5.22.18: The New York State Patient Centered Medical Home (NYS PCMH):
On April 1, 2018 the New York State Department of Health (NYSDOH), in collaboration with the National Committee for Quality Assurance (NCQA) launched an innovative model for primary care transformation known as the New York State Patient Centered Medical Home (NYS PCMH). This statewide, innovative advanced primary care approach is characterized by a systemic focus on high quality care, population health and integrated behavioral health.
The NYS PCMH Recognition Program, built upon the NCQA PCMH model, is exclusive to New York State and supports the state’s initiative to improve primary care and promote the Triple Aim: Improving Health, Enhancing Quality, and Reducing Costs.
Benefits and resources available through the NYSDOH:
NCQA and the NYSDOH have developed numerous resources to assist in your transformation journey:
“The project described was supported by Funding Opportunity Number CMS 1G1CMS331402 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.”
4.26.2018: Worker's Compensation Board Announces Proposals to Improve Medical Care for Injured Workers
To increase provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) is proposing an increase to provider fees and adoption of the universal CMS-1500 form to reduce administrative burden, among other measures. Access to quality medical care for injured workers is of utmost importance for a healthy workers' compensation system. When an injured worker has ready access to medical treatment, the worker heals and is restored to function more quickly and completely. This benefits not only the worker, but the employer as well.
On April 17, the Board announced a multipronged approach to address provider concerns around participating in the workers' compensation system and expand injured workers' access to medical care.
Proposal to Increase Medical Fees for All Medical Providers
The Board's current medical fee schedule has remained relatively unchanged since 1996 and remains a significant obstacle to attracting new providers and retaining existing ones. Therefore, the Board will be advancing a regulatory proposal in June to raise provider fees; this will be effective for services provided on or after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. These new fees will ensure providers in New York are receiving fair and reasonable reimbursement for prompt, quality treatment to our injured workers.
Proposal to Reduce Paperwork
Providers have indicated that the unique paperwork requirements in the workers' compensation system result in significant additional administrative costs. Therefore, the Board will be consolidating and eliminating forms, including converting to the use of the CMS-1500 form. The CMS-1500 is the universal claim form used by medical providers to bill health insurers. Careful review and discussion with different stakeholders confirms that the CMS-1500 is easy to use and provides the necessary information. The Board proposes replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. As the CMS-1500 is already used by medical providers and insurance carriers to process claims, the Board anticipates an easy transition to the CMS-1500 and will be working towards a January 1, 2019, implementation date.
Other Enhancements to Improve Access to Quality Medical Care
The Board is also committed to other improvements that will increase access to quality medical care and reduce administrative burdens:
Governor Cuomo continues to support a comprehensive legislative solution that expands the types of providers that may treat injured workers. Currently only physicians, chiropractors, podiatrists, and psychologists can be authorized. The proposed legislation would amend the Workers' Compensation law to conform with the Education law by permitting medical providers who are licensed in New York State to become authorized, opening participation to nurse practitioners, physician's assistants, licensed clinical social workers, and other providers. In most instances, injured workers would be able to seek treatment for their workers' compensation illness and injuries with the same providers they use for non-work related illness and injuries.
4.12.2018: Tips for the New Medicare Card
Excerpt Courtesy of AMA
CMS has started mailing newly-designed Medicare cards with the new Medicare Beneficiary Identifier (MBI), or Medicare Number. People enrolling in Medicare for the first time will be among the first to get the new cards, no matter where they live. Current Medicare beneficiaries will get their new cards on a rolling basis over the coming months. CMS will continue to accept the Health Insurance Claim Number (HICN) through the transition period.
CMS will be using the highest levels of fraud protection while they mail new cards to current Medicare beneficiaries. CMS is committed to mailing new cards to all Medicare beneficiaries over the next year.
4.12.2018: CMS Releases 2018 MIPS Eligibility Tool
You can now use the updated CMS MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-based Incentive Payment System (MIPS). Just enter your National Provider Identifier, or NPI, to find out whether you need to participate during the 2018 performance year.
Changes to Low-Volume Threshold
To reduce the burden on small practices, we’ve changed the eligibility threshold for 2018. Clinicians and groups are now excluded from MIPS if they:
• Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule (PFS)
This means that to be included in MIPS for the 2018 performance period you need to have billed more than $90,000 in Medicare Part B allowed charges for covered professional services under the PFS AND furnished covered professional services under the PFS to more than 200 Medicare Part B enrolled beneficiaries.
Note: The 2018 Participation Lookup Tool Update for Alternative Payment Model (APM) participants will be updated at a later time.
4.12.2018: The Sunshine Act: Program Year 2017 Open Payments Review and Dispute Period Began April 1st
The Sunshine Act, part of the Affordable Care Act, requires that any financial relationships between pharmaceutical industries or applicable manufacturers, and the doctors and hospitals with whom they work be disclosed and available in a public database.
Review and dispute for the Program Year 2017 Open Payments data begins on Sunday, April 1, 2018 and will last until May 15, 2018.
