MSSNY eNews: December 23, 2020 – Here’s to 2021!

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Here’s to 2021!

Never before have I so looked forward to New Year’s Eve.  Closing the chapter on 2020 will be a huge relief.   The drop of the ball in Times Square will signify the end of a year of darkness and the beginning of a New Year where we will cherish the family gathering, the coffee with colleagues and the dinners with friends that we once took for granted.

But before we get there, these last few weeks of 2020 have been quite busy so here is the update:

COVID-19 Vaccine Information:
Some of you have been lucky enough to be in the first group vaccinated within NYS (approximately 40,000 people as of yesterday.) However, most of you are still awaiting vaccination.  Those of you providing in person care to patients are in the first vaccination group (1a) and will get vaccinated as soon as the supply is available.

NYS is expecting approximately 500,000 – 600,000 doses of vaccine in the next couple of weeks. Sit tight, you have not been overlooked but remember there are about 2 million people in the 1a category.

Many of you have contacted the society with questions about where, when, and how you and your office staff get vaccinated. For doctors that are on a medical staff, employed or not, you will receive your vaccination from the hospital.  Priority is to be given based on exposure risk and personal health risk factors, NOT based on employment status. 

MSSNY has communicated with top officials at the DOH and the Governor’s office in charge of vaccine distribution concerning the questions that we do not yet have answers for:  Where do doctors not affiliated with a medical staff get vaccinated? How, when, and where do the office staff of community doctors get vaccinated?  If a community-based physician practice has applied to be a vaccine distributor, will they be getting vaccine now for themselves and their other 1a staff? 

We hope to have answers to these questions shortly and when we do, we will post them to our website, email them and post them on social media so stay tuned and know that we care and are listening.

The Year End Federal Spending Package
As noted in several articles below, late Monday, Congress passed a comprehensive spending package that would fund the federal government through 2021. The end-of-year package contains some positive measures for physicians, including a new round of funding for the Paycheck Protection Program and provisions to ensure the continued ability to deduct certain essential business expenses for those who receive these loans, and important provisions to help reduce the very steep impending 2021 Medicare cuts.

However, the congressional bill also included a surprise medical billing dispute resolution component. MSSNY has long supported efforts to add federal protections to help prevent patients from receiving unexpected bills. However, despite the valiant efforts by the collective house of medicine (with a substantial New York component) the final federal version is greatly tilted in favor of health insurance companies and is inconsistent with New York’s far more balanced approach to addressing surprise medical bills for patients insured under state-regulated plans.

MSSNY has communicated to our NYS Congressional delegation our concerns that health insurers will take advantage to dramatically cut payments for their network participating physicians at a time when community physician practices are already at the edge of extinction due to a variety of factors and in a year when physicians have put their health and their families’ health at risk to ensure their patients receive the care they need.

Further complicating the picture is the President now threatening to veto the entire package because he believes the $600 direct payments to most Americans called for in the COVID-19 relief package is insufficient.  As if 2020 was not already enough of a roller coaster. Stay tuned for further details.

A very Merry Christmas to all that celebrate.  May your stocking be filled with vaccine dates for you and your staff.   Here’s to a joyful, healthy, and happy 2021!

Bonnie Litvack, MD
MSSNY President

Year End COVID-19 Package: Congressional Hits and Misses
“The end-of-year package agreed to by Congress contains some positive measures, including a new round of funding for the Paycheck Protection Program that assisted many community-based physician practices on the verge of closure earlier this year due to historic drops in patient visits.

Also important are provisions to ensure the continued ability to deduct certain essential business expenses for those who receive these loans, and provisions to help reduce though not eliminate the very steep Medicare cuts countless physicians will face for delivering health care services to their patients in 2021.

“Regarding the surprise medical billing dispute resolution component of this package, we have long supported efforts to add additional federal protections to help prevent patients from receiving these unexpected bills.  However, while the final version contains slight improvements from earlier versions, it does not address our fundamental concern we have repeatedly raised that the dispute resolution mechanism to resolve insurer-physician differences is greatly tilted in favor of health insurance companies.  Health insurers will be permitted to present data as to the appropriate cost of the health care services while physicians for all practical purposes will not be permitted to offer their own data.

“This is grossly unfair, and inconsistent with New York’s far more balanced approach to addressing surprise medical bills for patients insured under state-regulated plans. With this new, even greater leverage, we are very concerned that health insurers will take advantage to dramatically cut payments for their network participating physicians at a time when community physician practices are already at the edge of extinction due to a variety of factors.  More forced employment arrangements are inevitable, furthering reducing competition in health care delivery and driving up costs.

“We thank the efforts of the many members of the New York Congressional Delegation who have worked diligently to improve many of these provisions from earlier versions. However, the bottom line remains that this year-end Congressional package does as much harm as good to our front-line physicians who have put their health and their families’ health at risk this year to ensure their patients receive the care they need.”

Congressional Package Helps to Prevent or Reduce Medicare Cuts
As a result of an advocacy effort across medicine including from the AMA and MSSNY, the year-end Congressional package – if signed into law – would take a number of steps to help prevent and/or reduce what would have been enormous cuts to Medicare payments to many physician specialties.  Specifically, it would:

  • Provide for a one-time, one-year increase in the Medicare physician fee schedule of 3.75%, to support physicians and other professionals in adjusting to changes in the Medicare physician fee schedule during 2021, and to provide relief during the COVID-19 public health emergency.
  • Delay for 3 years the Secretary’s implementation of Code G2211 which reportedly will increase the MPFS by approximately 3%.
  • Delay the -2% sequestration cuts for 3 months

As noted in this chart developed by the AMA analyzing the specialty by specialty impact of these Congressional actions, an example of the impact:

  • Under the original CMS Medicare 2021 payment rule, ophthalmologists were expected to see a 6% cut, but now will face likely no cut.
  • Under the original CMS Medicare 2021 payment rule, general surgeons were expected to see a 6% cut, but now will face likely no cut.
  • Under the original CMS Medicare 2021 payment rule, neurosurgeons were expected to see a 6% cut, but now likely will face no cut.
  • Under the original CMS Medicare 2021 payment rule, interventional radiologists were expected to see an 8% cut, but now it will be a likely 2% cut
  • Under the original CMS Medicare 2021 payment rule, internal medicine was expected to see a 4% increase, but now likely a 6% increase.
  • Under the original CMS Medicare 2021 payment rule, anesthesiology was expected to see an 8% cut, but now likely a 2% cut.
  • Under the original CMS Medicare 2021 payment rule, PM&R was expected to see a 3% cut, but now likely will have a 3% increase.

Importantly, as well, the long overdue E&M changes set forth in the CMS 2021 Medicare payment rule will go forward.

Congressional Package Includes Expansion of Paycheck Protection Program (PPP)
The Congressional year end package included an additional $284 billion for the Paycheck Protection Program (PPP).  Importantly, if signed into law, it would enable a second PPP forgivable loan for the hardest-hit small businesses (including physician practices) and non-profits with 300 or fewer employees which can demonstrate a loss of 25% of gross receipts in any quarter during 2020 when compared to the same quarter in 2019.

Importantly, it would also provide that loans will not be included in taxable income, and clarifies that deductions are allowed for expenses paid with proceeds of a forgiven PPP loan, effective as of the date of enactment of the CARES Act and applicable to subsequent PPP loans.  MSSNY had heard from several physicians concerned that receipt of a PPP loan/grant was going to cause them to not be able to deduct business expenses due to a recent IRS interpretation.

It would also provide for an additional $20 billion for EIDL Advance Grants. Small businesses and nonprofits in low-income communities are eligible to receive $10,000 grants, previous recipients are also eligible to receive the full $10,000 if their award was less in the first round of grants.

Please read here for a comprehensive AMA summary of this and many other provisions in the Congressional COVID relief package.

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Congress Passes Measure to Address Surprise Medical Bills – Improvements Over Earlier Version but Still Titled in Favor of Insurance Companies
As has been widely reported, among the provisions contained in the year-end Congressional COVID relief package is a comprehensive measure to establish a federal standard for addressing surprise out-of-network medical bills.

If signed into law, based upon initial review and conversations with Congressional staff and the AMA, the new federal surprise bill provisions will apply to patients insured by ERISA plans, and New York’s approach would continue to be followed for out of network claims from patients insured in state-regulated plans.  There are similarities in this federal standard to New York’s well-regarded approach, but also significant differences for which MSSNY expressed serious concerns.

Here is a comprehensive summary of these provisions from the AMA:

The measure would ensure that patients are “held harmless” from surprise out-of-network medical bills. Like New York’s law, patients would only be required to pay the in-network cost-sharing, (i.e., copayment, coinsurance, and deductibles) amount for out-of-network emergency care, for certain ancillary services provided by out-of-network providers at in-network facilities, and for out-of-network care provided at in-network facilities without the patient’s informed consent.

However, unlike New York’s law, the federal provision calls for a 30-day open negotiation period for out of network physicians and payers to settle out-of-network claims, and if the 30 day negotiation period is unsuccessful, requires either the physician or the health plan to initiate an independent dispute resolution (IDR) process within 4 days of the end of the 30-day period.

The federal IDR process is similar to New York’s mechanism in that the IDR entity would select which side – the physician’s or the insurer’s suggested payment – will prevail.  Physicians may batch similar services in one proceeding when claims are from the same payer, but the bill permits only 30 days of batching.  The IDR entity would consider numerous sources of information brought by either party, such as the provider’s training and experience, patient acuity, and the complexity of furnishing the item or service.

However, in a significant departure from New York, neither provider charges nor usual and customary charges may be considered by the IDR entity, and the IDR entity is required to consider the market-based median in-network rate.  This a major deficiency that MSSNY has highlighted in its advocacy efforts over the last year on this issue, and was noted by MSSNY President Dr. Bonnie Litvack in MSSNY’s press release:

“it does not address our fundamental concern we have repeatedly raised that the dispute resolution mechanism to resolve insurer-physician differences is greatly tilted in favor of health insurance companies.  Health insurers will be permitted to present data as to the appropriate cost of the health care services while physicians for all practical purposes will not be permitted to offer their own data.”

There were improvements in this version over a version announced a week ago including a prohibition of the consideration of Medicare or Medicaid data by the IDR, as well as elimination of provisions that would have set up cumbersome processes to require patients to receive a detailed description of services rendered within 15 days of the date of service and required a patient to be billed within 90 days of the date of service even if the claims had not been fully adjudicated by the health insurer.

The Congressional provisions also address “voluntary” out of network services by providing that non-participating providers at participating facilities may not bill a patient more than the cost-sharing requirements or balance bill the patient unless the notice and consent requirements are met. These consent requirements include providing the patient with written notice and consent 72 hours in advance of appointment; providing a good faith estimate of the costs of the services; and providing the patient with a list of in-network providers at the facility and information regarding medical care management, such as prior authorization.  At participating facilities, the notice and consent exception does not apply to out-of-network providers of radiology, pathology, emergency, anesthesiology, diagnostic and neonatal services; assistant surgeons, hospitalists, intensivists, and providers offering services when no other in-network provider is available.

Further analysis of this far-reaching legislation is ongoing, so please remain alert for further updates.

Tribute to MSSNY’s Long Time Tech Genius, Brian Petrucco
Our MSSNY family was very saddened by the unexpected passing of our long-time technical support staffer Brian Petrucco on December 13.  Brian was an unsung hero to our collective MSSNY efforts – anyone who has run or worked in an office can appreciate the absolutely indispensable role that a technical support person plays in our day to day lives.

Brian not only provided this support for the MSSNY Albany office, but he regularly traveled to the various MSSNY offices across the State to ensure our systems were working properly so we could better carry out our mission to provide needed services to our member physicians.

Brian genuinely loved what he did and was always happy to provide needed answers to various technical questions that the staff posed to him, and like an accomplished chef (Brian was also a very good cook!), he enjoyed providing the fine details of how he fixed a particular technical glitch.

Like many MSSNY staffers, his contributions grew significantly over the years, and he was often in the office over many hours over a weekend to ensure that our interconnected computer systems were functioning properly.  As the pandemic forced much of MSSNY’s staff to work remotely, he ably helped to ensure that our transition from in-person to virtual was seamless, and unnoticeable to our physician members.

Brian and his wife Tanya had a great love of exotic travel, including getting married on a glacier in Alaska.

Brian leaves a legacy of a tremendous amount of “behind the scenes” work to assist the physicians of New York and is someone that will be extremely hard to replace.

Rest in peace, Brian.

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Join Us for MSSNY’s Virtual Lobby Day on March 2
Please plan to put aside Tuesday, March 2 for MSSNY’s Annual Physician Advocacy Day – this time Virtual!  To register, click here: Webinar Registration – Zoom

The format will follow previous years formats, where assembled physicians and allies will hear from legislative leaders in the morning (this year via Zoom), and then have virtual visits with their respective legislators in the afternoon.

With the Governor and the State Legislature needing to create tens of billions of savings to the State Budget, any number of healthcare programs of interest to physicians could be on the table, not to mention concerns with the numerous proposals to inappropriately expand the scope of practice for various non-physicians as well as numerous proposals to mandate how physicians provide care to their patients.

Please plan to join hundreds of colleagues from around the State on March 2!

Pfizer to Deliver 70 Million Doses by June 30
The Trump administration has reached a deal with Pfizer to buy an additional 100 million doses of the company’s COVID-19 vaccine, effectively doubling the federal government’s supply from Pfizer.

The pharmaceutical giant is to deliver 70 million doses by June 30, 2021 and complete the rest of the order by the end of the following month, according to a statement released today by the Department of Health and Human Services. Pfizer said the U.S. government has agreed to pay $1.95 billion for the additional doses of its vaccine, which was developed jointly with BioNTech. (NPR, Dec 23)

MSSNY President Interviewed Re COVID-19 Impact on Healthcare Workers
USA Today (12/22) Network New York interviewed MSSNY President Dr. Bonnie Litvack, a Westchester County radiologist, about the COVID-19 pandemic and the impact on healthcare workers. Dr. Litvack said, “A lot of physicians and other health care workers have sort of borne the brunt of the pandemic. … It’s something that has affected physicians like it has most New Yorkers, in many ways, in terms of physical pain and mentally and the stress of increased patient caseloads and in terms of financial stress to keep their doors open.”

Summary: Physicians Foundation 2020 Survey of America’s Physicians
I want to start by thanking you for your support and participation in The Physicians Foundation Three-Part 2020 Survey of America’s Physicians. Throughout 2020, we have had multiple touch points with physicians regarding their perspective on the current state of the medical profession; how practice patterns, career plans and attitudes are evolving; their attitudes on navigating the current political landscape; and how COVID-19 is impacting their practices, patients, and their own wellbeing.

As the health care landscape evolves amid COVID-19, America’s physicians are faced with countless obstacles when it comes to delivering high-quality, cost-efficient care. As the foundation of our health care system, physicians’ voices must be heard.

For ease, I have attached in this email and linked here, an executive summary of all three surveys. We hope that you will share these to ensure physician insights are being included in all conversations about health care reform in America.

Robert Seligson
Chief Executive Officer
The Physicians Foundation

Note: MSSNY is a charter member of The Physician Foundation.

Dr. Fauci: Fast-Spreading COVID-19 Variant in U.K. Is Probably Already in U.S.
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, told CNN fast-spreading COVID-19 variant in U.K. is probably already in the U.S.

(12/22). Dr. Fauci said imposing a U.K. travel ban would be a “rather dramatic step” for the U.S., though more than 40 other countries have already closed their doors to Britain, reports The New York TimesPfizer and Moderna are both testing their vaccines against the new variant, according to CNN. Pfizer and Moderna are testing their COVID-19 vaccines against a mutated strain of the coronavirus that first appeared in England, CNN reported.

Moderna said: “We expect that the Moderna vaccine-induced immunity would be protective against the variants recently described in the U.K.; we will be performing additional tests in the coming weeks.”

Pfizer said it is generating data on how well blood samples from immunized people are able to neutralize the new strain, CNN reported.

The strain hasn’t been identified in the U.S., but the CDC said Dec. 22 that “given the small fraction of U.S. infections that have been sequenced, the variant could already be in the United States without having been detected.”

COVID-19 Patients with Neurological Problems Have A Higher Mortality Risk Individuals hospitalized with Covid-19 and neurological problems, including stroke and confusion, have a higher risk of dying than other COVID patients, according to a new study by researchers at Montefiore Health System and Albert Einstein College of Medicine. Montefiore and Einstein said in announcing the study that its findings have the potential to identify and focus treatment efforts on the individuals most at risk. The study was published Friday afternoon in Neurology, the medical journal of the American Academy of Neurology.

The study examined data from 4,711 COVID-19 patients who were admitted to Montefiore during the six-week period between March 1 and April 16. Of those patients, 581—or 12%—had neurological problems serious enough to warrant brain imaging.

Among patients who underwent brain imaging, 55 were diagnosed with stroke and 258 exhibited confusion or altered thinking ability, Montefiore and Einstein said. Individuals with stroke were twice as likely to die—the group had 49% mortality compared with a matched control group, which had 24% mortality. More than half of the stroke patients in the study did not have hypertension or other underlying risk factors for stroke.

People with confusion had a 40% mortality rate compared with 33% for their matched control, which was also statistically significant, the researchers found. “This study is the first to show that the presence of neurological symptoms, particularly stroke and confused or altered thinking, may indicate a more serious course of illness, even when pulmonary problems aren’t severe,” said Dr. David Altschul, chief of the division of neurovascular surgery at Einstein and Montefiore, and associate professor in the Department of Neurological Surgery and of radiology at Einstein, in a statement.

“Hospitals can use this knowledge to prioritize treatment and, hopefully, save more lives during this pandemic,” Altschul, who is also surgical director of the Montefiore Comprehensive Center for Stroke Care and the study’s co-author, added. Montefiore and Einstein said there were no funding sources for the study. (Crain’s Pulse, Dec. 20)

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CDC: Next Priorities for Vaccine: Ages 75+, Front-Line Essential Workers
People age 75 and older and front-line essential workers should be the next priority groups to receive COVID-19 vaccines, the CDC’s Advisory Committee on Immunization Practices put forth Dec. 20.

The committee vote establishes their recommendation for vaccine distribution in the remainder of phase 1 — phases 1b and 1c.

  • Healthcare personnel and long-term care facility residents made up phase 1a.
  • Phase 1b applies to adults age 75 and older and front-line workers essential to societal functions, such as teachers, firefighters, prison officers and police.
  • Phase 1c expands access to adults 65 and older, people with underlying medical conditions that put them at higher risk of severe illness from COVID-19, and other essential workers including those in food service, construction, waste, and trucking.

