MSSNY eNews: March 26, 2021 – More Ups than Downs
More Ups than Downs:
This week brings significant progress on the vaccine front with the start of the long-awaited allocation of vaccine supply to physician practices. Over 1,600 physician practices have enrolled in the NYS COVID-19 Vaccination Program and 190 of these have received 100 doses each of the Moderna vaccine since Monday. We anticipate that as supply increases more physician practices will be allotted vaccine, including Johnson & Johnson, Moderna and Pfizer. This is great news for patients who can now have their vaccine in a familiar setting, close to home with their trusted physician. This bodes well for the NYS vaccine roll out as NY is rapidly expanding the eligibility categories and needs its most seasoned vaccinators contributing to the effort.
Please remember that you must submit a weekly planning vaccine request indicating the amount of vaccine that you can administer in seven days. Click here for the latest NYS DOH vaccine guidance.
There was also good public health news this week with regard to NYS vaccination requirements. The New York State Supreme Court, Appellate Division, Third Judicial Department affirmed the dismissal of the challenge to the 2019 law that eliminated religious exemptions for state vaccination requirements. The role of vaccines in combating communicable diseases has never been more apparent than in the last few years with the Measles outbreak in 2019 and now the Covid-19 pandemic.
With this in mind, the Medical Society of the State of New York, the American Medical Association, the American Academy of Pediatrics, and the New York State American Academy of Pediatrics participated as amici curiae in the litigation in support of New York State and the law, and offered our conclusion that having medical exemptions only is in the best interest of public health.
On the downside, this week, the NYS legislature passed legislation repealing the Covid liability protections provided to physicians and other care providers enacted as part of last year’s State Budget. MSSNY along with other groups wrote to legislators to oppose A.3397/S.5177, noting that regardless of the nursing home data concerns, it is very important to maintain the liability protections for the duration of the public health emergency, particularly given that New York continues to have thousands of new Covid cases every day with an increasing proportion of more easily spread variants.
While NYS legislators rejected our appeals that the law should continue, during the floor debates in both the Assembly and Senate over this legislation, many did indicate that the “effective date” language in the legislation means that the repeal provisions would only apply prospectively should Governor Cuomo sign this legislation. These comments were very important given traditional statutory construction rules that legislation is meant to apply prospectively unless there is clear intent to the contrary.
If you have not already done so, please text MSSNY to 52886 to sign up for text message grassroots alerts. Over the next week the NYS Budget will be finalized and this year’s budget proposal includes many provisions that may detrimentally affect you, your practice and your patients including negative OPMC changes, changes to the excess malpractice fund with partial cost shifting to physicians, expansion of pharmacist scope of practice, a cut to the Committee on Physician Health and more (click MSSNY eNews: March 24, 2021 for a more comprehensive summary). We need you to stand ready to answer to call to action Grassroots Action Center. Your voice and your email/letter to your legislator make a difference and can affect the outcome.
Bonnie Litvack, MD
MSSNY Weekly Podcast
State Budget Negotiation Continue – Keep Up Physician Grassroots!
After passing their respective one-House Budget proposals last week, the Assembly and the Senate are now having negotiations with the Governor’s office to complete a State Budget before next week’s April 1 deadline. Below is a summary of the most pressing Budget issues where MSSNY has been advocating, as well as the continued need for physician grassroots efforts.
Both the Assembly and Senate Budget proposals recommended the rejection of the $51 million cut to the Excess Medical Malpractice Insurance program and 50% physician cost share imposition that had been proposed in the Executive Budget. Physicians can send a letter to legislators urging that they continue to fight to prevent this cut from being included in the Budget: Don’t Balance the Budget on the Backs of Physicians
The Assembly Budget proposal recommended the rejection of the “OPMC Modernization Act” provisions from the Executive Budget including several provisions that would substantially curtail physician due process rights when a complaint has been filed against them with the OPMC. The Senate Budget proposal recommended the rejection of almost all of the “OPMC Modernization Act” provisions but left in components related to background checks for new licensees and expanded information on the physician profile.
Physicians can send a letter urging the Legislature to continue to fight to preserve due process protections for physicians and rejecting these seriously unfair proposed changes: Reject Governor’s Physician Disciplinary Proposal
The Assembly Budget proposal recommended the rejection in its entirety of the pharmacy scope expansion provisions from the Executive Budget proposal. The Senate Budget proposal recommended the rejection of Executive Budget proposals to greatly expand the physician-pharmacy Collaborative Drug Therapy program and pharmacist self-ordering of lab tests, but mostly accepted the proposal to expand the immunizations that can be performed by pharmacists.
