February 6, 2020
Volume 15 Number 11
Tuesday, February 25, 2020, 7:30 a.m. to 8:30 a.m.: MSSNY Webinar, “Steps to Physician Wellness and Resiliency”
Registration is now open for this useful MSSNY webinar, “Steps to Physician Wellness and Resiliency,” on Tuesday, February 25, from 7:30 a.m. to 8:30 a.m. Jeffrey Selzer, MD, will serve as faculty. Educational objectives are:
- Review the warning signs that may indicate that stress, depression, anxiety or substance use are affecting one’s 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.
Make your voice heard – get on the bus! Come with us to Albany on Wednesday, March 4, 2020.
The New York State Legislature is now in session, and the need for physician advocacy and grassroots involvement is greater than ever. This year, because of the June 23 state and federal primaries, the session will be three weeks shorter than usual and legislators will be in Albany more days per week. So, crucial issues may already be under discussion by March 4 - and it's critical that you be there!
We'll urge legislators to:
- Oppose the Governor’s proposed changes in the physician discipline system. (Those changes are needless.)
- Oppose the legalization of recreational marijuana. (Health and safety concerns are growing even more urgent.)
- Oppose proposed cuts in the Excess Layer of Medical Liability program. (The Excess Program is essential.)
- Help us fight insurers' tough rules for prior authorizations. (Physicians AND patients suffer.)
- And more.
Sign up to participate! Join your colleagues from all around New York State. We'll urge our legislators and key policymakers to make the right choices for New York's physicians and their patients.
We'll travel in our own bus to MSSNY's Lobby Day.
- Our bus will be on the road by 7:00 a.m. We'll have breakfast and discussion en route.
- We arrive in Albany and join physicians from all over the state, to hear talks by key legislators and Cuomo administration staffers. We'll be in the Lewis Swyer Theater in the "Egg" building, Empire State Plaza.
- After the morning program we'll have a brief luncheon. Some members of the NYS Legislature will come to the luncheon to speak with their constituents.
- After lunch, we'll visit many of our Manhattan legislators in their offices.
- We'll be back in Manhattan by 7:00 p.m.
You board at either Eighth Ave & 35th Street (6:20 a.m.), or Park Ave & 77th Street (6:35 a.m.) Or, if you wish, you can travel on your own and meet us in Albany.
- You get background information in advance.
- You meet lawmakers in prearranged visits. You can talk with them "up close."
- Your prearranged group has an experienced leader. You meet colleagues.
- You get an unvarnished, possibly eye-opening perspective!
- Admission $50 for MSSNY members. Medical students and residents free.
- Your name, cell phone, email, address (street/city/state/zip), specialty. And, are you: MD? DO? A student?
- Are you a member of MSSNYPAC? Would you like information?
- Are you in MSSNY's PAL (Physician Advocacy Liaison) network? Would you like information?
- Would you like to board the bus at 8th Ave & 35th St. (6:20 a.m.), or at Park Ave & 77th St. (6:35 am.)? Or, would you like to travel on your own?
The Legislative Horizon
Sign up to receive alerts from MSSNY’s Grassroots Action Center!
If you’re concerned with the formation of health care policy in New York State, a great idea is to subscribe to the Grassroots Action Center. MSSNY’s Division of Governmental Affairs will alert you when legislation and issues of importance to physicians and patients, either in the NYS legislature or in Congress, are at critical stages.
Contact from constituents could be vital to influencing the future of that legislation or issue! MSSNY’s alerts will recommend actions you can take for maximum impact - such as calling your legislators, tweeting and/or emailing a letter (which you can modify as you wish).
Subscribe today! Just text MSSNY to 52886 and you will be prompted to enter your email address. When you sign up, it is best to use your NY-based voting address, or your practice address (if you do not reside in NY), for your alerts.
Reject changes the Governor wants to make in New York’s physician discipline system!