The next step is for CDC Director Robert Redfield, MD, to accept the committee’s recommendations. They would then be published in the CDC’s “Morbidity and Mortality Weekly” later this week and shared as official CDC guidance.

Stanford University Protest

Stanford Medicine residents protested after they were not included in the vaccine distribution plan. (Photo: Becker’s Hospital Review, Dec. 22)

Stanford Medicine Residents Protest Being Left Out of The Vaccine Allocation
“We take complete responsibility for the errors in the execution of our vaccine distribution plan,” said Lisa Kim, a Stanford Medicine spokesperson. “Our intent was to develop an ethical and equitable process for distribution of the vaccine.

We apologize to our entire community, including our residents, fellows, and other frontline care providers, who have performed heroically during our pandemic response. We are immediately revising our plan to better sequence the distribution of the vaccine.”

An algorithm chose who would be the first 5,000 in line. The residents said they were told they were at a disadvantage because they did not have an assigned “location” to plug into the calculation and because they are young, according to an email sent by a chief resident to his peers. Stanford Medicine has about 1,300 across all disciplines.

Only seven made the priority vaccination list, despite the fact that this week, residents were asked to volunteer for ICU coverage in anticipation of a surge in COVID-19 cases. The algorithm has been corrected. The university quickly revised its vaccine distribution plan to prioritize health workers including residents and fellows. Stanford also created a new committee that would consider the interests of all stakeholders.

New Member Benefit: MSSNY’s Partner with Premier Group (Essensa) Purchasing
We are excited to announce registration information for our new group purchasing partnership between MSSNY and Premier.

We expect this new partnership to result in lower operating costs and improved access to supplies and products for MSSNY members who sign on to purchase through Premier negotiated agreements.

Sign up today and begin taking advantage of the value and savings Premier brings to the table for MSSNY members:  

  • A leading healthcare improvement company dedicated to better care and outcomes at lower costs
  • Nearly 30 years of experience in the alternate site group purchasing organization space
  • A portfolio featuring more than 900 suppliers and 2,000 products and services ranging from pharmaceuticals to medical/surgical supplies to business solutions and more (including numerous PPE solutions!)
  • A distributor neutral approach, meaning MSSNY members can continue using existing distributors while accessing Premier-negotiated pricing
  • A commitment to hands-on service to ensure MSSNY members are receiving the best value for all their purchasing needs

Click the links below to access specifics on the program:

  • Continuum of Care Overview: High level overview of the Premier program and the value it provides
  • GPO FAQ: Questions and answers to further introduce Premier and explain the program
  • Physician Practices information sheet: Provides value proposition of the Premier program, followed by specific suppliers and contracts members will be able to access, broken down by category
  • What to Expect: Step by step onboarding guide for members

Questions? Email or call (888) 258-3273.

Register now!

JAMA Original Investigation Dec 22, 2020: Variation in US Hospital Mortality Rates for Patients Admitted With COVID-19 During the First 6 Months of the Pandemic

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Registration Now Open Veterans Matters: PTSD in Returning Veterans Webinar
Tuesday, January 26th @ 7:30 am

The Medical Society of the State of New York is hosting a Continuing Medical Education (CME) program entitled Veterans Matters: PTSD in Returning Veterans live webinar on Tuesday, January 26, 2020 at 7:30 am.

Click HERE to register for the program! View the program flyer

When:          January 26, 2020 at 7:30 am
Faculty:        Frank Dowling, MD

Educational Objectives:

  • Identify diagnostic criteria for PTSD
  • Discuss medical and psychiatric comorbidities of military related PSTD
  • Discuss evidence-based treatment modalities for PTSD including medications and psychotherapy
  • Discuss strategies to help veterans overcome stigma to seek and accept treatment for military-related trauma

For more information, contact Jangmu Sherpa at 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.

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Unique Rheumatology Practice Opportunity – Great Neck, NY
Partnership opportunity available at an established rheumatology practice in Great Neck, NY. Looking for a dedicated physician to join our practice or merge practices. Contact 516-972-2986 / for more info.

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MSSNY eNews: November 20, 2020 – I Am Thankful



I Am Thankful
While this is a Thanksgiving season like no other, as the holiday approaches I find myself even more thankful than in years past.

I am thankful that our scientists worked around the clock to develop effective vaccines to combat this pandemic and that delivery of the first shipment is imminent. Our NYS Vaccine Task Force is hard at work to ensure a seamless vaccine roll out in New York. Thank you to all who have signed up to distribute the vaccine and those that intend to sign up.

Here is information that you will need concerning the process:

Information for Private Practicing Physicians Regarding COVID-19 Vaccine 

The following information was obtained from the NYS Department of Health November 19, 2020 webinar regarding steps for physicians to serve as a distributor of COVID 19 vaccine to patients.

Step One — Register for the Immunization Information System

  • Physicians who do not have an account are urged to register in the NYS Immunization Information System (NYSIIS). Physicians residing in New York City will need to register with the Citywide Immunization Registry (CIR)
  • This is because all COVID-19 Vaccination Program providers (each location submitting a profile) will need a NYSIIS or a CIR account
  • Your practice may currently have a NYSIIS or CIR account, but it is important to review the information so that appropriate staff has access

For health care providers located outside of New York City, take the following steps for new users in NYSIIS-See the Checklist to Go Live with NYSIIS here.

  1. NYSIIS is located on the Health Commerce System. If responsible staff do not yet have an HCS account, they must apply for one.
  2. Take the NYSIIS Administrative User Training located here.

New York City physicians should register their practice online in CIR here.

Step 2: Enroll in the COVID-19 Vaccination Program

  • In addition to registering with NYSIIS or CIR, physicians will then need to enroll in the COVID-19 Vaccine Program.
  • NYSDOH and NYC DOHMH are implementing a phased approach to provider enrollment and will notify private practices physician as each new group is opened for enrollment. MSSNY understands that this will occur for private practicing physicians beginning in December.
  • Providers in NYS, outside of NYC, will enroll in the NYS COVID-19 Vaccination Program through the Health Commerce System.
  • Providers in NYC will enroll in the NYC COVID-19 Vaccination Program through the CIR.
  • Networks with facilities or providers in both NYS and NYS should enroll their facilities or provides outside of NYC in the NYS Covid-19 Vaccination Program through the Health Commerce System and enroll facilities or providers in NYC in the NYC Covid-19 Vaccination Program through the CIR.

Step 3 Ordering, Receiving and Administering Vaccine

  • When COVID-19 vaccine is available, providers in NYS, outside of NYC, will order Covid-19 Vaccine through NYSII and providers in NYC will order Covid-19 vaccine through the CIR. Orders will be approved by NYS DOH and shipped directly from the vaccine manufacturer or CDC distributor.
  • When vaccine is available, functions staff perform in NYSIIS or CIR will include monitoring vaccine inventory, entering doses administered and/or performing data exchange (uploading and downloading data) between the provider’s electronic health system and NYSII/CIR; entering vaccine returns and wastage, and generating reports for internal review (e.g. doses administered).

I am thankful to our Physician Wellness and Resilience Committee for actualizing our Peer to Peer program just when it was needed most.  I am thankful to all that volunteered as peer supporters and am comforted to know that you are there should any of us need you. Please spread the word about our Confidential helpline phone number (1-844-P2P-PEER) and email address (

I am thankful that our MSSNY has professional and dedicated staff that go above and beyond to promote our agenda and help sustain our practices.  This past weekend our MSSNY EVP Mr. Phillip Schuh received the well-deserved honor of the AMA Medical Executive Lifetime Achievement Award for guiding New York physicians through a rapidly changing medical practice environment during his more than 30 years with MSSNY.

This year, I am thankful for things big and small but most importantly for the health of my family and friends and the fortitude of our profession.

Wishing you and your family a safe and very happy Thanksgiving,

Bonnie Litvack, MD
MSSNY President

MSSNY in the news this week:

Also ran in:

MSSNY Weekly Podcast

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Gov. Cuomo’s Press Conference Last Night

  • The positivity rate in the micro-cluster focus areas dropped slightly to 4.11 percent. Excluding these areas, it was 2.38 percent. Of the 195,239 tests reported yesterday, 5,310, or 2.72 percent, were positive. Total hospitalizations rose to 2,276. Sadly, we lost 31 New Yorkers to the virus.
  • New York updated the COVID-19 micro-cluster focus zones. Rockland County’s Yellow Zone will be expanded, and parts of Orange and Westchester counties will become Yellow Zones due to increased cases, positivity, and hospital admissions from these areas. All the maps of the current micro-cluster focus zones are available here.
  • I met with President-elect Joe Biden and Vice President-elect Kamala Harris and fellow governors to discuss the ongoing COVID response. We look forward to a strong federal-state partnership and to working hand-in-hand in the months ahead. Topics of discussion included how to achieve a fast and equitable vaccine distribution, how to help our communities recover economically and more.
  • Round two of the successful Nourish NY program is underway. So far, 1.7 million pounds of raw milk has been turned into dairy products and distributed by food banks, in addition to 210,000 pounds of produce. Over 940,000 households have received products sourced from New York farms through this initiative, which is helping keep businesses and families afloat.
  • A smaller Thanksgiving celebration doesn’t mean you have to skip out on the great food. To help New Yorkers plan for smaller holiday gatherings, I Love NY created a list of scaled-down recipes that are great for smaller Thanksgiving celebrations.

NYSDOH Gives Update on Medicaid Redesign Team’s (MRT II) Pharmacy Benefit Carve Out Initiative
The New York State Department of Health (DOH) hosted a webinar earlier this week to provide an update on the State Budget initiative to transition the Medicaid Pharmacy benefit from Managed Care back into the fee-for-service (FFS) program. Among the goals in transitioning the pharmacy program from Managed Care back to FFS, is to provide full transparency into prescription drug costs, centralizing and leveraging negotiation power, and, importantly, providing a single drug formulary with standardized utilization management protocols rather than dozens of separate formularies.

Key highlights for providers from the November 16th webinar included an update on the transition and communications timeline. Specifically, that Managed Care Plans (MCPs) will no longer be responsible for physician/practitioner administered drugs that are not included on the Medicaid Pharmacy List of Reimbursable Drugs and that those drugs will not be subject to the carve-out.

However, the new policy also directs the MCPs to continue to offer the benefit when provided by a non-pharmacy provider. (e.g. outpatient hospital, clinic, physician’s office)[1] To learn more details, please click here.

The update also included critical information for physicians about enrollees and billing under the new system such as providers must be enrolled in the FFS program as billing providers in order to continue to serve Medicaid Managed Care members. For additional information regarding this aspect of the transition, please go here.

MSSNY’s Department of Governmental Affairs will provide an update following DOH’s next webinar, which is scheduled for mid-December.

NY Physicians Still in Need of Affordable PPE to Meet Patients’ Needs
Many physician offices across the state of New York are straining to meet their patient care needs due to a lack of available and affordable PPE. This challenging dynamic was highlighted in a USA Today-New York article earlier this week.

A recent physician survey conducted by MSSNY noted that nearly 2/3 of the physician respondents indicated that they are at least “sometimes” finding it difficult to obtain needed PPE. Over 40% of the physician respondents have indicated that it takes them at least 4 weeks to get their PPE from when they order it; while 53% of the physician respondents said the cost of PPE has gone up by at least 25% compared to pre-pandemic levels, and nearly 1/3 have said the cost has gone up by more than 50%.

Of greatest concern, 1/3 of the physician respondents indicated that the lack of available/affordable PPE has adversely impacted their ability to care for their patients. The survey results indicate that further government intervention is urgently needed to help make PPE more widely available to our community physician practices.

We look forward to working with Senator Schumer and our New York Congressional Delegation on measures such as that announced today to help expand this availability so that patient care is not disrupted or delayed due to these shortages.

(See AMA Project N95 article below to order PPE if you are an AMA member.)

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MSSNY President Speaks About Physicians’ Efforts to Combat Misinformation During The COVID-19 Pandemic
MSSNY President Dr. Bonnie Litvack spoke to Spectrum News Buffalo ‘s Captial Report about physicians’ efforts to combat misinformation during the COVID-19 pandemic. In New York, Dr. Litvack said that while physicians are facing an increase in coronavirus cases, they also have to confront misinformation about how dangerous the virus is, how the virus spreads, and the importance of different public health measures aimed at stopping the spread of the virus.

AMA Collaborates with Project N95 Again to Make PPE Available to AMA Members
The American Medical Association (AMA) is collaborating with Project N95 (a not-for-profit, National COVID-19 Clearinghouse) again to make quality-certified personal protective equipment (PPE) available exclusively for AMA members to purchase with no minimum.  

To place an order: 

Go here to begin the process. Please note that Project N95 has updated its website, so the order process has changed.

  • Order deadline:

The deadline to place an order is Monday, Nov. 23, at 3 p.m. Central time.

  • Available equipment(we are offering two new products (duck bill respirator, face shield))
  • Makrite 9500 N95 Surgical Respirator; size S
  • Makrite 9500 N95 Surgical Respirator;size M/L
  • Makrite 910-N95FMX Surgical Respirator (Duck Bill)
  • AAMI Level 1 Isolation Gown
  • Face Shield 2/ Elastic and Foam Headband
  • Bundle (1 box M/L Surg Respirator, 1 box S Surg Respirator, 3 bags Isolation Gowns)

All orders will be aggregated and shipped no later than December 26, via UPS ground.  Gowns and face shields may start shipping as early as December 8. Respirators ship on December 21 and the bundle ships December 26.

MSSNY in Crain’s: Physicians Urge against Looming Medicare Cuts
The Medical Society of the State of New York last week issued a statement in support of New York congressional members—both Democrats and Republicans—who signed a letter urging legislation to prevent double-digit Medicare cuts in 2021.

Dr. Bonnie Litvack, president of the medical society, said in a statement that the proposed decreases could “significantly, adversely impact access to care to many seniors.” The group, she added, earlier this month also joined with eight other northeastern state medical associations in sending a letter urging Congress to pass legislation to prevent the cuts.

Litvack said they “could not come at a worse time as we again confront a surge in Covid-19 cases and practices have not fully recovered from record drops in patient visits.”

The cuts are tied to a proposed change by the Centers for Medicare and Medicaid Services to the Medicare Physician Fee Schedule. The medical societies noted in their letter to congressional leaders that the rule would increase payments for evaluation and management codes, which are needed. At the same time, however, CMS is bound by statute to remain budget neutral, needing to offset any increases by making corresponding decreases.

To meet the requirement, CMS has proposed a nearly 11% decrease to the conversion factor that determines all Medicare payment rates, the medical societies noted.

“These cuts will be harmful to primary care physicians and other medical specialty types,” the group wrote. “For example, while the positive evaluation and management changes were meant to give primary care providers a significant increase, having a conversion factor decrease of 11% means that those benefits are diminished—especially in the face of increased cost and decreased reimbursements during the pandemic.”

The proposed rule would bring extreme cuts to many specialties—8% for critical care, 9% for cardiac surgery, 11% for radiology and 8% for anesthesiology, they noted.

“Many of these physicians are the same ones that are on the front lines of Covid-19 and cannot withstand further cuts of this magnitude,” the medical societies reiterated in their letter. “We urge you to work together to pass legislation to waive the statutory budget neutrality requirements to avoid these cuts.”

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AMA Announces New CPT Codes For COVID-19 Immunizations
The AMA on November 10 announced a handful of new CPT codes for reporting COVID-19 vaccine products and immunization administration.

The code release includes two vaccine product codes and four vaccine administration codes. These new CPT codes will allow healthcare providers to report and track the administration of these COVID-19 vaccines once they receive approval or an emergency use authorization from the Food and Drug Administration. The codes will go into effect at that time.

The vaccine codes are linked to products manufactured by Pfizer Inc. and Moderna Inc. They are:

  • 91300, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use. Vaccine manufacturer: Pfizer Inc.
  • 91301, SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage, for intramuscular use. Vaccine manufacturer: Moderna Inc.

Each vaccine product code is linked with a pair of vaccine administration codes, which correspond to first and second doses.

For the 91300 product code, providers would report:

  • 0001A, immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; first dose
  • 0002A, …; second dose

For the 91301 product code, providers would report:

  • 0011A, immunization administration by intramuscular injection of SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; first dose
  • 0012A, second dose

The AMA says that it is critical that the codes “are available prior to the public availability of the vaccines to facilitate updating of healthcare electronic systems across the U.S.” November 16, 2020 Medicare Web

Monica Sweeny MDDr. Monica Sweeney Receives AMA Spirit of Medicine Award
The American Medical Association (AMA) Foundation Board of Directors have named Dr. Monica Sweeney as a recipient of the 2020 Excellence in Medicine Awards.

In her notification to Dr. Sweeney of her Dr. Debasish Mridha Spirit of Medicine Award, Dr. Jacqueline A. Bello, the AMAF President, stated:

“This annual awards program honor physicians who represent the highest values of altruism, compassion and dedication to patient care. The caliber of our nominees was awe-inspiring, and your selection from such an impressive group speaks volumes in recognizing your dedication to the profession of medicine. As an Excellence in Medicine Awards recipient, you will be honored during an awards ceremony hosted by the AMA Foundation in 2021 (date TBD). In addition, this award comes with an AMA Foundation grant of $2,500 to the organization of Dr. Sweeney’s choosing.”

Dr. Sweeney has been an active member of MSSNY since 1989. She currently serves on MSSNY’s Committee to Eliminate Health Disparities, Infectious Diseases Committee, Task Force on End of Life Care, and Women Physicians Committee. She previously served as a delegate to MSSNY’s House of Delegates and on the Preventative Medicine and Family Health Committee and the Rural Subcommittee.

Phil Schuh MSSNY CEO

MSSNY EVP Is Recipient of AMA Medical Executive Lifetime Achievement Award
Phil Schuh, CPA, has been MSSNY’s Executive Vice President and CFO since 2010 and head of MSSNY’s Finance Division for the previous 20 years. He has been an innovator, mediator, and financial wizard during challenging times. Phil is also a Founding Board Member of the prestigious Physicians Foundation, where he meets with other key state medical society leaders to collaborate on solutions endemic to all. Phil is also the CEO of MSSNY’s Empire State Medical, Scientific & Educational Foundation, Inc.

As Phil stated in his AMA speech, “I want to thank the New York Delegation, MSSNY’s leadership and staff for allowing me to be part of their lives. My job has provided me the opportunity to work with many AMA delegates. I am always amazed at the intensity and focus that you bring to the table.”

Mr. Schuh will be retiring from MSSNY at the end of 2020.

