March 4 Albany – Be There! MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF NEW YORK Volume 71 • Number 3 • www.mssny.org Providing Information to Assist Physicians in the State of New York March 2015 Governor Cuomo’s 2015-16 Health Spending Plan: $127.4M Excess Program Continues Governor Cuomo announced his $141.6 billion spending plan for 2015-16. Overall state spending is projected to increase by 1.7%. He projects a budget surplus of $1.8B and proposes to increase spending on Education by $1.1B. Spending on the Medicaid program is projected to increase to $62M. Items of interest to organized medicine in the proposed budget include: • Elimination of the New York physician profile database including the requirements for physicians to update their profiles • Continuation of the Excess program at $127.4M; would establish a new provision that participation is contingent upon a finding that physician or dentist has no outstanding state tax liabilities • Authorization of Retail Clinics – clinics which provide a limited list of services in retail stores- provided that they adhere to regulations which would among other things require them: to be accredited; accept walk ins; adhere to advertising and signage standards; disclose ownership interests; directly employ a medical director; and strengthen primary care through integration of services with the patient’s other health care providers • Regulation of non-hospital owned Urgent Care practices including requiring such urgent care practices to be accredited and approved to operate by the Department of Health. Under this proposal, the Public Health and Health Planning Council (PHHPC) is authorized to: establish the scope of services that Medical Audits: Top Ten Tips for Physicians to Anticipate, Respond and Protect Their Practices This information is provided by Physicians Advocacy Institute (PAI) and the American College of Emergency Physicians (ACEP). Philip Schuh, MSSNY’s Executive Vice President, serves on the PAI Board of Directors. The pressure on both governmental and private payers to reduce the cost of healthcare and the often mistaken, but real, public perception of rampant Medicare and Medicaid fraud has caused both public and private payers to increase audits of all medical providers, including physicians. In addition, medical audits have succeeded in returning billions of dollars to the Medicare and Medicaid programs and private payers. For example, the U.S. Health and Human Services Office of Inspector General (OIG) has found that $7 is returned to the Treasury for every $1 spent on audits. This is in part because the payers have access to providers’ claims data and there are software programs that allow payers to easily review claims data and billing patterns to identify potential issues of inappropriate billing and fraud. Although medical audits can be burdensome to a physician practice and may sometimes result in large demands for repayments, there are things that physicians can do to mitigate the chance of being audited and from adverse outcomes in the event of an audit. The list below is by no means exhaustive, but should serve as a starting point for physicians to consider in preparing for and protecting themselves in the case of an audit. Assess the Risk of an Audit Before It Occurs Governmental contractors and private payers use software programs to compare physicians with others in their specialty to identify physicians who may be over-utilizing 2 certain CPT® codes that have been found to be frequently improperly billed. For example a recent Supplemental Medical Review Contractor (SMRC) audit of Medicare claims found that 61% of the more intensive level Evaluation and Management codes (CPT 99214 and 99215) for claims submitted between July 1, 2011 and December 20, 2012 had been improperly paid Physicians should use one of the readily available commercial products or information available on CMS’ website, such as the Part B Nationalization Summary Data File (BESS), to determine if their billing is out of line with others in their specialty, thereby putting them at risk of an audit. Physicians should also review Medicare’s Comprehensive Error Rate Testing (CERT) report to determine if they are billing codes commonly found to have been improperly paid by Medicare and ensure that they are properly using and documenting these codes. Physicians who do not conduct such an analysis are doing themselves a grave disservice. Not only are such reviews a standard component of an effective fraud and abuse compliance program, but they also serve to show physicians how they are being viewed by payers. The results (Continued on page 12) Join the White Coat Armada on March 4 in Albany! Call your County Executive for more information today! may be provided by urgent care providers; standards for the appropriate referral and continuity of care, staffing, equipment and maintenance and transmission of patient records • Amendment to the OBS statute to require OBS practices to be registered with the Department of Health and to include within the parameters of the OBS law procedures requiring neuraxial anesthesia and major upper or lower extremity regional nerve blocks. Requires that OBS procedures cannot be longer than six hours. Also requires OBS accrediting agencies to: (a) require OBS practices to perform quality improvement and quality assurance activities and utilize ABMS or equivalent certification, hospital privileging or other equivalent methods to determine competence; (b) carry out surveys or complaint/ incident investigations upon department request; and (c) report individual findings of surveys and compliant/incident investigations • Authorization of the Public Health and Health Planning Council (PHHPC) to review the type of procedures performed (Continued on page 9) I-STOP: Beyond the Mandate Most of the recent dialogue surrounding I-STOP, the Internet System for Tracking Over-Prescribing law, has been narrowly focused on the looming March 27, 2015 mandate that all patient medications be prescribed electronically. Last month’s News of New York featured MSSNY’s stance on that deadline, and we urged members to prompt legislators and Governor Cuomo to postpone the e-prescribing mandate by 12 months to March 27, 2016. At press time, the Assembly had not met to vote on the bill to delay the mandate. The fact remains that the mandate is coming – whether it’s March 2015 or March 2016. This month, we take a closer look at how e-prescribing can improve practice workflows, protect against drug misuse and, ultimately help improve patient outcomes. Fight Prescription Drug Abuse Nationwide, drug overdose is the leading cause of death from injury, according to the Centers for Disease Control and Prevention (CDC), with most of those drug overdose deaths (53%) being caused by prescription drugs. An alarming 6.2 million adults in the U.S. use prescription drugs non-medically. Forty-six patients die each day from an overdose of prescription painkillers, and another 6,748 end up in emergency departments for the misuse or abuse of drugs. In 2013, a shocking 22,767 drug overdose deaths were related to pharmaceuticals. This is why the CDC has termed drug abuse as an epidemic, causing more deaths than traffic accidents. In New York state, drug overdose deaths have risen 56% since 1999, according to the CDC, and New York physicians are the first line of defense in preventing drugseeking patients from misusing prescription medications. How E-Prescribing Can Help Firstly, electronic prescribing is simply more secure than paper prescriptions. Paper prescriptions are subject to transcription errors and are targets for theft and tampering, making it relatively easy for drug-seeking patients to alter prescriptions by increasing dosage, frequency or duration of medications. E-prescriptions are also delivered directly to the pharmacy, without exposing the physician’s DEA number to the patient. The consequences of DEA number theft include physician identity theft, temporary inability to prescribe controlled substances and a damaged reputation, to name just a few. Workflow efficiency is another key benefit to implementing e-prescribing. A Medical Group Management study shows that e-prescribing helps practices achieve an average annual savings of $15,769 per full-time physician, per year. Such savings are realized in the form of lower administrative burdens, including reduced time for providers and staff in clarifying and/or otherwise recommunicating with pharmacies and health plans regarding patient prescriptions. Another benefit to using e-prescribing for (Continued on page 11) Inside News HIV Diagnosis and Prevention webinars ��������������� page 3 Why you should go to Albany on March 4 ��������������� page 4 Judges needed at Poster Symposium 5/1 ��������������� page 5 YPS 3/21: Are you a disruptive physician �����������������page 6 Dr. Cohen’s OpEd :“MOC on the Run” ��������������� page 7 U.S. Supreme Court to Decide Whether Providers May Sue Over Medicaid Rates Question: What is the status of the lawsuit over whether or not providers may sue in court over Medicaid rates? Answer: On January 20, 2015, the United States Supreme Court heard oral arguments in Armstrong v. Exceptional Child Center, Inc. The issue to be decided is whether or not healthcare providers have the right to bring suit in federal court over Medicaid rates that they feel are inadequately low. A United States District Court in Idaho ruled that Idaho’s Medicaid rates did not comply with the requirement under federal law that states must assure payments which “are consistent with efficiency, economy and quality of care and are sufficient to enlist enough providers” in the program to ensure adequate access to care. The District Court’s decision was upheld by the United States Court of Appeals for the Ninth Circuit. Idaho Medicaid officials petitioned the United States Supreme Court for review. Their petition was granted with respect to the issue of whether or not providers have a private right of action to enforce the provision of federal law which the Idaho District Court had found the Medicaid program had failed to meet. The legal issue con- cerns the fact that Congress did not provide for a right to enforce the statute in question. The providers argued that the Supremacy Clause of the United States Constitution gives them the right to bring an enforcement action, as the federal law provision mandating sufficient payments takes precedence over the Idaho state statute setting the Medicaid rates. The case is significant, as unless the Supreme Court finds a private right of action for providers to institute such suits, there is no effective enforcement mechanism to ensure that Medicaid rates established by a state are indeed sufficient to meet the standard established under federal law. Absent such a private enforcement right, the only other way to enforce this provision is for the Department of Health and Human Services to withhold federal matching funds from the state. We will continue to follow this case, and report when the Supreme Court issues its opinion. If you have any questions, please contact our Managing Partner, Michael J. Schoppmann, Esq at 1-800-445-0954 or via email at [email protected] HIV 2015: Diagnosis, Treatment And Prevention Webinars Have Begun; Physician Registration Now Available The Medical Society of the State of New York is offering “HIV 2015: Diagnosis, Treatment and Prevention – Current Perspectives.” Faculty is William Valenti, MD, chair of MSSNY’s Infectious Disease Committee, a member of Governor Andrew Cuomo’s “Task Force to End the Epidemic 2020” and co-chair of the Task Force’s clinical care committee. Educational objectives are as follows: • Apply diagnosis and treatment for all HIV infected individuals • Become familiar with the key points of new HIV testing laws and understand the provisions of the HCV law • Implement the new HIV testing algorithm • Describe the activities that can bring HIV to subepidemic proportions and result in individual and community viral load suppression The remaining webinars on this topic (content is the same) will be held on March 10 and March 24 from 7:30-8:30 a.m. Physicians and other providers can register for the webinar at: https://mssny.webex.com. Click on the “Upcoming” tab and select the “Register” button to the right of the program. Seating is limited for the webinars; physicians are encouraged to reserve their spot as soon as possible. