Tag: MSSNY eNews December 17 2021

Wishing Each of You a Joyful Holiday Season and a Happy, Healthy 2022

Colleagues: 

As we come to the end of 2021 and look forward to 2022, I am filled with hope for the future. Despite huge challenges for physicians in the face of this historic pandemic, we have dug deep, persevered, and helped our patients navigate extraordinary challenges.  My hope is that 2022 will bring an end to this pandemic.

2021 has been a busy year for MSSNY. The improvements and changes underway give me a renewed sense of hope that our future—and the future of all organized medicine—is bright. We started the year by conducting a nationwide search for a new MSSNY EVP and were thrilled to hire Troy Oechsner, who hit the ground running. After extensive research, MSSNY is getting ready to implement a new database service to replace our present database dinosaur and is in the process of developing a plan for a complete overhaul of the MSSNY website. Troy hired Valerie Cammiso as our new VP of Membership and Heather Lopez as Director of Physician Payment and Practice. Troy, Valerie, and Heather each possess a sense of optimism and confidence—and all three have a wealth of experience in their respective fields that I’m confident will bring renewed value to MSSNY membership. They join an existing stellar MSSNY staff that continues to produce excellent work on behalf of all of us.

And our voice in Albany and Washington, DC remains strong. Here are just a few highlights of MSSNY’s work this year:

• Rejected Physician Responsibility for 50% Excess Insurance Cost-Share
• Protected Physician Due Process During OPMC Investigations
• Protected Physician Confidentiality When a Complaint Has Been Filed Against Them With OPMC
• MSSNY Advocacy resulted in the recent announcement that claims submitted to liquidated health insurer Health Republic would be paid
• MSSNY worked with the NY Congressional Delegation, the American Medical Association (AMA) and the Federation of Medicine to prevent implementation of a 2% sequester cut until at least 2022 and to mostly prevent implementation of a 10% cut to Medicare physician payment conversion factor while continuing to move forward with payment increases to E&M codes.

As the year winds down, I wish each of you a joyful holiday season and a wonderful 2022 filled with good health and happiness.

Joseph Sellers, MD, FAAP
MSSNY President

Provider Relief Fund Reporting Period 1 Portal Open Until December 20 @ 12 PM
The Provider Relief Fund Reporting Period 1 portal will be reopened from 9:00 a.m. ET on December 13, 2021 through 11:59 p.m. ET on December 20, 2021. During this time, PRF recipients may register, request corrections, and/or submit their report on PRF payments received prior to June 30, 2020. This will be the final opportunity for providers to report on Reporting Period 1 payments.  Providers who submitted their reports before November 30, 2021 may request to have their report reopened for revisions by contacting the Provider Support Line (866-569-3522). All reports must be finalized and submitted before December 20, 2021 at 11:59 pm ET to be compliant with the terms and conditions of the PRF program.

To access the PRF reporting portal, please click here.
For additional information about PRF reporting, please visit the PRF webpage.

Federal No Surprises Act Takes Effect in 15 Days: Are You Ready?
On January 1, 2022, a new and complex set of rules enacted by the federal government regarding “surprise bills” goes into effect. The statute is broad and sweeping and will have significant effects on any health care provider who renders services to out-of-network or uninsured patients. While many jurisdictions, including New York, New Jersey, Connecticut and Florida already have rules addressing surprise bills, the Federal law varies from the state laws in many ways, including having a far wider application.

The penalties for violating the Federal No Surprises Act law can be substantial. If you are uncertain about an aspect of the new law—whether you are covered, what aspects of your practice are covered, and how to comply—the GW Federal Surprise Bill Working Group can provide unmatched expert guidance.

Garfunkel Wild, P.C., a law firm dedicated to the health care industry, is pleased to announce the creation of a Federal Surprise Bill Working Group that has developed a particular level of expertise in addressing client questions about the new Federal No Surprises Act law.

Should you have any questions regarding the above, please contact the Garfunkel Wild attorney with whom you regularly work, or contact us at info@garfunkelwild.com.

DFS Develops Model Form for Physicians to Share with Patients Regarding Protections from Surprise Billing
The New York Department of Financial Services has finalized a New York-specific model form that physicians, hospitals and other health care providers will need to post on their website and in their practice location advising their insured patients of their legal protections against surprise medical bills.  The form developed by the DFS is a modified version of the template form developed by the US Department of Health and Human Services.  As noted in an upcoming DFS Circular letter, “Beginning January 1, 2022, each health care provider and facility must make publicly available, post on their public websites, and provide to insureds, a one-page notice in clear and understandable language containing information on:  the requirements and prohibitions of such provider or facility under 42 U.S.C. §§ 300gg-131 and 300gg-132 (relating to prohibitions on balance billing for emergency services and surprise bills); any other applicable state law requirements on such provider or facility prohibiting out-of-network balancing billing (including any state laws that provide consumer protections that go beyond the NSA); and information on contacting appropriate state and federal agencies in case an individual believes that such provider or facility has violated any state or federal prohibitions on balance billing for emergency services and surprise bills.