Don’t Wait, Apply Now! 2020 MIPS Extreme and Uncontrollable Circumstances Exception and Interoperability Hardship Exception Applications are Due Dec. 31

Extreme and Uncontrollable Circumstances Application & COVID-19

The COVID-19 pandemic has impacted all clinicians across the United States and territories. However, CMS recognizes that not all practices have been impacted by COVID-19 to the same extent. For the 2020 performance year, CMS will be using our Extreme and Uncontrollable Circumstances policy to allow MIPS eligible clinicians, groups, and virtual groups to submit an application requesting reweighting of one or more MIPS performance categories to 0% due to the current COVID-19 public health emergency.

If you have any concerns about the effect of the COVID-19 pandemic on your performance data, including cost measures, for the 2020 performance period, submit an application now and be sure to cite COVID-19 as the reason for your application.

If you have an approved application, you can still receive scores for the Quality, Improvement Activities, and Promoting Interoperability performance categories if you submit data. If the cost performance category is included in your approved application, you will not be scored on cost measures even if other data are submitted.

Learn more in the 2020 Exceptions Applications Fact Sheet.

Note: CMS has proposed to allow APM Entities to apply to reweight MIPS performance categories as a result of extreme and uncontrollable circumstances, such as the public health emergency resulting from the COVID-19 pandemic. Learn more in the 2021 Quality Payment Program Proposed Rule Overview Fact Sheet.

MIPS Promoting Interoperability Hardship Exceptions

MIPS eligible clinicians, groups, and virtual groups may qualify for a re-weighting of the Promoting Interoperability performance category to 0% if they:

  • Are a small practice;
  • Have decertified EHR technology;
  • Have insufficient Internet connectivity;
  • Face extreme and uncontrollable circumstances such as disaster, practice closure, severe financial distress, or vendor issues; or
  • Lack control over the availability of CEHRT.

Note: If you are already exempt from reporting Promoting Interoperability data, you don’t need to apply.

How do I Apply?

New for 2020: You must have a HCQIS Access Roles and Profile (HARP) account to complete and submit an exception application on behalf of yourself, or another MIPS eligible clinician, group, virtual group or APM Entity. For more information on HARP accounts, please refer to the Register for a HARP Account document in the QPP Access User Guide.

Once you register for a HARP account, sign in to, select ‘Exceptions Applications’ on the left-hand navigation, select ‘Add New Exception,’ and select ‘Extreme and Uncontrollable Circumstances Exception’ or ‘Promoting Interoperability Hardship Exception.’

How do I Know if I Am Approved? If you apply for either of the exceptions, you will be notified by email if your request was approved or denied. If approved, this will also be added to your eligibility profile on the QPP Participation Status Tool, but may not appear in the tool until the submission window is open in 2021.

For More Information

Questions? Contact the Quality Payment Program at 1-866-288-8292 or by e-mail at: To receive assistance more quickly, please consider calling during non-peak hours—before 10:00 a.m. and after 2:00 p.m. ET.

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Calling All MSSNY Social Media Ambassadors!
MSSNY has created a gallery of social media assets for both our Peer to Peer (P2P) program, which offers physicians, residents, and medical students an opportunity to talk with a peer about life stressors, and our “Masking Up” campaign to stop the spread of COVID-19.

Please download and share to your social media accounts to help get the word out:

Tag us @mssnytweet and @mssnygram and use one or more of the following hashtags in your posts: #MSSNY, #MSSNYStrong, #P2P #MaskUpNY #MaskUpAmerica.

Click HERE to view the flyer and register for the program!

When:                 November 23, 2020 at 7:30 am
Faculty:               Jack McIntyre, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention and treatment options
  • Identify barriers to identification and treatment in military culture and methods to overcome them

For more information, contact Jangmu Sherpa at 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.

If you missed the TBI in Returning Veterans webinar on November 3rd, you can now view it online at  

MSSNY’s Peer to Peer (P2P) Program

Last weekend we heard of the suicide death of a physician at North Shore University Hospital. MSSNY has been working hospital officials to make sure that all personnel have resources available to reach out and get help or speak with a peer if needed.  Since this tragedy may have impacted many of our colleagues, MSSNY wants to let you know that you are not alone.

The Medical Society of the State of New York offers to physicians, residents, and medical students an opportunity to talk with a peer about some of life 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 now has over 40 peer supporters trained to support their colleagues

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: or phone: 1-844-P2P-PEER (1-844-727-7337) and request that you be connected with a peer supporter.

Veterans Matters: Suicide in Veterans Webinar
The Medical Society of the State of New York is hosting a CME live webinar entitled Veterans Matters: Suicide in Veterans on Monday, November 23, 2020 at 7:30 am.

Click HERE to view the flyer and register for the program!

When:           November 23, 2020 at 7:30 am
Faculty:        Jack McIntyre, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention, and treatment options
  • Identify barriers to identification and treatment in military culture and methods to overcome them

For more information, contact Jangmu Sherpa at 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 </a.of their participation in the activity.

Registration Now Open 
Veterans Healthcare Training Conference
Veterans Mental Health Training Initiative: ½ Day Virtual Conference
Saturday, December 5th @ 8:30 am – 11:30 am

The Medical Society of the State of New York, New York State Psychiatric Association and the New York State Chapter of National Association of Social Workers is hosting a joint ½ day virtual conference on Saturday, December 5, 2020 at 8:30 am to 11:30 am. .

Register HERE for the program! Click HERE to view the flyer.
View the Agenda HERE.

Educational Objectives:

  • Identify signs and symptoms of mental health responses, including depression, anxiety, PTSD, and suicidal ideation in veteran patients
  • Review relevant statistics related to the veteran population, including their access to and use of healthcare
  • Recognize the importance of primary care specialists and community mental health providers in screening individuals for military service
  • Discuss the impact the COVID-19 pandemic has had on mental health of veteran patients 

Panel 1: 9:15 – 10:10 am.

The Challenges: The Health & Mental Health Issues Facing Veterans & Their Families Amid Pandemic, & Efforts to Address, Including VMHTI .

Keynote Speaker: Joe Geraci, Lt. Colonel, U.S. Army; LMHC
Panelists: Frank Dowling, MD (MSSNY)
Gretchen Foley, MD
Sharon Bailey, Major, USAF (Ret.), LCSW-R.
Invited legislators: Senator Carlucci, Assemblywoman Gunther.

This panel will focus on challenges faced by veterans, related to the COVID-19 pandemic, including factors that exacerbate mental health and substance use disorder, suicidal ideation, and self-medication trends..

The focus of this panel will be to discuss short term impacts that have emerged as a result of COVID-19, as well as longer-term effects of global fear, stress, and isolation, including the re-triggering of Post-Traumatic Stress symptoms..

Speakers will review current statistics related to the pandemic and cultural factors that may cause or heighten anxiety and/or depression symptoms, as well as efforts that have been put in place to address and manage these challenges. Keynote Speaker, Moderator, and Panelists will include Veterans, Physicians, and Mental Health Experts in the Field of Veteran Services.

Panel 2: 10:30 – 11:20 am.

What Has Helped: The Successes, Including Veterans Sharing What Has Made a Difference in Transition, & Clinicians Sharing Best Practices for Identification,
Treatment & Referral .

Panelists: Malene Ingram, MD & Colonel, U.S. Army (MSSNY)

Marianne Goodman, MD
Mike Shurmatz, U.S. Army (Ret.), LMSW
Ben Pomerance, Esq., Deputy Director for Program Development for NYS Division
of Veterans’ Affairs.

Invited Legislators: Senator Brooks, Assemblywoman Barrett

This panel will be a continuation from Panel 1 (The Challenges) and will subsequently focus on what has been most helpful for veterans who have been struggling during the COVID-19 pandemic, and what that brings up for them.

Speakers will discuss what is most effective in terms of improving overall mental health, decreasing anxiety, minimizing substance misuse, and reducing the risk and prevalence of suicide in the veteran community.  Speakers will share what practices have been most effective, as well as what areas to focus on for screening, treatment, and best-fit referrals.

This panel will discuss what has proven to be successful, in order to pave the way for, and build upon, positive outcomes for veterans seeking care. Keynote Speaker, Moderator, and Panelists will include Veterans, Physicians, and Mental Health Experts in the Field of Veteran Services..

For more information, contact Jangmu Sherpa at 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 3.0 AMA PRA Category 1 credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Registration Now Open for Steps to Physician Wellness and Resiliency
Registration is now open for Steps to Physician Wellness and Resiliency on December 10th from 7:30-8:30 am.

Frank Dowling, MD will serve as faculty for this webinar.

Educational Objectives are:

  • Review the warning signs that stress, depression, anxiety, or substance use may impact work or personal life
  • Identify strategies to increase personal empowerment toward making positive change, including self-assessment tools
  • Recognize self-monitoring strategies for stress-related problems and know when to seek professional assistance

Register by clicking here.  Please click here to view the flyer for this program.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

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.





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Rhinebeck Estate for SaleElegant, custom-built home with unparalleled craftsmanship and attention to detail. Set on 10.6 acres in Rhinebeck, bordering Drayton Grant Park at Burger Hill, this home offers character, ambiance and livability. The foyer entry features a tastefully designed staircase, millwork, high ceilings & cherry wood floors. Custom windows provide plenty of natural light. The kitchen with marble counter-topped island evokes farmhouse luxury, with cozy fireside seating area for winter, and glass doors from the hexagonal eat-in kitchen leading to the expansive stone terrace for warmer months. The master suite boasts a high vaulted ceiling, double walk-in closets & bath with clawfoot tub. Two bedrooms with generous closets plus two full baths are also on the second floor plus a sitting room/office or fourth bedroom. Generous closets throughout including a hidden 3 floor elevator. Immaculate lower level with media room, exercise room, bar, wine cellar & full bath. Beautifully landscaped gardens surround the home, a well-established vegetable garden is adjacent to 2-story barn, which is equipped with water & electricity and hilltop views abound. Close to Village & Amtrak. EXCLUSIVE View full listing Contact Nader Kayal, MD, 845-518-7780 / or Rachel Hyman-Rouse at Gary DiMauro Real Estate 845-876-5100 x 10 / 917-686-4906

UES Park Avenue Medical Office Space for Rent – One or Two Days a Week
Elegant office space on UES, in Park Avenue doorman building.  Enormous furnished windowed consult room, large exam room and private secretarial area.  Private elevator to office, huge waiting room and all shared office space. One – two days available; ideal for low volume Practitioner of any specialty. Please contact office manager Theresa – 212-288-2171 or via email at

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Dermatology Practice for Sale – Staten Island, NY
Building includes 3 exam rooms, waiting area. Please respond by calling 718-987-3300 or email












MSSNY eNews: November 4, 2020 – COVID-19 Stories from the Frontline


Gov. Provides Flexibility for Physicians to Report COVID/Flu Test Results
Governor Cuomo’s latest Executive Order issued Tuesday night importantly contains a provision providing greater flexibility to physicians and other professionals to report positive and negative COVID-19 and influenza tests to the NYS Department of Health.  Physicians and labs will now be required to report these test results within 24 hours of receipt rather than 3 hours, as had previously been required in a September 21 notice from the NYS Commissioner of Health.

MSSNY together with the pediatric, family physician, internal medicine, emergency medicine and urgent care associations had strongly advocated for the Commissioner and Governor’s office to provide this additional flexibility.

MSSNY Praises Governor’s Executive Order Provision for Flexibility in Reporting COVID-19 and Influenza Test Results to DOH
“Physicians across the state very much appreciate that the Governor’s latest Executive Order contains a provision to provide some additional time flexibility for reporting positive and negative COVID-19 and influenza test results to the Department of Health.  Under this provision, physicians and other test providers can report positive and negative test results in 24 hours, rather than 3 hours as previously required.

“Physicians are anxious to provide these needed tests to their patients to ensure proper diagnoses, to begin necessary treatments and if necessary, to ensure their patients can begin quarantining as soon as possible.  Physicians are also anxious to ensure that results are reported timely to assist the State in its containment and other response efforts.

“We thank the Governor and the Commissioner of Health for taking this important action.”

Statement Attributable to:
Bonnie Litvack, MD
President, Medical Society of
the State of New York

NY Legislative Election Results Still Being Tabulated but Seat Flips Likely
With tens of thousands of ballots still to be counted within many legislative races across the State, after Tuesday’s election, Republicans stood a chance to pick up several seats in the New York State Senate to narrow the Democratic majority, currently at 40-23.  More on this here.

As of this writing, Republican candidates were winning in 7 Senate districts currently held by Democrats, including districts in Long Island, Brooklyn, and the Hudson Valley.  On the other hand, Democrats were winning in 3 Senate districts currently held by Republicans in the Buffalo and Rochester areas.  There are also other competitive Senate races still too close to be called in Syracuse and the greater Capital District, where the number of outstanding ballots to be counted exceeds the difference in vote totals.

With regard to New York’s Congressional delegation, after Tuesday night’s election, Republican challengers to Democratic incumbents held a lead in 3 Congressional seats, including on Long Island, Staten Island and the Mohawk Valley/Southern Tier, again with thousands of ballots still to be counted.  More here.

Even with these potential Republican gains, the New York State Assembly and Senate will still be governed by sizable Democratic majorities in 2021, and the US House of Representatives will maintain a Democratic majority.

Regardless of the ultimate outcome of these races, there are likely to be dozens of new legislators in Albany next year, and we will need physicians to continue to work to educate these new lawmakers on the litany of issues physicians face in delivering care to their patients. Play stay tuned for further updates.

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About 20 Percent of New Yorkers Have Had COVID-19, Study Finds
While the first case of COVID-19 was confirmed in New York City March 1, the virus was present as early as mid-February, and more than 1.7 million have been infected, according to a study published Nov. 3 in Nature. Researchers analyzed 10,691 blood plasma samples in weekly intervals between February and July from patients at New York City-based Mount Sinai Health System. After measuring antibodies from two groups, a positive control group from patients seeking urgent care at the health system’s emergency departments and a second group seeking routine care visits, they determined that at least 1.7 million New Yorkers have been infected with SARS-CoV-2 so far, with a 0.97 percent fatality rate — 10 times higher than the flu.

The positive control group, or “urgent care” group, included 4,101 samples and was meant to detect increasing infections in patients with moderate to severe COVID-19. The routine care group included 6,590 samples and was intended to represent the general population, since scheduled visits were not related to COVID-19.

Researchers said antibody presence increased in both groups at different rates, with the urgent care group seeing a sharp rise. Positive samples were detected as early as mid-February and leveled out around 20 percent across both groups after cases started to let up at the end of May. Antibody levels stabilized between May and July.

“We show that the infection rate was relatively high during the first wave in New York but is far from seroprevalence that might indicate herd immunity,” Florian Krammer, PhD, study author and vaccinology professor at Mount Sinai’s Icahn School of Medicine, said in a news release.  “Knowing the detailed dynamics of the seroprevalence shown in this study is important for modeling seroprevalence elsewhere in the country.”  (Becker’s Hospital Review, Nov.3)

US Sees Five Highest Days of COVID-19 Cases Leading Up to Election
The US recorded 91,530 new Covid-19 infections on the day many Americans cast their ballots, adding to a series of staggering case numbers reported within just the past week. The country’s five highest days of coronavirus cases have all been recorded since October 29, affirming experts’ warnings another surge is well underway and will only get worse.

The nationwide seven-day average of new daily cases now stands at about 86,363 — more than double what it was on September 4, data from Johns Hopkins University show.

And while doctors have stressed basic public health measures like masks and social distancing can turn things around, such measures remain a point of contention in some parts of the US.

As of Tuesday, at least 36 states reported more new cases in the last week versus the week prior, Johns Hopkins data show. And six states — Idaho, Maine, Minnesota, New Mexico, Ohio, and Pennsylvania –reported their highest one-day COVID-19 case count Tuesday.

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Reminder: Upcoming MIPS Important Dates and Deadlines
CMS would like to remind clinicians of important upcoming Merit-based Incentive Payment System (MIPS) dates and deadlines:

  • December 31 – 2020 Promoting Interoperability Hardship Exception and Extreme and Uncontrollable Circumstances Exception Applications Clinicians, groups, and virtual groups who believe they are eligible for these exceptions may apply, and if approved, will qualify for a re-weighting of one or more MIPS performance categories. CMS will notify applicants via email whether their requests are approved or denied. If approved, the exception will also be added to the QPP Participation Status Tool but may not appear in the tool until the submission window opens in 2021.
  • Note: CMS has proposed for the 2020 performance year to allow Alternative Payment Model (APM) Entities to submit Extreme and Uncontrollable Circumstances applications as a result of COVID-19. For more information about the impact of COVID-19 on Quality Payment Program participation, see the Quality Payment Program COVID-19 Response webpage.
  • December 31 – 2021 virtual group election period closes. Solo practitioners and groups with 10 or fewer clinicians (including at least one MIPS eligible clinician) who want to participate in MIPS as a virtual group for the 2021 performance year must submit their election to CMS.
  • January 4, 2021 – 2020 MIPS performance year data submission window opens.
  • March 1, 2021 – Deadline for CMS to receive 2020 claims for the Quality performance category. Claims must be received by CMS within 60 days of the end of the performance period. Deadline dates vary to submit claims to the MACs. Check with the MACs for more specific instructions

Training for New Medical Treatment Guidelines Available
Training is available for the new Medical Treatment Guidelines (MTGs) that are to go into effect on January 1, 2021.

Elbow Injuries
Foot and Ankle Injuries
Hip and Groin Injuries
Hand, Wrist and Forearm Injuries (including Carpal Tunnel Syndrome)
Occupational Interstitial Lung Disease
Occupational/Work-Related Asthma
Post-Traumatic Stress Disorder*
Major Depressive Disorder*

The Board has developed training for each of the MTGs to introduce health care providers to the new guidelines. Each training will provide an overview of the General Guideline Principles, conditions associated with the body part or disease, and treatment recommendations.

As an added benefit, there is opportunity to obtain complementary continuing medical education (CME) accreditation upon completion of each course. For those on your staff who would benefit from the training but do not need CME accreditation, training presentations are available as pdfs.

To register for the training courses and receive CME accreditation, go to MTG Training for CME Accreditation

For the non-CME training, go to Training for Non-medical and Administrative Staff

* Post-Traumatic Stress Disorder and Major Depressive Disorder have been posted for a 60-day public comment period starting on October 21, 2020.  Training for these MTGs will be adjusted if needed based on the feedback received during the public comment period.

More Information

For more information, please visit the Board’s website or call (877) 632-4996. You can also email

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Veterans Matters: Suicide in Veterans Webinar
The Medical Society of the State of New York is hosting a CME live webinar entitled Veterans Matters: Suicide in Veterans on Monday, November 23, 2020 at 7:30 am.

Click HERE to view the flyer and register for the program!