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. For assistance in registering or questions, please contact Anna Cioffi at [email protected] org; or at 518-465-8085. The program is supported by a grant from the state Department of Health. MSSNY Partners with Covisint to Assist You with PQRS Reporting Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, -2.0% but it could be more. Understanding the rules can be confusing but is necessary. That’s why we’ve partnered with Covisint to help. They have been a qualified CMS registry since 2008 and have helped thousands of eligible professionals report PQRS successfully. They have the expertise to help you understand how the rules affect you and which reporting options are available. MSSNY members receive a discount ($195); for non-members, the cost is $299. Eligible professionals (EP) can choose to report on one measures group from 25 available measures groups for 20 eligible patients with 11 of the 20 patients required to be Medicare Part-B. EPs who can’t report using the measures group option, or if they prefer, can report between 3-9 individual measures at a 50% reporting rate. EPs, who are part of a group of 10 or more, also have additional requirements to avoid a value modifier penalty. Trust Covisint to provide you with all of the details so you can make an educated decision on the best reporting option for you. Visit Covisint at www.pqrs.covisint.com or contact them at 866.823.3958 for more information. Page 2 • MSSNY’s News of New York • March 2015 40 YEARS STRONG Since 1975, MLMIC has been putting policyholders first. Our premiums are specialty and territory specific, without a profit motive or high operating expenses. We declare dividends to share favorable results with our policyholder owners. And we protect our insureds against loss with effective risk management programs and a vigorous defense that is second to none. Endorsed by MSSNY See what MLMIC can do for you. Call (888) 996-1183 or visit MLMIC.com/physicians March 2015 • MSSNY’s News of New York • Page 3 PRESIDENT’S COLUMN MEDICAL SOCIETY OF THE STATE OF NEW YORK NEWS OF NEW YORK Medical Society of the State of New York Andrew Y. Kleinman, MD President Michael Rosenberg, MD Chairman of the Board Philip A. Schuh, CPA Executive Vice President COMMUNICATIONS AND PUBLICATIONS L. Carlos Zapata, MD, Commissioner News of New York Published by Medical Society of the State of New York Vice President, Communications and Editor Christina Cronin Southard, Editor [email protected] News of New York Staff Julie Vecchione DeSimone, Assistant Editor [email protected] Roseann Raia, Communications Coordinator [email protected] Steven Sachs, Web Administrator [email protected] Susan Herbst, Page Designer News of New York Advertising Representatives For general advertising information contact Christina Cronin Southard Phone 516-488-6100 ext 355 [email protected] The News of New York is published monthly as the official publication of the Medical Society of the State of New York. Information on the publication is available from the Communications Division, Medical Society of the State of New York, 865 Merrick Avenue, P.O. Box 9007, Westbury, NY 11590. The acceptance of a product, service or company as an advertiser or as a membership benefit of the Medical Society of the State of New York does not imply endorsement and/or approval of this product, service or company by the Medical Society of the State of New York. The Member Benefits Committee urges all our physician members to exercise good judgment when purchasing any product or service. Although MSSNY makes efforts to avoid clerical or printing mistakes, errors may occur. In no event shall any liability of MSSNY for clerical or printing mistakes exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement in error if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the error. Liability of MSSNY to the advertiser for the failure to publish or omission of all or any portion of any advertisement shall in no event exceed the charges paid by the advertiser for the advertisement, or for that portion of the advertisement omitted if the primary or essential message of the advertisement has not been totally altered or substantially rendered meaningless as a result of the omission. MSSNY shall not be liable for any special, indirect or inconsequential damages, including lost profits, whether or not foreseeable, that may occur because of an error in any advertisement, or any omission of a part or the whole of any advertisement. See You In Albany March 4 Are you happy with the state of being of a physician these days? I am sure that, like many of us, you do not like the direction it is going. So, what are you going to do about it? If you have concerns, don’t just complain to yourself, in the medical staff room, or on blogs. Bring Andrew Y. your concerns to your legislators Kleinman, MD and other government officials. It has often proved successful. And one way you can productively express your concerns with the state of health care delivery is to show up in Albany for Physician Lobby Day March 4. Let your legislators know in person your concerns with the impact of various policies and detrimental legislative proposals on your patients’ ability to get the care they need. I remember when I first decided to get involved. Several years ago, I remember a colleague angrily describing to me a problem he and other physicians had with a particular insurance company which was inappropriately denying coverage for their claims. It occurred to me that I, too, often found myself complaining but wasn’t doing anything about it. I realized that we needed to stop simply talking to ourselves and instead take action, to bring these concerns to folks who could actually remedy these problems. So I worked with my colleagues in Westchester County to create a “Hassle Factor” log to generate concrete examples of these problems that my colleagues and I experienced, and we brought them to the attention of New York State Attorney General’s office. This produced an AG’s investigation into the practices of this insurance company that resulted in a settlement that called for the company to pay for numerous claims it had previously denied. And that’s just one example. Time and time again, our ability to generate significant physician advocacy providing concrete examples about the impact of bad health care policy on the ability our patients to receive the care they need has produced positive results. Some physicians ask me “What has MSSNY done for me lately”? You Are MSSNY! First of all, let me reiterate that MSSNY is not just a handful of physicians and staff – It is you! It is the embodiment of the tens of thousands of physician members across New York State. Staff can do a lot but in the end we fail or succeed based upon our own direct advocacy to lawmakers and policymakers in support of our goals. And we have succeeded often. Our collective advocacy to the State Legislature has resulted in the rejection of countless well-intended but extremely detrimental proposals that would have raised physician medical liability premiums, inappropriately expanded the scope of numerous non-physicians providers and imposed burdensome government regulation of the care you provide to your patients. Moreover, our collective advocacy has produced numerous laws and enforcement actions that require that health insurers pay you timely, limit the ability of insurers to deny the care you believe your patients need, and better assure comprehensive coverage of out of network care. And we are optimistic that our collective advocacy this year will produce a delay in the March 27 date for required e-prescribing. Many Bumps in the Road But we face so many more challenges. There are proposals to impose heavy-handed regulation of office-based surgery and urgent care sites, authorize corporately owned retail clinics, and require pain management education. Not to mention the numerous threats we again face of bills to increase physician liability exposure and inappropriately expand non-physician scope of practice. And we need to make our legislators more fully aware of the shortcomings of Exchange coverage. I cannot say this enough – Legislative and regulatory success is the product of our collective advocacy. MSSNY staff, MSSNY physician leaders, and YOU! We need you to do your part. Your advocacy, combined with your colleagues, is an essential part of whether we will be successful or not. And it is an essential part of our responsibility to our profession and our patients. Yes, I know your time is very limited, as is mine. But we forfeit the right to complain if we have not taken the time to advocate to our legislators on behalf of our patients. Therefore, we need you to show up at the State Capitol on March 4 along with hundreds of your colleagues to advocate together on behalf of our patients. To register now, click here. https://www.surveymonkey. com/r/6H8VPGC. Don’t let people who didn’t go to medical school dictate how we deliver care to our patients. I’ll see you on March 4. MEDICAL SOCIETY OF THE STATE OF NEW YORK AT YOUR SERVICE MSSNY’S WESTBURY OFFICE Main Phone Number......................................516-488-6100 Toll Free Number...........................................800-523-4405 Main Fax Number..........................................516-488-1267 MSSNY Website......................................... www.mssny.org Extensions for specific services Alliance.. ........................................................................396 Communications............................................................ 351 Computer Information Systems..................................... 361 Member Benefits/Marketing.......................................... 424 Membership Information............................................... 336 Medical, Educational & Scientific Foundation.............. 350 Office of the Executive Vice President.......................... 397 Ombudsman Claims Assistance..................................... 318 Physician Records/Credentials....................................... 367 Socio-Medical Economics............................................. 