As part of his 2020-21 Executive Budget, Governor Cuomo is proposing to bypass important due process protections for physicians during investigations and disciplinary proceedings – even though very few complaints to the OPMC ever result in actual findings of misconduct. With the changes the Governor is proposing, the DOH would be able to disclose that a physician is under investigation at the very beginning, and the OPMC would have enhanced power to suspend a physician’s license before disciplinary hearings are complete. The Governor wants to:
- Make investigations and administrative warnings public, “when the Commissioner of Health deems it warranted.”
- Eliminate lifetime licensure, so that out-of-state, but NY-licensed, physicians must renew periodically.
- Let the State Health Commissioner suspend a physician's license at the start of an investigation if the physician is deemed a mere risk to the public. (The current standard is “immanent danger to the public.”)
This unfair, heavy-handed proposal would affect both private practice and employed physicians. It’s important to improve public safety, but it is also important to protect medical workers against the consequences of unfounded allegations against them. Tell your legislators to reject the proposal. Please click here.
MSSNY President Dr. Art Fougner has issued a statement (statement), and has said via media outlets across the state (read here), that MSSNY is anxious to address gaps in the disciplinary process to protect the public - but also has strong objections to the Governor’s proposal. “Recognizing that there are enormous professional implications when disciplinary action is taken against a physician, or even when there has been an accusation, we must also ensure that fair due process is provided when a physician is accused of professional misconduct,” Dr. Fougner said.
“There are over 100,000 physicians in NY State. In 2016, about 10,000 reports were made to NY’s Office of Professional Medical Conduct (the OPMC). Out of those, [only] about 300 resulted in serious actions [fewer than 3%]…And the time it took was the result of painstaking investigation, with full due process rights provided…Without details, it is difficult to know just what cases would trigger this transparency or result in summary loss of license. A physician’s license can already be pulled if he/she is deemed an imminent threat to public safety…However, plastering a physician’s name on the front page of every newspaper in the state for any claim by a disgruntled patient is quite a different matter, especially before all the facts are known.”
The Governor’s proposed budget: A long list of healthcare-related items
Governor Cuomo has released his proposed $178 billion budget for the 2020-21 State Fiscal year, including measures to close a $6.1 billion budget deficit. These measures would assume an additional $2 billion in new tax revenue and $1.8 billion in reduced payments to localities, and would also assume the creation of a new Medicaid Redesign Team (MRT), charged with recommending $2.5 billion in Medicaid savings. Among the most notable items for physicians:
Items of concern:
- Physician discipline: Expanding the Commissioner of Health’s ability to notify the public that a physician is under investigation, and making it easier for the Commissioner to summarily suspend a physician license during a disciplinary investigation. Send a letter to your legislators: Please click here.
- The New York State physician profile: Expanding the information on the profile to include the physician’s office hours, insurance participation information, mandatory completion of a workforce survey, and whether the physician is accepting new patients.
- Recreational (“adult-use”) marijuana: Legalizing, regulating and taxing the production, distribution, transportation and sale of this drug.
- Adult immunizations: Expanding the list of adult immunizations that pharmacists will be permitted to provide, to include all the immunizations that are recommended by the ACIP (the CDC’s Advisory Committee on Immunization Practices).
- The collaborative drug therapy program: Expanding the existing physician-pharmacist collaborative drug therapy program, to include nurse practitioners and physician assistants.
- Requiring the regulation of Pharmaceutical Benefit Managers (PBMs) by the NYS Department of Financial Services (DFS), and requiring the PBMs to disclose financial incentives they receive.
- A comprehensive anti-smoking package, including: Prohibiting the sale or distribution of e-cigarettes or vapor products that have a characterizing flavor; prohibiting the sale of tobacco products in all pharmacies; expanding the definition of “place of employment” to define indoor space, and to limit second-hand smoke exposure; restricting the advertising of vapor products; requiring manufacturers of vapor products to disclose to the DOH Commissioner and the public, information regarding the ingredients, by-products, or contaminants in vapor products; banning coupons and manufacturer discounts and displays in shops; and increasing penalties for illegally selling tobacco products to minors.
