Tag: MSSNY eNews December 1 2021

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MSSNY Physician Leadership Meets with Governor Hochul’s Team to Discuss Elective Surgery Limitations
MSSNY physician leaders and staff met with top officials to Governor Hochul this week to discuss aspects of her recent emergency order that will give the NYS Department of Health the authority to limit elective procedures at hospitals that have less than 10% bed capacity.

MSSNY President Dr. Joseph Sellers, President-Elect Dr. Parag Mehta, and Vice-President Dr. Paul Pipia emphasized MSSNY’s ongoing strong support for Governor Hochul’s efforts to ensure that all health care workers be vaccinated against COVID and offered the physician community’s assistance to help tackle the enormous challenges facing our healthcare system currently due to rising COVID hospitalizations across the State. At the same time, they urged caution in restrictions on “elective” surgeries to ensure that such restrictions do not unduly interfere with patients’ ability to receive urgently needed care, such as necessary cancer screening tests (mammograms, colonoscopies, etc.) and surgeries that address patient health issues that substantially impact patients’ ability to live without pain and go to work.

The elective procedure limitations will begin on Friday December 3 and be re-evaluated by January 15. They will be implemented on a hospital-by-hospital basis, not based on cumulative numbers in the county or the region of the State. Hospitals with less than 10% bed capacity could be able to continue to perform elective procedures if patients can be safely moved and/or directed to other facilities not facing similar bed capacity limitations.  As of now, 37 facilities across the State, mostly in Western NY, Central NY, the Mohawk Valley and the Capital Region have reached the threshold of less than 10% bed capacity and some of these facilities have already paused elective procedures.

As of this writing, it is unclear how the restrictions on elective procedures could apply to procedures to be performed at ambulatory surgery centers that are part of health systems containing hospitals facing these capacity limitations. The NYS DOH is developing a document that will set forth how the elective procedure limitations would be implemented in hospital systems, as well as the medical procedures that will be subject to these limitations. MSSNY will share that information with our members when it becomes available.

MSSNY Welcomes Mary Bassett, MD, MPH  as NYS Department of Health Commissioner
MSSNY sent the following statement to the press today:

Statement Attributable to:
Joseph R. Sellers, MD, FAAP, FACP
President, Medical Society of the State of New York

“MSSNY extends a warm welcome to Dr. Mary Bassett as she begins her tenure today as New York State’s Health Commissioner. Our member physicians look forward to working closely with Dr. Bassett to address the health needs of all New Yorkers.

“Dr. Bassett joins New York State at a uniquely challenging time in history and we are confident that her wealth of knowledge and experience in the field of public health will help her to guide New Yorkers through to the end of the COVID-19 pandemic—and future public health challenges.

“During her years as commissioner of the NYC Department of Health and Mental Hygiene, Dr. Bassett worked to tackle racial, ethnic, and economic health inequities. We look forward to working with her to address those needs throughout the State in our shared fight for quality, accessible, and affordable health care for all New Yorkers.”

Health Equity from an Actuarial Perspective
The American Academy of Actuaries published a discussion brief exploring if and how methodologies or approaches actuaries use to develop financial models and identify physicians for network participation may contribute to health disparities. Health plans contract with physicians and other health care providers to develop networks to serve their members.

These contracts establish a health plan’s reimbursement for services and other terms of network participation. However, these methodologies do not typically account for physicians’ patient mix, putting physicians who treat high risk patients at a disadvantage. This thoughtful report on how these methodologies for evaluating reimbursement levels and network participation may impact health equity or health care disparities focuses on the following areas/questions:

• How do overall health plan spending goals or other outcome goals and considerations affect network development and physician contracting, and do they have effects on access to care and health disparities?
• How do alternative payment models (APMs) and cost targets for risk-bearing contracts affect physician incentives and disparities in health care access and outcomes?
• Are quality provisions and outcome measures in APM contracts aligned with achieving equitable health outcomes?
• How do the risk adjustment methods used in physician
  contracting and network development affect access to care outcomes?