332 albany office Continuing Medical Education...........518-465-8085 ext.17 Public Health Committees.................518-465-8085 ext. 11 Governmental Affairs.....................................518-465-8085 Fax..................................................................518-465-0976 Other Numbers Committee for Physicians’ Health.................800-338-1833 Dispute Resolution Agency............................516-437-8134 Kern, Augustine, Conroy & Schoppman.......516-294-5432 Page 4 • MSSNY’s News of New York • March 2015 CMS: New Rules for Oversight CMS recently announced new rules that strengthen oversight of Medicare providers and protect taxpayer dollars from bad actors. These new safeguards are designed to prevent providers with unpaid debt from re-entering Medicare, remove providers with patterns or practices of abusive billing and implement other provisions to help save more than $327 million annually. CMS is using new authorities created by the Affordable Care Act to clamp down on Medicare fraud, waste and abuse. CMS currently has in place temporary enrollment moratoria on new ambulance and home health providers in seven fraud hot spots around the country. The moratoria are allowing CMS to target its resources in those areas, including use of fingerprint-based criminal background checks. CMS has demonstrated that removing providers from Medicare has a real impact on savings. For example, the Fraud Prevention System, a predictive analytics technology, identified providers and suppliers who were ultimately revoked, and prevented $81 million from being paid. These new changes allow CMS to: 1. Deny enrollment to providers, suppliers and owners affiliated with any entity that has unpaid Medicare debt; this will prevent people and entities that have incurred substantial Medicare debts from exiting the program and then attempting to re-enroll as a new business to avoid repayment of the outstanding Medicare debt. 2. Deny or revoke the enrollment of a provider or supplier if a managing employee has been convicted of a felony offense that CMS determines to be detrimental to Medicare beneficiaries. The recently implemented background checks will provide CMS with more information about felony convictions for high risk providers or suppliers. 3. Revoke enrollments of providers and suppliers engaging in abuse of billing privileges by demonstrating a pattern or practice of billing for services that do not meet Medicare requirements. A fact sheet regarding the safeguards is available on CMS’s webpage. To see the final rule visit: https://www.federalregister.gov/public-inspection Join MSSNYPAC today at www.mssny.org mssnypaC The Flipped Classroom- iClickers by Robert Goldberg, DO Executive Dean of the Touro College of Osteopathic Medicine (NYC) The administration and faculty of the Harlem Campus of the Touro College of Osteopathic Medicine (Touro COM) in New York City actively strive to advance medical education in all possible ways. In alignment with the recent initiative of the AMA, we look for methods and procedures to improve our curriculum and the very nature of medical education. As a new school we have an opportunity to initiate new methods, as we are free from legacy and traditions that make up the fabric of many other institutions. We believe that through dynamic and measured innovation medical education can evolve in unprecedented ways. We embrace the talents of our medical students, weaned on electronic media, as we develop new and exciting means to present material and core concepts. It is indeed a wonderful time to be in academics, and in particular, to be a dean of a medical school during this sea of change. The concept of the “flipped classroom” is used here at TouroCOM. Through this platform, material is accessible to our students where and when they want to access it. The materials are reviewed before the student enters the classroom. Instructors are then ready and able to engage a class that has been introduced to the subject material so that they at the ready to interact. Use of iClickers This column will explore and present another component of the flipped classroom, the use of iClickers as a device to measures effectiveness of knowledge transfer through the use of video streaming Flipped Classroom model of curriculum delivery. This allows the faculty to measure micro performance and facilitates the ability of the administration to formulate student achievement at the macro level. The flipped classroom model at TouroCOM incorporates electronic content delivery with in-classroom clinical correlation and active student engagement. Video recordings made by the faculty are made available to the students before classroom time. In class, the instructors can present clinical scenarios derived, built from or incorporated in the materials provided to the class. Following the case presentation, well referenced questions are presented and multiple choice answers are listed. Students use personal identifiable iClickers to select their answer. The instructor then projects an array of the initial student responses to the class. Based upon the results, the instructor addresses the action decision points. If there is a high correct response rate as demonstrated in the array, the instructor moves on. If however, the selections show a slight variance, students can be called upon to explain their answer. A discussion ensues. Not Looking for Just the “Right Answer” The purpose of the discussion goes well beyond selecting a “correct answer.” The discussion invites an instructor to engage students in discussions among themselves as they explore the case presentations (along with any lab or imaging results made available) against the framework of the digital content viewed in preparation for the class. Students are encouraged to defend their ideas, learn from their peers and learn critical thinking skills through the process. By doing so in the classroom, fellow students are invited to contribute to the discussion and the faculty is able to coax wide participation. After some discussion, the question is posed again, and the student response then made is included as a component of the student’s course grade. Observations and data show that students are able to draw concise conclusions from the discussions, as evidenced by the correlation to the correct answer. Rather than hearing, “No, you are wrong,” students can explain their reasoning and the faculty can both advise and encourage while providing real time feedback to the class. The student responses for this series of iCLicker responses are electronically recorded, and are tracked and become part of the student’s grade; an added benefit of which is greater than 95% attendance for many sessions. Results Identify Areas Requiring Clarification The sessions also allow the faculty to identify core concepts that may require more time to explain. They will get feedback themselves as to the effectiveness of their audio visual recordings, slide bank and reading assignments. This feedback serves as the driver for edits and improvements to the electronic curricular content, as well as providing evidence to other areas of the school, from the curriculum committee to the admissions committee. Importantly, iClicker sessions allow for delivery across two campuses of TouroCOM, while serving as a platform for distinct in class discussion. Migration from traditional lectures required faculty effort, engagement and ultimately ownership of the system. Now in year three, recording quality has improved along with student grades, and satisfaction. MSSNY welcomes articles discussing topical educational issues from Deans of all New York medical schools. Please contact Christina Southard, VP Communications Division, at 516-488-6100 or email at [email protected] if you are interested in submitting an article to the News of New York. Physician Advocacy Day – An Excellent Opportunity to Engage with Your Elected Representatives Given the added pressure physicians in practice today feel as a result of the imposition of so many new policy changes and new governmental mandates, MSSNY’s Physician’s Advocacy Day on March 4th is an excellent opportunity for physicians to engage with their elected representatives in Albany to express their concern regarding the health policy direction being taken on the state level. (At press time, Advocacy Day had not yet taken place.) And with the enormous leadership changes being taken in the Assembly our advocacy is more important than ever! Last month, we wrote to tell you about an initiative advanced in the proposed budget for FY 2015-16 which would enable the development of corporately owned care settings such as limited service clinics in retail spaces designed to compete with physician primary care practices. We also warned that without your intervention other initiatives in the proposed budget would, if enacted, significantly impose new, costly and burdensome regulation on the care which can be delivered by physician urgent care and office based surgical practices. A new potential threat has arisen in the form of legislation (A.355, Rosenthal) recently reported by the Assembly Health Committee to the Assembly floor which if enacted would require physicians every two years to complete three credit hours of CME in pain management, I-STOP, and drug enforcement administration requirements for prescribing controlled substances; appropriate prescribing; managing acute pain; palliative medicine; prevention, screening and signs of addiction; responses to abuse and addiction and end of life care. While we must aggressively work to combat these threats we must also strive toward enactment of legislation which would: enable truth in advertising by health care professionals; facilitate access by patients to the physician of their choice and bring about reasonable meaningful relief in the medical liability premium burdens physicians must bear. Affecting public change in Albany requires political strength. Political strength is measured in numbers. With new members we will grow stronger. It is more important than ever before for physicians to join MSSNYPAC. If you are a member of MSSNYPAC, thank you! You have shown true dedication to your profession and patients. But we need so many more to also contribute. If you haven’t yet joined, please do so immediately by going to MSSNYPAC under the Governmental Affairs Tab on MSSNY’s new website (direct link: http://bit.ly/1sylHT7). Together all of medicine can achieve tangible objectives which protect physician practices and the patient’s they serve. Please contribute now. Unless we play our fair part in political action, we risk losing further ground to those who seek to take away our ability to control the care we provide to our patients. Physician Judges Needed For HOD Poster Symposium Doctors: If you’re coming to the House of Delegates in Saratoga – or just live in the neighborhood – and are free on Friday afternoon, May 1, from 2 – 4:30 pm, please consider participating as a judge at the MSSNY Resident and Fellow Section Poster Symposium. It’s always an exciting, lively event! Please contact [email protected] or 516-488-6100 extension 383 if you’re interested. Physicians prefer facts to speculation. These are the facts. • The actions of New York State Government deeply affect the professional practice of every single New York physician and the thousands of patients to whom they provide care. • You can substantially influence whether this effect is positive or negative through engaging in collective political action with your colleagues by joining MSSNYPAC – the physician’s political action committee. Every physician in New York State CAN AND SHOULD JOIN MSSNYPAC. Join online or find out more by visiting www.mssnypac.org. March 2015 • MSSNY’s News of New York • Page 5 Members in the News Dr. Thomas Named Medical Director of Rehabilitation Services for MVHS John D. Thomas II, MD has been named medical director of Rehabilitation Services for Mohawk Valley Health System (MVHS). Dr. Thomas has served as medical director for Rehabilitation Services John D. Thomas II, MD at St. Elizabeth Medical Center (SEMC) since 1998. In this role, he consults to several national companies and performs