- Creating an administrative simplification work group to address health-insurance hassles, and to expedite physician credentialing applications.
- Establishing a Behavioral Health Parity Compliance Fund to collect penalties on insurance carriers that violate New York’s Behavioral Health Parity laws. (The Fund will be used to support the Substance Use Disorder and Mental Health Ombudsman programs.)
- Significantly reducing the interest rate on medical malpractice and other court judgments, from 9% to a market-based rate.
- Reducing the business income tax rate from 6.5% to 4% for businesses with 100 or fewer employees (and with net income below $390,000), that file under Article 9-A.
- Providing $14.2 million in funding to ensure access to a full array of reproductive services for women. This replacement funding is needed due to the loss of Title X funding.
- Providing $8 million to improve maternal health outcomes, and to implement bias training and incentives for an expansion of community health workers in the field of Maternal Mortality.
- Continuing the funding for the Excess Medical Malpractice Insurance Program.
- Continuing the funding for MSSNY’s Committee for Physicians’ Health.
Other items of note:
- Expanding the scope of New York’s surprise bill law to include in-patient services following an emergency admission.
- Convening a new Medicaid Redesign Team (MRT), assigned the task of coming up with $2.5 billion in savings.
- Authorizing the Department of Financial Services to investigate the pricing of any prescription drug, if that drug’s price has increased by more than 100% within a one-year time period.
- Capping at $100 the co-payments required of insured patient for a one-month supply of insulin.
- Developing a website, “NYHealthCareCompare,” where New Yorkers will be able to look up charges for medical services, assess the quality of services provided, get information about financial assistance programs, and find out what to do about a surprise medical bill.
- Requiring local governments to limit property tax increases to 2 percent or less, or be held accountable for excess growth in Medicaid costs.
Several previous Budget items, proposed but rejected, were not included in the Governor’s initial proposal - such as cuts to Medicaid payments for treating dual eligible patients, elimination of “prescriber prevails” under Medicaid, and expansion of CRNAs’ scope of practice. These items could, however, be brought up under the new MRT plan.
Surprise Bill resolution heats up in Congress – Contact legislators now
With key Congressional committees likely to present new approaches to the surprise medical bill issue, we need to urge New York’s Senators Schumer and Gillibrand, as well as our Representatives, to enact a fair law – one that’s similar to New York’s highly acclaimed surprise bill law. Just click on https://p2a.co/nS5hrfM to send an instant letter!
After the existing Budget resolution expires on May 22, Congress will need new revenue sources to help fund the federal Budget – and, most unfortunately, the Congressional Budget Office has erroneously identified the grossly unfair Pallone/Alexander surprise billing legislation (H.R. 3630/S.1895) as one revenue source. Per that legislation, insurers would be permitted to pay for surprise out-of-network bills based upon the insurers’ own, self-determined in-network rates; physicians would have little power to seek more fair payment.
The Pallone/Alexander approach is in significant contrast to New York’s law, which seeks a fair balance between two goals: It strives to protect specialty care in hospital emergency departments without eliminating insurers’ incentives to put together comprehensive physician networks.
During the week of February 10, New York physician leaders will be meeting on Capitol Hill with key members of New York’s Congressional delegation. Their message will be that physicians very much agree with the legislation’s purpose - to protect patients from surprise bills - but disagree strongly with the solutions being offered.
Fluoroscopy imaging: MSSNY opposes proposed changes in PAs’ scope of practice
MSSNY Albany staff recently joined leaders of the NYS Radiological Society for a day of Albany meetings with key lawmakers, to express concerns over a bill (S1812/A2982) that would allow PAs (physician assistants) who complete a brief training program to operate fluoroscopy imaging technology as part of a diagnostic or treatment procedure.
