be used. As additional stability data become available, the expiration dates for some products may change. Follow the instructions below to determine the expiration date of COVID-19 vaccines.
- Pfizer COVID-19 vaccine: This vaccine product has an expiration date located on the vaccine vial.
- Moderna COVID-19 vaccine: The expiration date is NOT printed on the vaccine vial or carton. To obtain the expiration date of the lot number received, providers can scan the QR code located on the vial or carton or access the manufacturer’s website directly, enter the lot number and the expiration date will be displayed.
- Janssen/Johnson & Johnson COVID-19 vaccine: The expiration date is NOT printed on the vaccine vial or carton. To determine the expiration date:
- Scan the QR code located on the outer carton, or
- Call 1-800-565-4008, or
- Go to jnj/, enter the lot number and the expiration date will be displayed.
For Moderna and Janssen/J&J COVID-19 vaccines it is important to write the expiration date on the carton or vials since it is not printed. Orders of Moderna and Janssen/J&J received in NYSIIS will contain a placeholder date of 12/31/2069. The actual expiration date must be updated in NYSIIS and CIR as well, as part of inventory management. Vaccines should always follow a first in, first out process in which vials that have the earliest expiration date are used first. CDC’s https://www.cdc.gov/vaccines/covid-19/downloads/expiration-tracker.pdf can help providers keep track of the expiration date by lot number. Vaccine inventory should be managed using a “first in first out” tracking process to limit the potential for wastage.
Beyond Use Dates (BUDs)
All vaccines have expiration dates, and some routinely recommended vaccines have a beyond use date (BUD), which is calculated based on the date the vial is first punctured and the storage information in the package insert. Whenever a vial of COVID-19 vaccine is moved to storage conditions that affect BUD or a multidose vial is punctured, label the vial(s) with the beyond use date/time. The BUD must never exceed the labeled expiration date. Once the vaccine has reached its expiration or beyond use date/time, unused doses must be disposed of as medical waste and reported in NYSIIS as wastage or in CIR as wastage. A summary of COVID-19 vaccine beyond use dates and resources are listed below.
- Pfizer: Pfizer-BioNTech COVID-19 Vaccine Beyond-Use Date (BUD) Tracking Labels for Vaccine During Freezer or Refrigerator Storage
- Freezer (-25° C to -15° C): Two weeks
- Refrigerator (2° C to 8° C): 31 days
- After Puncture: 2° C to 25° C for up to 6 hours
- Moderna: Moderna COVID-19 Vaccine Beyond-Use Date (BUD) Tracking Label for Vaccine During Refrigerator Storage
- Refrigerator (2° C to 8° C): 30 days
- After Puncture: 2° C to 25° C for up to 12 hours
- Janssen/J&J: Janssen COVID-19 Vaccine Preparation and Administration Summary
- After Puncture: 2° C to 8° C up to 6 hours OR 9° C to 25° C for up to 2 hours
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