Patients to be Held Harmless for Inaccurate Health Plan Provider Directories
Reliance on inaccurate information provided in a health insurer’s provider directory would become a basis for a patient to receive protection from out of network bills under New York’s surprise bill law, pursuant a regulation recently proposed by the New York Department of Financial Services. Payment for care in those instances would be determined through New York’s Independent Dispute Resolution process.

The regulation will help to conform New York’s law to the provisions of the federal No Surprises Act enacted by Congress last December and which takes effect in January. It requires health plans to ensure provider directories are current and accurate, with regular verification of provider contract status and updates required at least once every 90 days, and for the updated information to be posted within 2 business days of the receipt of the information. The federal NSA law also requires a health care provider to have a process in place to provide updated practice information to the health plan to help ensure that the health plan’s provider directory information remains accurate. No Surprises Act: Three Ways to Address New Provider Directory Requirements – Healthcare Business Today.

For more information regarding other important new requirements physicians need to be aware of regarding the implementation of the NSA, please review our e-news article from November 19.

MSSNY Micro Masterclass Webinar:  Submitting Formal Insurer Complaints to the Appropriate Agency
Do you have unresolved claims payment issues with an insurer? Not sure how to pursue a resolution? Settle in with your lunch and join Heather Lopez, Director of MSSNY’s Payment and Practice Division, at 12:15 pm on December 9 for a 15-minute masterclass on filing and following up on insurer complaints.

Heather will share information on how to determine the proper agency for the complaint as well as providing contact information for each of the agencies. Please register to join us for the webinar at https://bit.ly/31j1fUt.

MSSNY Tip of the Week: Current Guidance on Medicare Revalidation Process
Medicare revalidation is due every 5 years and there are multiple scenarios that can influence how yours is processed. Click here to view the most current information from the CMS manual to ensure you are following guidelines to help save time.

If you have questions about this or any other insurance concern, contact MSSNY’s Director of Physician Payment and Practice, Heather Lopez, at 518.465.8085 X332 | hlopez@mssny.org.

Guidance for Physicians: CDC Recommends COVID Boosters for 18 and Older
On November 29, 2021, the CDC strengthened its recommendation on booster doses to indicate that everyone 18 years of age and older should get a booster shot either 6 months after their initial Pfizer or Moderna series or 2 months after their initial J&J vaccine. Click here to view Guidance for The New York State COVID-19 Vaccination Program.

Vaccinations and boosters continue to protect and are critical to enjoying a safe and healthy holiday season with family and friends. New Yorkers are strongly encouraged to get vaccinated to help prevent the spread of the deadly COVID-19 virus.

Contact Your Representatives of Congress to Prevent Staggering Medicare Cuts in 2022
Physicians are just 31 days away from a disastrous 10% Medicare payment cut unless Congress acts to stop this cut. Please contact Senators Schumer, Senator Gillibrand and your Congressional Representative today. Tell Congress to cancel Medicare cuts today!

The 2022 Medicare payment rule reduces the conversion factor by approximately 3.75% resulting from the expiration of an increase to the conversion factor enacted by Congress last December. In addition, there is a 2% cut resulting from the scheduled re-implementation of the previously delayed Medicare sequester provisions, and imposition of a 4% Statutory PAYGO sequester resulting from passage of the American Rescue Plan Act.

Earlier this fall, Reps. Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN) circulated a “Dear Colleague” letter highlighting the financial uncertainty within the Medicare payment system and the dangers facing patient care if Congress fails to enact legislation to prevent this staggering cut. Within a matter of weeks 245 of their colleagues showed their support for fixing the problem of these extreme Medicare cuts by co-signing the letter, including many of the members of the New York Congressional delegation. This strongly supported letter was an important advocacy building block towards stopping these cuts, but we need our Representatives to strongly push leadership to ensure that funding to prevent these cuts is included in a year end package.

Please urge Congress to act to protect care for our seniors! Tell Congress to cancel Medicare cuts today!

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