When:           November 23, 2020 at 7:30 am
Faculty:        Jack McIntyre, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention, and treatment options
  • Identify barriers to identification and treatment in military culture and methods to overcome them

For more information, contact Jangmu Sherpa at 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.





Elegant, Custom Built Home with Unparalleled Craftsmanship – Rhinebeck, NY
Rhinebeck Estate for SaleElegant, custom-built home with unparalleled craftsmanship and attention to detail. Set on 10.6 acres in Rhinebeck, bordering Drayton Grant Park at Burger Hill, this home offers character, ambiance and livability. The foyer entry features a tastefully designed staircase, millwork, high ceilings & cherry wood floors. Custom windows provide plenty of natural light. The kitchen with marble counter-topped island evokes farmhouse luxury, with cozy fireside seating area for winter, and glass doors from the hexagonal eat-in kitchen leading to the expansive stone terrace for warmer months. The master suite boasts a high vaulted ceiling, double walk-in closets & bath with clawfoot tub. Two bedrooms with generous closets plus two full baths are also on the second floor plus a sitting room/office or fourth bedroom. Generous closets throughout including a hidden 3 floor elevator. Immaculate lower level with media room, exercise room, bar, wine cellar & full bath. Beautifully landscaped gardens surround the home, a well-established vegetable garden is adjacent to 2-story barn, which is equipped with water & electricity and hilltop views abound. Close to Village & Amtrak. EXCLUSIVE View full listing Contact Nader Kayal, MD, 845-518-7780 / or Rachel Hyman-Rouse at Gary DiMauro Real Estate 845-876-5100 x 10 / 917-686-4906

UES Park Avenue Medical Office Space for Rent – One or Two Days a Week
Elegant office space on UES, in Park Avenue doorman building.  Enormous furnished windowed consult room, large exam room and private secretarial area.  Private elevator to office, huge waiting room and all shared office space. One – two days available; ideal for low volume Practitioner of any specialty. Please contact office manager Theresa – 212-288-2171 or via email at

UES Park Avenue Medical Office Space         

Dermatology Practice for Sale – Staten Island, NY
Building includes 3 exam rooms, waiting area. Please respond by calling 718-987-3300 or email

OBGYN Physician for Our Upper East Side Practice
Gynecology office setting only – No Obstetrics. Please contact the office at 212-772-3722 Email: Office Location: VCARE OBGYN 328 East 75th St. Suite 4 New York NY 10021 REQUIREMENTS: Doctor of Medicine degree. New York Medical License. DEA Board Certified OBGYN













MSSNY eNews: August 12, 2020 – DFS: You Cannot Charge Patients for PPE


Reminder: Network Health Care Providers May Not Charge Patients for PPE Costs
As noted in last Friday’s MSSNY e-news, the New York Department of Financial Services (DFS) issued Insurance Circular Letter No. 14 (2020), advising health insurers to immediately notify participating providers that they should not charge insureds fees that are beyond the insureds’ financial responsibility for covered services, such as fees for PPE, and instruct participating providers to refund any such fees to insureds.  It also noted that “Insurers and participating providers should work together to resolve any issues regarding increased costs due to COVID-19, including for PPE, and insureds should be held harmless for such charges.”

MSSNY President Dr. Bonnie Litvack Issued a Statement in Response to Require Health Insurers to Reimburse Health Care Practitioners for PPE Costs
that “MSSNY does not condone health plan-participating health care practitioners charging their patients for the huge jumps in the cost of personal protective equipment (PPE), as state regulations limit the ability of such practitioners to bill patients for these costs.”

However, given the enormous profits of the health insurance industry, MSSNY has urged the DFS to require health insurers to reimburse health care practitioners for these enormous jumps in PPE costs, and the significant difficulty in even obtaining it in the first place. The statement noted a recent MSSNY survey reported that nearly three quarters of the respondents expressed significant difficulty in obtaining PPE altogether, while nearly 40% of the respondents indicated that their PPE costs had gone up by more than 50%.

MSSNY President Testifies at Legislative Hearing Looking at COVID and Hospitals
MSSNY President Dr. Bonnie Litvack presented testimony today at a joint Assembly-Senate legislative hearing examining Covid-19 and hospitals. Dr. Litvack’s testimony raised number of critical issues that impacted and continue to impact physician care from the height of the pandemic, including:

  • Physician wellness, noting MSSNY’s Peer to Peer program
  • Lack of available and affordable PPE
  • Ensuring the ability of patients to receive medically necessary elective surgery in the event of a second surge
  • Ending Executive Order scope of practice changes

Please join the NYS Department of Health Thursday, August 13th at 1-2 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers.

For audio only, please dial in: 844-512-2950 and Access Code: 1166339

News: August 12, 20MLMIC Banner

MSSNY: Restore Physician Supervision for Non-Physician Providers
The Medical Society of the State of New York is calling on the state to restore physician supervision for non-physician health care practitioners following a systemwide approach to reduce Covid-19 infections. Dr. Bonnie Litvack, president of the medical society, said in a statement: “These orders that eliminate essential physician supervision potentially place patients at risk.” (Crain’s, 9/10)

Medicaid/CHP: Deadline Extended to Aug. 28 for Provider Relief Fund
This listserv notice is to remind Medicaid and Child Health Plus (CHP) providers that on July 31, 2020, the U.S. Department of Health and Human Services (HHS) extended the application deadline to August 28, 2020 for the Provider Relief Fund (PRF) for Medicaid and Child Health Plus under the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program and Health Care Enhancement Act.  HHS has reopened its Provider Relief Fund (PRF) Application and Attestation Portal to facilitate this deadline extension.

HHS has been hosting a series of informational webinars to address questions and support providers through the application process. The next provider and provider organization webinar will be held on Thursday, August 13, 2020, at 3:00 PM Eastern. Please visit to register.

CMS instructions on how to apply for PRF funding are shown below.

To Apply:

All eligible medical, dental, and long-term services and supports (LTSS) providers may begin the application process here. Also available here are Medicaid and CHIP Provider Distribution Instructions and the Medicaid and CHIP Provider Distribution Application Form. It is recommended that you use these documents to help you complete the process through the Enhanced Provider Relief Fund Payment Portal. Visit the CMS website here for additional information.

LabCorp, Quest Diagnostics: “Turnaround Time for COVID-19 Test Results Down to 1-3 Days”
LabCorp and Quest Diagnostics both said their average turnaround times for COVID-19 diagnostic tests now stand between one and three days. LabCorp said it has completed over 10 million COVID-19 tests since March and has a capacity of 180,000 per day with plans to increase further. Its average time to deliver results for COVID-19 diagnostic tests is now one to three days, the lab company said Aug. 10.

LabCorp is prioritizing testing for residents and staff of nursing homes in hot-spot states as well as hospitalized patients. All other tests are performed in the order in which they are received. Quest said its average turnaround time is two to three days as of Aug. 10. It has performed about 11.2 million COVID-19 tests and has a capacity of 150,000 tests per day. Quest said it expects to scale up to 185,000 tests by Labor Day. (Becker’s Hospital Review, Aug. 14)

Neck Gaiters, Bandanas More Harmful than Not Wearing a Mask, Duke Study
Wearing bandanas or neck gaiters as face coverings to protect against COVID-19 may actually do more harm than not wearing a mask at all, a study published in Science Advances found.

Researchers at Durham, N.C.-based Duke University analyzed the effectiveness of 14 face coverings ranging from bandanas to N95 masks. They created a simple device involving a laser and cellphone camera to track individual particles emitted from a person’s mouth when speaking. Researchers had trial participants say the same phrase with and without wearing each mask 10 times.

N95 masks proved the most effective, allowing no droplets to escape. Handmade cotton masks were about as effective as surgical masks, both blocking a substantial amount of droplets. Bandanas and breathable neck gaiters ranked least effective, emitting a higher droplet count than control tests involving no masks.

Bandanas and neck gaiters have more porous fabric, which may break up bigger particles into smaller ones that are more likely to float in the air, hence the higher droplet count, Martin Fischer, PhD, a chemist and physicist who developed the testing device, explained in a video created by Duke and cited by The Washington Post.

Dr. Fischer said these types of coverings are a popular choice among Americans because they are convenient to wear and don’t restrict air, which is also why they’re not offering much protection. “It’s not the case that any mask is better than nothing,” he said in the video. “There are some masks that actually hurt rather than do good.”

To view the full study, click here.(Becker’s Hospital Review, Aug. 14)

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Elegant, Custom Built Home with Unparalleled Craftsmanship – Rhinebeck, NY
Set on 10.6 acres in one of the most sought-after neighborhoods in Rhinebeck, this stunning home borders Drayton Grant Park at Burger Hill (a conservation land and the highest point in Rhinebeck). Features beautifully landscaped gardens with sweeping hilltop views and a well established vegetable garden and barn. This handsome home is generously proportioned throughout, with an inviting foyer entry with tastefully designed staircase, millwork, high ceilings, cherry wood floors and custom windows.

Rhinebeck Estate for SaleA world class kitchen with a marble counter-topped island, enjoys both a cozy fireside seating area perfect for winter evenings, and glass doors in the hexagonal eat-in-kitchen opening onto the expansive stone terrace for three season enjoyment and entertaining.

A luxurious Master suite, with high vaulted ceiling design, his and hers walk-in closets and a gorgeous master bath with cast iron clawfoot tub. The second floor also includes two spacious bedrooms with generous closets and 2 full bathrooms, An additional large sitting room/office could easily make a lovely fourth bedroom. Lower level features a media room, exercise room, bar, wine cellar and full bathroom. Additionally there is a two story barn equipped with water and electricity.

The house is located 7 minutes to the charming center of Rhinebeck village with its many superb restaurants, boutiques & shops. The highly rated Northern Dutchess Hospital, the excellent Rhinebeck schools and the County Fairgrounds, a most desirable venue destination throughout the year, are all nearby. Rhinecliff train station is a mile beyond with Amtrak service south to NYC(1hour 40 minutes) and north to Hudson, Albany, Niagara Falls and Montreal. View full listing Contact Nader Kayal, MD, 845-518-7780 / or Joshua M. Briggs at Heather Croner RE-Sotheby’s 917 213-9042 /

Upper East Side Office to Share
Includes waiting room, 2 exam rooms and room for medical assistants. Flexible schedule. Call Bianca at 212-327-1851.

For Sale: 715 Park Avenue
Medical office, 1,800 sq. ft. Rectangular, 11 1/2 ft ceilings, street level access. Private entrance on 70th Street, side of the building. Windows on Park Avenue and 70th Street. Excellent office space for plastic surgeon, dermatologist or dental practice. Central air conditioning, high voltage electric service, two bathrooms. *Sale could include active Cardiac / Medical Practice. Please contact Janet @ 212-288-5468.

Office Space and Quad-A Certified O.R. for Rent
Plastic surgery office and/or quad A – certified operating room available for rent. We welcome you to tour our facility, where safety and luxury are combined in the most prime location on the upper east side. We assure you will be delighted by what you discover. We take pride in our facility, where your patients’ safety and satisfaction are our number one priority.
    • Fully equipped operating room perfect for a board-certified plastic surgeon
  • Pre-op and recovery areas
  • A bright and modern waiting area
  • 3 consultation rooms, administrative room, kitchenette, and 2 bathrooms
  • Full day office rental per week / O.R. rental per case

For inquiries please call 212.737.8700, email

Office Space and Quad-A Certified O.R. for Rent







COVID-19 Update May 15, 2020


Got PPE?
As physicians we like order and consistency but much in our current reality has been chaotic. Particularly frustrating has been the shortage of essential medical supplies that has plagued us from nearly the first day following the WHO pandemic declaration.  As an organization and a profession, we spoke out early and often about the lack of adequate PPE and the threat it conferred on the health and safety of our doctors, staff and patients in our Emergency Rooms and ICUs.  Thank goodness the crisis has eased in our hospitals and that they are preparing for a possible future surge by re-stocking emergency closets.

In the meantime, our community doctors remain in crisis mode struggling to procure PPE to keep open/reopen their offices.  Our MSSNY was told that local Offices of Emergency Management (OEM) would aid our doctors but sadly, many county warehouses were empty and lists of OEM sources led to dead ends.  This week brings new PPE concerns with the FDA and CDC warning that dozens of tested KN95 masks were defective with some filtering as few as 20% of particles.

The email we sent this week about physician PPE needs yielded about 1000 responses in the first 24 hours.  Clearly, the situation is dire.  Your MSSNY is actively working on a plan to address the PPE acquisition challenges you are facing.  Our physicians are essential to a safe and successful re-opening of New York.  This cannot happen without a reliable supply of protective equipment for our offices.

“Not being heard is no reason for silence.” –Victor Hugo, French novelist.

We will not be silent. Physician offices must GET PPE.

Bonnie Litvack, MD
MSSNY President

Are You Stressed Out from COVID-19? MSSNY Help Line is Live for You!
The Medical Society of the State of New York announced today that it has established a help line NYS physicians that have been experiencing COVID 19 related stress.  The MSSNY helpline is staffed by psychiatrists that will provide one-time support for those in need.

The helpline number is: 518-292-0140

Physicians can call this number 24/7 and will get an answering service who will ask for the individuals name and contact information.   There will be a return call to the individual within an hour of the call being received.

The MSSNY helpline is part of the MSSNY Peer to Peer (P2P) support program which is currently in development by MSSNY.  MSSNY is seek volunteer peer supporters for this program and additional information will be forthcoming within the next several weeks.  Additional information on how to become a volunteer peer support may be obtained by contacting Cayla Lauder at or Pat Clancy at

Gov. Cuomo Issues Criteria for Physicians Defining COVID-19 related Inflammatory Illness
Today, Gov. Cuomo has issued the first in the nation criteria for Health Care Professionals defining COVID-19-Related Inflammatory Illness in Children

Notes from Governor Cuomo’s COVID-19 Briefing

– Hospitalizations and intubations are down

– New COVID Cases 431 as of yesterday, up from 420 May 12

– 132 deaths yesterday

– “We’re where we are when this first started.”

– “Our Curve is down, and the curve in the rest of the nation is up.”


– 5/10 regions will open

– NY on PAUSE is extended to May 28 for regions that do not open today

– If a region hits benchmark between now and then, they can reopen

Phase 1 Reopening

– Retail Business Owner

– Curbside pickup

– In store pickup when curbside is not possible

– Masks must be worn by employees and customers (unless under two

years of age or for medical reasons) and hand sanitizer

will be available

Beaches for Memorial Day

– Agreement has been made with New York, New Jersey, Connecticut, Delaware

to open beaches for Memorial Day

– State and local beaches may open Friday before Memorial Day weekend on

the following conditions:

– No more than 50% capacity with controlled exists/ entrances

– No group activities

– Enforce social distancing measures

– No concessions

– City/town/county beaches can open under same conditions

– Must fully enforce minimum rules and may add additional



– According to DeRosa, BioReference Lab Core and Quest have been partnered and

30K tests a day are being saved for nursing homes


– Businesses that open today have signed a compliance agreement. If there is a

violation, they can be closed on that basis.


– According to Mujica, the Comptroller report coming out today states revenues

are down 14%. He continued noting that the federal government has been

working on a bill that will provide funds to the state.

MSSNY Leglisative Podcast for this Week

Re-Opening Your Medical Practice in the COVID-19 Era on May 26, 12 Noon-1PM
As physicians are now considering re-opening their practices, they need to appreciate that they cannot simply “go back to normal”.  With furloughs, layoffs, severe limitations of medical services, decreased revenues and office closures, physicians need to consider strategies to maximize the success of their practices going forward.

These include financial analysis and planning, how to best protect and treat patients and employees, and what needs to be done to ensure that their practices operate efficiently, safely and profitably.  Topics addressed will include:

What you need to consider before re-opening?

  • What financial issues must be considered to better prepare your practice to move forward?
  • How can you ensure your practice operates appropriately as it relates to patients?
  • Is there a continued role for telehealth?
  • What will the new practice culture look like going forward?
  • What reasonable accommodations and workplace safety precautions should be made for employees?
  • What are potential discrimination issues that can arise, including, for example, from a phased re-opening, or gradual return of employees from furlough?
  • Given that employees have had a furlough period, and there may be a backlog of work, can/should employers make changes to or limit their PTO policies for the remainder of the year?
  • How do we handle/resolve employment contract breach issues?
  • Is there liability to the practices for exposing employees or employees’ family to Coronavirus? Wrongful reopening?

Register in advance for this webinar.

Presented by:

Barry B. Cepelewicz, M.D., Esq.
Garfunkel Wild, P.C. 

Roy W. Breitenbach, Esq.
Garfunkel Wild, P.C.

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There Are Limits to Coronavirus Antibody Testing, AMA Warns
Physicians and the general public should be cautious about the use of antibody testing for identifying previous COVID-19 infections, and they should especially be cautious of using the tests to determine if a person is immune to the new coronavirus, the American Medical Association warned.

Per a new guidance released by the association May 14, while antibody tests may play a key role in identifying the overall prevalence of COVID-19 in the U.S. population, including among those who do not show symptoms, the testing has inherent limitations.

The limitations include antibody tests currently on the market showing a significant number of false positive results. These tests may also identify antibodies for other coronaviruses, such as those that cause the common cold.

Also, a vast majority of more than 120 tests on the market have not been authorized by the FDA, and the association urges physicians to note the regulatory status of all available coronavirus antibody tests. Thus, the association recommends that “currently available antibody tests not be used as the sole basis of diagnosing COVID-19, and not be offered to individuals as a method of determining immune status.”

The test should not be used to support >decisions on returning to work or ending physical distancing, the association said.

Anyone in NYC with Coronavirus Symptoms Eligible for Testing
Any New Yorker with symptoms of the coronavirus will now be eligible to get tested for Covid-19. The new rules come after weeks where the city refused to test patients unless they were sick enough to be hospitalized. A limited number of vulnerable people, like the elderly in hard-hit neighborhoods, and frontline workers were also deemed eligible.

But now, the city is moving to set up a widespread program to test New Yorkers for the disease and hunt down people they have been in contact with. In the coming months, the effort will be crucial for the city’s plans to gradually lift stay-home restrictions and reopen its economy.

Under the new rules, anyone with a fever, cough, shortness of breath and symptoms like loss of smell and taste can get tested. Anyone who has been in close contact with a confirmed Covid-19 patient is also eligible for testing. Workers in nursing homes, homeless shelters and adult care facilities are eligible as well, regardless of whether they have symptoms.

The city is opening a dozen new testing sites over the next two weeks and will have a total of 23 publicly run sites. Though the eligibility criteria have broadened, there is no guarantee there will be enough tests available to meet demand. Appointments have filled up fast at available sites.

