MSSNY eNews: September 1, 2021 – Number of Adults Who Oppose COVID-19 Vaccine at New Low, Poll Finds

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Number of Adults Who Oppose COVID-19 Vaccine at New Low, Poll Finds
The number of Americans strongly opposed to getting a COVID-19 vaccine is at the lowest level seen since the vaccines were released, according to latest findings from the Axios/Ipsos Coronavirus Index.

Each week since March 2020, Axios/Ipsos has polled a nationally representative group of U.S. adults about the pandemic. The latest iteration included 1,071 adults polled from Aug. 27-30.

1. Only 20 percent of Americans said they are not likely to get the vaccine, representing the lowest figure since the survey’s creation. This figure peaked at 63 percent last September.

2. The percentage of adults who said they are not at all likely to get vaccinated also fell to 14 percent.

3. In the last week, the number of parents who say they’ll likely get their kids vaccinated has also increased. About 68 percent said they would or already have vaccinated their children.

4. Thirty-one percent said they were not likely to get their kids vaccinated, down from 43 percent who said the same between Aug. 13-16.

To view the full survey, click here.
–Bean, Becker’s Hospital Review

Urge Your Members of Congress to Push Back Against Steep Medicare Cuts for 2022
Physicians are urged to contact their Representatives in Congress to urge them to join a letter demanding action to prevent a nearly 10% cumulative cut to Medicare physician payment in January 2022.  Ask your representative to sign-on NOW! Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) recently circulated a “Dear Colleague” letter to send to US House leadership highlighting the financial uncertainty within the Medicare payment system and the dangers facing the physician community if Congress fails to enact legislation to address these problems.

In what amounts to a “perfect storm” of payment cuts going into effect on January 1, 2022, physician practices face the following stack of Medicare financial hits:

• Expiration of the current reprieve from the repeatedly extended 2% sequester stemming from the Budget Control Act of 2011. Congress took action earlier this year to prevent the 2% cut but that authorization expires 1/1/22.
• Imposition of a 4% Statutory “PAYGO” sequester resulting from passage of the American Rescue Plan Act. Should lawmakers fail to act, it will mark the first time that Congress has failed to waive Statutory PAYGO.
• Expiration of the Congressionally enacted 3.75% temporary increase in the Medicare physician fee schedule (PFS) conversion factor to avoid payment cuts associated with budget neutrality adjustments tied to PFS policy changes.
• A statutory freeze in annual Medicare PFS updates under the Medicare Access and CHIP Reauthorization Act (MACRA) that is scheduled to last until 2026, when updates resume at a rate of 0.25% a year indefinitely, a figure well below the rate of medical or consumer price index inflation.

This would result in a combined 9.75 % payment cut on January 1! And all of this comes at a time when physician practices are still recovering from the emotional and financial impact of the COVID-19 public health emergency. It’s time to give New York’s and our country’s physicians the peace of mind they deserve as they continue to fight on the front lines of the COVID-19 pandemic without having to worry if their practices will survive these potentially catastrophic cuts.

MSSNY has been working together with the AMA and other state and specialty medical associations to prevent these cuts from going forward. A strong collection of bipartisan cosigners to the Bera-Buchson letter will help demonstrate to House and Senate leadership that this confluence of payment cuts needs to be prevented via legislation ASAP.  Please contact your Representative today and urge them to show their support by signing on to Reps. Bera and Bucshon’s “Dear Colleague” letter.

Info for Physicians on Health Care Worker Vaccination Mandate
The New York Public Health and Health Planning Council (PHHPC) approved an emergency regulation to be adopted by the NYS Department of Health requiring health care workers in all Article 28 regulated settings – hospitals, nursing homes, clinics, Ambulatory Surgery Centers, dialysis facilities, etc. – to be vaccinated against Covid.  This includes physicians and other care providers who may not be employed directly but who provide care at these health care settings (such as a physician with privileges at a hospital or who sees patients at a nursing home).  There is an exemption for health care workers for documented medical contraindications, but after objection from various groups including MSSNY, the proposed “religious exemption” to this vaccination requirement was dropped from the regulation.

Based upon the recommendation of MSSNY’s Emergency Preparedness and Infectious Disease Committees, MSSNY President Dr. Joseph Sellers recently issued a statement supporting mandatory vaccination of health care workers as one important step to increase our vaccination rate and reduce the spread of Covid: MSSNY Applauds NYS COVID-19 Vaccination Mandate for Healthcare Workers 

The regulation will require health care workers at hospitals and nursing homes to have a first dose by September 27, and for other Article 28 regulated settings, by October 7.  The regulation will be effective for 90 days.

