MSSNY Pulse: November 18, 2022
Message from MSSNY President Parag Mehta, MD:
This past weekend, MSSNY Delegates to the American Medical Association (AMA) Interim Annual Conference successfully brought numerous resolutions before physicians from around the country (see article below for details). Approximately two dozen delegates and alternates from New York attended the AMA Conference in Honolulu, listening to and speaking with other delegates from around the USA and beyond.
As your MSSNY President, I attended along with our President-Elect Dr. Paul Pipia and Vice President Jerome Cohen. Our MSSNY Delegation was led by Drs. Charlie Rothberg and Joseph Sellers. Please join me in congratulating our New York physician leaders for working to advocate for our interests.
This month, we celebrate Native American Heritage Month, which aims to provide a platform for Native people in the United States of America to share their culture, traditions, music, crafts, dance, and ways and concepts of life.
I wish you hope, joy, peace, good health, and love today and always. Happy Thanksgiving Day!
I am blessed and grateful to be surrounded by a devoted and talented staff, gifted leaders, and amazing members of MSSNY. Though we are far apart, we are connected with MSSNY Pulse.
And finally, I am sharing beautiful thoughts from Hawaiian culture written by Kumu Keala Ching:
‘O ke aloha ka mea i ho’ola ai ma ke ola à e ola ke ala pono ma ‘o aku o ka hana aloha. “O ia nò ka mea
nui ma kêia ao hulihuli, e nânã ià ‘oe iho ma mua o kou kuhi hewa ià ha”i. E ola ke aloha à e ala ke ola!
Compassion (gentleness, unity, truth, humbleness, and patience) is what brings healing within life’s journey, and the living journey is beyond our work of compassion. We embrace this mindset as we journey within these changing times, observing within before pointing at the wrong beyond. Live compassionately and journey beyond.
Encouraging the mindset of compassion during these times of change! The truth will guide our journey!
|Embrace gentleness within and beyond||E Akahai è|
|Firmly standing upon unity seen and unseen||E Lökahi kü|
|Live, speak and know the truth. Truth is life||‘Oia’i’o nô|
|Eternal humbleness is truly the flame of life.||Ha’aha’a è|
|Know and be patient. Patience is a gift||Ahonui, Ahonui, Ahonui|
|Compassion is recognized, seen, and unseen||Aloha|
Parag Mehta, MD
MSSNY Advocates for New York Physicians and Patients at the AMA
MSSNY Delegates to the American Medical Association (AMA) Interim Annual Conference this past weekend successfully brought numerous resolutions before physicians from around the country.
Among the many issues MSSNY brought to national attention included:
- Advocating for federal rules requiring increased hazard pay for physicians working during health emergencies such as COVID.
- Requiring COVID vaccinations for public schools.
- Protecting physicians in state medical licensing boards from external political influence, particularly related to charges based on health misinformation.
- Allowing physicians to claim CME credits that more accurately reflect hours spent on preparing and presenting CME programs.
- Working to streamline or eliminate unproven metric collection by physicians that takes away from patient quality care.
- Improving the FairHealth database — which is considered in New York surprise billing disputes — by including frequency reporting.
The MSSNY Delegation to the AMA collaborated with specialty society and other New York and national representatives to the AMA to advance these and other initiatives that are crucial to protect physicians and our patients.
Highlights from the 2022 AMA Interim Meeting
New Survey Reveals Current Physician Practice Environment is Not Sustainable to Improve Health Outcomes
The Physicians Foundation released part three of its 2022 Survey of America’s Physicians, which assessed the state of the physician practice and strategies to improve it.
“Before the pandemic and now, regulations and compliance have changed the landscape of physician practice—resulting in an environment that has negatively impacted physicians’ ability to deliver patient care and their overarching outlook on the profession,” said Gary Price, M.D., president of The Physicians Foundation. “Not only has our survey found that nearly half of physicians do not have high professional morale, but also that half would not recommend medicine as a career to young people. Many physicians feel overworked, underappreciated, and unable to do their jobs to the best of their ability.”
Approximately one in three physicians has experienced a reduction in staff over the past year with the most shortages reported for registered nurses (90%), nursing assistants (86%), social workers (85%), physicians (84%) and licensed practice nurses (83%).
Among those who reported staff shortages, physicians stated that the most impactful contributing factors were:
- 85% reported administrative burdens
- 79% reported increased working hours without compensation
- 71% reported reduced salaries/benefits
Without action to address how we staff our care centers and how we deliver primary care, shortages will grow, and the resulting health of the country will worsen. The path towards this action is clear—physicians have identified what would most support them in ensuring access to high-quality, cost-efficient care for all patients. Approximately nine in 10 physicians identified simplifying/streamlining prior authorization for medical services and prescriptions; reimbursing physicians for providing telehealth services; simplifying access to integrated mental health services and advancing interoperability of EHRs as important.