Fluoroscopy is an X-ray-based technique that allows continuous imaging of an instrument, a body part or a dye during a diagnostic or treatment procedure; it is used in cardiac, orthopedic and other surgeries, and in diagnostic studies. An X-ray is passed through the body and the images are transmitted to a monitor so that movement can be detected and evaluated. Concerns over medical radiation exposure have grown in recent years.
MSSNY opposes this proposal; it does not require adequate time for training, or for appropriate supervision by a qualified physician. MSSNY will continue to monitor the issue and share updates as they happen.
New Medicare card transition period has ended: Claim Reject Codes began January 1!
With a few exceptions,* if you have not used patients’ new Medicare numbers (MBIs – Medicare Beneficiary Identifiers) on claims after January 1, you will get the following codes or notices, regardless of the date of service:
- Reject codes on electronic claims: A Claims Status Category Code numbered A7 (acknowledgment rejected for invalid information), a Claims Status Code numbered 164 (entity’s contract/member number), and an Entity Code consisting of IL (subscriber).
- Notices on paper claims: Claim Adjustment Reason Code (CARC) 16 (“Claim/service lacks information or has submission/billing error(s)”), and Remittance Advice Remark Code (RARC) N382 (“Missing/incomplete/invalid patient identifier”).
If your patients do not bring their Medicare cards with them, you can get the MBIs via NGS’s look-up tool. You can sign up to use the tool at the link here: https://www.cms.gov/Medicare/New-Medicare-Card/Providers/MACs-Provider-Portals-by-State.pdf. You can also go via NGSConnex: Registered users of NGSConnex can access the MBI Lookup Tool to get their patients’ MBIs. The user must enter the provider’s NPI, and the patient’s first and last name, date of birth, and Social Security number (not the old Medicare number, or HICN). If you don’t have access to NGSConnex: Go to NGSConnex to register for a free account.
Are some of your patients still wondering how to get the new Medicare card? Give them the “Get Your New Medicare Card” flyer. It’s available in English or Spanish:
Do you yourself still have questions about the new Medicare numbers? To learn how to get and use MBIs, see the MLN Matters Article at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE18006.pdf
(*To view the exceptions, click here: https://www.cms.gov/Medicare/New-Medicare-Card/index)
Reminder: CMS is updating instructions for Global and PC/TC (Professional Component/Technical Component) billing
CMS has announced that effective March 9, 2020, for both paper and electronic claims, when a global diagnostic service code is billed (for example, with no modifier TC, for “technical component,” and no modifier -26), the address where the technical component was performed must be reported on the claim.
Global billing does not apply to anti-markup tests. To read more on global billing and how CMS’s new instructions also affect the professional component and the technical component by themselves, click on: https://www.cms.gov/files/document/mm10882. And, be sure that your Billing and Coding staff know about this development before the March 2020 effective date, as it will affect your claim submissions down the road.
An urgent message about your 2019 MIPS eligibility: Please recheck it! CMS has fixed certain glitches
The 2019 MIPS data submission period for your 2019 MIPS attestations is now open. But the question is: Were you eligible for MIPS in 2019? After CMS had released its final 2019 Merit-based Incentive Payment System (MIPS) eligibility data, the agency discovered that there had been inconsistencies in the data. These inconsistencies have been corrected, but if you checked your eligibility following the December 4th listserv announcing final MIPS eligibility, your status may have been affected by the data inconsistencies. CMS encourages you to use the QPP Participation Status Tool to re-check and confirm your final 2019 MIPS eligibility. Click on: https://qpp.cms.gov/participation-lookup/ . Of course, if you haven’t yet checked your final eligibility for the 2019 MIPS performance period, you should do so now to understand your 2019 participation requirements.