independent evaluations and disability reviews. In addition, Dr. Thomas serves as assistant to the chief medical officer at SEMC. Dr. Thomas attended Hamilton College in Clinton, New York, and the University of the Northeast Medical School in Tampico, Mexico. He completed an Internship at St. Vincent’s Hospital in New York City through New York Medical College and a Residency in Physical Medicine and Rehabilitation at Strong Memorial Hospital through the University of Rochester School of Medicine and Dentistry. He is board certified in Physiatry. A member of MSSNY since 1988, Dr. Thomas is also active in the American Medical Association and has served as both trustee and president of the Oneida County Medical Society. He is a member of the American Academy of Physical Medicine and Rehabilitation, American Academy of Pain Management, American Academy of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Disability Analysts. Are You a Disruptive Physician? Avoid Medicare Penalties Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, - 2.0% but it could be more. Understanding the rules can be confusing but is necessary. Attention MSSNY Members! Save $104 Call (516) 488-6100, Extension 403 or email: [email protected] for your MSSNY Member discount code Use it at the time of submission and receive a discounted submission rate of $195 Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more information. Page 6 • MSSNY’s News of New York • March 2015 Young physicians and residents can learn “how not to be a disruptive physician,” as well as the “hidden rules, regulations and risks” you must watch out for in medical practice, at the combined YPS/ RFS Annual Meetings, Saturday, March 21, 2015. The meetings will be held at MSSNY Downstate, 865 Merrick Avenue, Westbury. Upstate members may participate via webinar at the Monroe County Medical Society, 132 Allens Creek Road, Rochester, NY 14618. Webinar participation from home is also an option if you cannot attend either site in person. Residents start off with breakfast and their business meeting at 8:15; YPs join at 10:00 for the presentation and their business meeting. Lunch will be served at both locations. These presentations will deal with the latest in the evolving rules and regulations governing day to day practice. If you feel there’s too much information out there to keep up with, come and find out what’s really crucial for your practice. Learn best practices for medical records and malpractice risk management, and the importance of communication and how to manage risks attendant to patients and staff. Our presenter is the ever-popular Michael Schoppmann of Kern Augustine Conroy & Schoppmann. Come to network and to discuss relevant issues troubling you; consider running for a leadership position. Register now [email protected] Alliance Save These Dates: March 4, April 30 and May 1! March 4 is Legislation Day in Albany, when we lobby our legislators on behalf of our physician spouses. Registration and breakfast begin at 8:00 am; the program begins at 8:30 am in the EGG. You may register by clicking on this link: www. surveymonkey.com/r/6H8VPGC. Please e-mail Stephanie Cospito at [email protected] gmail.com if you plan to attend. And the 79th AMSSNY Annual Meeting will be held on April 30 and May 1 in Saratoga Springs, in conjunction with the MSSNY House of Delegates. We ask your involvement in both Lobby Day and the Annual Meeting as a show of support to your physician spouse. For additional information, please contact Kathleen Rohrer, AMSSNY Executive Director at [email protected] mssny.org. All across the state this winter, Alliance members have been fund raising for scholarships for students entering health careers and for local not for profits focusing on children and health issues. In Onondaga County, Alliance members are planning a “Doctors’ Day” event honoring their physician spouses. Doctors’ Day was established to honor and pay tribute to members of the medical profession everywhere and to recognize their contributions and continuing dedication. March 30 was chosen as the official day on which to celebrate Doctors’ Day because on this day in 1842, Dr. Crawford W. Long of Jefferson, GA, became the first physician in history to use ether anesthesia during surgery. The official symbol of Doctors’ Day is the red carnation. AMSSNY is proud to support the New York State Physicians Home. While not an actual building, this organization helps physician families in need when a life crisis occurs. Contributions may be sent to Physicians Home, care of Dr. Joseph B. Cleary, President of the Physicians Home, 445 Park Ave, 9th Floor, NY, NY 10022 to honor a friend, family member or physician. Our state Alliance contributes a portion of the funds raised at our Fall Leadership Conference and our Spring Annual Membership meeting to this worthy cause. Our Kings County member, Mrs. Betti Jabbour, has been our liaison to the Physicians Home for the past ten years. Our organized counties in the state still contribute annually to the Physicians Home. Please check out the AMA Alliance online newsletter, The Alliance in Motion, and the online resource, Physician Family, which features topics relating to physicians and spouses throughout life – from residency to retirement. Not a member of AMSSNY? Please contact our Executive Director, Kathleen Rohrer, at [email protected] or call 1-800-523-4405 for an application. We welcome all spouses and domestic partners of physicians. See you in Albany and Saratoga Springs! Op-Ed: MOC on the Run by Joshua Cohen, MD, MPH, MSSNY Councilor In a stunning reversal in February, the American Board of Internal Medicine (ABIM) announced they would suspend aspects of their maintenance of certification (MOC) program, adjust reporting of MOC participation, and hold pricing at or below 2014 rates through 2017. The widely circulated statement, “We got it wrong and sincerely apologize” has been abundantly covered by the media and hailed as a huge victory for those on the front lines of the anti-MOC battle. For those certified by ABIM, the celebrations have begun even as the specifics of the intended changes remain vague. But what does this mean for those certified by other boards? What changes might we expect from the American Board of Medical Specialties (ABMS) which sets policy for all the boards and was the initial impetus for the MOC program? ABIM Statement Let’s look at the ABMS first. Following the ABIM statement, ABMS issued a brief and elusive statement. They stated support for ABIM’s goal of making MOC more meaningful, but still emphasized the requirements of the 2015 Standards for the ABMS Program for MOC. One major component of those standards is a requirement for boards to include the Part IV practice assessment and performance improvement. This subtle challenge of the ABIM announcement may signal an unwillingness of ABMS to allow ABIM to make the proposed changes. Stay tuned for a possible battle which may pit the member board against its parent. For me and other neurologists, a more pressing question is how our board, the American Board of Psychiatry and Neurology (ABPN), will pivot following this shocking move by ABIM. Since the launch of MOC, ABPN has been repeatedly criticized for having one of the most difficult and confusing MOC programs. I remember reading the requirements over and over when they were first released, puzzling over what they meant and how I could comply. Since that time, ABPN has made a number of changes. They worked hard to clarify the requirements as diplomates complained they had no idea what they were supposed to be doing. Their website has a permanent disclaimer, “ABPN’s MOC Program are subject to change ... consult the ABPN website regularly.” Some Changes Last June, I had the incredible opportunity to speak at a joint conference of the American Medical Association (AMA) and the ABMS at which 23 of 24 member boards were in attendance. Some boards shared significant physician-friendly changes they had made or were making to their MOC programs such as open book exams, providing test banks for diplomates containing all possible questions that could appear on the recertification exam, or offering proctored tests from the comfort of one’s home. The ABPN representative did not share any of their own best practices or suggest intent to innovate as these other boards described. However, a few weeks later, the ABPN announced big changes to their MOC program. Now, only one feedback module was needed for Part IV and it could come from patients or peers. Total CME was reduced, as were the number of self assessment modules and performance in practice (PIP) modules. Physicians were no longer required to log activities in the ABPN folio system. Changes were positive and helpful, but diplomates remained aggravated by the cumbersome process. The ABIM announcement provided new hope that further change was on the horizon. Barraged by buoyant diplomates after the ABIM media storm, the ABPN president and CEO,Larry Faulkner, MD, e-mailed diplomates this Tuesday with a response. To many, the tone and approach was surprising. Dr. Faulkner declared, in bold letters no less, that “most of the changes now planned by the ABIM are consistent with policies and practices already in place in the ABPN MOC program.” He rattled off a bullet-pointed list of examples of how the programs are similar. Highlighting the recent ABPN decision to give 3 years of MOC credit to diplomates who completed subspecialty training and passed subspecialty exams, he emphasized the reduced burden on physicians. He indicated that 95% of diplomates pass recertification exams and are given a second chance to pass before certification is pulled. And he touted the ABPN’s success in reducing cost, with a 34% reduction in costs since 2007, including a planned cut of 7% in 2016. Most significantly, he stressed that no other changes in the ABPN’s MOC program are planned at this time. In other words, the fervor around ABIM’s announcement this week will not push the ABPN to reform its program. Will diplomates be assuaged by Dr. Faulkner’s assurances? My guess is no. Looking at the ABIM’s new plan, they go much further than ABPN, especially surrounding the dreaded Part IV. Despite the changes in the past 8 months, the ABPN MOC program continues to have some of the lowest satisfaction of physicians in any board. Telling diplomates that you’re doing great and they should be proud of you may not be ABPN’s best strategy when ire is so great. Expect more grumbling – for ABIM, that seemed to do the trick. This article originally appeared in MedPage Today. MOC Critics Establish an Alternative Board Certification A week after two divergent perspectives on maintenance of certification (MOC) appeared in the New England Journal of Medicine, the author of the opposition paper has offered an alternative route to board certification. In a press release made available January 14, cardiologist Paul Teirstein, MD, from La Jolla, California, announced a continued certification program offered by the National Board of Physicians and Surgeons (NBPAS) that is less costly and requires a fraction of the time required by the MOC program offered through the American Board of Medical Specialties (ABMS). The NBPAS website lists 11 physician board members. Initially, NBPAS will certify only physicians in internal medicine specialties and subspecialties and family practice, founding board member Gregg Stone, MD, professor of medicine at Columbia University in New York City, told Medscape Medical News. Other specialties will follow, he said, although he did not specify a time