According to the regulation, an acceptable medical exemption to the required vaccine is where a “licensed physician or certified nurse practitioner certifies that immunization with COVID-19 vaccine is detrimental to the health of member of a covered entity’s personnel, based upon a pre-existing health condition”.  It further provides “the requirements of this section relating to COVID-19 immunization shall be inapplicable only until such immunization is found no longer to be detrimental to such personnel member’s health.”  Furthermore, it instructs these covered health care entities that “the nature and duration of the medical exemption must be stated in the personnel employment medical record, or other appropriate record, and must be in accordance with generally accepted medical standards, (see, for example, the recommendations of the Advisory Committee on Immunization Practices of the U.S. Department of Health and Human Services), and any reasonable accommodation may be granted and must likewise be documented in such record”.

Moreover, as with other mandatory vaccinations, physicians or other care providers risk disciplinary sanction for certifying a medical exemption without an adequate medical justification for doing so.

Tip of the Week: Does Your Office Do Pre-Visit-Planning?
Does your office staff conduct pre-visit planning before your patients come in for their appointment?  It’s a great opportunity for staff to compile a list of various ancillary tests/screenings that have been completed or will need to be completed soon. Having the pre-visit planning done prior to the patient arriving at the office will save time because everything is listed in one single document. Organizations often have different EHR systems, which can cause items to get lost in the mix and add administration time to your schedule. Pre-visit planning allows clinical staff to collect this information—allowing you to focus on the patient rather than administration tasks.

Additional advantages to pre-visit planning:

• Assists in patient engagement
• Improves practice efficiency
• Saves money

Click here for an example of a pre-visit planning sheet. Contact Heather Lopez, MSSNY’s Director of Physician Payment & Practice at 518.465.8085 X332 | hlopez@mssny.org with any questions or concerns. Happy planning!

CDC Health Alert for Physicians Re Anti-Parasitic Drug Ivermectin for COVID-19
The Centers for Disease Control and Prevention (CDC) has issued a health alert warning physicians and the public about the rise in prescriptions for the anti-parasitic drug ivermectin for use in the treatment or prevention of COVID-19. The CDC also cautioned about the risk of severe illness caused by ivermectin, which was seen in increased calls to poison centers.

Current NIH Treatment Guidelines state that there is insufficient evidence to recommend either for or against the use of ivermectin for the treatment of COVID-19 outside of clinical trials.   This recommendation is consistent with the Infectious Disease Society of America’s Guidelines on the Treatment and Management of Patients with COVID-19, which suggests against the use of ivermectin in hospitalized patients and ambulatory persons with COVID-19, outside of the context of a clinical trial. Additionally, there is no evidence to suggest that ivermectin can prevent you from becoming infected with COVID-19.

After receiving multiple reports of people who have been hospitalized after self-medicating with ivermectin intended for animals, the FDA recently reminded the public that:

• FDA has not approved or issued an Emergency Use Authorization for ivermectin for use in treating or preventing COVID-19 in humans. Ivermectin tablets are approved at very specific doses for some parasitic worms, and there are topical formulations for head lice and skin conditions. Ivermectin is not an anti-viral.
• Taking large doses of this drug is dangerous and can cause serious harm.
• If you have a prescription for ivermectin for an FDA-approved use, get it from a legitimate source and take it exactly as prescribed.
• Never use medications intended for animals on yourself. Ivermectin preparations for animals are very different from those approved for humans.

For additional information see the FDA Information Page and the FDA Ivermectin FAQ.

MSSNY Seeks Physicians and Practices to Participate in New Telehealth Initiative
The Medical Society of the State of New York is pleased to announce a new telehealth initiative in cooperation with the Physicians’ Foundation and the American Medical Association. MSSNY is seeking 5-10 physician and/or institutional based practices involved in various stages of telehealth.  This telehealth initiative is a year-long project and will allow practices to optimize and measure telehealth in all settings.

Telehealth is now a viable platform for physicians to provide clinical services such as for management of patients with chronic conditions. MSSNY is interested in helping physicians, especially those in small practices, implement telehealth to augment services currently offered to patients.

In 2020, the Physicians Foundation launched a collaboration with the American Medical Association called The Telehealth Initiative (TTI). TTI was designed to bolster implementation support at the state- level by equipping state medical associations with telehealth programming that could build on existing offerings.

As part of the project, MSSNY and the AMA will work together to develop relevant educational content, resources, measurement tools, and evaluation support to help practices with telehealth implementation.  MSSNY, as part of this program, will be part of a national network and support needed to establish and maintain strong relationships with physicians, practices, and health systems interested in implementing, optimizing, or sustaining telehealth. In addition to providing ongoing support, this year’s program will emphasize the importance of realizing the true value of virtual care.