Please urge your legislators to continue to fight to reject these short-sighted proposals that would empower big box chains at the expense of community-based physician-led medical homes: Oppose Uncoordinated Siloed Care to be Provided by Pharmacists
The Assembly Budget proposal recommended the rejection of almost all of the Executive Budget telehealth Budget proposal except for a provision that expands the locations where telehealth services can be provided. The Senate accepted the Governor’s telehealth Budget proposal, but importantly added language supported by MSSNY that would require equitable payment for telehealth services as compared to in-person services.
Please send a letter urging that equitable payment for telehealth services be included in the final Budget; and ensuring out of state telehealth service providers are not prioritized over community based New York physicians for providing telehealth services: Urge Legislators to Support Payment Parity in Telehealth. (More info below)
Committee for Physicians Health
The Senate Budget proposal restored the nearly $200,000 cut that had been proposed to CPH in the Executive Budget. While the Assembly Budget proposal did not affirmatively restore the cut, there have been indications that they will support the restoration of this cut.
Both the Assembly and Senate Budget proposals recommended the rejection of the Executive Budget proposal to eliminate the right of prescribers to apply for a year to year waiver of e-prescribing requirements.
Medicaid “Prescriber Prevails”
Both the Assembly and Senate Budget proposals recommended the rejection of the Executive Budget proposal to remove the statutory protection for the prescriber’s determination (not State Medicaid’s) to prevail for a medication prescribed to a patient covered by Medicaid.
Nurse Practitioner Collaborative Practice
The Assembly Budget proposal included the Governor’s proposal to extend the existing modified nurse practitioner independent practice statute for another 6 years. The Senate Budget proposal did not include these provisions.
Both the Senate and the Assembly rejected the 1% Across the Board Medicaid cut.
Recreational Use Marijuana
MSSNY Working to Secure Telehealth Expansion in FY 2022 Budget
Telehealth coverage expansion is among the items being negotiated extensively between the Assembly, Senate and Governor as they work to finalize a State Budget for FY 2022. Physicians are urged to send a letter to their legislators here urging equitable payment for patient care services delivered via telehealth and to ensure continued coverage of telehealth services by New York community-based physicians.
Urge Legislators to Support Payment Parity in Telehealth. As shared in last week’s Capital Update, the Assembly plan rejected all of the Executive Budget’s Telehealth proposal, with the exception of a provision that expands the locations where Telehealth services can be provided. The Senate, however, accepted the Executive’s Telehealth full, but added language supported by MSSNY, that would require payment for Telehealth services that is on par with in-person visits.
MSSNY is continuing to push for expansion of Telehealth services through the budget and is working with legislative leaders to address significant concerns with the proposal advanced in the Executive Budget, including its proposal to create an interstate compact and network adequacy, which has the potential to cut out New York-based, community physicians, especially those in network. MSSNY is also continuing to strongly advocate for physician payments for telehealth services that are on par with in-office visits.
US Senate Passes Measure to Prevent 2% Sequester Cut; House Expected to Follow Suit in Mid-April
This week the US Senate voted 90-2 to pass an agreement reached by Leaders Schumer and McConnell to extend the 2% Medicare sequester moratorium that expires on April 1. The bipartisan legislation, offered as an amendment by Senators Shaheen and Collins, would provide a 9-month extension of the moratorium, through December 31.
Last week, the House of Representatives passed different legislation that would have both extended the moratorium through the end of the pandemic and eliminated an additional 4% Medicare sequester scheduled to take effect on January 1, which was required by so-called “PayGo” rules to offset part of the cost of passing the American Rescue Plan COVID-19/stimulus package. Consequently, the House will need to pass the Senate language when it returns to DC the week of April 12. According to the American Medical Association, the House is expected to vote favorably, and the Centers for Medicare & Medicaid Services is expected to hold off on processing April claims until then to avoid making reduced payments.
MSSNY thanks Senator Schumer and Gillibrand for their actions, as well as the 25 of the 27 New York Congressional delegation members representing both parties whose support for preventing this cut in last week’s House vote demonstrated that there was wide bipartisan support for finding a way to prevent this cut from being implemented at a time when physicians and other care providers are still struggling with the consequences of the pandemic.
Legislature Passed Bill to Repeal COVID Legal Protections
Legislation (S.5177) to repeal the COVID liability protections provided to physicians and other care providers enacted as part of last year’s State Budget was passed by the Senate this week. The same-as legislation (A.3397) recently passed the Assembly. It will be sent to the Governor for his signature, which as of this writing has not yet occurred, nor has the Governor announced whether he will sign or veto the bill.