frame. Cost is $169 for 2-year certification, no matter the number of specialties, NBPAS says. The American Board of Internal Medicine (ABIM) lists recertification costs of $2000 to $2500 over the course of 10 years. The NBPAS website says the application takes less than 15 minutes to complete. Will Qualifying Bodies Accept It? However, the value of the new option is unclear. Currently, some hospitals and insurers require physicians to pass MOC, and some physicians see not certifying as a threat to job security. “This is a grassroots movement which will grow in acceptance relatively rapidly,” Dr Stone said. “I state that because of the widespread outpouring of support we’ve received” for an alternative to MOC. He said he is confident that the numbers of supporters will change demands of certification. In the press release, Dr Teirstein notes that more than 20,000 physicians have signed an online anti-MOC petition. He says the requirements for the new certification will demonstrate lifelong learning after original certification, but with less cost and time. Among the requirements are that a physician: • Must have been previously certified by an ABMS member board • Must have a valid, unrestricted license in at least one US state Must have completed a minimum of 50 hours of continuing medical education within the past 24 months, provided by a recognized provider of the Accreditation Council for Continuing Medical Education. Reprieve Announced: CMS to Shorten 2015 Attestation Reporting Period: from 365 to 90 Days The Centers for Medicare & Medicaid Services (CMS) has announced that it intends to give providers a “reprieve” by issuing a new rule which would “update” the Medicare and Medicaid Electronic Health Records (EHR) incentive programs, and shorten the attestation period in 2015 from 365 to 90 days, in order to help “accommodate” those changes. In a late January blog post (http://ow.ly/ ISBdz), the deputy administrator for innovation and quality and the Chief Medical Officer (CMO) for CMS, Patrick Conway, M.D., stated that CMS is following “multiple tracks” to realign the Meaningful Use program “to reflect the progress toward program goals and be responsive to stakeholder input.” This new rule would be separate from the proposed rule implementing Stage 3 of the Meaningful Use program, which has already been submitted to the Office of Management and Budget for review. It was generally acknowledged, even by CMS, that the 365 day attestation period presented problems, so the proposed changes should be welcome. In addition to shortening the attestation period, CMS is also considering proposals to modify other aspects of the pro- gram in order to match long-term goals, reduce complexity and lessen providers’ reporting burdens, as well as shortening the EMR reporting period in 2015 to 90 days in order to accommodate these changes. ABIM Suspends Part of Controversial Recertification Process The American Board of Internal Medicine (ABIM) has suspended controversial aspects of its maintenance-of-certification (MOC) program, specifically the “Practice Assessment,” “Patient Voice” and “Patient Safety” requirements, for at least two years, and apologized for these provisions. At a recent AMA meeting, physicians pointed out that board-certification is becoming a frequent requirement for credentialing by hospitals, health systems and health insurance plans. Proposals advanced included asking the AMA to pass resolutions opposing discrimination on the basis of board certification by hospitals, employers, state licensing boards, insurers and government programs which could restrict a physician’s right to practice medicine without interference, and asking the AMA to oppose any mandated MOC unless research shows a link between certification and improved patient outcomes. The ABIM, along with the other twenty-three members of the American Board of Medical Specialties, recently changed its recertification process from one that required an examination every ten years to one requiring continuous education and self-assessment. Dr. Richard Baron, President of the ABIM, said, in a letter posted on the Board’s website, http://ow.ly/ IPzkt, that “ABIM clearly got it wrong. We launched programs that weren’t ready and we didn’t deliver an MOC program that physicians found meaningful.” The ABIM now will not revoke an internist’s board certification for noncompletion of the program’s suspended aspects. Allstate Loses Appeal Over $352 Claim Allstate Insurance Co. took a matter to arbitration, appealed to a master arbitrator, tried to have that award vacated by the courts, and finally appealed to the Appellate Division, but lost every round. In Matter of Allstate Ins. Co. v. Westchester Medical Group, “C” was injured in a motor vehicle accident on February 22, 2011 and sought treatment from a medical group. C assigned her no-fault benefits to the medical group, which submitted a claim for $352.81 for medical services rendered. Allstate maintained it was not obligated to pay this sum, contending the medical group failed to respond to its request for “additional verification” to prove the claim. An arbitrator ruled in favor of the medical group on April 25, 2012, finding that the medical group did in fact comply with Allstate’s request, and that Allstate “did not appear to be acting in good faith.” A master arbitrator confirmed the award on July, 23, 2012. On March 18, 2013, the New York State Supreme Court in Nassau County denied Allstate’s petition to vacate the master arbitrator’s award and confirmed the award. Finally, on February 4, 2015, the Appellate Division, Second Department, affirmed the lower court’s ruling and held that Allstate failed to demonstrate any grounds for vacating the master arbitrator’s award. It has taken nearly four years for the medical group to prevail in the litigation and obtain a court order for payment of the $352 claim. For more information on the above items, contact Kern Augustine Conroy & Schoppmann, P.C. at 1-800-445-0954 or viaemail at [email protected] DrLaw.com. March 2015 • MSSNY’s News of New York • Page 7 #BlackLivesMatter – A Challenge to the Medical and Public Health Communities Mary T. Bassett, M.D., M.P.H., Commissioner, New York City Department of Health and Mental Hygiene This article was published on February 18, 2015, at NEJM.org. at http://bit.ly/1AY7KWX Two weeks after a Staten Island grand jury decided not to indict the police officer involved in the death of a black man, Eric Garner, I delivered a lecture on the potential for partnership between academia and health departments to advance health equity. Afterward, a group of medical students approached me to ask what they could do in response to what they saw as an unjust decision and in support of the larger social movement spreading across the United States under the banner #BlackLivesMatter. They had staged “white coat die-ins” but felt that they should do more. I wondered whether others in the medical community would agree that we have a particular responsibility to engage with this agenda. Should health professionals be accountable not only for caring for individual black patients but also for fighting the racism –both institutional and interpersonal – that contributes to poor health in the first place? Should we work harder to ensure that black lives matter? First, it’s essential to acknowledge the legacy of injustice in medical experimentation and the fact that progress has often been made at the expense of certain communities. Researchers exploited black Americans long before and after the infamous Tuskegee syphilis study.4 But there is room for optimism. Over the past two decades, for example, we’ve seen a welcome resurgence in social epidemiology and research documenting health disparities. Whereas stark racial differences in health outcomes have sometimes inappropriately been attributed to biologic or genetic differences in susceptibility to disease or bad individual choices, new methods and theories are allowing for more critical, nuanced analyses, including those examining effects of racism. By studying ways in which racial inequality, alone and in combination with other forms of social inequality (such as those based on class, gender, or sexual preference), harms health, researchers can spur discussions about responsibility and accountability. Who is responsible for poor health outcomes, and how can we change those outcomes? More critical research on racism can help us identify and act on long-standing barriers to health equity. Critical Action There is also much we can do by looking internally at our institutional structures. Though the U.S. physician workforce is more diverse than it was in the past, and some efforts have been made to draw attention to the value of diversity for improving health outcomes, only 4% of U.S. physicians are black, as compared with 13% of the population, and the number of black medical school graduates hasn’t increased noticeably in the past decade.5 Renewed efforts are needed to hire, promote, train, and retain staff of color to fully represent the diversity of the populations we serve. Equally important, we should explicitly discuss how we engage with communities of color to build trust and improve health outcomes. Our target “high-risk” communities, often communities of color, have assets and knowledge; by heeding their beliefs and perspectives and hiring staff from within those communities, we can be more confident that we are promoting the right policies. The converse is also true. If we fail to explicitly examine our policies and fail to engage our staff in discussions of racism and health, especially at this time of public dialogue about race relations, we may unintentionally bolster the status quo even as society is calling for reform. In terms of broader advocacy, some physicians and trainees may choose to participate in peaceful demonstrations; some may write editorials or lead “teach-ins”; others may engage their representatives to demand change in law, policy, and practice. Rightfully or not, medical professionals often have a societal status that gives our voices greater credibility. After the grand-jury decision last November not to indict the police officer who shot a black teenager in Ferguson, Missouri, I wrote to my staff noting that in this time of public outcry, it is important to assert our unwavering commitment to reducing health disparities. We can all do at least that. As a mother of black children, I feel a personal urgency for society to acknowledge racism’s impact on the everyday lives of millions of people in the United States and elsewhere and to act to end discrimination. As a doctor and New York City’s health commissioner, I believe that health professionals have much to contribute to that debate and process. Let’s not sit on the sidelines. As New York City’s health commissioner, I feel a strong moral and professional obligation to encourage critical dialogue and action on issues of racism and health. Ongoing exclusion of and discrimination against people of African descent throughout their life course, along with the legacy of bad past policies, continue to shape patterns of disease distribution and mortality.1 There is great injustice in the daily violence experienced by young black men. But the tragedy of lives cut short is not accounted for entirely, or even mostly, by violence. In New York City, the rate of premature death is 50% higher among black men than among white men, according to my department’s vital statistics data, and this gap reflects dramatic disparities in many health outcomes, including cardiovascular disease, cancer, and