45 C.F.R. § 149.430(c) provides clarification regarding the methods for this disclosure.  When posting on the provider’s or facility’s website, the information or link to the information must appear on a searchable homepage of the provider’s or facility’s website.  If a provider or facility does not have a website, this requirement does not apply.  Additionally, for the information to be publicly available, the provider or facility must include the information on a sign posted prominently at the provider’s or facility’s location.  A sign is posted prominently if the sign is posted in a central location, such as where insureds schedule care, check in for appointments, or pay bills.  If the provider does not have a publicly accessible location, this requirement does not apply.  Lastly, the notice provided to the insured must be a one-page (double-sided) notice, using print no smaller than 12-point font.

The provider or facility must provide the notice in person or through postal mail, or if the insured consents, through electronic mail.”

MSSNY Podcast: Omicron, Medicare and Surprise Bills
Listen to today’s MSSNY podcast as MSSNY Senior VP and Chief Legislative Counsel Moe Auster updates physician members on Omicron, Medicare, and Surprise Bills.

MSSNY in the News
WSYR LocalSyr.com (News 9) – 12/14/21
President of the Onondaga County Medical Society discusses the strain of COVID-19
(Interview with Dr. Robert Dracker,  President of the Onondaga County Medical Society)

PoliticsNY – 12/14/21
PoliticsNY Power Players in Health Care
(MSSNY President-Elect Parag Mehta named PoliticsNY Power Player)

CBS WRGB News 6 Albany  12/10/21
Capital Region hospitals not concerned over elective surgery postponements
(MSSNY President Dr. Joseph Sellers quoted) 

The Journal News (LoHud) – 12/06/21
Some NY counties lagging behind in COVID-19 vaccinations for ages 5 to 11. Here’s where
(MSSNY President Dr. Joseph Sellers quoted)

Also ran in:
Daily Messenger
Wayne Post
Genesee Country Express
Democrat and Chronicle
Observer-Dispatch
Times Telegram
Star-Gazette
Poughkeepsie Journal
The Steuben Courier Advocate
Irondequoit Post
The Evening Tribune
Wellsville Daily Reporter
Yahoo News
The Leader

Rochester First (WROC) – 12/03/21
Free rapid take-home tests and booster shots coming to Monroe County
MSSNY President Dr. Joseph Sellers Interviewed

The Hill – 11/29/21
Time to think beyond the vax? Reflections from a COVID-stricken doc
Op-ed by MSSNY Member, Dr. Frank Contacessa

LoHud.com – 11/22/21
As COVID surges, New York’s flu season is off to a troubling start. Will ‘twindemic’ hit?
(MSSNY President Dr. Joseph Sellers quoted)

Also ran in:
Daily Messenger
Democrat and Chronicle
Genesee Country Express
Star-Gazette
The Evening Tribune
The Leader
The Poughkeepsie Journal
The Steuben Courier Advocate
Times Telegram
Wayne Post
Wellsville Daily Reporter
Yahoo news           

InsuranceNewsNet – 11/21/21
Stakeholders Praise 4 House Members Letter to Admin Regarding Surprise Billing Interim Final Rule
(MSSNY President Dr. Joseph Sellers quoted)

Buffalo News – 11/12/21
Covid cases are rising in younger people. So are urgent calls to get them vaccinated
(Former MSSNY President Dr. Thomas Madejski quoted)

Harlem World Magazine – 11/03/21
Attorney General James Defends New York State’s Gun Licensing Protection Law At Supreme Court
(MSSNY President Dr. Joseph Sellers quoted)

Crain’s Health Pulse – 11/3/21
Labor costs driving up expenses for hospitals, physician practices
MSSNY Past Presidents Dr. Thomas Madejski and Dr. Charles Rothberg interviewed)

Podcast on Omicron and Antivirals with MSSNY Infectious Diseases Committee Chair Dr. William Valenti Available Now
Questions about the Omicron COVID Variant and the newly developed antivirals for COVID-19?  Listen to MSSNY’s latest podcast on Omicron and antivirals here.  Chair of MSSNY Infectious Diseases Committee, Dr. William Valenti offers insight on the latest COVID variant, Omicron, and provides information on the newly developed COVID antivirals.  Also be sure to check out all MSSNY’s other podcasts on topics ranging from Emergency Preparedness to Veterans Matters to Legislative Updates.  And go to https://cme.mssny.org  to explore all of MSSNY’s CME programs.

COVID-19 Exacerbating Physician Stress: MSSNY is Here to Help
Stress and burnout among physicians have been well documented for years. The COVID-19 pandemic is exacerbating the public health problem of physician burnout in New York state. Throughout the pandemic, physicians and other health professionals have faced concerns about safety, overworking, and feelings of loss.

MSSNY understands that with the Holiday season, comes a great deal of stress for many.

If someone you know is struggling with life stressors, encourage them to reach out to the P2P program to connect them to a peer supporter!