Many groups including MSSNY wrote to legislators to oppose A.3397/S.5177, noting that regardless of nursing home concerns that led many to question this law, it was important to maintain these legal protections for the front-line physicians and other health care workers still managing the thousands of new COVID cases in New York every day with an increasing penetration of more easily spread variants.
MSSNY also raised concerns that despite statutory construction rules that presume legislation is to be applied prospectively in the absence of clearly defined statutory intent to the contrary, there was still a possibility S.5177/A.3397 could be interpreted by a court to retroactively repeal these essential liability protections for care provided during the height of the pandemic when there were not clear medical protocols for COVID treatment and when many non-COVID health care services were required to be postponed.
Importantly, there were comments made by several Assemblymembers during the floor debate on the legislation when it was passed by the NYS Assembly that the “effective date” language means that the repeal provisions would only apply prospectively. The point was also made by Senator Shelly Mayer during the floor debate in the Senate.
NYS Legislature Appears to Have Reached Agreement on Legalizing Recreational Marijuana
According to news reports the New York State Legislature and the Governor’s office, appears to be close to agreement on legislation that would legalize recreational marijuana use and purchase for adults at least 21 years old. The legislation would also license dispensaries and impose special taxes on marijuana. News articles report that this legislation would include a 13% sales tax, 9% of which would go to the state and 4% to the localities.
Localities are also given the discretion to opt out of allowing a dispensary in a county. News reports also indicate that some of the resulting annual proceeds are going to low-income, mostly minority neighborhoods under a “community reinvestment” program to assist communities that have been subject to disparate enforcement of marijuana laws. With preventing against impaired driving a significant concern for many groups, the legislation is also expected to allow police to use marijuana odor to help determine if a driver is impaired but would ban odor from being a reason to search a vehicle. It should also be noted that there was still discussion whether driving while ability impaired by marijuana would be treated as a violation or as a misdemeanor. (CLANCY)
NYS Continues to Expand Vaccine Eligibility to 50 Years of Age and Older
New York State continues to expand eligibility to the COVID-19 vaccine to adults over 50. The March 23, 2021 guidance is here.
All providers can vaccinate any New Yorker, including those with comorbidities or underlying conditions, and individuals 50+. Enrolled providers other than pharmacies may vaccinate any eligible individual. Pharmacies must prioritize K-12 school faculty and staff and childcare workers but are also authorized to vaccinate individuals aged 50 and older and individuals with comorbidities.
New York State Department of Health also issued interim guidance to ensuring access to health care services and effective April 1, 2020, individuals may bring a companion with them to healthcare appointments. Companions must also wear appropriate face coverings, practice hand hygiene and respiratory etiquette, and comply with temperature checking and symptom screening. A copy of the guidance is here.
MSSNY has been working closely with the state to get vaccine supply to community physician offices and several physician practices around the state may receive an allocation of vaccine supply shortly. MSSNY has been informed that over 190 practices have received vaccine. Physicians who would like to become a COVID-19 immunizer, will need to enroll into either the NYSIIS or CIR systems. Physicians can find information about enrolling here.
Providers in receipt of COVID-19 vaccine, irrespective as to whether such doses are via a direct State or federal allocation or a redistribution, will now be required to report to the vaccine tracker on Mondays and Thursdays by 10am. All providers with COVID -19 vaccine doses on hand or that depleted their allocation since their last report are now required to fill out the vaccine tracker both days. This reporting will continue to be used for allocation determinations and is still required.
Physicians and patients can determine eligibility by going here. (CLANCY)
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 a phone call away! (LAUDER)
MSSNY Medical Matters Program on Mental Health of Children and Teens During COVID
Registration now open
Medical Matters: COVID-19 & Mental Health of Children and Teens
Date: April 21, 2021 @ 7:30am
The COVID-19 pandemic has affected the mental health of the entire population. Learn more about how children and teens have been affected by registering for Medical Matters: COVID-19 & Mental Health of Children and Teens. This webinar will take place on Wednesday, April 21st at 7:30 am. Linda Chokroverty, MD will serve as faculty for this program. Click here to register for this webinar.
- Identify normal stressors impacting children and teens and those that have resulted from the COVID-19 pandemic
- Examine what is known so far about the mental health impact of COVID-19 on children and teens
- Describe resources to assist children and teens during the COVID-19 pandemic
- Appraise the scope of COVID-19’s long term mental health impact on children and teens
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)
Veterans Matters: Military Culture: Everything Physicians Need to Know about Veterans as Patients Webinar Registration Now Open
Thursday, April 22nd @ 7:30 am
The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: Military Culture: Everything Physicians Need to Know about Veterans as Patients live webinar on Thursday, April 22, 2021 at 7:30 am.