HIV. These common medical conditions take lives slowly and quietly – but just as unfairly. True, the black–white gap in life expectancy has been decreasing,2 and the gap is smaller among women than among men. But black women in New York City are still more than 10 times as likely as white women to die in childbirth, according to our 2012 data. Physician Peer Reviewers Independent Contractors New York Licensed – NY Worker’s Compensation Board Certified MES Peer Review Services (PRS) is a URAC accredited leading provider of Independent Physician Peer Review services. In response to continued and anticipated growth, PRS is seeking New York Worker’s Compensation Board Certified Physician Peer Reviewer 1099 Consultants to add to our nationwide panel of peer reviewers. PRS affiliates with reviewers to provide peer reviews for all industries, including, Group Health, Disability and Workers’ Compensation. PRS Reviewer Qualifications and Requirements • Current, unrestricted New York medical license • New York Worker’s Compensation Board Certified • ABMS or AOA Board Certification • At least 5 years of active practice in respective medical discipline • Current active practice providing direct patient care (minimum 8 hrs per week) • Good standing in the National Practitioner Databanks, Departments of Professional Regulations, Offices of Inspector General, etc. • Ability to meet strict turn-around-time requirements • Ability to discuss case under review with the treating provider when required • Ability to work via the secure PRS web portal, which observes federal privacy guidelines Benefits of Working with PRS • Physician reviewers can work remotely wherever they have access to the internet (home, office, etc.) • Review as few or as many cases as your schedule permits (steady, daily, reliable work available for those reviewers who want it) • S ignificant opportunity for substantial extra income • No overhead, no expense To learn more about this advantageous opportunity please contact PRS’ National Network Development Supervisor: Linda French at [email protected] Page 8 • MSSNY’s News of New York • March 2015 Gaps in Morbidity and Mortality Physicians, nurses, and public health professionals witness such inequities daily: certain groups consistently have much higher rates of premature, preventable death and poorer health throughout their lives. Yet even as research on health disparities has helped to document persistent gaps in morbidity and mortality between racial and ethnic groups, there is often a reluctance to address the role of racism in driving these gaps. A search for articles published in the Journal over the past decade, for example, reveals that although more than 300 focused on health disparities, only 14 contained the word “racism” (and half of those were book reviews). I believe that the dearth of critical thinking and writing on racism and health in mainstream medical journals represents a disservice to the medical students who approached me – and to all of us. The World Health Organization proclaimed in 1948 that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”3 Today, both individual and social well-being in communities of color are threatened. If our role is to promote health in this broader sense, what should we do, both individually and collectively? Many health professionals who consider that challenge stumble toward inaction – tackling racism is daunting and often viewed as divisive and requiring action outside our purview. I would like to believe that there are at least three types of action through which we can make a difference: critical research, internal reform, and public advocacy. In reflecting on these possibilities, I add to nearly two centuries of calls for critical thinking and action advanced by black U.S. physicians and their allies. Examining Institutional Structures 1. Krieger N. Discrimination and health inequities. In: Berkman LF, Kawachi I, Glymour M, eds. Social epidemiology. 2nd ed. New York: Oxford University Press, 2014:63-125. 2. Harper S, MacLehose RF, Kaufman JS. Trends in the black-white life expectancy gap among US states, 1990-2009. Health Aff (Millwood) 2014;33:1375-1382 3. Preamble to the constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946: signed on 22 July 1946 by the representatives of 61 States (official records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948 (http://who.int/about/ definition/en/print.html). 4. Washington HA. Medical apartheid: the dark history of medical experimentation on black Americans from colonial times to the present. New York: Doubleday, 2006. 5. Diversity in the physician workforce: facts & figures. Washington, DC: Association of American Medical Colleges, 2014 (http://aamcdiversityfactsandfigures.org/ section-ii-current-status-of-us-physician-workforce/). Physicians Must Start Using Revised 855R Applications Medicare Administrative Contractors (MACs) will require the use of the revised CMS 855R (Reassignment of Benefits) application as of May 31, 2015. The revised CMS 855R were available for use on the CMS website as of December 29, 2014. However, MACs may accept both the current and revised versions of the CMS 855R through May 31, 2015. After May 31, 2015, MACs will return any newly submitted CMS 855R applications on the previous version (07/11) to the provider/supplier with a letter explaining the CMS 855R has been updated and the current version of the CMS 855R (11/12) must be submitted. The revised CMS 855R has been streamlined and some sections have been re-ordered for clarity. It includes an optional section for primary practice location address. This information is shared with other programs, such as Physician Compare, to help beneficiaries identify where their physicians are primarily practicing and must be an address affiliated with the group/organization where the benefits are being reassigned. Cuomo’s Health Spending Plan (Continued from page 1) in outpatient settings, including OBS practices and ASCs for the purpose of (a) identifying the types of procedures performed and the types of anesthesia/sedation administered in such settings; (b) considering whether it is appropriate for such procedures or anesthesia/sedation to be performed in such settings; (c) considering whether settings performing such procedures or administering such anesthesia/sedation are subject to sufficient oversight; (d) considering whether settings performing such procedures or administering such anesthesia/sedation are subject to an equivalent level of oversight regardless of setting; and (e) making recommendations to the department regarding the foregoing • Authorization of the Commissioner to utilize methodologies of reimbursement that are value based. Specifically authorizes a DSRIP performing provider system (PPS) or subset of providers to arrange by contract for the provision of services in exchange for value based reimbursement • Appropriation for MSSNY’s Committee for Physicians’ Health $990,000 • Elimination of existing fees for requesting arbitration of workers compensation cases and certain registration fees for radiologic sites • Establishment of a private equity pilot program, allowing up to five business corporations to make private capital investments to assist in restructuring health care delivery system • Establishment of a $1.4 billion capital construction fund to build a new hospital in Brooklyn and to assist in capital construction and health care integration across upstate New York The Division of Governmental Affairs will continue to review and update our members as more specifics on these proposals become available. Open Letter to MSSNY Physicians Who Signed Up for Veterans Choice Program We thank you for your willingness to assure our veterans can receive the timely quality care they deserve. As you may be aware, Congress recently enacted a law with strong bi-partisan support that would make it easier for veterans to receive timely care by a non-VA physician. The new program, referred to as the “Veterans Choice Program,” enables the VA to enter into provider agreements with non-VA physicians in the community to deliver care to veterans who meet the following eligibility criteria: • Veterans who are unable to receive timely care – defined as wait times of more than 30 days. • Veterans who live too far away from a VA facility – defined as more than 40 miles. Set to sunset in August 2016, the Veterans Choice Program will wind down as the VA ramps up efforts to rebuild its workforce and improve accountability at its facilities. To read an AMA summary of this new program, please click here (summary of the Veterans Choice Program Interim Final Rule ) The AMA has also provided information how physicians can apply to participate in this Veterans Choice Program. Health Net and TriWest are the two VA contractors that are implementing the Veterans Choice Program. Physicians interested in delivering care through the Veterans Choice Program must join the Health Net or TriWest network of non-VA providers. Follow these steps to apply: Step 1: Use the Veterans Choice Program Contractor Map to identify which VA contractor is administering the Veterans Choice Program in your locale. Health Net is the entity operating the program in New York State. Step 2: Review the Conditions of Participation to verify that your practice is configured to participate in the Veterans Choice Program. Step 3: Go to the contractor website to complete the Participating Provider Agreement and join its provider network. Join the Health Net Network® here. Please contact Regina McNally, VP of MSSNY’s Socio-Medical Economics Division, at [email protected] if you have further questions about this new program. March 2015 • MSSNY’s News of New York • Page 9 WHO’S IN CHARGE? Four Ways That Most Doctors Harm Their Online Reputation me dic “Thi s h e r e’s at i o f ap o n s yo u’re a l i s t o f ap p p e r f o ro ve d p ro a l l o we d t p ro ve d rm , w o di sp c e du r en es it ch a rg h t h e amo yo u’re a l l s e , a l i s t u o e f or e ve r y n t yo u’re a we d t o l l o we t hi ng d to yo u d o.” Consider this – 83% of patients use Google to find a doctor. But according to BetterDoctor. com physician marketing expert Dutch Rojas, thousands of doctors hurt their “Google” reputations without even knowing it by committing the following four mistakes: Mistake #1: Not Having a Personal Website Even if you’re included on your practice’s website, having your own personal website is imperative because prospective patients will often Google your name (not the name of your practice) and personal sites can show up higher in Google results. Mistake #2: Ignoring Review Sites You want to ensure that your name, address, specialty, and phone number are up to date so that you don’t lose patients to incorrect contact information on third-party sites. Seems ridiculous doesn’t it? But it’s no more unthinkable than a legislator or an insurance company executive with the power to create legislation that will dictate how a physician can treat a patient. The MSSNY is working hard to make sure that doesn’t happen, but we need your support. Help us keep the healing in the hands of the healers. Mistake #3: Using Bad Photos (Or None at All) High quality photographs are usually a patient’s top request (try head shots on a neutral background) because it makes patients more comfortable, conveys warmth and professionalism, and builds trust. Mistake #4: Doing Your Own Copywriting A professional copywriter can help bring your story to life, propel you higher in Google search rankings (you need pages of 250 words or more) and allow you to show how you’re