Officials are aiming to do 20,000 tests a day by late May. Next week, test sites will open at the Highbridge Recreation Center in Washington Heights and in Midwood, Brooklyn.

The city has moved its contact tracing program out of the Health Department and into the public hospital system, a move that sparked controversy.

Meanwhile, the number of children suffering from an inflammatory syndrome linked to Covid-19 spiked again on Thursday, reaching 100 confirmed cases.

The city has launched a PSA campaign to warn parents about the disease.

The number of people newly hospitalized for Covid-19, the number of ICU patients in public hospitals, and the share of patients testing positive all declined in the latest data Thursday.

The virus has killed 20,406 people in the city, and there are now 186,293 confirmed cases.

“Practical Considerations in Reopening Your Medical Practice”
By Andrew L. Zwerling

The outbreak of the COVID-19 virus and the response to it, including governmental orders that closed in whole or in part medical practices that performed elective procedures, created a difficult landscape for medical practices to navigate in the effort to remain viable, let alone operationally functional.  As the government slowly lifts stay-at-home orders and bans on elective procedures in New York State, the reopening of medical practices creates its own set of issues and burdens for medical practices to consider and handle.  Lapses in doing so correctly may lead to potentially punishing outcomes.

A threshold issue of significance is ensuring adherence to safety protocols that must be implemented either because they are required by the government or because the failure to implement them may expose a medical practice to future liability should an employee become ill from the COVID-19 virus.

For example, may an employer ask an employee if he or she had COVID-19 or was exposed to anyone who had it or has symptoms of COVID-19?  May an employer require an employee to have his or her temperature taken or submit to a COVID-19 test as a condition of re-entering the workplace?  May an employer require an employee with COVID-19 symptoms to stay home?  May an employer require employees to wear masks and/or gloves?  If so, who should bear the cost?  How does a medical practice social distancing with respect to staff and patients?  Should patients be screened prior to or after their arrival for appointments? What new and different cleaning and sanitation protocols must be implemented in response to COVID-19?  These questions and others should be answered before a medical practice reopens.

A host of employment law issues are also implicated in the reopening. For example, if an employer reduces an employee’s hours and wages does that reduction violate the terms of an employment contract?  If an employer reduces the wages of an exempt employee will that reduction fall below required thresholds and thereby undermine the exempt status of that employee?  If, to compensate for staffing shortages, an exempt employee performs the tasks of a non-exempt employee will that functional change convert the employee to non-exempt status?  If an employer reduces an employee’s salary because he or she is working fewer hours what steps must the employer take – for example, providing the employee with a “Rate of Pay Change” form – in order to avoid costly violations of the New York State Labor Law?

Although the issues related to reopening are many and may seem daunting, they are all susceptible to resolution if an employer conducts the proper due diligence and consults with the legal experts who can assist in providing the requisite guidance.

[1] Andrew L. Zwerling is a Partner-Director at Garfunkel Wild P.C. with over 38 years as a trial and appellate lawyer in State and Federal courts, including his successful argument before the United States Supreme Court.  A member of his firm’s Employment Law Practice Group, he has been advising clients how to respond to COVID-19 issues affecting their practices and businesses.  He may be reached at 516-393-2581 and by email at  

May 20, 2020 @ 7:30am Medical Matters CME Webinar Registration Now Open
Mental Health and COVID-19 for Health Professionals

Register now for MSSNY’s next webinar related to the COVID-19 pandemic, Medical Matters:: Mental Health and COVID-19 for Health Professionals.  Just like we need to take extra precautions to protect ourselves from the risk of being infected by COVID-19, we also need to be concerned about psychological risks for health professionals. Faculty for this program is Craig Katz, MD.

Click here to register for this webinar

To view the companion pieces to this webinar, be sure to go to and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

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. 

Study Puts U.S. Covid-19 Infection Fatality Rate At 1.3%


The researchers looked at 116 counties in 33 states and found 40,835 confirmed cases and 1,620 confirmed deaths through April 20. Asymptomatic COVID-19 patients who recovered with no symptoms were not counted in the data, which could have skewed results. The researchers also said they could not estimate age-adjusted IFR-S because the data is not available.

COVID-19 kills 1.3% of symptomatic people and could kill 500,000 Americans in the coming months if as many people contract the highly-contagious virus this year as contracted the seasonal flu last year, according to a caveat-laden estimate published Thursday in Health Affairs.

“After modeling the available national data on cumulative deaths and detected COVID-19 cases in the United States, the IFR-S (Infection Fatality Rate – Symptomatic) from COVID-19 was estimated to be 1.3%,” said the researchers, led by Anirban Basu, Stergachis Family endowed director and professor in the Department of Pharmacy, CHOICE Institute, University of Washington, Seattle.

“This estimated rate is substantially higher than the approximate IFR-S of seasonal influenza, which is about 0.1% (34,200 deaths among 35.5 million patients who got sick with influenza).”

FBI: Hackers Breaking into COVID-19 Research Organizations
China-linked hackers are breaking into American organizations carrying out research into COVID-19, U.S. officials said on Wednesday, warning both scientists and public health officials to be on the lookout for cyber theft. In a joint statement, the Federal Bureau of Investigation and the Department of Homeland Security said the FBI was investigating digital break-ins at U.S. organizations by China-linked “cyber actors” that it had monitored “attempting to identify and illicitly obtain valuable intellectual property (IP) and public health data related to vaccines, treatments, and testing from networks and personnel affiliated with COVID-19-related research.”

The statement offered no further details on the identities of the targets or the hackers. The Chinese Embassy in Washington did not immediately respond to a request for comment. China routinely denies longstanding American allegations of cyberespionage. Coronavirus-related research and data have emerged as a key intelligence priority for hackers of all stripes. Last week Reuters reported that Iran-linked cyberspies had targeted staff at U.S. drugmaker Gilead Sciences Inc., whose antiviral drug remdesivir is the only treatment so far proven to help COVID-19 patients. In March and April, Reuters reported on advanced hackers’ attempts to break into the World Health Organization as the pandemic spread across the globe. (Reuters)

Sanofi: If Successful, Americans Has First to Access Vaccine
Sanofi, the French drug company working with the U.S. Department of Health and Human Services (HHS) to develop a coronavirus vaccine, indicated that Americans will be the first to gain access to the vaccine should the company be successful.

“The U.S. government has the right to the largest pre-order because it’s invested in taking the risk,” Sanofi CEO Paul Hudson told Bloomberg.

HHS announced in February that its Biomedical Advanced Research and Development Authority (BARDA) will provide “expertise and reallocated funds” to Sanofi to develop the vaccine. Hudson said the U.S. expects “that if we’ve helped you manufacture the doses at risk, we expect to get the doses first.”

BARDA has given $30 million to Sanofi so far, according to Bloomberg.

Sanofi also partnered with British pharmaceutical company GlaxoSmithKline on the project and says it could make 600 million doses annually, though Hudson aims to double that projection.

Hudson warned that European countries could be left behind if they do not put in more resources toward vaccine development. “I’ve been campaigning in Europe to say the U.S. will get vaccines first,” Hudson told Bloomberg from his home in Paris. “That’s how it will be because they’ve invested to try and protect their population, to restart their economy.”

The Trump administration is pushing to speed up the development of vaccines through a program dubbed “Operation Warp Speed,” seeking to have millions of doses ready by January, an ambitious timeline that would be significantly faster than any previous vaccine development. Hudson told Bloomberg that Sanofi plans to begin human trials in the second half of this year and aim to have a vaccine available by the second half of 2021.

On Tuesday. the American biotechnology company Moderna announced that the Food and Drug Administration has given them fast-track designation, which is designed to expedite the development of treatments for life-threatening diseases such as COVID-19. (The Hill, May 13)

MSSNY Now Has More Than 50 Podcasts Available
Did you know you can now listen to all of MSSNY’s podcasts at Spotify, iTunes, I Heart Radio or Google Podcast?  Just search “MSSNY” and you will be able to listen to the MSSNY weekly update and messages from the new MSSNY president, Bonnie Litvack, MD.  You will also find podcasts on COVID-19, immunizations, emergency preparedness and veterans matters.  You can also access all of MSSNY’s podcasts by clicking here.

Nassau County Med Society Seal


Nassau County Webinar
DATE: May 21, 2020
Time: 7pm

Zoom Webinar Link 

Guest Speaker
Dr. David A. Hirschwerk
Attending-Infectious Diseases
Executive Vice Chair-Dept. of Medicine
North Shore University Hospital/LIJ Medical Center


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COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 14, 2020


Notes from Governor Cuomo’s COVID-19 Briefing

– Hospitalizations and intubations are down
– New COVID Cases 420 as of yesterday
– 157 deaths (121 in hospitals, 36 in nursing homes)

– Not a matter of if we reopen, but when and how
– Check the data on a daily basis; Transparency is key
– NYS will post daily dashboard of relevant local information
– Build Back Better in areas of education, telecommuting, telemedicine, public
transit, and public health

Local Government Management:
– Manage compliance among business and individuals for reopening procedures
– React immediately if numbers change

Federal Assistance:
– We still need federal help to fund schools, hospitals, local governments,
police officers, and firefighters
– President Trump expedited $3.9B to the MTA
– Cap on SALT increases federal taxes on NYers by $12B-$15B
– D.C. must not delay, exclude special interests and not provide corporate
bailouts; If corporation accepts federal funds, they should rehire same amount
of workers

– This experience has taught us we need to make medical equipment in the U.S.
– Initial $3M in grants to businesses to mfg. medical  supplies/equipment in NY

Contact Empire State Development to grow or start medical supply business:

COVID-Related Illness in Children:
– DOH is investigating 110 cases of what may be rare COVID- related illness in
children with symptoms similar to atypical Kawasaki disease
or toxic shock like syndrome
– Illness has taken lives of 5 year-old boy, 7 year-old boy, and 18 year-old girl
– NYS and DOH are leading national effort to understand and combat new syndrome
– So far, 16 other states, Washington D.C., and six European countries have
reported cases
– While this illness is rare, seek care if child has prolonged fever (more
than five days), abdominal pain, diarrhea, vomiting, bloodshot eyes, skin rash
– NYS issued first-in-the-nation criteria to healthcare professionals defining
this syndrome

– Business will reopen while abiding by reopening guidelines for particular regions
which will be enforced by local government.
– According to DeRosa, there will be regional control meetings to ensure regions
are adhering to guidelines
– Social acceptability continues to be left up to individuals
– Religious institutions should adhere to guidelines for large gatherings and
remember the situation in New Rochelle
– There is federal legislation pending regarding liability for businesses that
tests positive for COVID
– Regions will be able to open at 12:01 a.m., so Friday can be a day of business

MSSNY President Submits Testimony on the Impact of the COVID19 Crisis on NY Physician Practices
May 13, 2020, Westbury, NY— Dr. Bonnie Litvack, MD, a Westchester radiologist and President of the Medical Society of the State of New York (MSSNY), today submitted testimony to the Joint Legislative Committee Hearing on Small Businesses, describing the impact of the COVID19 crisis on physician practices delivering patient care across the state of New York.

“Like many small businesses across the state, New York physicians have faced devastating consequences for their practices as a result of the coronavirus outbreak,” said Dr. Litvack. “Our first priority is, of course, to ensure that our patients, through the crisis and after, can continue to receive the care they need. However, physicians need to be assured that our practices can keep our doors open for patients now and in the future.”

To learn details about the impact, MSSNY conducted two surveys of its membership over the last month. Key takeaways from MSSNY’s most recent survey include:

  • 79% have seen a reduction of more than 50% in the volume of patients visiting their practices.
  • Nearly 3/4 had a greater than 50% drop in practice revenue.
  • More than a quarter had to lay off or furlough more than 50% of their staff, and 40% had to lay off or furlough at least 25% of their staff.

However, the bad news from the second survey was mixed with some modestly positive news that more physicians have received a small business Paycheck Protection Program loan. The CARES Act has provided some funding to help make up for some of the enormous deficits suffered by physician practices. However, it is not nearly enough to ensure the survival of many physician practices across the state.

Dr. Litvack’s testimony provided recommendations for how Congress and the New York State legislature can support physicians going forward including “advance” payments by commercial insurers to physicians and requiring health insurers to make bonus payments to their network physicians to account for the costs associated with additional Personal Protective Equipment (PPE) and the mark-up in price, that will be essential as practices begin to open up.

MSSNY also continues to work with the New York Congressional delegation to press for needed additional funding in future stimulus packages to help further offset the devastation to these practices. Physicians also need assurance that existing funding streams in previous stimulus packages will continue to be made available to community physicians so they may continue to provide patient care.

MSSNY will continue to urge the necessity of additional funding to New York State to prevent potentially devastating cuts.

“New York’s health care system, including physicians, shouldn’t have to face financial ruin, while working around the clock to save lives,” said Dr. Litvack. “New York has shouldered the brunt of this crisis and we desperately need fiscal attention.”

5,300 Excess Deaths in New York City May Be Tied to Pandemic, CDC Says
Officials have identified 5,293 excess deaths in New York City that may have been caused by COVID-19 but weren’t included in the official death toll, according to the CDC’s Morbidity and Mortality Weekly Report published May 11.

From March 11 to May 2, a total of 32,107 deaths were reported to the New York City Department of Health and Mental Hygiene. Of those deaths, about 24,172 were found to be in excess of the expected seasonal baseline. Of the 24,172 deaths, 57 percent (13,831) were lab-confirmed COVID-19 deaths and 21 percent (5,048) were probable COVID-19 deaths, leaving 22 percent of deaths (5,293) without an identified cause.

The 5,293 excess deaths may be directly or indirectly due to the pandemic. The deaths could include deaths among people with COVID-19 “who did not access diagnostic testing, tested falsely negative, or became infected after testing negative, died outside of a health care setting, or for whom Covid-19 was not suspected by a health care provider as a cause of death,” according to the CDC. Fear related to the virus could also prompt some to delay seeking or obtaining lifesaving care.

Other findings suggest the true number of national cases and deaths is also likely much higher than reported. (May 13 Becker’s Hospital Review)

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Mount Sinai Health System Launches Center for COVID-19 Recovery
New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease.

The Center for Post-COVID Care, opened May 13, will help patients hospitalized for COVID-19 transition from the hospital to their homes. The center is also open to patients who were never hospitalized but need help during their recovery.

At the center, patients will be offered a personalized treatment plan that will include input from several specialties, including primary care, pulmonary medicine, cardiology, infectious disease and physiatry, as well as social workers and pharmacists. The center will also focus on evaluating the long-term effects of the disease, which are largely unknown. Mount Sinai will create a COVID-19 registry and collect information on sociodemographics, behaviors, underlying conditions, mental health conditions and medications from patients with the disease.

“This center will provide a unique opportunity to follow this population and systematically evaluate the long-term impact of COVID-19,” said Dennis S. Charney, MD, president for academic affairs at Mount Sinai Health System. (Becker’s Hospital Review, 5/15)

MedPage Today: 4.91% of 763 (86% Physicians) Had/Have COVID-19
Of 763 respondents in a MedPage Today survey — 86% of whom were physicians — 4.91% reported they had or currently have COVID-19. The findings come from an ongoing MedPage Today poll conducted every 2 weeks to monitor challenges U.S. healthcare workers face during the COVID-19 pandemic. The most recent survey took place from April 29 to May 3 and was distributed by email and posted on the MedPage Today site.

COVID-19 continues to waylay healthcare workers, the latest findings revealed. Nationally, 20% of respondents said 1% to 5% of their facility’s healthcare workers were out due to COVID-19 illness or exposure. About one in ten put COVID-19 absenteeism at 6% to 10%, and 6% said the virus sidelined 11% or more of their workforce.

The survey also showed:

  • COVID-19 testing still is severely lacking, but trending toward improvement

The majority of respondents, 56%, still rated their access to COVID-19 testing as     fair or poor, representing an improvement from the 67% fair-to-poor rating of 2 weeks ago. “It is still very difficult. We still predominately test if you are being admitted or, now, if you need an elective surgery or admission to a skilled nursing facility. Outpatient is still chaos,” wrote an infectious disease specialist. “Only admitted patients get tested,” noted a cardiologist in New York City. “The hospital is not routinely testing staff workers who want testing,” another New York physician said.

  • About 70% of hospitals lack access to all COVID-19 treatments, including experimental therapies

Only 31% of respondents said their facility could access all therapies including experimental treatments; the same percentage was reported 2 weeks ago. “I cannot get remdesivir yet. Convalescent plasma limited,” one critical care physician wrote. “Stopped using hydroxychloroquine after data was suggesting harm but we had access to it when it was being given more regularly,” an infectious disease specialist noted. “Gilead drug [remdesivir] or IL-6 inhibitors” were not available, a Chicago anesthesiologist wrote, while an Atlanta critical care doctor reported access to “most treatments, including tocilizumab.” 

  • Personal protective equipment (PPE) continues to be a problem

About half (49%) of respondents said their access to PPE was fair or poor, similar to the 51% who said so 2 weeks ago. “We have PPE, but we need to save and reuse our N95 mask,” an emergency medicine doctor in Cleveland remarked. “No N95 is provided unless you can do a mask exchange to have it cleaned and reused,” a nurse practitioner in West Virginia said. “N95 masks and face shields are available only for COVID-confirmed patients,” a cardiologist in northern California noted. “Everything is locked down,” another physician stated. “In order to see a patient in consultation, you have to ask an administrator for an N95 mask. They are available, but barriers are high.”

Most respondents (86%) in this survey were doctors; 4% were nurses, 4% were nurse practitioners, and 3% were physician assistants. Nearly two-thirds (65%) currently worked in a hospital. Specialties included emergency medicine (6%), critical care/ICU (6%), anesthesiology (6%), cardiology (6%), infectious disease (3%), neurology (2%), and pulmonology (2%), among others.

About a quarter of respondents practiced in New York City (17%) or northern New Jersey (8%). Another 10% worked in Los Angeles, 6% in Chicago, 5% in Boston, 4% in Detroit, and 3% in Miami.