MSSNY is seeking interested physicians and practices interested in participating in the program and will commit to collaborating with the MSSNY, the Physicians Foundation, and the AMA, to optimize telehealth and measure the value of telehealth in their settings. The collaborative will provide training through virtual events as well as opportunities to network and learn from peers.

For those interested in being part of this initiative, please contact Cayla Lauder, Program Coordinator, at clauder@mssny.org or Pat Clancy, Sr. VP/Managing Director of Public Health and Education, at pclancy@mssny.org. 

NGS Virtual Conference: Medicare Preventive Services
The National Government Services Provider Outreach and Education (POE) Team is hosting a special virtual conference on 9/14, 9/15, and 9/16 focusing on Medicare Part B Preventive Services. Each session will begin with a presentation, followed by a Q&A.  There are no associated charges for this virtual conference and you may register for as many sessions as you’d like.

The three-day conference will wrap up with the Jurisdiction K/Jurisdiction 6 (JK/J6) Part B Ask-the-Contractor Teleconference (ACT) with focus on Medicare Preventive Services. During this ACT call, you will have the opportunity to ask any outstanding questions you have about the topic and get answers from the POE Team Consultants.

To register, click here and select the link(s) to view and register for sessions. Please note: All times listed are eastern time.

Note: Since a Medicare Administrative Contractor is presenting this information, each session will also be eligible to receive one Medicare University Credit (MUC) and one continuing education unit (CEU) with the American Academy of Professional Coders (AAPC) per hour of education, if you are a certified professional coder. Please remember, if you will be reporting CEUs to the AAPC, you will need to keep your email registration confirmation as proof of session for any future AAPC audit. If you do not have a registration confirmation in your name, you will not be able to report CEUs with the AAPC. Please note: MUCs/CEUs are not available for the Ask-the-Contractor Teleconference.

DOH COVID-19 Vaccine Update for Physicians
The FDA granted full licensure for Pfizer’s COVID-19 vaccine on August 23, which applies to the use of this vaccine in the 16+ population.  The vaccine also continues to be available under emergency use authorization (EUA) for adolescents 12 through 15 years of age and for the administration of a third dose in certain (moderately or severely) immunocompromised individuals.  This vaccine will now be marketed as Comirnaty (koe-mir’-na-tee).  DOH encourages you to reach out to your patients who have not yet been vaccinated to let them know about this development and encourage them to get vaccinated as soon as possible.

​The FDA also approved an amendment to the EUA for Pfizer-BioNTech extending the expiration dates of COVID-19 Vaccine from six to nine months. The extended expiration date is effective immediately for all currently available batches that have not yet expired and have been maintained in ultra-cold storage. Note: The expiration date extension does NOT apply to vials dated July 2021 and earlier.

Vaccination providers that have Pfizer vaccine in storage must:

1. Mark the appropriate carton and vials with the new expiration date and
2. Update the expiration date in the NYSIIS or CIR inventory module.

The extension of vaccine expiration applies to any vaccine that has been stored in a manner consistent with the storage guidelines that have been in place to this point. Specifically:

• Vaccine moved from ultra-cold storage to standard frozen storage and back once to ultra-cold storage
• Vaccine in a standard freezer for a total of up to 14 days
• Vaccine in a refrigerator for a total of up to 31 days, including vaccine that was previously in a standard freezer for 14 days

All of the above conditions are consistent with the existing storage guidance.  Vaccine stored under these conditions can be used until the correct beyond-use date, based on the vaccine storage conditions, or the updated expiration date, whichever occurs first.  Vaccine cannot be used after the new expiration date, even if the storage-determined beyond-use date would be after the updated expiration date.

Cartons and vials of Pfizer-BioNTech COVID-19 Vaccine with an expiry date of August 2021 through February 2022 printed on the label may remain in use for 3 months beyond the printed date as long as authorized storage conditions between -90°C to -60°C (-130°F to -76°F) have been maintained.  Note: the ultra-cold temperature range has been broadened to include -90° C (-130°F).  Frozen vials stored at -25°C to -15°C and refrigerated vials (2°C to 8°C) are NOT eligible for a 3-month use extension.

Updated expiry dates for vaccine maintained in ultra-cold storage are shown below.

No changes have been made to the vaccine itself to enable extension of expiry dating. This change is based on stability data generated on batches manufactured over approximately the past nine months of COVID-19 vaccine development, from the batches that supplied early clinical trials through the commercial scale batches currently in production.

Currently available vaccine will not have an updated NDC.  Please refer to the current EUA Fact Sheet for information.

Additional information on Pfizer storage and handling may be found at:
Administration Overview for Pfizer-BioNTech COVID-19 Vaccine | CDC

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