different from other physicians. Additionally, Rojas suggests that devoting 10 minutes per week to “Googling yourself ” can reveal online reputation issues before they become a big problem. Just like a preventative health checkup, regularly monitoring your “Google health” can work wonders. BetterDoctor.com provides a quick and easy tool that empowers doctors to build and manage their online presence. The Financial Cost of Smoking in New York (1=Lowest, 25=Avg.) • Total Cost per Smoker (Rank) – $1,982,856 (49th) • Tobacco Cost per Smoker (Rank) – $1,527,924 (50th) • Health Care Cost per Smoker (Rank) – $208,467 (46th) • Income Loss per Smoker (Rank) – $233,894 (36th) • Other Costs per Smoker (Rank) – $12,570 (44th) For the full report, please click here. Medical Society of the State of New York www.mssny.org Westbury Headquarters: 865 Merrick Avenue, Westbury, NY 11590 • (516) 488-6100 Who's in Charge.indd 1 Page 10 • MSSNY’s News of New York • March 2015 8/19/14 9:39 AM Not a MSSNY Member? Join Now: 516-488-6100 I-STOP: Beyond the Mandate e-prescribing solutions in the marketplace. As a result of that analysis, MSSNY identified DrFirst as the vendor delivering the most effective stand-alone e-prescribing platform in terms of clinical workflow, ease of use, and cost-effectiveness. MSSNY has partnered with DrFirst to provide MSSNY members with legend drug and controlled substance e-prescribing capabilities bundled together for a special discounted price. (Continued from page1) both legend drugs and controlled substances lies in meeting Meaningful Use requirements in light of the recent schedule change by the DEA for hydrocodone combination products (HCP) from a Schedule III to Schedule II controlled drug. The impact of this change is that with no call-ins or refills permitted, providers are required to create a greater number of new prescriptions for products like Vicodin, which as a result will increase the total number of prescriptions issued. Since Meaningful Use stage 2 requires that more than 50-percent of all prescriptions must be transmitted electronically, an increase in paper prescriptions may push providers out of Meaningful Use compliance. MSSNY Endorses DrFirst Identifying Doctor Shoppers The most significant advance that e-prescribing gives providers is in the improvement to the quality of patient care. Access to patient medication history during the prescribing process gives providers better information about home medications. Combining medication history with automated clinical decision support such as formulary compliance, dose checking, drugto-drug, drug-to-allergy and drug-to-condition alerts helps providers avoid over-prescribing, or prescribing medications that may cause adverse drug events. Accessing patient medication history at the point of e-prescribing also helps providers more easily identify potential doctor shoppers, thus helping to stem prescription misuse. The advantages of e-prescribing for patients are also quite significant. In addition to the patient safety benefits outlined above, patients benefit from the ease and efficiency of e-prescribed medications. Having medications ready when the patient arrives at the pharmacy, with the formulary compliance check already completed by the physician, and any prior authorization activities completed in advance, there are fewer hurdles for patients. This convenience translates into better medication adherence as well since there is virtually no delay in patient access to their initial prescription. Get Ready to E-Prescribe Now The benefits of universal e-prescribing are numerous, which is why MSSNY believes its members should pursue implementation of e-prescribing for both legend drugs and controlled substances now, regardless of the CLASSIFIED ADVERTISING Classified ads can be accessed at www.mssny.org. Click classifieds. APRIL 2015 ISSUE CLOSES March 18 $150 per ad; $200 with Photo PHYSICIANS’ SEARCH SERVICES • ALLIED MEDICAL PLACEMENTS LOCUM TENENS • practice valuation • practice brokerage practice consulting • Real estate for help, information or to place your ad, call 516-488-6100 x355 • Fax 516-488-2188 Office Space Available Park Ave South & 23rd St Manhattan, Space to Rent. Beautiful 18,000 sq. ft. facility on 6th floor of a Class A building with doorman. Impressive entryway, bio reference laboratory drawing station on the floor. Close to major subway and bus lines. Available to select physicians of all specialties Friday and or Saturday.Receptionist available. Ten fully equipped exams rooms of your choice available plus four larger executive exam rooms. Available immediately. For more details Call Henry Weisberg, Business Manager at 646-367-7362 or Cell 718-616-1105. Professional Office/Home in Long Island Centereach, NY-Professional Office Is 1,500 Sq Ft, Five 9x12 Rooms, Reception Area, Waiting Room & Consultation Room, Basement, One Storage Room, Parking For Approx 9 Cars, Building & Parking Handicap Accessible. Attached Colonial Style Home Consists Of 4 Bedrooms, 3.5 Full Baths, Living Room, 15x25 Den, Fireplace, Kitchen, Sun Room, In-Ground Sprinklers, In-Ground Pool with Child Safety Fence. Total With Office Approx 4,200 Sq. Ft. $499,900 RE/MAX Integrity Leaders – Rita Tsoukaris: (631) 332-7897 or Email: [email protected] I-STOP e-prescribing mandate deadline. The value to practitioners and patients is clear, and it is important that practices deploy an e-prescribing solution now to ease the transition and avoid potential hiccups as they transition from paperbased scripts to electronic scripts. Physicians also must go through the DEA – mandated identity proofing process before being permitted to prescribing controlled substances electronically. To support and guide its members, MSSNY’s healthcare information technology committee conducted a thorough analysis of numerous The MSSNY-endorsed software includes DrFirst’s Rcopia® legend drug e-prescribing and DrFirst’s EPCS GoldSM 2.0 controlled substance e-prescribing platforms, packaged for MSSNY as a stand-alone, web-based solution. Providers using Rcopia and EPCS Gold will be able to e-prescribe legend drugs or controlled substances within a single workflow. The software will also support doctors with realtime prescription monitoring, instant access to medication histories for their patients, patientspecific formulary data, and clinical alerts such as drug-drug and drug-allergy interaction warnings. DrFirst will guide MSSNY members through the identity proofing and authentication processes that are required by the Drug Enforcement Agency (DEA) to allow a doctor to prescribe controlled substances electronically. The e-prescribing software also includes DrFirst’s Patient AdvisorSM service, which helps doctors monitor and improve patient adherence to medication therapy, and allows doctors and their staff to process and complete medication prior authorizations electronically, right within the e-prescribing workflow. For more information, MSSNY members can call DrFirst’s MSSNY E-prescribing hotline at 866-980-0553 or visit www.drfirst.com/mssny. OBITUARIES ANUNTA, Boonchuay; Buffalo NY. Died December 26, 2014, age 73. Erie County Medical Society. BLUM, Edmond; New York NY. Died January 20, 2015, age 84. New York County Medical Society. HENRIKSSON, Jan; Roslyn NY. Died December 31, 2014, age 46. Nassau County Medical Society. KIRKPATRICK, Harold James; Glens Falls NY. Died January 07, 2015, age 75. Warren County Medical Society. LEHRFELD, Jerome Warner; Commack NY. Died January 07, 2015, age 83. Nassau County Medical Society. MOUSAW, David F.; Glens Falls NY. Died January 02, 2015, age 69. Warren County Medical Society. NAGEL, Richard J.; Orchard Park NY. Died January 21, 2015, age 86. Erie County Medical Society. OLSON, John Peter; Rochester NY. Died November 27, 2014, age 84. Monroe County Medical Society. PENNISI, Anthony Mario; Rockville Centre NY. Died January 03, 2015, age 87. Nassau County Medical Society. ROMANOWSKI, Richard R.; Buffalo NY. Died January 15, 2015, age 82. Erie County Medical Society. ROSTEING, Horace Michael; Williamsville NY. Died December 24, 2014, age 84. Erie County Medical Society. SLAFF, Bertram A.; New York NY. Died January 14, 2015, age 93. New York County Medical Society. WONG, Santiago Alejan; Medford NY. Died April 09, 2013, age 72. Suffolk County Medical Society. business showcase Upper East Side Office Unique opportunity to acquire spacious,well-appointed psychiatry/ psychotherapy office suite at below market cost. Income earning property in prewar co-op building, UES, four offices, waiting area with fireplace, high ceilings, soundproofing, 2 bathrooms, separate street entrance closed circuit tv and interoffice intercom for security. Call 917-414-3683 Prime Office Space: One block from New York Hospital Two or One Consulting Rooms with two exam rooms, fully equipped, lab, storage, separate Doctors entrance. Call: Ralph I. Lopez M.D.418 East 71st Street 10021(212) 772-8989 or (917) 282-5973 [email protected] Active Orthopedic Office For Rent/Lease In Busy Downtown Flushing Practice has been there for almost 30 years. Excellent Opportunity as a primary or secondary office! Near Flushing Hospital and New York Hospital of Queens. Call (516)642-2155. Place Your Classified Ad In News Of New York! Leasing or Selling Space? Selling your practice or equipment? All Ads $150; $200 with Photo • Call 516-488-6100, ext 355 March 2015 • MSSNY’s News of New York • Page 11 Medical Audits: Top Ten Tips for Physicians to Anticipate, Respond and Protect Their Practices (Continued from page1) of a benchmarking analysis can therefore provide physicians with information critical to tailoring a defense to an audit or a repayment demand. Of particular importance, physicians should understand the proper benchmark for their practice – the more sub-specialized the practice, the more aberrant the physician’s coding may appear when compared with other physicians, even within his or her specialty. For example, a trauma surgeon’s billing and coding will vary dramatically from that of a general surgeon, but a payer’s audit software may compare all surgeons regardless of sub-specialty. Proper benchmarking can also have implications for other payer policies impacting physicians’ bottom line, such as physician designation programs and tiered networks. One way to assess whether a practice’s coding and documentation is consistent with its clinical cases is peer review by other physicians in the practice. Physicians armed with such knowledge, before an audit or demand for repayment, are better equipped to effectively respond when faced with an audit. Ensure that Coding and Billing Practices Comply with Coding Rules and Relevant Medical Policies Before an Audit Occurs Physicians should regularly conduct random audits of their coding and billing practices to ensure that they comply with CPT and other coding rules and the relevant medical policies of the payers to whom they submit claims. As previously stated, the mere fact that a physician’s utilization of a particular code is out-of-line with his or her specialty does not mean that he or she is coding inappropriately. It may simply reflect that particular physician’s patient mix or subspecialty. In addition, physicians often take false comfort in the codes applied by their electronic health record (EHR) systems. It is, however, incumbent on physicians to ensure that their coding and billing practices, including codes and information populated by EHR systems are compliant. To do this, EHR systems should not be set at default levels, physicians should not blindly copy and paste between medical records