When: April 22, 2021 at 7:30 am
Faculty: Lt. Colonel Lance Allen Wang (Ret.) & Sharran Chambers-Murphy, Desert Storm-era Veteran
- Describe the unique aspects of military culture and how they impact patients who are veterans;
- Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality; and
- Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back to civilian life.
For more information, contact Jangmu Sherpa at firstname.lastname@example.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 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (SHERPA)
NY Nursing Homes Can Now Welcome Visitors
New York nursing homes can begin welcoming visitors with limited exceptions under new state guidance released Thursday. The Department of Health and Gov. Andrew Cuomo directed nursing home operators to align their policies with federal guidance, which allows for outdoor and indoor visitation “at all times for all residents” regardless of vaccination status, except in certain cases where risk of COVID-19 transmission is high. The new policy, which took effect immediately, limits indoor visitation for: unvaccinated residents if the nursing home’s Covid-19 positivity rate exceeds 10 percent and less than 70 percent of residents are fully vaccinated; residents with confirmed Covid-19 infections; or residents in quarantine. Compassionate care visits are exempt from the restrictions.
Facilities must continue to follow infection control practices and DOH recommends that all nursing homes offer testing to visitors while Covid-19 is still present in communities across New York. Visitors unable to adhere to federal Covid-19 infection prevention principles “should not be permitted to visit or should be asked to leave” according to the new guidance.
State AGs Ask Facebook and Twitter to Remove Vaccine Misinformation
In a letter to Facebook Chief Executive Mark Zuckerberg and Twitter CEO Jack Dorsey, the Democratic Attorneys General said “anti-vaxxers” lacking medical expertise and often motivated by financial gain have used the platforms to downplay the danger of COVID-19 and exaggerate the risks of vaccination.
They called on both companies to enforce their own community guidelines by removing or flagging vaccine misinformation.
The letter said anti-vaxxers control 65% of public anti-vaccine content on Facebook, Instagram, and Twitter, and have more than 59 million followers on those platforms and Google’s YouTube.
It also said some misinformation targets Blacks and other communities of color where vaccination rates are lagging.
“Given anti-vaxxers’ reliance on your platforms, you are uniquely positioned to prevent the spread of misinformation about coronavirus vaccines that poses a direct threat to the health and safety of millions of Americans in our states and that will prolong our road to recovery,” the letter said.
Facebook spokeswoman Dani Lever said the company has removed millions of pieces of COVID-19 and vaccine misinformation and tries to combat “vaccine hesitancy” by regularly directing users to reliable information from health authorities.
Twitter said it has removed more than 22,400 tweets in connection with its policy toward COVID-19 posts and prioritizes removing content that could cause “real-world” harm.
Wednesday’s letter was signed by the attorneys general of New York, Connecticut, Delaware, Iowa, Massachusetts, Michigan, Minnesota, North Carolina, Oregon, Pennsylvania, Rhode Island, and Virginia. (Becker’s Hospital, April 25).
Social Media in Medicine Wednesday, April 21, 2021 at 6 PM EST.
MSSNY Vice President, Parag H. Mehta, MD and MSSNY YPS Chair, Daniel E. Choi, M.D. present Social Media in Medicine: A Beginners Guide to Social Media for Physicians.Register now for Virtual Webinar
- 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
Current State of Coronavirus Variants in the U.S.
On the heels of this winter’s surge and amid an accelerating vaccine rollout, many states are lifting or scaling back virus restrictions in a bid to return to normal life. Many epidemiologists and public health experts have urged continued caution, saying that the U.K. variant B.1.1.7 spreading nationwide could cause another surge and prolong the pandemic.
“The continued relaxation of prevention measures while cases are still high, and while concerning variants are spreading rapidly throughout the United States, is a serious threat to the progress we have made as a nation,” Rochelle Walensky, MD, CDC director, said during a March 22 White House news briefing.
The CDC confirmed 7,501 cases of the B.1.1.7 variant in all 50 states and Puerto Rico as of March 23. Florida has confirmed the most B.1.1.7 cases of all states, with 1,042 infections as of March 23. Some health experts have expressed concern that spring breakers traveling to Florida may take the variant back to their home states. Michigan follows closely behind Florida with 986 B.1.1.7 cases, and California has reported the third most at 471.