For more check out The Physicians Foundation’s Part Three of Three: 2022 Survey of America’s Physicians.
MSSNY 16th Annual Poster Symposium Friday, April 21, 2023
MSSNY Medical Students and Resident/Fellow members are invited to submit abstracts that will be considered for poster presentation at this year’s House of Delegates. Deadline for abstract submission: 4 pm, Monday, January 16, 2023.
Please note that medical student membership requires enrollment in an LCME or COCA-accredited school. However, non-LCME/COCA students doing rotations in New York hospitals may participate without membership. Click here for more details.
Abstract Reviewers Needed
MSSNY will once again hold a Residents/Fellows and Medical Students’ Poster Symposium during the 2023 MSSNY House of Delegates. We are seeking volunteers to serve as reviewers of abstracts for the symposium. January 16, 2023, is the deadline for submission of abstracts and abstract review will take place between January 20 and February 20.
If you are interested in reviewing abstracts, please contact Kathy Rohrer at email@example.com
How to Tell Patients They’re Dying
Successful communication with patients entails conveying what is happening to them and ensuring that they understand. Some physicians say death and dying are not dirty words, so they should not be afraid to tell the patient, but at the same time, physicians should be mindful of how and when to say them. Physicians should be clear enough and use the D-word if needed. But it does not have to be said or repeated unnecessarily, as long as the patient understands what you mean.
Read more about Dr. Nakagawa’s approach and beliefs in telling a patient of their limited time remaining.
How to Tell Patients They’re Dying (Nakagawa, Medpage).
New NYSDOH Report Supports Efforts to Prevent Opioid Overdose Deaths in NY and Provides Specific Data to Mobilize Public Health Action
The New York State Department of Health (NYSDOH) has just released the latest report in a series of Data to Action reports supporting efforts to prevent opioid overdose deaths in the state. Data to Action reports are short communications on important topics that provide specific data to mobilize public health action. This report, Continuous buprenorphine prescriptions for 6 months or more for the treatment of opioid use disorder in New York State, 2017-2021, presents data and information regarding continuous buprenorphine prescriptions for 6 months or more for the treatment of opioid use disorder (OUD). Additionally, it informs the general public, local health departments, emergency medical service providers and emergency departments/hospitals, correctional health settings, healthcare insurance providers, community and family members as well as other coalitions and organizations that work on opioid abuse, dependence, and overdose preventions about the trends of buprenorphine dispensing for 6 months or more for OUD. It also provides recommended actions and resources to promote the use of buprenorphine for the treatment of OUD.
For more information:
- Direct opioid prevention related questions and requests for additional information to firstname.lastname@example.org.
- Opioid data website: https://www.health.ny.gov/statistics/opioid/
Opioid data dashboard: https://www.health.ny.gov/opioiddashboard
More County Medical Society Leaders Urge Governor Hochul to Veto Disastrous Lawsuit Expansion Bill
As physicians continue to press Governor Hochul to veto legislation that would strike a huge blow to New York’s health care safety net and make patient access to care even more challenging, this week Spectrum News reported on the opposition to this legislation from the Dutchess County Medical Society noting a letter from DCMS that states “The citizens of Dutchess County and all of New York will lose out. They will face increased health insurance premiums and longer wait times, which lead to worse health outcomes.”
This is the latest in a series of op-eds across New York State from MSSNY and county medical society leaders urging the Governor to veto legislation (S.74-A/A.6770), which would raise New York’s already excessive liability insurance costs by 40% by greatly increasing the types of damages awardable in wrongful death lawsuits. Other physician leader op-eds have appeared in the Albany Times-Union, Buffalo News, Syracuse Post-Standard, Poughkeepsie Journal, Utica Observer-Dispatch Westchester Journal-News. Additionally, the New York Post issued an editorial calling on Governor Hochul to veto the bill that quotes MSSNY President Dr. Parag Mehta.
There are many other groups urging Governor Hochul to veto this legislation. Hospitals, business groups, and municipalities are all taking various steps to urge a veto. The Lawsuit Reform Alliance of New York released an ad campaign, “Not One More Cost Hike”, to educate elected officials, local business owners, families, and voters of the costly consequences of A.6770/S.74-A. Their ads have appeared in several news outlets across the State of New York. More information can be found at www.NotOneMoreCostHike.org
Again, physicians across the state can join the thousands of their colleagues who have already registered their opposition to this legislation by sending a letter from Veto Liability Expansion (p2a.co).