Email: P2P@mssny.org or call 1-844-P2P-PEER (1-844-727-7337) to request to be connected with a peer supporter.

Without an intervention, it is possible that a high number of physicians over the next few years may develop chronic stress reactions, anger, clinical depression, substance abuse, post-traumatic stress disorder, and suicidality.

If you wish to become a trained peer supporter, please reach out to Cayla Lauder, MPH, Program Coordinator, at clauder@mssny.org.

MSSNY Calls on Governor Hochul to Sign Bill to Increase PBM Transparency & Limit Insurers’ Mid-Year Formulary Changes: Members Urged to Take Grassroots Action
Physicians are again urged to send a letter asking Governor Hochul to sign two bills into law that are critical to helping patients access the medications they need and to ensuring greater oversight of pharmacy benefit formulary development practices.  Physicians can send a letter or tweet from here.

The first piece of legislation, (A.1396, Gottfried/S.3762, Breslin), will provide greater accountability and transparency of the practices of Pharmacy Benefit Managers (PBMs). The bill was amended from the version that passed the Legislature in 2019, but vetoed, to address concerns raised in Governor Cuomo’s veto message two years ago.

The bill requires that PBMs be licensed by the Department of Financial Services (DFS) and adhere to standards established by DFS. It also calls for disclosure of all possible revenue streams, terms, and conditions, that they place on their networks of pharmacies. MSSNY has supported greater oversight and regulation of PBMs as one manner to address restrictive formularies and excessive prior authorization requirements that interfere with patients obtaining needed medications.

The second bill, A.4668, People-Stokes/S.4111, Breslin, would significantly limit the ability of health insurers to move medications to higher cost-sharing tiers for their prescription drug formularies during a policy year. The bill was revised from the version that passed both chambers two years ago, but was vetoed by then Governor Cuomo. To address concerns raised in his veto message, the legislation now prohibits the applicability of a mid-year formulary change to a patient who was on the medication at the beginning of the policy year, or suffers from a condition for which the medication is part of a treatment regimen, for that condition. However, other mid-year formulary changes could still occur.

Physicians can send a letter to ask Governor Hochul to sign both bills here.

MSSNY Tip of the Week: Time-Based Billing for E/M Guide
Effective January 1, 2021, the new time-based billing for E/M codes went into effect and should be used now. This will allow you to bill a higher-level CPT code in the event certain time metrics are met. To ensure you are receiving the most appropriate reimbursement for your time, please take a moment to review this document.

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.

The Telehealth Initiative
As part of the Telehealth Initiative project, MSSNY and the AMA will work together to develop relevant educational content, resources, measurement tools, and evaluation support to help practices with telehealth implementation. MSSNY will be part of a national network to establish and maintain strong relationships with physicians, practices, and health systems interested in implementing, optimizing, or sustaining telehealth. In addition to providing ongoing support, this year’s program will emphasize the importance of realizing the true value of virtual care. MSSNY has secured four signed statements of interest: C DOC, Mount Sinai, Northwell TeleICU/Telehealth, and Eger Healthcare and Rehabilitation Center.

MSSNY is hoping to have close to 10 practice sites in total. As a collaborating partner, team leaders will participate in a “kick-off” meeting with leaders from practice sites in New York and in other states. Each practice site will be involved in dissemination of a telehealth survey assessing practice/physician experience using telehealth. In addition to participation in the Telehealth Survey, the project team will collect baseline, mid- point, and final data points to measure the impact of telehealth in their practices using the Return on Health framework. Access to educational resources from the AMA and expert mentoring to discuss optimization and sustaining telehealth into practice, virtual events and discussions which provides a network for physicians and care teams to share experiences will be provided to all participants.

If you or someone you know is interested in joining this initiative, please reach out to Cayla Lauder, MPH, Program Coordinator at clauder@mssny.org.

Please Urge Governor to Veto Multiple Pro-Trial Lawyer Tactical Bills
With just a few weeks left in the year, physicians are again urged to contact Governor Hochul’s office to encourage her to veto multiple problematic pro-trial lawyer bills that if signed could have the effect of significantly disadvantaging defendants generally in litigation in New York State, including physicians and hospitals defending against malpractice claims.

While these bills do not have the same gargantuan premium impact as other legislation sought by the trial bar that would expand lawsuits and awards against physicians, they would continue to make New York’s already dysfunctional medical liability adjudication system even more unbalanced and add to New York’s notorious outlier status with regard to medical liability payouts.  These bills include:

• A8041/S7052 (“The Comprehensive Insurance Disclosure Act”) – Imposes excessive insurance disclosure requirements on defendants during litigation, which has been strongly opposed by many groups. Business groups urge Hochul to veto insurance bill (nystateofpolitics.com)
• A2199/S473 – Expands the time period for the imposition of New York’s excessive 9% judgment interest in cases where a plaintiff’s request for summary judgment was not initially granted, but then overturned on appeal.
• A8040/S7093 – Changes a long-standing rule that heretofore excluded a “hearsay” statement made by a defendant’s employee.

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