Health officials are also monitoring other coronavirus variants spreading nationwide. The CDC has confirmed 219 cases of the South Africa variant, known as B.1.351, in 27 states as of March 23. Sixty-one cases of the Brazil/Japan P.1 variant have also been detected in 18 states.
“Increasingly, states are seeing a growing proportion of their COVID-19 cases attributed to variants,” Dr. Walensky said. “The newly identified variant, B1427/B1429, is estimated to account for 52 percent of cases in California, 41 percent in Nevada and 25 percent in Arizona. And the B.1.1.7 variant is estimated to be responsible for 9 percent of cases in New Jersey and8 percent in Florida.” (Becker’s Hospital Review, March 25).
Harlem Hospital and Vaccine Hesitancy in Black Communities
Six Takeaways for Hospital Leaders
About half of eligible staff at New York City-based Harlem Hospital have received a COVID-19 vaccine, reflecting wariness in the Black community and prompting conversations about how leaders can acknowledge these fears while still encouraging vaccination, reports The New York Times.
Harlem Hospital, also branded as NYC Health + Hospitals/Harlem, is known for providing healthcare to the Black community and had the lowest staff COVID-19 vaccination rate among New York City hospitals at one point. As of mid-March, the hospital had a 51 percent staff vaccination rate, putting it in the middle of the 11 hospitals in the city’s public system.
Vaccine hesitancy at Harlem Hospital, where a majority of the staff is Black, reflects broader trends across the nation, administrators said.
Six key takeaways for hospital leaders, per the Times:
- At Harlem Hospital and across the U.S., confidence in COVID-19 vaccines is rising among Black Americans. Though initially more skeptical, Black Americans are now about as willing to get vaccinated as their white counterparts, and politics is emerging as a greater determinant of willingness, recent polls show.
- Harlem Hospital’s low vaccination rate was not surprising to leaders. A poll in late 2020 showed that only 30 percent of hospital employees were willing to be vaccinated, said Eboné Carrington, the hospital’s CEO. Black staff cited concern tied to the legacy of medical injustices and general skepticism of a vaccine developed quickly, under a presidential administration they did not trust. “The staff reflects a population of people who traditionally are reluctant to vaccinate, and not just hesitant, but rightfully fearful, at having been wronged,” Ms. Carrington said.
- Mitchell Katz, MD, president, and CEO of NYC Health + Hospitals, noted the lack of long-term studies about the vaccines, along with the negative experiences many Black and brown Americans have had with healthcare providers. Dr. Katz said he was going to be patient and focus on personal outreach, such as one-on-one conversations, to boost vaccination rates.
- “I think that the history of medical experimentation on Black people plays a role in some of the decision-making,” said Keisha Wisdom, BSN, RN, nursing chief at Harlem Hospital. “It is real, and it is something we have to talk about. And then find a way to continue that dialogue.”
- Some nurses said they did not feel an urgency to get the vaccine because they already had COVID-19, Ms. Wisdom said, adding that some staff felt more secure now that there were not personal protective equipment shortages.
- Jasmine Travers, PhD, RN, assistant professor at the Rory Meyers College of Nursing at New York University, said that empathizing with staff reluctance is good, but not enough. “We should not just chalk up a refusal to that person’s own wishes; we also need to look into ourselves and understand how we are approaching it. We can’t tiptoe around the subject,” Dr. Travers said. “It’s one thing to want to be respectful, but we have to interrogate people around how we can better support them. What is the work that needs to be done?” (Becker’s Hospital Review, April 24)
Kings County Webinar March 30: Beyond Tuskegee; Vaccine Hesitance and Equity
The Medical Society of the County of Kings, along with the Provident Clinical Society and Region 1 National Medical Association, is hosting a webinar on Tuesday, March 30 from 7:30-9:00 pm on “Beyond Tuskegee: COVID-19 Vaccine Hesitancy and Equity.” There is no charge to attend, and you are welcomed to share with colleagues and other healthcare professionals.
Study: COVID-19 Associated with Prominent Neurologic Symptom
Non-hospitalized coronavirus disease 2019 (COVID-19) “long haulers” experience prominent and persistent neurologic symptoms that affect cognition and quality of life, according to a new study published March 23, 2021 in the Annals of Clinical and Translational Neurology.
“Our study is the first to report neurologic findings in non-hospitalized COVID-19 long-haulers, including detailed neurologic exam, diagnostic testing, and validated measures of patient quality of life, as well as cognitive function test results,” said corresponding author Igor Koralnik, MD, chief of Neuro-infectious Diseases and Global Neurology, Ken & Ruth Davee Department of Neurology, Northwestern Medicine, in a press release.
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