New Law Will Require Certain Information to be Provided to Patients with Epilepsy
Earlier this year Governor Hochul signed into law a bill A3298 (nyassembly.gov) that require physicians and other clinicians treating a patient for their epilepsy and at elevated risk of sudden unexpected death due to epilepsy (SUDEP) to provide the patient with written materials about the risk of SUDEP. As reported in previous publications, MSSNY together with the New York State Neurological Society worked with the sponsors to narrow the applicable patient scenarios where the information would be required to be provided.
The law technically took effect this past week, November 15. However, since the law requires that the patient materials are to be developed by the New York State Department of Health and they have not been developed yet, DOH officials have indicated that the law cannot be enforced at this time.
Earlier this week, MSSNY participated in a meeting convened by the NYSDOH together with physician experts in neurology and epilepsy to help develop the pamphlet that will be provided to physicians to provide to these patients who are at elevated risk of SUDEP.
Transition of Medicaid Pharmacy Benefit to a Single State Formulary Begins April 1, 2023
Starting April 1, 2023, the NYS DOH will transition the Medicaid pharmacy benefit from Managed Care (MC) to the Medicaid Pharmacy program, NYRx. Features of the new program include providing the State with full visibility into prescription drug costs, centralized negotiation power, and a single drug formulary with standardized utilization management protocols, as compared to the numerous and varying formularies used by MC plans under the existing program.
Information regarding specific outpatient drugs covered by the NYRx Medicaid Pharmacy program, and whether a prior authorization is required, can be found on the eMedNY website. However, when the pharmacy benefit transitions to NYRx, many Managed Care (MC) patients will be able to continue taking their medication without needing prior authorization, at least initially.
NYS DOH will use clinical editing criteria which may enable members to continue to receive non-formulary/non-preferred medication. Additionally, prior authorizations established in Managed Care will continue to be honored and could allow for non-formulary/non-preferred drug coverage. There will also be a transition period from April 1, 2023 through June 30, 2023, during which members will be provided with a one-time, temporary fill for drugs that would normally require prior authorization under the NYRx Preferred Drug Program (PDP). This will allow additional time for prescribers to either seek prior authorization or switch to a preferred drug which does not require prior authorization.
MSSNY has participated in numerous stakeholder meetings to work to minimize any potential new administrative burdens on physicians and their patients, which will continue as DOH announces new elements of the program. To learn more, view DOH’s comprehensive FAQ.
MSSNY in The News
MSSNY Assistant Treasurer Dr. Frank Dowling and NY Delegate Dr. Corliss Varnum were featured this week in Medpage Today’s article COVID Vaccine Mandates in the Spotlight at the AMA’s Interim Meeting.
Dutchess County Medical Society was also mentioned in Spectrum News 1 Albany’s story Hochul faces renewed veto calls for expansion of wrongful death law.
Highlights to CMS Final Rule
As many of you are aware, CMS has finalized their 2023 Medicare payment rule, which incorporates a 4.5% cut to the conversion factor. MSSNY is working together with the AMA to urge Congress to prevent these cuts. You can help by sending a letter from this link: Stop Exorbitant and Unsustainable Cuts to Medicare Payments.
Below are the additional highlights. MSSNY will be putting on a webinar in January to review specific code changes to further assist your practice.
CMS has decided to include several additional services to the Medicare CY 2023 Telehealth Services List on a Category 3 basis. Category 3 services were temporarily added to the Medicare Telehealth Services List in the wake of the COVID-19 pandemic and have a reasonable likelihood of clinical benefit when furnished via telehealth. The Medicare Telehealth Services List is available on the CMS website.
Chronic Pain Management & Treatment Bundles
CMS finalized their proposal to create separate coding and payment for Chronic Pain Management and Treatment (CPM) services beginning January 1, 2023, by creating HCPCS codes G3002 and G3003, with two modifications to HCPCS code G3002.
Procedures Subject to the Multiple Procedure Payment Reduction (MPPR) and the OPPS Cap
The list of services for 2023 that are subject to the MPPR are diagnostic cardiovascular services, diagnostic imaging services, diagnostics ophthalmology services, and therapy services. CPT® codes 0493T, 0642T, 0651T, 0658T, and 76883 are not within the statutory scope of services to which the OPPS cap applies, as they cannot be split into professional and technical components, or they only describe the professional component (PC). Therefore, CMS proposed to add these codes to the OPPS DRA caps list in error. CMS will not add the aforementioned codes to the list of services to which the OPPS cap applies. However, CPT® codes 0640T, 0641T, 0689T, 0690T, 0694T, 0700T, and 0701T, meet the definition of imaging services under section 1848(b)(4)(B of the Act, and thus, should be subject to the OPPS cap.