A limitation of this poll is that identities of respondents and their locations, license status, and individual responses were not verified independently. Click here for MedPage Today COVID-19 survey results in more detail. (Updated May 12, 2020)

WHO Official: COVID-19 May Never Be Eradicated
A top World Health Organization official said during a May 12 news briefing. “This virus may become just another endemic virus in our communities, and the virus may never go away,” said Mike Ryan, MD, executive director of WHO’s emergencies program. He said HIV has not gone away, but effective therapies and prevention measures have allowed people with HIV to live long, healthy lives. He clarified that he was not comparing the two diseases but emphasized that COVID-19 could be managed if an effective vaccine was globally distributed. (Becker’s Hospital Review, 5/14)


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COVID-19 Map – Johns Hopkins Coronavirus Resource Center



COVID-19 Update May 12, 2020


Notes from Governor Cuomo’s COVID-19 Briefing

– Hospitalizations and intubations are down
– Deaths 195 (142 in hospitals, 53 in nursing home)

Emerging Issue Among Youth:
– NYS DOH is investigating 100 cases of what may be COVID related illness
in children with symptoms similar to Kawasaki disease and toxic shock-like
– Illness has taken lives of 5 year old boy, 7 year old boy, and 18 year old
– Out of 100 cases, 5% of cases are found in those aged 1 or younger,
18% of cases are found in those aged 1-4, 29% is found in those aged 5-9,
28% in kids aged 10-14, 16% in those aged 15-19, and 4% in
those 20-21
– DOH is advising all hospitals to prioritize COVID-19 testing for children
presenting symptoms

– Heed Dr. Fauci’s warnings on risking an outbreak that cannot be controlled
– Learn from others’ mistakes (China, South Korea, Germany)
– Maintain regional management and citizen participation
–  Calibrate/control by monitoring diagnostic testing, antibody testing,
hospitalizations rate and capacity, infection rate
– – Finger Lakes, Mohawk Valley, and Southern Tier meet reopening criteria
– Status of regions will be updated daily and available to view at

Federal Assistance:
– This is time to pass a smart federal bill
– No time for handouts to corporations, political port, or partisanship
– Bill must fund state and local governments, working families, state testing
and tracing
– NY needs $61B in federal support or we will have to reduce spending
– Schools, local governments, and hospital spending will be cut by
20% each
– Federal bill must also respond to working families with:
– Landlord and renter assistance
– Payroll protection
– Funeral costs
– Repealing of SALT

– “No bailout boondoggles”

– Corporations have already forecasted next scam and will use pandemic
to enact layoffs and not rehire as many employees increasing corporate
profit and stock values on backs of American workers

Nursing Homes
– We now have more testing capacity, so nursing homes should be prioritized

– We will work with regions who do not have the testing capacity to do
two tests per week for staff

Dr. Fauci: Death Toll Higher than Reported
Dr. Anthony Fauci, the Trump administration’s top infectious disease expert, testified Tuesday that the consequence of reopening the country too early could be “really serious” if states don’t have the capability to respond to new coronavirus infections. The warning offered a stark contrast to the case made in recent weeks by President Trump, who has pushed to quickly restart the economy in spite of a mounting death toll and few signs that the months long pandemic is beginning the subside.

“My concern is that we will start to see little spikes that then turn into outbreaks,” Fauci told the Senate HELP Committee during a hearing on how to safely reopen the nation. “The consequences could be really serious.” The vast majority of states have yet to meet the most basic reopening benchmarks set out by the White House by last month, even as most move in stages toward lifting their social distancing guidelines.

That means that new outbreaks are likely as public life resumes, Fauci said, prolonging the coronavirus fight if states are not adequately prepared to respond. Already, more than 80,000 Americans have died from the disease — a figure that most public health experts agree likely undercounts the true toll. “There is no doubt even under the best of circumstances when you pull back on mitigation, you will see some cases appear,” he said.

Fauci added it’s almost certain the death toll is higher than recorded. He said that schools and businesses hoping to open their doors any time soon should not count on therapeutics or vaccines, saying that public safety hinges on the nation’s ability to regularly test Americans. “The idea of having treatments available or a vaccine to facilitate the reentry of students into the fall term would be something that would be a bit of a bridge too far,” he said. (Politico, May 11)

Please Join the NYS DOH in a COVID-19 Update Webinar

Thursday May 14th at 1-2PM for

COVID-19 update for healthcare providers.

To accommodate the large number of participants, find our webinar streaming via YouTube Live (and available for viewing immediately thereafter) on the NYSDOH COVID website for providers: 

For audio only, please dial in: 844-512-2950

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Registration Now Open Mental Health and COVID-19 for Health Professionals May 20, 2020 @ 7:30am Medical Matters CME Webinar
As health professionals, we are at great psychological risk simply by virtue of our “exposure” to the reality of COVID-19.  Registration is now open for MSSNY’s next Medical Matters webinar related to the COVID-19 pandemic, Medical Matters: Mental Health and COVID-19 for Health Professionals. Faculty for this program is Craig Katz, MD.

Registration is now open for this webinar

Educational objectives:

Better understand the mental health risks posed by COVID-19 for physicians
Review the possible range of psychological and psychiatric responses to the pandemic
Discuss principles and interventions for helping ourselves, our families, and our colleagues

To view MSSNY’s other COVID-19 related programs, be sure to go here and view Medical Matters: Coronaviruses 2020: COVID-19 An Evolving Story recorded on March 18, 2020, Medical Matters: Psychosocial Dimensions of Infectious Outbreaks recorded on April 1, 2020 and Medical Matters: COVID-19 for Office-Based Physicians: How to Handle Surge and Psychological First Aid recorded on April 29, 2020.  You can also listen to MSSNY’s podcasts related to COVID-19 by going here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

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.

NYC’s Death Toll Worse than City and State Figures
New York City’s death toll from the coronavirus may be thousands of fatalities worse than the tally kept by the city and state, according to an analysis released Monday by the U.S. Centers for Disease Control and Prevention.

Some of those excess fatalities could be COVID-19 deaths that went uncounted because a person died at home, or without medical providers realizing they were infected, the researchers at New York City Department of Health and Mental Hygiene said. It might also represent a ripple effect of the health crisis, they wrote. Public fear over contracting the virus and the enormous strain on hospitals might have led to delays in people seeking or receiving lifesaving care for unrelated conditions like heart disease or diabetes.

“Tracking excess mortality is important to understanding the contribution to the death rate from both COVID-19 disease and the lack of availability of care for non-COVID conditions,” the report said.

The report underscored the challenges authorities face in quantifying the human toll of the crisis. Deaths caused by the coronavirus are believed to be undercounted worldwide, due in large part to limits in testing and the different ways countries count the dead.

Through Sunday, New York City had recorded nearly 14,800 deaths confirmed by a lab test and another nearly 5,200 probable deaths where no test was available, but doctors are sure enough to list the virus on the death certificate. In its analysis, the report released Monday said the 5,293 excess deaths were on top of both confirmed and probable fatalities.

Between March 11 and May 2, about 24,000 more people died in the city than researchers would ordinarily expect during that time period, the report said. That is about 5,300 more deaths than were blamed on the coronavirus in official tallies during those weeks. (AP News, March 11)

NY Rolling Out Training for Virus Detectives
New York is poised to launch a training plan for the huge corps of disease detectives it plans to deploy to track people who coronavirus. The effort, seen as a key to keeping the outbreak from flaring again once it is under control, is likely to involve hiring several thousand people who have no background in public health.

Because getting huge groups of people together in one place for a contact-tracing boot camp is not possible, the training is being done through a five- to six-hour online course launching Monday. “There’s all this discussion about using technology in some way. But fundamentally, this is a pretty human activity,” said Josh Sharfstein of the Johns Hopkins Bloomberg School of Public Health, which developed the course with Bloomberg Philanthropies, the charitable foundation of former Mayor Michael Bloomberg.

When someone becomes newly infected with the virus, the tracers will be tasked with figuring out everyone who might have had contact with that person, reaching out to them and advising them how to quarantine themselves until they know for certain they aren’t sick with the virus.

In the video training, actors portray how the tracing interviews—mostly conducted by phone or video chat—are supposed to go. Sharfstein said the training, to be offered on the Coursera website, will be available to anyone, not just those seeking to become contact tracers.

Bloomberg is putting up $10.5 million through his foundation to help the state roll out its tracing plan. Gov. Andrew Cuomo has made hiring at least 30 contact tracers per 100,000 residents requirement for any region of the state to reopen. (Crain’s, May 12)

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NIH to Test Remdesivir in Combo with Eli Lilly Arthritis Drug
The National Institutes of Health announced its sponsorship of a controlled clinical trial of the investigational antiviral drug remdesivir in combination with the anti-inflammatory drug baricitinib to treat COVID-19. The trial is NIH’s second iteration of its Adaptive COVID-19 Treatment Trial, launched Feb. 21.  It tested Gilead Sciences Inc.’s antiviral drug remdesivir in treating COVID-19. Analysis of the trial revealed patients who took remdesivir experienced significantly shorter recovery periods than patients who received placebos.

“ACTT 2 will examine if adding an anti-inflammatory agent to the remdesivir regimen can provide additional benefit for patients, including improving mortality outcomes,” said Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases. The new trial will incorporate baricitinib, Eli Lilly’s anti-inflammatory drug commonly used to treat rheumatoid arthritis. Baricitinib is expected to inhibit cytokine signaling that causes lung inflammation and shortness of breath among COVID-19 patients.

Investigators will evaluate the recovery times of patients prescribed remdesivir with baricitinib versus those of patients prescribed remdesivir only. ACTT 2 is expected to enroll about 1,000 U.S. hospitalized adults with COVID-19 at 100 sites. (Becker’s Hospital Review, May 11)

COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 11, 2020


Gov. Cuomo’s Press Conference Today, May 11


– Total hospitalizations 7,226 as of yesterday

– Net intubations is down

– Lives lost 161 (112 in hospitals, 49 in nursing homes)

– New hospitalizations 488 as of yesterday


– Regions can reopen when numbers show decline in accordance with CDC guidelines

and there is testing/tracing plan in place

– Regions must meet 7 metrics

– 14 day decline in hospitalizations OR under 15 new hospitalizations

(3-day average)

– 14 day decline in hospitalized deaths OR under 5 new (3-day average)

– New hospitalizations – under 2 per1 00K residents (3 day rolling average)

– Share of total beds available (threshold of 30%)

– Share of ICU beds available (threshold of 30%)

– 30 per 1k residents tested monthly (7-day average of new tests per day)

– 30 contact tracers per 100k residents or to meet current infection rate

– Southern tier, Mohawk Valley, and Finger Lakes Regions meet metrics for reopening

Phased Reopening of Businesses:

– Businesses will reopen on a risk vs. reward basis

– Businesses will have to consider:

– Adjusted workplace hours and shift design

– Social distancing

– Non-essential travel restrictions

– Wearing masks if in frequent contact with others

– Strict cleaning and sanitation standards

– Continuous health screenings

– Continuous tracing, tracking, and reporting

– Liability for maintaining processes 

Local Officials:

– Testing – tracing in place

– Monitor infection rate with hospitals

– Communicate with other local governments

– Regional Control room of healthcare professionals and other necessary

personnel to monitor the situation across regions 

Regional Control Rooms:

– Announcing members of regional control rooms to monitor regional metrics today

Looking Back:

– Virus attacked us from Europe in January and February and no one knew

– Projected hospitalizations were 120K

Please join the NYS Department of Health at a COVID-19 Update
Thursday May 14th at 1-2PM for a COVID-19 update for healthcare providers.
To accommodate the large number of participants,
find our webinar streaming via YouTube Live
(and available for viewing immediately thereafter)
on the NYSDOH COVID website for providers.
For audio only, please dial in: 844-512-2950

FDA Approves First Coronavirus Diagnostic Test That Uses CRISPR Technology
The Food and Drug Administration on Thursday authorized the first test to detect the coronavirus using CRISPR technology.

The test, manufactured by genetic engineering company Sherlock Biosciences, provides results in approximately one hour. The test kit works by programming a CRISPR molecule to detect the presence of a genetic signature specific to SARS-CoV-2 in a nasal swab, nasopharyngeal swab, oropharyngeal swab, or broncho-alveolar lavage (BAL) specimen. When the signature is found, the CRISPR enzyme releases a detectable signal. The test is designed for use in high-volume CLIA laboratories and hospitals.

Sherlock is working to rapidly scale the production of the test kit and said it will share plans for distribution and availability in the coming weeks.

“While it has only been a little over a year since the launch of Sherlock Biosciences, today we have made history with the very first FDA-authorized use of CRISPR technology, which will be used to rapidly identify the virus that causes COVID-19,” Sherlock Bio Cofounder, President, and CEO Rahul Dhanda said in a statement. “We are committed to providing this initial wave of testing kits to physicians, laboratory experts, and researchers worldwide to enable them to assist frontline workers leading the charge against this pandemic.”

The company said it is also developing an instrument-free, handheld test that would provide rapid detection of the SARS-CoV-2 virus in a format like an at-home pregnancy test. May 8 Modern Healthcare

This story first appeared in our sister publication, Genomeweb.

Map Shows Communities Vulnerable to Severe Cases of COVID-19
An interactive map created by Experian shows which populations are most at-risk of developing severe cases of COVID-19.The map uses data on the community’s health, such as rates of pre-existing conditions like chronic lung disease or severe asthma, demographic information and social factors like population density and use of public transit to determine a community’s risk.

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Estimated Volume Losses for 30 Service Lines
Across all service lines, COVID-19 pushed the number of unique patients who sought hospital care down by an average of 54.5 percent, according to a year-over-year analysis from Strata Decision Technology.

For the analysis, data scientists examined more than 2 million patient visits and procedures from 51 healthcare delivery systems in 40 states. The 228 hospitals represented in the study had varying rates of COVID-19 cases.

Here are the estimated volume losses for 30 service lines for a two-week period in late March-April 2020 compared to the same period a year prior:

Ophthalmology: 81 percent
Spine: 76 percent
Gynecology: 75 percent
Orthopedics: 74 percent
Ear, nose and throat: 72 percent
Endocrine: 68 percent
Dermatology: 67 percent
Gastroenterology: 67 percent
Rheumatology: 66 percent
Neurosciences: 66 percent
General medicine: 64 percent
Urology: 62 percent
Genetics: 60 percent
Vascular: 59 percent
Hepatology: 58 percent
Cardiology: 57 percent
Pulmonology: 56 percent
Breast health: 55 percent
General surgery: 54 percent
Nephrology: 52 percent
Hematology: 49 percent
Allergy and immunology: 48 percent
Behavioral health: 45 percent
Burns and wounds: 44 percent
Cancer: 37 percent
Obstetrics: 30 percent
Infectious disease: 23 percent
Neonatology: 20 percent
Not assigned: 4 percent
Normal newborn: 2 percent
View the full report here. (May 11)

Physicians Rethinking Use of Ventilators for Some COVID-19 Patients
Some COVID-19 patients come to the hospital with low blood oxygen levels — levels that should have them gasping for air — but instead, these patients are awake and talking, resulting in some physicians rethinking the use of ventilators for them, according to The Wall Street Journal.

It is unclear why certain COVID-19 patients are unaffected by low blood oxygen levels and able to tolerate them, but some physicians are now holding off invasive mechanical ventilation for these patients.

Initially during the pandemic, physicians would rush to intubate these patients sooner, afraid of their sudden and swift deterioration. But recently, physicians at Stony Brook (N.Y.) Hospital and Ochsner Medical Center-West Bank Campus in Gretna, La., have put these patients on ventilators less often and are instead using other machines, such as CPAP machines, BiPAP machines or high-flow nasal cannulas.

Scott Weingart, MD, chief of emergency critical care in the department of emergency medicine at Stony Brook Hospital told the Journal about a 42-year-old COVID-19 patient with dangerously low blood oxygen levels, who was able to sit up and talk. Dr. Weingart and his team used a high-flow nasal cannula to increase the patient’s blood oxygen levels and placed the patient on his stomach, called “prone positioning,” which can boost oxygen levels. The patient was discharged without being placed on a ventilator.

The hospitals eschewing the use of ventilators in favor of CPAP and BiPAP machines are also careful to use filters on the masks and keep patients in specially ventilated rooms since these devices could release the virus into the air, they told the Journal.

Ventilators have played a key role in COVID-19 patient care during the pandemic, and as a result, demand for the machines soared. But their use comes with several risks. Studies have shown that many COVID-19 patients placed on ventilators die. A recent study published in the Journal of the American Medical Association showed that of 320 New York state patients who received invasive mechanical ventilation, 88.1 percent died. (Becker’s Hospital Review, May 11)

Northwell Health Surpasses 10,200 COVID-19 Patient Discharges
Northwell Health has discharged 10,210 COVID-19 patients as of May 11, surpassing the threshold of 10,000 patient discharges, the health system told Becker’s Hospital Review.

The state’s largest health system said the milestone comes more than two months after its hospitals saw the first COVID-19 cases and more than 30 days after Northwell experienced the surge’s peak.

“Based on the data we’ve seen, Northwell has treated more COVID-19 patients than any other health system in the nation,” Northwell President and CEO Michael Dowling said in a news release. “Our success is a reflection of the selfless work of both front-line staff and behind-the-scenes innovation that has enabled us to respond to an unprecedented influx of patients.”

Northwell said it has treated more than 41,000 COVID-19 patients since the beginning of the pandemic. This included about 13,000 hospitalized patients on Long Island, in New York City and Westchester County, as well as those seen in emergency departments, urgent care centers and physician offices. (Becker’s Hospital Review, May 11)


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COVID-19 Map – Johns Hopkins Coronavirus Resource Center

COVID-19 Update May 7, 2020

Do You Have a Story To Tell or a Photo To Share With Your MSSNY Colleagues? Send to or Call 516-488-6100 Ext. 355!

COVID-19 Map – Johns Hopkins Coronavirus Resource Center

Gov. Cuomo’s Press Conference Thursday, May 7

– Total hospitalizations down to ~8,600. Net change also down.
– Intubations are down.
– Number of new cases relatively flat (607). Gov says this has been a slow
– Deaths since May 6: 231; 191 in hospitals; 40 in nursing homes.
– Top priority is protecting essential workers. Gov honors their courage and
efforts to take care of society.

– Have been “aggressively” testing essential workers: 25 downstate healthcare
facilities, over 27k employees.
– Found 12% of NYC healthcare workers tested positive (slightly lower
than general population, 19.9%).
– Shows that masks, gloves, and sanitizer have worked.

– Gov said many farms have been particularly impacted by COVID-19, facing waste
and financial loss.
– Launched $25 million Nourish NY Initiative (funds 50 food banks). Wants to
continue this, urged philanthropies/foundations to help.
– Contact
– 20,000 households will receive Nourish NY products within the next week.

– Need to prioritize public health over the economy. No doubts that we will
reopen, Gov just wants to do so safely.
– Gov says leaders making decisions should be willing to participate in
anything they authorize.
– Reiterated that decisions must be made based on facts and data.


– PAUSE to expire May 15, then will look at different regions to see where to
begin reopening. Economy will be starting at this point.
– Gov wants to ensure the most vulnerable and financially needy are protected.
He attributed moratorium on evictions, funding food banks, and more as relief
efforts. Hopes extension of moratorium can ease the anxieties of many.
– Gov is working on relief from the banks for landlords, as well as relief for
banks themselves. However, the state’s priority is protecting families from being evicted.
-Have overflow facilities across the state to take nursing home residents
that cannot be cared for.