and a patient’s history and diagnosis codes should relate to conditions addressed on the date of service. Lastly, payers, including Medicare Administrative Contractors (MACs), are increasingly performing pre-payment audits. Although pre-payment reviews can be burdensome, physicians can use them to engage in dialogue with a payer’s medical director to identify why they have been selected for pre-payment review, to ensure that their coding and 4 billing practices comply with a payer’s rules and medical policies, and, where appropriate, to challenge and potentially correct a payer’s application of CPT, other coding rules or Medical Policies. Determine on Whose Behalf an Audit is Being Conducted and The Type and Scope of the Audit Before Responding Third party payers frequently contract with outside vendors to review medical records and to conduct audits, sometimes referred to as “proxy” audits. Unfortunately, these companies do not always identify the payer on whose behalf they are working or the type and scope of the audit – critical information which physicians have the right to know. If either the name of the payer or the type and scope of the audit are not readily apparent from a communication requesting medical records or initiating an audit, physicians should ask and should document the answers. Such information is essential not only for physicians to know what type of audit they are facing but also to confirm that the entity seeking access to the records is legally authorized to access them under HIPAA or any more stringent state law. Depending on the type of the audit, physicians should also carefully consider retaining counsel or other consultants. Retaining counsel is generally recommended when facing audits which could result in findings of fraud, such as Medicare Unified Program Integrity Contractor (UPIC) and Zone Program Integrity Contractor (ZPIC) audits. Pay Attention to Deadlines and Procedures Physicians should designate an individual responsible for responding to medical audits and for keeping physician informed of its progress. Among other things, this individual should calendar all deadlines and document and retain all communications between the practice and the auditors. If a request for medical records or an audit letter includes a deadline for providing the requested information, the practice should either timely respond or immediately seek an extension. In addition, if the request does not specify the deadline, the designated responder should ask. This is critical because failure to understand and meet deadlines can have consequences. Page 12 • MSSNY’s News of New York • March 2015 For example, failure to respond to requests for records within 45 days in a MAC pre-payment review can result in payment denial for the claim. In addition, failure to appeal a Recovery Audit Contractor (RAC) audit finding within the first 30 days can result in recoupment pending appeal, even if an appeal is subsequently filed within the 120-day appeal window. This practice’s designated individual should also verify how and where records are to be submitted. For example, can they be submitted electronically, or, must paper copies be provided? If the practice elects to retain an attorney or other consultant, the practice’s designated individual can also be the point of contact for communications with these outside professionals. Ensure that Medical Records are Complete Before submitting medical records for review, physicians must verify that the records are complete, including adding any documents or test results that had not yet been added to the medical chart. This is critically important because many payers do not allow physicians to supplement the records after the fact, which can result in overpayment demands based on incomplete information. Physicians should review the records and include any explanation or support for any unusual services or tests. In addition, the individual submitting the records should verify that no information has been cut off or omitted in copying, including verification that both sides of two-sided copies were copied. Finally, the individual designated to oversee the audit should retain copies of all records submitted to ensure that any requests for repayments or audit findings are accurate based on the records submitted. When an Auditor’s Overpayment Demand is Based on Extrapolation from a Claims Sample, Ensure that the Methodology is Fair Some payers use extrapolation, the calculation of an alleged overpayment amount based on a review of a sample of a physician’s records. Recovery Auditors (RACs) may not use extrapolation unless they determine that a provider has a sustained or high error rate OR unless an educational corrective action by the MAC has failed to correct any errors. However, a RAC’s determination to use extrapolation cannot be challenged on appeal. Extrapolation is commonly used by commercial payers, using a variety of different formulas. If an auditor or payer demands repayment based on an extrapolation, physicians should endeavor to determine if the claims sample used was randomly selected and the extrapolation methodology is fair. A complete discussion of extrapolation and testing for fairness is included in PAI’s White Paper, Medical Audits: What Physicians Need to Know, which is posted at www.physiciansadvocacyinstitute.org. However, there are some things that a physician can easily do to gauge the fairness of an overpayment amount calculated based on extrapolation. Ensure that Outliers were Removed from Calculation For example, physicians should ensure that all outliers were removed from the calculation, that zero paid claims were removed from the calculation and that underpaid claims, rather than just allegedly overpaid claims, were included in the calculation. Physicians who believe that underpaid claims were not included in the sample or calculation should consider requesting a 100% claims review. Although this can be burdensome for both physicians and payers, it can prevent unfair extrapolation from a small, possibly unrepresentative claim sample, and can also help identify underpaid claims, thereby reducing the amount demanded, or, in some cases, eliminating the demand altogether. Verify Audit Findings Audit findings are often erroneous. In fact, a Department of Health and Human Services Office of the Inspector General (OIG) report issued in August 2013 based on a review of 2010 and 2011 claims found that approximately 44% of all appealed RAC contractors’ findings of alleged overpayments are overturned at the third level of appeal (the ALJ level). (Medicare Recovery Audit Contractors and CMS’s Actions to Address Improper Payments, Referrals of Potential Fraud, and Performance, OEI-04-11-00680, p. 11). Other reports have found even higher success rates for providers on appeal. Therefore, physicians should never assume that an auditor’s findings are accurate. Rather, they should verify the substance of any findings – for example whether a particular code was billed correctly, whether a patient’s diagnosis supported a particular procedure, or whether a required pre-authorization was obtained. They should also check the auditor’s math. When faced with a demand for repayment, physicians often believe that it is easier to just pay the amount demanded. Although that may save time in the shortrun, physicians taking that route not only may pay more than is legitimately owed, but also may be subject to continued demands for re-payment for the same reason in the future. Therefore, if a physician disagrees with the auditor’s findings after objectively reviewing the audit report, he or she should strongly consider filing an appeal. Understand Appellate Rights and Procedures and Appeal All Erroneous Adverse Findings Physicians should understand a payer’s appeals procedures and should timely file any appeal of an erroneous audit finding. Understanding a payer’s appeals procedures is important and can have a significant impact the ultimate result of the audit. For example, the RAC program allows physicians 120 days to file a first level of appeal from a demand for overpayment (the “redetermination” level of appeal). However, unless the first level of appeal is filed within 30 days, the physician will be subject to automatic recoupment of the amount demanded on the 41st day, even if an appeal is subsequently timely filed. Therefore, physicians who believe they have a strong case on appeal should consider filing it within 30 days to avoid recoupment. This is particularly important in light of CMS’ moratorium on submitting appeals to the ALJ level until the current backlog is cleared. (possible cite to Ed Gaines article Significance of the Delays in the Assignment of Administrative Law Judges in Medicare Part B Appeals). As a further example, the RAC appeals process allows for informal discussions as a supplement to the formal appeals. These informal discussions can be useful in having audit findings overturned without having to complete the formal appeals process. Even when audit findings are not changed as a result of informal discussions, they can be useful in understanding the RAC contractor’s reasoning. Physicians should be aware, however, that these informal discussions do not alter any of the deadlines for filing appeals. Include All Necessary Information to Refute Erroneous Audit Findings on Appeal. An appeal of audit findings should be written as if the individual deciding the appeal knows nothing about the audit or the auditor’s findings. Each and every audit finding being appealed should be restated and refuted. If a physician is relying on CPT coding policy or specialty society coding guidance on appeals regarding coding, citations to or copies of these materials should be included in the appeal. Likewise, if a physician is relying on medical literature to refute a finding of lack of medical necessity, a citation to or a copy of the study or article should be included. A summary of a physician’s arguments on appeal should also be included. Address Any Identified Coding and Billing Problems There are times when an audit identifies genuine coding and billing issues. In such cases, physicians should take immediate steps to correct the identified issues and show the payer the remedial measures that have been implemented. For example, a staff member or an electronic medical record system may have applied an incorrect code in certain instances. Or, the correct code may have been applied, but the documentation was not sufficient to support the code. Depending on the payer, the situation of the physician practice, and the circumstances of the demand for repayment, payers may be willing to negotiate reduced payment amounts and/or a plan allowing payment over time. Therefore, if a physician can identify the source of a problem and fix it, a payer may be satisfied that the issue will not recur and as a result be more willing to negotiate a reduced re-payment amount and/or a reasonable payment plan. The information provided in this article constitutes general commentary and information on the issues discussed herein and is not intended to provide legal advice on any specific matter. This article should not be considered legal advice and receipt of it does not create an attorney-client relationship. PAI is a not-for-profit 501(c)(6) advocacy organization whose mission is to advance fair and transparent payment policies and contractual practices by payers and others in order to sustain the profession of medicine for the benefit of patients. ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
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