Caregiver Behavior Management Training
Caregiver training codes, CPT® codes 96202 and 96203, are new codes to be used to report the total duration of face-to-face time spent by providers providing group training to guardians and caregivers of patients.
Proposed Revisions to the “Incident to” Physician’s Services Regulation for Behavioral Health Services
In support of CMS’ 2022 Behavioral Health Strategy to improve access to and quality of mental health care services, CMS is finalizing its proposal to amend the direct supervision requirement under “incident to” regulations at § 410.26 to allow behavioral health services to be furnished under the general supervision of a physician or NPP when these services or supplies are provided by auxiliary personnel incident to the services of a physician or NPP.
Evaluation and Management Visits
CMS finalized their proposal to create Medicare-specific coding payment of ‘Other E/M’ prolonged services, like what CMS adopted in CY 2021 for payment of Office/Outpatient (O/O) prolonged services. Specifically, CMS adopted the general CPT framework for Other E/M visits, so that practitioner time or medical decision making (MDM) would be used to select the E/M visit level. This includes listing the qualifying activities by the physician or nonphysician practitioner (NPP) that count toward the time spent when time is used for the visit level. CMS also finalized their proposal to adopt the revised CPT codes and descriptors for Other E/M visits, except for prolonged services, which CMS proposes Medicare-specific coding. Additionally, CMS adopted the CPT E/M Guidelines regarding MDM for E/M services.
Home or Residence Services (CPT Codes 99341, 99342, 99344, 99345, 99347-99350)
CMS finalized a work RVU of 1.00 for CPT code 99341, a work RVU of 1.65 for CPT code 99342, a work RVU of 2.87 for CPT code 99344, a work RVU of 3.88 for CPT code 99345, a work RVU of 0.90 for CPT code 99347, a work RVU of 1.50 for CPT code 99348, a work RVU of 2.44 for CPT code 99349, and a work RVU of 3.60 for CPT code 99350. CMS also finalized their proposal to refine the direct PE inputs by removing supply item SK062 (codes 99341 and 99342). For CPT code 99344, CMS is proposing to refine the direct PE inputs by removing supply items SK062, SJ053, and SJ061.
Prolonged Services for Home or Residence Services (CPT Codes 99358, 99359)
CMS finalized their proposal to create a new code, G0318, for a prolonged home or residence visit. They also finalized their proposal to change the status indicator for prolonged CPT codes 99358 and 99359 to “I,” which indicates that these codes are not valid for Medicare purposes, and that Medicare uses another code for reporting of, and payment for, these services. To see the summary in its entirety please click here.
Keep your eyes open for an upcoming webinar MSSNY will be conducting specific to code changes in January. You don’t want to miss this!
Audits, Yes, Audits! Need Help Managing Your Insurance Contracts?
Audits, yes, audits! When was the last time you or your staff looked at your contracts with insurance companies? If it has been over a year, it is time to review and identify if anything needs to be updated or has potentially expired. Many contracts are “evergreen contracts,” meaning they will renew yearly until either party would like to amend. But this could be holding back your reimbursement, and you may lose additional dollars. Another good practice is to take a random sample of your claims and compare them to the contract. Doing this exercise checks the accuracy of contract rates vs. actual rates to ensure everything is correct. If you notice that things are not, it is time to contact your provider relations manager for a call. If you do not know who your provider relations rep is, contact Heather Lopez at email@example.com for assistance.
Spoil the No Surprise Act Webinar
MSSNY is hosting a webinar on the upcoming No Surprise Act(NSA effective 1/01/2022), and our experts are here to give YOU the information YOU need to be at ease. In collaboration with CMS, we will provide YOU with detailed specifics to spoil any Surprises.
Edyne Zephirin from CMS will be presenting the webinar on November 30th @ 7:30 am specific to the No Surprise Act. Please register today to save your spot and share it with your colleagues
Physician Addiction: A Health Care Crisis Webinar December 6
The New York County Medical Society Cordially invites you to a CME program, Physician Addiction: A Health Care Crisis, on Tuesday, December 6 from 6:00 to 7:00 p.m. with Steven Mandel, MD and the Physician Wellness Committee: Jill Baron, MD, Harris Stratyner, MD, Stuart Gitlow, MD, Paul Earley, MD, Jeffrey Selzer, MD and Chris Bundy, MD. To register, Click Here
Addiction in physicians is an extremely serious problem. It is estimated that up to 15% of physicians will develop a substance use disorder (SUD) during their lifetime. Job stress and comorbidities, especially post–COVID symptoms, have led many to turn to drugs and other substances to alleviate their anxiety. This program aims to provide education and a safe platform for physicians who may be struggling with substance use and to educate our physician members about the signs and symptoms for substance use and addiction so they can better identify patients with these conditions. The program is the work of Steven Mandel, MD, and is supported through the Physician Wellness Committee, with Jill Baron, MD. Other participants include Harris Stratyner, MD; Stuart Gitlow, MD; Paul Earley, MD; Jeffrey Selzer, MD; and Chris Bundy, MD.