Is Your Practice in Need of PPE? MSSNY Can Help!
Are you facing challenges obtaining needed PPE for your practice?

If you are a MSSNY member, please let us know if you would like MSSNY’s assistance in obtaining protective equipment, including N95 and KN95 masks.  MSSNY is working with vendors and the New York State Health Department to help physicians meet their PPE needs so that they can get back to treating patients.

Please be aware that some businesses promoting PPE availability have not been properly vetted, have provided substandard products and in some cases have not delivered on the ordered products.  Please contact / / if you are a member and require MSSNY’s assistance.

New MSSNY Officers and Councilors Elected May 7, 2020
The Nominating Committee held a meeting on Thursday, January 30, 2020.  After careful consideration of the recommendations submitted by the district branches, county medical societies, the medical student, resident & fellow and young physicians sections, your Committee respectfully submits the following candidates for election on April 25 and 26:

Officers (Each for term of 2020-2021)

President                Bonnie L. Litvack, MD, Westchester
President-Elect        Joseph R. Sellers, MD, Schoharie
Vice-President         Parag H. Mehta, MD, Kings
Secretary                Frank G. Dowling, MD, Suffolk
Assistant Secretary Joshua M. Cohen, MD, New York
Treasurer                Mark J. Adams, MD, Monroe
Assistant Treasurer Howard H. Huang, MD, Jefferson
Speaker                  William R. Latreille, MD, FACP, AME, Franklin
Vice-Speaker          Maria A. Basile, MD, Suffolk

Councilors (Four for term 2020-2023)

First District            Adolph Meyer, MD, Kings
First District            David Jakubowicz, MD, Bronx
Fifth District            Barry Rabin, MD, Onondaga
Seventh District       Janine Fogarty, MD, Monroe

Councilor (One for unexpired term of Edward Bartels to 2021)

Eighth District          Mark Jajkowski, MD, Erie

Resident and Fellow Section Councilor (One-year term 2020-2021) – Raymond Lorenzoni, MD

Medical Student Section Councilor (One-year term 2020-2021) – Shireen Saxena, Monroe

Officers, Councilors and Trustees

Trustees (One Five-Year Term 2020-2025) – Thomas J. Madejski, MD, Orleans

Coronavirus Fear Prompting Avoidance of Healthcare, Poll Finds
Around 29 percent of U.S. adults said they have delayed or avoided seeking medical care due to concerns about contracting COVID-19, a new poll shows.

The poll, conducted by market research firm Morning Consult on behalf of the American College of Emergency Physicians between April 18 and April 20, surveyed a national sample of 2,201 U.S. adults.

Four survey findings:

  1. Sixty-three percent of respondents said they are “very” or at least “somewhat” concerned about wait times at healthcare facilities, and 59 percent expressed concern about receiving adequate care.
  2. Fifty-four percent of adults between 18 and 39 years of age said they have actively delayed or avoided seeking care due to COVID-19 concerns, compared to 59 percent of adults, ages 40 to 74 years.
  3. Around 80 percent of respondents said they are concerned about contracting COVID-19 from another patient or visitor if they need to go to an emergency room.
  4. Most respondents (73 percent) are concerned about overstressing the health care system when considering a trip to the emergency department. (Becker’s Hospital Review, Ap 29)

Look Out for COVID-19 Scams Directed at Physicians
Unfortunately, scammers are using the COVID-19 pandemic to try to steal your Medicare Number, personal information, and money. And they are using robocalls, social media posts, and emails to do it.

Remember, if anyone reaches out to get your Medicare Number or personal information in exchange for something, you can bet it is a scam.

·  Be on the lookout, so you can stop scams before they happen. Here are recent Coronavirus scams to watch for:

·  Robocalls offering you respiratory masks they will never send

·  Social media posts fraudulently seeking donations for non-existent charities, or claiming to give you stimulus funds if you enter your bank account information

·  Fake testing kits, cures, “immunity” pills, and offers for protective equipment

Remember this:

·  Medicare will never contact you for your Medicare Number or other personal information unless you have given them permission in advance.

·  Medicare will never call you to sell you anything.

·  Visit for more information and tips on preventing Medicare scams and fraud.

Hackers Targeting Healthcare to Steal COVID-19 Info, U.S., U.K. Warn
Sophisticated hackers are targeting healthcare and medical research organizations to gain information about the novel coronavirus, according to U.S. and U.K. cybersecurity agencies.

The Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency and the U.K.’s National Cyber Security Centre in a joint alert issued Tuesday said they have found evidence that “(advanced persistent threat) actors are actively targeting organizations involved in both national and international COVID-19 responses.”

APT groups typically comprise hackers backed by a nation state. The CISA and the NCSC did not say whether the attacks they have identified were linked with specific countries.

Hospitals have already seen an uptick in cyber attacks trying to take advantage of the COVID-19 outbreak to spread malware. But the attacks warned of by the U.S. and U.K. cybersecurity agencies this week differ in that APT groups are frequently looking to steal intellectual property or sensitive data related to COVID-19 research.

Hackers affiliated with APT groups have looked to exploit healthcare organizations’ weak password practices, according to the agencies.

The CISA and the NCSC are investigating “large-scale password spraying campaigns” that have targeted healthcare entities in the U.S. and the U.K., as well as international healthcare organizations. In a password spraying campaign, a hacker will try to enter different commonly used passwords into many accounts to try to break into them.

“These attacks are successful because, for any given large set of users, there will likely be some with common passwords,” the alert reads.

Hackers have also been taking advantage of the shift to remote work by searching out vulnerabilities in virtual private network, better known as VPN, products.

The CISA and the NCSC warned that they are investigating multiple attacks against organizations involved in COVID-19 research, including against pharmaceutical companies, medical research organizations and universities. Those attacks may have been perpetrated to “steal sensitive research data and intellectual property for commercial and state benefit,” the agencies said.

To protect against cyberthreats, the CISA and the NCSC recommended organizations implement multi-factor authentication, update VPNs and set up security monitoring capabilities, among other mitigation tactics. (Modern Healthcare, May 6)

Q & A: What About Mild or Asymptomatic Cases of COVID-19?
Asymptomatic transmission has not only been confirmed in China, but recent modeling data found that mild or asymptomatic cases that went undetected (“undocumented”) accounted for 85% of total infections in the earliest stages of the outbreak. The study found these cases were less infectious on a per-contact basis, but because those individuals were not isolated, they infected more people in total.

The big unknown, however, is how common it may be for people to become infected but with symptoms too mild to seek treatment. Currently, detection is based on molecular testing, which is performed only on individuals who come into contact with the healthcare system. The prevalence of such mild or asymptomatic infections will not be known until an inexpensive serological test, detecting antibodies to the virus that signal previous exposure, is available for use with routine blood draws. Thus, the extent of exposure in the population may not be known for years.

How do you contract COVID-19?

Research points to droplet and fomite transmission, with recent data suggesting the virus can survive on surfaces such as plastic and stainless steel for up to several days. It can also survive in the air for a few hours, indicating it may also potentially be aerosol transmissible.

The virus may also be transmitted through the fecal-oral route, with research suggesting some patients develop gastrointestinal symptoms, and that the virus is shed through stool.

A small cohort study in China found the virus present in two patients’ tears, indicating it might be transmissible through eye secretions.

How infectious is the COVID-19 coronavirus?

Research from China found a similar viral load in symptomatic and asymptomatic patients, which may suggest patients can transmit the virus whether they have mild or severe disease.

Latest data from the World Health Organization estimated the “R0” as 2.0 to 2.5, meaning infected individuals transmit it to 2-2.5 others on average. By contrast, the R0 for measles is 12-18, while for seasonal influenza it is a little over 1.

How virulent is COVID-19?

According to JAMA, global mortality for COVID-19 is reported to be 4.7%, and about 1.7% of patients died in the first 141,000 cases in the U.S., though the authors emphasized this was not an accurate case-fatality rate due to the uncertain denominator.

CDC examined the first 4,200 U.S. cases, and found 508 (12%) of patients were hospitalized, and of those, 121 were known to be admitted to an intensive care unit, and 44 patients died. Similar to China, both hospitalization and mortality rates increased with increasing age, though this data indicated 20% of hospitalized patients and 12% of patients admitted to an ICU were ages 20-44. Nine patients ages 20-44 died, though in the entire group most deaths were among adults ages 65 and older.

Notably, however, mortality rates vary dramatically from one country to another, raising more questions about case-finding and record-keeping than there are answers.

What are the early symptoms of COVID-19?

In addition to fever, cough and shortness of breath, CDC now lists several other symptoms: chills, repeated shaking with chills, new loss of taste or smell, muscle aches, headache and sore throat.

Examining data from patients admitted in New York City, prior to respiratory symptoms, including about three-quarters presented with cough or fever, and almost 60% with shortness of breath. Gastrointestinal symptoms seem to be more common in U.S. patients, with about a quarter reporting diarrhea and 20% reporting vomiting.

It appears not all patients present with symptoms, with research out of Germany in February finding patients testing positive for COVID-19 despite being afebrile and otherwise normal-seeming.

How is COVID-19 diagnosed?

A patient is swabbed, then the sample is tested via reverse transcription polymerase chain reaction (RT-PCR) to determine presence of viral RNA.

The FDA recently authorized the first serology test to detect IgM and IgG antibodies under Emergency Use Authorization, for diagnosing COVID-19 infection in combination with other clinical and lab data.

What are the risk factors for more severe disease?

Reports from China indicate disease is much more severe in older patients, with the highest mortality rate among adults age 80 and older. Patients with other comorbidities are also the most at risk, with U.S. data finding hypertension and obesity were the most common chronic medical conditions among patients hospitalized with COVID-19, followed by chronic lung conditions, diabetes and cardiovascular disease.

Data out of New York City found obesity as a risk factor for mechanical ventilation. Patients requiring mechanical ventilation were also more likely to need vasopressors, and experienced other complications such as atrial arrhythmias and new renal replacement therapy.

What does severe disease look like?

JAMA detailed 21 patients from Washington state, 15 of whom needed mechanical ventilation. All 15 had acute respiratory distress syndrome, and eight developed severe ARDS by 72 hours. Vasopressors were used for 14 patients, though most patients did not present with evidence of shock, and seven patients developed cardiomyopathy. Mortality among this group was 67%, 24% remained critically ill and 9.5% were discharged from the ICU, as of March 17.

In New York City, a third of patients required intubation, and of these, 30% did not get supplemental oxygen, meaning they deteriorated quickly.

However, U.K. research indicated a lower proportion of COVID-19 patients in the critical care unit survived compared to patients with non-COVID-19 viral pneumonia (52.1% vs 77.8%, respectively).

How is the disease treated?

Treatment mainly consists of supportive care, according to CDC recommendations. The most common complications of severe disease include pneumonia, hypoxemic respiratory failure/ARDS, shock, multiorgan failure. Since pneumonia is common, IV antibiotic use has been widely reported, along with supplemental oxygen, with anecdotal reports of proning and ultimately, mechanical ventilation, including some patients who receive extra corporeal membrane oxygenation (ECMO).

Although corticosteroids were widely used in China, the CDC generally recommends against them except in patients with steroid-responsive comorbidities such as septic shock. “[P]atients with MERS-CoV or influenza who were given corticosteroids were more likely to have prolonged viral replication, receive mechanical ventilation, and have higher mortality,” whereas reports from China in COVID-19 were uncontrolled and observational, the CDC explained. Research indicates patients hospitalized with COVID-19 often develop blood clots, leading some international societies to call for patients to receive prophylactic anticoagulant treatment to prevent this complication.

What are the potential therapeutic options for treating the virus?

There are currently no approved therapies to treat COVID-19. The NIH released treatment guidelines, which noted both insufficient clinical data to recommend for or against use of both remedisivir and hydroxychloroquine and chloroquine. Specifically, the agency noted monitoring patients who receive HCQ for adverse effects, especially prolonged QTc interval. The FDA recently issued a warning about the heart risks of the drug. NIH also said there is insufficient clinical data to recommend use of convalescent plasma or hyperimmune globulin, as well as interleukin-6 inhibitors and interleukin-1 inhibitors. The agency recommended against the use of hydroxychloroquine plus azithromycin, lopinavir/ritonavir (Kaletra) or other HIV protease inhibitors, interferons and Janus kinase inhibitors.

What is the status of clinical trials for these potential therapies?

Remdesivir has been available for compassionate use. An interim analysis of a formal trial from the National Institute of Allergy and Infectious Diseases including data from U.S. patients found remdesivir met its primary endpoint in severe COVID-19 patients, significantly faster time to recovery versus controls, and trended towards a survival benefit. Manufacturer Gilead Sciences also reported topline results from a phase III trial comparing two dosing regimens in severe cases, but without a usual-care control group, showing a trend favoring a 5- versus 10-day treatment period.

Many hospitals have begun to use hydroxychloroquine or chloroquine, which is most commonly used to treat patients with malaria, as well as arthritis and systemic lupus erythematosus, although the supporting evidence is anecdotal at best. The FDA has issued an Emergency Use Authorization for hydroxychloroquine held in the National Strategic Stockpile, although that does not make COVID-19 an approved indication. Latest data from the U.S. found no difference in risk of ventilation the drug in male veterans with severe COVID-19.

A small case series in China found three of five patients treated with convalescent plasma were later discharged from the hospital, though questions about scaling this as a potential therapy remain. Some centers have also tried anti-cytokine agents such as tocilizumab (Actemra) but evidence of benefit over standard treatment remains scant. Controlled trials with tocilizumab are now underway, including one sponsored by drugmaker Genentech/Roche.

Sanofi and Regeneron announced a phase II/III trial for sarilumab (Kevzara), another anti-interleukin-6 agent, for patients with severe COVID-19.The Milken Institute has collated currently ongoing trials for COVID-19 interventions on its website.

What are the vaccine prospects?

Several companies and public health agencies have vaccines in development, including the National Institute of Allergy and Infectious Diseases. Phase I trials with vaccines are underway, with a timeline of 12-18 months for a vaccine to be ready for wide-scale deployment.

As of April 21, the Milken Institute counted 115 vaccine candidates in development, including six in phase I and five in phase I-II safety and efficacy studies in humans.

What is the prognosis for patients with COVID-19?

Older patients and those with other comorbidities are the most at risk, whereas the disease appears to be less severe among younger patients. U.S. data seems to indicate fewer children contract severe disease than adults, and hospitalization in this population is most common among infants and children with underlying conditions.

Research is starting to come from China that COVID-19 vertical transmission from mother to baby is possible, given several isolated case reports.

What are some potential complications of COVID-19?

Data from New York City indicated ST-segment elevation on the EKG was complex, and confirmed COVID-19 cases were complicated by ST-segment elevation, which could have indicated potential acute MI.

Neurologic complications have been reported, with limited case reports from Italy linking COVID-19 infection to Guillain-Barré syndrome. And in China, more than a third of confirmed COVID-19 cases had neurologic symptoms, such as acute cerebrovascular events, impaired consciousness and muscle injury, which were more common among patients who required mechanical ventilation.

What are the long-term sequelae of COVID-19?

It is unclear whether or how often COVID-19 survivors will experience persistent pulmonary or other problems, or for how long. Many patients have remained hospitalized with the illness for weeks outside of China, out of an abundance of caution and for public health reasons.

Researchers from China pointed to cardiovascular system abnormalities in nearly half of a small group of SARS patients in a 12-year follow-up cohort, as well as about two-thirds with high lipids and 60% with glucose metabolism problems. They suggested COVID-19 may also cause chronic damage to the cardiovascular system, as the virus has a similar structure to SARS. Last Updated May 07, 2020.

COVID-19 Info and Advice for All Physicians
COVID-19 presents new challenges for everyone. However, healthcare professionals are facing unique personal and professional challenges within the context of this rapidly shifting landscape.

Individuals may find themselves managing multiple new challenges at once. Some medical professions, such as anesthesiology, emergency medicine, or intensive care, incur greater risks for contamination as they perform intubation procedures on hospitalized COVID-19 patients.

Healthcare clinicians wearing full-body PPE in the hospital are faced with physical barriers to self-care during shifts: eating, drinking, and lavatory visits may be delayed or eliminated, leading to depletion in personal reserves.

Craig Spencer, MD, MPH, director of Global Health in Emergency Medicine and an ER physician at New York-Presbyterian/Columbia University Medical Center in New York City, is on the front lines of managing the COVID-19 patient surge. In a Washington Post op-ed and a Twitter thread, he wrote about his daily experience of navigating the compounding stressors of the patient surge; managing patient life support with limited ventilators; being unable to attend to personal needs during long shifts; and, to protect his family, vigilant decontamination before leaving work and again once he arrives home. Other healthcare clinicians report quarantining themselves in sections of the home to limit the risks of contaminating family members.

These new and daunting circumstances require careful attention to self-care, stress management, and wellness practices to best ensure continued health and performance in a time of great need.

COVID-19 Strategies for Coping and Wellness

1. Take stock. As routines drastically change, health choices may falter. Ask yourself how you are doing in regard to daily health behaviors: the quantity and quality of sleep, exercise, nutrition, and hydration.

2. Stabilize yourself with good health behaviors. After taking stock, choose one area for improvement and set a goal. Examples of concrete goals are maybe 30 minutes of daily exercise, limiting evening screen time in the hours before bed, and eating three servings of vegetables daily.

COVID-19 brings a high degree of uncertainty, and feelings of loss of control are common. Setting a self-care goal can help keep you grounded and focused on things you can control. Good self-care will ensure that your immune system is best supported and able to fight illness. Remember too that when you are well cared for yourself, you can be of best service to others.

3. Observe your stress level. Stress manifests mentally, emotionally, and physically. Observe the tension level in your muscles, the frequency and intensity of any difficult emotions, and potential physical effects such as headaches, upset stomach, or difficulty sleeping.

4. Identify your emotions. Anxiety, sadness, fear, anger, and frustration may all be common. Acknowledge these emotions as they arise. Often, they are temporary and observing them without judgment can allow them to dissipate quicker.

5. Employ stress reduction techniques. Stress activates the sympathetic nervous system and keeps you in a state of “high alert.” Even low-grade prolonged stress can have negative impacts on sleep, mood, blood pressure, cortisol — all of which reduce your tolerance to future stressors. Ongoing stress can also promote unhelpful choices, like using alcohol for stress relief, and further deplete sleep, mood, and energy. In this time of COVID-19, stress mitigation is key, and calming your nervous system is medicinal.