Here’s what happened: CMS initially based your 2019 MIPS eligibility status on a review of Medicare Part B claims and PECOS data from October 1, 2017, to September 30, 2018. Then, CMS did a review of Medicare Part B claims and PECOS data from October 1, 2018, to September 30, 2019, and reconciled these findings with the initial ones. If you’d like to see your claims and PECOS data, click on: https://pecos.cms.hhs.gov/pecos/login.do#headingLv1 . (If the initial review showed that you were exempt from MIPS at a practice, you will remain exempt.)
What might have changed between the initial review and the final one? Perhaps, at a particular practice, you were initially determined to be eligible for MIPS, but your eligibility status changed later. Result: You may no longer be eligible at that practice. And, please note: If you joined a new practice (meaning you assigned your billing rights to a new or different TIN) and billed Medicare services between October 1, 2018, and September 30, 2019, CMS evaluated your MIPS eligibility based on your association with that new practice (identified by TIN) exclusively during this second review.
HHS OIG targets Medicare Advantage Plans’ Risk-Adjusted Medical Reviews
CMS pays Medicare Advantage (MA) Plans more for patients with multiple chronic conditions, than it pays for basically healthy patients without chronic conditions. So, the plans need to identify and single out patients who have multiple chronic conditions, by having those patients’ health status reviewed and “risk-adjusted.” The result: Massive reviews, voluminous chart requests!
The HHS Office of the Inspector General (OIG) has recognized the burden these reviews place on physicians. It has issued these recommendations:
- Certain Medicare Advantage plans were found to have obtained unlinked chart reviews for certain beneficiaries, and to have received risk-adjusted payments for those beneficiaries even though the 2016 encounter data contained no service records! CMS should provide targeted oversight of these plans.
- Certain contractors, based on chart reviews, reported diagnoses that – they asserted – merited extra-high payment. CMS should audit those chart reviews to find out whether those diagnoses were valid.
- Certain contractors, having performed reviews, identified diagnoses that – they asserted – merited risk adjustment even where those chart reviews were not linked to service records. CMS should reassess the risks and benefits of using chart reviews that are not linked to service records, as sources of diagnoses for risk adjustment.
Wuhan Coronavirus (2019-nCoV): What are the DOH and MSSNY doing now?
The DOH: Response & preparation: With the World Health Organization declaring the Wuhan Coronavirus a global health emergency, MSSNY is participating in a bi-weekly conference call with the New York State Department of Health (DOH) regarding preparation and response efforts. As you know, test results are awaited for several cases. The DOH has issued guidance on January 17, 2020. You can view that guidance at: http://www.mssnyenews.org/wp-content/uploads/2020/01/Notification_102455.pdf . The DOH also has a website dedicated to the coronavirus: https://www.health.ny.gov/diseases/communicable/coronavirus/
MSSNY: On February 19, 2020, from 6:00 p.m. to 8:00 p.m., MSSNY will offer a virtual drill titled "Incident Command System and Crisis Communications." While this drill uses a biological scenario that isn't the coronavirus, it does provide essential information on the DOH's incident command system, and on the communications that will be employed if the coronavirus outbreak becomes much larger. The drill will outline the local, state, and national chain of command for a public health emergency, and will stress the importance of planning for medical surge. Faculty are: Arthur Cooper, MD; Pat Anders, MS, MEP; William Valenti, MD and Lorraine Giordano, MD. Educational objectives are:
- To obtain information about the local, state and national chain of command in a public health emergency, and to learn how to access resources.
- To understand the importance of planning for medical surge and the triage of patients during a health emergency, as well as staff and family considerations, in the office-based practice setting.
- To develop an understanding that all public health emergencies can potentially have mental-health implications for survivors, and for others connected with the event.
- To acquire skills for managing patients in a public health emergency
Also: On March 18, 2020, MSSNY will offer a webinar on Wuhan coronavirus (2019-nCoV), conducted by William Valenti, MD, chair of MSSNY's Infectious Disease Committee. More information will be available shortly on this webinar.