This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of the Westchester Academy of Medicine and the New York County Medical Society. The Westchester Academy of Medicine is accredited by MSSNY to provide Continuing Medical Education for physicians.
The Westchester Academy of Medicine designates this live webinar activity for a maximum of 1.5 AMA PRA Category I Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The Society thanks the Clifford L. Spingarn, MD, Memorial Education Fund for support of this program.
Salary Data and Contract Review: What You Need to Know with Resolve CEO Kyle Claussen Tuesday, December 6, @ 12 pm
Kyle Claussen is the CEO of Resolve and a partner in the law firm of MorganTheeler, LLP. He received his undergraduate degree from North Dakota State University, his law degree from the University of La Verne College of Law, and his LL.M. in Taxation from Boston University. Kyle is a member of the American Health Lawyers Association and is one of the leading experts in physician employment agreements.
Resolve has empowered over 10,000 physicians in their employment agreements leading to national recognition with various state and national physician societies. Kyle has been featured on a variety of physician focus media sources including ZdoggMD, White Coat Investor, Physician Side Gigs, Physician Moms Group, Beyond Medicine, The Physician Philosopher, and others. Kyle is married to an Ophthalmologist and has 3 children and a dog. Register Today!
Cybersecurity: Locking the Back Door Webinar December 14, 2022 @ 7:30AM (EST)
In this webinar, STI will introduce you to Cybersecurity Trends that are affecting the Healthcare industry. The cybersecurity landscape keeps evolving as bad characters continue to get more creative. Over the last year, they have come up with new attack vectors and adjusted their tactics to circumvent ways that had been implemented to prevent them in the past.
STI’s Director of Technical Services, Al Toper, is an Air Force veteran with over 40 years in the technology field. Please join him as he shows you these new attack vectors and things you can do to help prevent you from being the next victim. Register Today
Spoil the No Surprises Act Webinar
MSSNY is hosting a webinar on the upcoming No Surprises Act (NSA effective 1/01/2023), and our experts are here to give YOU the information you need to be at ease. In collaboration with CMS, we will provide you with detailed specifics to spoil any surprises.
Edyne Zephirin from CMS will be presenting the webinar on November 30th @ 7:30 am specific to the No Surprises Act. Please register today to save your spot and share it with your colleagues.
In Need of a New Winter Wardrobe?
MSSNY members receive a 15% discount on full-priced Brooks Brothers merchandise at stores, by phone, and online. Login to your MSSNY account for details on how to save!
MSSNY Advocacy Update Podcast: Post-Election Re-cap & Physician Grassroots Efforts Still Needed in 2022
Listen to MSSNY’s November 18 podcast as Senior Vice-President & Chief Legislative Counsel Moe Auster discusses the election results and what to expect.
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 RateSheet, please click here.
Concierge Practice for Sale Boca Raton Florida
FOR SALE: Established Independent Concierge Internal Medicine Practice in Boca Raton, Florida. Stable turnkey operation in a pleasant work environment. Ideal for someone with the desire to transition to a better approach to medical practice. Financing available.
Rheumatology Practice Sublet – Great Neck, NY
Sublet opportunity available at an established medical office in Great Neck, NY. Prime location near LIJ, Northshore University and St. Francis Hospitals. Fully equipped office with onsite parking and proximity to mass transit. Contact firstname.lastname@example.org for more info.
Medical Office for Share in Medical Park with Free Big Parking Lot in Westchester County
Medical office for sublet in Medical Park with free big parking lot, located at West Harrison, border of White Plains in Westchester County. Office includes a big waiting room with a kitchen, doctors office, exam room, and reception area. All rooms are available for whole days of Monday, Tuesday, Wednesday, Saturday, Thursday (Thursday full day on every 1st and 3rd week and Thursday morning on every 2nd and 4th week each month, or we can discuss more options). Monthly rent $600 for once a week usage, $1100 for twice a week usage, $1500 for three-day a week usage. Newly renovated and fully furnished. Text May if you are interested 646-338-4803
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 email@example.com. 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.