If you have a favorite stress reduction tool, ask yourself if you are using it frequently enough. If you do not have a favorite stress reduction tool, these are some good options to try:

·       Shine: Calm Anxiety & Stress offers a special toolkit for COVID-19 anxiety, with a free app that offers guided relaxation and meditations, daily motivational messages, and an “ask an expert” section

·       Headspace is a stress, meditation, relaxation, and sleep app, free with NPI provider number

·       The UCLA Mindful: Meditations for Well-Being app includes recorded mindfulness meditations of varying lengths and a weekly podcast

·       The Society for Health Psychology, a division of the American Psychological Association, offers a wide range of recommended wellness tools, including a sleep app and resources to address trauma

·       Calm Your Nervous System is a free, stream able, 20-minute guided relaxation audio file. Using headphones or earbuds allows background binaural technology to deepen your relaxation response

Use your favorite tool daily or as needed throughout the day to de-stress, interrupt any unhelpful thought patterns, and as a general wellness practice.

6. Have compassion for yourself and others. Recognize that everyone is doing their best in this time of crisis, including yourself. Remind yourself that everyone is navigating unchartered territory without a playbook. Anchor yourself and avoid reacting to the emotional instability of others. Use any of the calming tools listed above or another you may love.

7. Stay socially connected. Social connection is certainly different with “physical distancing” — and it may be more important than ever. Reach out to others by phone, email, text, or various social media platforms. Check in with older adults, anyone you know to be socially isolated, and daily friends and colleagues that you do not have contact with now due to quarantine or shelter-in-place orders.

8. Find personal space in isolation. Paradoxically, physical distancing is forcing people and families in close proximity for extended periods of time. During a stable time of emotional neutrality, discuss individual needs for personal space and develop a plan.

9. Set a timer and limit your access to the news. Reports of mounting disease and death counts can be distressing and anxiety-provoking. The volatility of the stock market and loss of investment and retirement income may represent a personal threat to security and trigger anxiety or despair. While staying informed is important, limiting news and screen time can support stress management and mental health. If you find yourself constantly scanning the news, consider containing your news-checking to twice daily and for a defined and brief period.

10. Gratitude and positivity. Daily, find a positive story in the news that illustrates resilience and positivity amidst challenge. Allow yourself to reflect on one personal gratitude each day.

Resources and Guidelines by Specialty

Below, the MedPage Today staff has compiled a list of COVID-19 resources for physicians and other healthcare professionals. We will be updating this list frequently to ensure it remains a collection of the latest guidelines, resources, and best practices in dealing with COVID-19 both personally and professionally. You can track the U.S. COVID-19 outbreak on a real time dashboard, by state and by county.

American Society of Anesthesiologists library

American College of Cardiology – ACC’s COVID-19 Hub
ASNC/SNMM – Guidance and Best Practices for Nuclear Cardiology Laboratories
European Society of Cardiology – COVID-19 and Cardiology
American Heart Association- COVID-19 Resources
Society for Cardiovascular Angiography and Interventions – Considerations for the Cath Lab Considerations for Cardiac Catheterization Laboratory Procedures During the COVID-19 Pandemic

American Academy of Dermatology

Emergency Medicine
American College of Emergency Physicians
American Academy of Emergency Medicine
American College of Surgeons – How to Set Up a Regional Medical Operations Center to Manage the COVID-19 Pandemic

American Association of Clinical Endocrinologists – AACE Position Statement: Coronavirus (COVID-19) and People with Diabetes – The American Association of Clinical Endocrinologists’ (AACE) guidance on helping people with diabetes prepare for and prevent the spread of COVID-19. Some precautions for this high-risk population include staying home as much as possible, washing hands regularly, and stocking up on prescriptions. The guidance also advises people with diabetes to check with each individual states’ department of health website to see if he or she is able to purchase an additional 30-day supply of insulin or other diabetes medication.

American Academy of Otolaryngology-Head and Neck Surgery

AMA Journal of Ethics – COVID-19 Ethics Resource Center

American Gastroenterological Association
American College of Gastroenterology
SAGES (gastroenterology surgeons)

Understanding and Addressing Sources of Anxiety Among Health Care Professionals During the COVID-19 Pandemic
American Medical Association – Guide to telemedicine
American Medical Association – CMS payment policies and flexibilities

CDC – COVID-19 Guidance for Older Adults
American Geriatrics Society – information hub and article in Journal of the American Geriatrics Society

Health Policy
CDC – Evaluating and Testing For COVID-19
CDC – Healthcare Infection Control Guidance
CDC – Guidance for Emergency Medical Care Services
CDC – Healthcare Personnel with Potential Exposure Guidance
CDC – Inpatient Obstetric Care Guidance
AMA – COVID-19 Resource Center for Physicians – Includes a physician’s guide to COVID-19 along with information from JAMA and other resources.
AMA – COVID-19 FAQ – Addresses what to tell patients, how to manage PPE, and other practice issues.
National Institutes of Health – Coronavirus (COVID-19)
CDC – Clinician Outreach and Community Activity Call CDC: Contact Tracing Not Needed for HCPs Exposed to COVID-19

American Association for the Study of Liver Diseases

Infectious Disease
Infectious Diseases Society of America
American Society of Microbiology – Novel Coronavirus (COVID-19) resources
The Lancet – COVID-19 Resource Center
New England Journal of Medicine – Coronavirus (COVID-19)

National Kidney Foundation regarding dialysis
American Society of Nephrology regarding dialysis and hospitalized patients with kidney failure

American Academy of Neurology- COVID-19 resources
National MS Society – Disease-Modifying Treatment Guidelines for COVID-19 – Recommendations of the National MS Society’s National Medical Advisory Committee
American Headache Society – Headache Clinic Workflows During the COVID-19 Pandemic – Telemedicine and precaution to treat patients
Movement Disorders Society – MDS Statement, References, and Resources for the COVID-19 Pandemic
American Epilepsy Society – COVID-19 Resources for Epilepsy Clinicians – Patient management, medications, and more

American Association of Critical-Care Nurses – Resources
American Association of Critical-Care Nurses – Online course on pulmonary, ARDS, and ventilator resources
American Nursing Association
Oncology Nursing Society – Interim Guidance During the COVID-19 Pandemic

American College for Obstetricians and Gynecologists: COVID-19 Guidelines
CDC – Considerations for Inpatient Obstetric Healthcare Settings
Society for Maternal-Fetal Medicine

American Academy of Ophthalmology – Important Coronavirus Updates for Ophthalmologists

MedPage Today – COVID-19 Poses Special Challenges to Cancer Care – While having an unprecedented impact on all aspects of the nation’s healthcare system, the COVID-19 pandemic created unique circumstances and challenges for cancer care, according to authors of a review from the early U.S. epicenter in metropolitan Seattle. ASCO – ASCO recommendations
Oncology Nursing Society – COVID-19 Resource Page – Links for providers and patients, Nat’l Comprehensive Cancer Network – COVID-19 Resource Page – Links for providers of cancer care:
American Cancer Society Answers to Common Questions – Oriented toward patients, caregivers

College of American Pathologists
American Society of Clinical Pathologists

Pain Management
ASIPP – Statement from ASIPP on COVID-19
American Association of Pain Management – Managing Pain and Related Symptoms during Coronavirus
ASRA – Recommendations on Chronic Pain Practice during the Pandemic
DEA – Coronavirus Guidance

American Academy of Pediatrics – Management of Infants Born to Mothers with Suspected or Confirmed COVID-19

Primary Care
American Academy of Family Physicians
American College of Physicians

Psychiatry and Psychology
American Psychiatric Association: COVID-19 mental health impacts
Interagency Standing Committee: mental health and psychosocial aspects of COVID-19
The Lancet: The psychological impact of quarantine and how to reduce it
CDC: Mental Health and Coping During COVID-19

Public Health
CDC – Manage Anxiety & Stress

Pulmonology/Critical Care
Society for Critical Care Medicine
American Thoracic Society

American College of Radiology (ACR) on nuclear-med ventilation scans
ACR on CT scans
Society for Interventional Radiologists

American College of Rheumatology – COVID-19 Resources

American Academy of Sleep Medicine – COVID-19: FAQs for Sleep Medicine

American College of Surgeons (ACS) general information and directory
ACS: elective case triage
ACS: review committees for triage decision-making
SAGES (gastrointestinal surgeons)
American Association of Neurological Surgeons


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COVID-19 Update May 6, 2020


It was the best of times.
It was the worst of times.
And then came Coronavirus.

The year began great. My issue as an OB-GYN is Maternal Mortality. Not long after my inauguration, the legislature passed the law enabling Confidential Maternal Mortality Reviews. I should have quit then.

The rest of year, I sallied forth on such issues as Vaping, Medicaid Redesign (Part Deux), the NY Health Act, the Budget with its OPMC expansion, and, of all things, Measles and Vaccinations.

Nothing, however, prepared me for the Coronavirus Pandemic. Clearly, no one was prepared for the virus which has decimated NY State, both physically and emotionally. My family too suffered a terrible loss. We will all be picking up the pieces for quite some time.

A year goes by very quickly, indeed. Some goals I could not achieve.  I fancied myself a resource for physicians in need. Yet, when PPE supplies ran out, I was sadly unable to assist those doctors who called for help. I tried to break down silos. I might have made a few dents, but my successors will have to finish that job. I just ran out of time.

Dr. Bonnie Litvack, Madame President, now you have the gavel. I know for a fact that our Medical Society of the State of New York is in capable hands. Know that you will always have my support.

So, to my colleagues and to all the MSSNY staff, thank you so very much for all your help.

NY is blessed with so many wonderful physicians, many of whom I am fortunate to call friends.

It has been a privilege.

I leave you now with the inimitable Roy Rogers and Dale Evans

Art Fougner, MD
MSSNY President


Tomorrow @ 1 P.M. DOH COVID-19 Update
Please join the NYS Department of Health Thursday, May 7th at 1:00 PM – 2:00 PM for a COVID-19 update for healthcare providers.

To accommodate the large number of participants, our webinar will be streaming via YouTube Live:

For audio only, please dial in: 844-512-2950

COVID-19 Map – Johns Hopkins Coronavirus Resource Center

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MSSNY Press Release

 Thanks Rep. Carolyn Maloney for Leadership on Legislation to Provide Loan Forgiveness to Frontline Medical Professionals

May 6, 2020, Westbury, NY—MSSNY applauds Representative Carolyn Maloney (D- Manhattan) for introducing legislation (H.R. 6720) that would forgive private, and federal, student loans taken out by physicians, medical residents and a range of other healthcare professionals, caring for COVID-19 patients. The bill also includes researchers working to find a cure and vaccine for the disease. Representative Maloney modeled her proposal after the September 11th Victim Compensation Fund.

“New York physicians have been on the frontlines since the beginning of the COVID-19 crisis, risking their lives to save as many victims of the virus as possible,” said Dr. Art Fougner, President of MSSNY. We are grateful to Rep. Maloney for her leadership in advancing this important bill, as it is a critical step in thanking frontline medical professionals for their service during this unprecedented time.  We urge the US Congress to incorporate these ideas into its next stimulus package that is currently under development.

The bill establishes a commission to work with the Education and Treasury Departments to review applications from borrowers and to determine which frontline applicants are eligible for loan forgiveness.

New York State is the hardest hit in the country with 319,000 confirmed cases and 19,415 deaths, to date

Data from NY State Antibody Study and DOH Fatality Tracker

18-24 0.046% 1 out of every 2,163
25-34 0.058% 1 out of every 1,729
35-44 0.181% 1 out of every 552
45-54 0.424% 1 out of every 236
55-64 1.020% 1 out of every 98
65-74 2.236% 1 out of every 45
75+ 4.430% 1 out of every 23

*89.2% of fatalities have at least 1 comorbidity

Advance Payments Boon to NY Physicians
As physicians struggle to stay afloat during the Covid-19 crisis, advance payments from insurers will help.

MSSNY, on Tuesday, applauded Empire BlueCross BlueShield for advancing payments to certain independent primary care physician organizations and multi-specialty groups that include primary care. MSSNY noted that means much needed money to hundreds of groups across the country, beginning this month.

“With physicians reporting dramatic drops in patient visits and revenue in our collective response to the Covid-19 pandemic, we thank Empire Blue Cross for implementing a program to help its network physicians with an advance payment program,” said Dr. Art Fougner, president of MSSNY, in a statement. “It will provide a lifeline to these practices until regular patient visits can resume.”

MSSNY noted that UnitedHealth and CDPHP have also adopted advanced payment programs during the crisis. Fougner urged other insurers to do the same.

Last month, MSSNY reported devastating findings from a physician survey. Some 80% of survey respondents said they had suffered a loss of revenue of more than 50% since the Covid-19 outbreak began. And 83% reported they had experienced a reduction of more than 50% in the volume of patients visiting their practices.

More than a quarter of respondents said they had to lay off or furlough more than half their staff. And the majority had applied for forgivable loans through the Small Business Administration.

“As independent primary care providers play a critical role in our communities, Empire is making advanced payments to certain independent primary care and multi-specialty

organizations that are especially vulnerable financially, as a result of this pandemic,” the insurer said in a statement provided to Crain’s. — Crain’s Health Pulse May 6.

NY Hospitals Get $5B as Feds Target COVID-19 Hot Spots
New York hospitals will get $5 billion from the U.S. Department of Health and Human Services as part of a $12 billion plan to distribute money to COVID-19 hot spots.

The funding will be distributed to 90 hospitals in the state, with New York City facilities receiving $509 million.

The money was designated for facilities with at least 100 COVID-19 patients as of April 10, with a fixed amount given per inpatient admission. Within the fund, $2 billion was set aside for hospitals that treat a greater share of Medicare, Medicaid, and uninsured patients.

The 395 U.S. hospitals given funding accounted for 71% of COVID-19 inpatient admissions, according to HHS. The federal agency said Friday that payments would be made to hospitals within days.

The distribution follows a round of funding that frustrated New York hospitals because it did not account for the areas that have treated the most Covid-19 patients, as well as facilities with high numbers of Medicaid and Medicare Advantage patients. HHS previously distributed $30 billion of the $175 billion allocated for health care providers in the Coronavirus Aid, Relief and Economic Security Act, based on the percentage of Medicare revenue each provider represented. HHS did not announce how much individual hospitals would receive. Crain’s NY Business May 5.

NYC Health and Hospitals Raised $20 Million to Help Healthcare Workers
New York City Health and Hospitals said Friday that it has raised more than $20 million to assist health care workers on the front lines of the Covid-19 crisis. That includes $12.7 million in new funds from nearly a dozen donors.

Goldman Sachs contributed $500,000; BNP Paribas, $400,000; and Advent International, $300,000. The money is being used to purchase scrubs, meals, transportation and hotel rooms for frontline workers, the health system said.

Relief funds also will support an existing Health and Hospitals program that has ramped up in response to the crisis: Helping Healers Heal. The program includes trained peer-to-peer teams of health care.

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Gov. Cuomo: What Businesses Require to Reopen
To open, a business would have to have new safety precautions

  • Adjust workplace hours and shift design as necessary to reduce density in the workplace;
  • Enact social distancing protocols;
  • Restrict non-essential travel for employees;
  • Require all employees and customers to wear masks if in frequent contact with others;
  • Implement strict cleaning and sanitation standards;
  • Enact a continuous health screening process for individuals to enter the workplace;
  • Continue tracing, tracking, and reporting of cases; and
  • Develop liability processes.

The seven criteria to reopening a region

Seven Criteria Chart
These seven criteria will need to be met before each region can reopen.
Here is where they stood on May 4, 2020.
(Photo: Joseph Spector, USA TODAY Network New York)

Hospitalization decline

A region has to have at least 14 days of decline in total net hospitalizations or under 15 new hospitalizations in a three-day average.

Decline in hospital deaths

An area would have to show a 14-day decline in hospital deaths or fewer than five deaths over a three-day average.

New hospitalizations

New cases in a hospital would have to stay under 2 people per 100,000 residents, based again on a three-day average.

Total beds available

To be prepared for a potential surge in cases due to reopening, the state’s criteria would require a region’s hospitals to have at least 30% total hospital beds available.

ICU needs

The same 30% threshold of open beds would be needed in intensive care units.

Having enough PPE

A region would also need to have at least 90 days of personal protective equipment stockpiled to ensure enough to give out if cases rises.

Diagnostic Testing Capacity

Each region must have the capacity to conduct 30 diagnostic tests for every 1,000 residents per month.

The state is expanding its ability to add contact tracers to better hunt down where the virus is spreading.

New-Dominant Strain of Coronavirus Appears More Contagious Than Original
A newer strain of the novel coronavirus appears to be even more contagious than the original, according to a study published April 30 on bioRxiv.

Scientists at Santa Fe, N.M.-based Los Alamos Research Laboratory analyzed data from real-time mutation tracking of SARS-CoV-2, the virus that can cause COVID-19. Fourteen different mutations of SARS-CoV-2 spike proteins were identified, with the mutation Spike D614G of “urgent concern,” the researchers wrote. The strain emerged in February in Europe, and by mid-March had spread worldwide, according to the study.

The new strain spreads faster and may make people more vulnerable to reinfection, the study authors wrote.

The study has not yet been peer-reviewed.

(Becker’s Hospital Review, May 6)

Data Suggests Most New Covid-19 Hospitalizations Involve People Staying Home
Gov. Andrew Cuomo is urging New Yorkers to comply with face mask, hand-washing and social distancing orders after early data on new COVID-19 hospitalizations suggests the bulk of those patients have primarily been staying at home.

The governor, who recently required hospitals to report more details on admitted patients, said preliminary findings from 113 hospitals over a three-day period suggest that two-thirds of the 1,200-plus new patients surveyed had been admitted from their homes. By contrast, just 18 percent of new admissions came from people in nursing homes, 2 percent were homeless and less than 1 percent came from jails and prisons.

“Everything is closed down, government has done everything it could, society has done everything it could, now it’s up to you,” he said during a morning news conference today in Manhasset. “Are you wearing a mask? Are you doing the hand sanitizer? … It comes down to personal behavior. This is not a group that we can target with this information, it’s really about personal behavior.”

The preliminary data found that only 17 percent of those being hospitalized for Covid-19 were employed, nearly all — 96 percent — had comorbidities and about three-quarters were aged 51 or older, Cuomo said. Just 4 percent reported using public transportation.

It also suggests that the vast majority of the Covid-19 hospitalizations are occurring downstate, and a disproportionate percentage of the hospitalizations in New York City involve African Americans, Latinos and Asians, he said.

Cuomo has argued that the data on new hospitalizations will allow the state to better target its reopening strategy.

About 600 people were still being admitted to hospitals for treatment of the virus as of Tuesday, down from 900 to 1,000 last week. (Politico Pro, May 5)


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