Note: Physicians and teaching hospitals must work directly with the reporting entity to reach a resolution. The Centers for Medicare & Medicaid Services (CMS) does not mediate or moderate disputes.
Physician and teaching hospital review of the data is voluntary, but strongly encouraged. While the opportunity to dispute any data expires at the end of the calendar year in which the record is published, the disputes must be initiated during the 45-day review and dispute period, ending on May 15th, in order to be reflected in the June 30th publication.
CMS will publish the Open Payments Program Year 2017 data and updates to previous program year’s data in June 2018.
If You Have Never Registered In Open Payments Before:
Before you begin, make sure you have your National Provider Identifier (NPI) number and State License Number (SLN). Initial registration is a two-step process and should take approximately 30 minutes:
4.12.2018: Health Advisory for New York: Potential Life-Threatening Vitamin K-Dependent Antagonist Coagulopathy Associated with Synthetic Cannabinoids Use
The New York State Department of Health (NYSDOH) has been notified of an outbreak of patients presenting to Emergency Departments in other states with serious unexplained bleeding. Laboratory investigation has confirmed that some of these patients were exposed to brodifacoum, a long-acting anti-coagulant found in rat poison. This exposure is believed to have come from synthetic cannabinoids contaminated with brodifacoum.
What are the Clinical Signs of Coagulopathy?
Clinical signs of coagulopathy include bruising, nosebleeds, bleeding gums, bleeding disproportionate to injury, vomiting blood, coughing up blood, blood in urine or stool, excessively heavy menstrual bleeding, back or flank pain, altered mental status, feeling faint or fainting, loss of consciousness, and collapse.
4.12.2018: New CDC Training on Antibiotic Stewardship
The Center for Disease Control and Prevention (CDC) is offering online training for antiobiotic stewardship, completely free!
8 hours of free CME:
3.9.2018: Apply to Participate in the 2018 CMS Study on "Burdens Associated with Reporting Quality Measures" to Receive Improvement Activity Credit for 2018
The Centers for Medicare & Medicaid Services (CMS) is conducting the 2018 Burdens Associated with Reporting Quality Measures Study, as outlined in the Quality Payment Program Year 2 final rule (CMS 5522- FC).
CMS is conducting this study to:
Clinicians and groups who are eligible for the Merit-based Incentive Payment System (MIPS) that participate successfully in the study will receive full credit for the 2018 MIPS Improvement Activities performance category. Applications for this study will be accepted through March 23, 2018 and will be notified in spring of 2018 if selected.
Who Should Apply
MIPS-eligible clinicians participating in MIPS as an individual or as part of a group. Clinicians do not need any outside knowledge of MIPS to participate in the study; rather the study team is interested in learning more about clinicians’ experience participating in MIPS.
A limited number of clinicians who are not eligible for MIPS in 2018 will also be included in the study. To check you participation status please see the QPP Website.
Study Requirements: To learn more about the study requirements, please click here
To Apply: Click here to begin your application.
Applicants will be notified by email of their status in spring of 2018.
3.9.2018: Ten Things to Know for the MIPs Reporting Deadline
Deadlines are fast approaching if you plan to submit data for the 2017 Merit-based Incentive Payment System (MIPS) performance period. Don’t wait until the last minute to submit your data. Submit early and often.
The two key dates are:
Now is the time to act. Here are the top 10 things you need to do and know if you are an eligible clinician. This list focuses on reporting via the qpp.cms.gov data submission feature, not on group reporting on via the CMS Web Interface and not on individual reporting on Quality measures via claims submission data.
Note: If you’re not sure if you are required to report for MIPS, enter your National Provider Identifier (NPI) in the MIPS Lookup Tool to find out whether you need to report. Additionally, if you know you are in a MIPS APM or Advanced APM, you can use the APM Lookup Tool.
If you are in an ACO or other APM, make sure you are working with your ACO or APM to make sure they have any patient information they need to report. Remember you need to report on Advancing Care Information measures on your own.
Questions about your participation status or MIPS data submission?
2.16.18: CMS Debuts New Voluntary Bundled Payment Model
The Centers for Medicare and Medicaid Services (CMS) has launched a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced), which is available to organizations in Region II (New York and New Jersey).
The goal of the model is to better support health care providers who invest in practice innovation, care redesign and enhanced care coordination. In BPCI Advanced, participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget while maintaining or improving performance on specific quality measures. Participants bear financial risk, have payments under the model tied to quality performance, and are required to use Certified Electronic Health Record Technology. BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM), as well as a Merit-Based Incentive Payment System APM (MIPS APM) for select Participants beginning in 2019, under the Quality Payment Program.
2.16.18: ACIP 2018 Immunization Schedule
The Advisory Committee on Immunization Practices (ACIP) has released its 2018 adult immunization schedule for patients ages 19 years and older, including changes to herpes zoster and measles, mumps, rubella (MMR) vaccinations.
For herpes zoster, the ACIP recommends that two doses of the recently approved recombinant zoster vaccine (Shingrix) be administered two to six months apart in adults ages 50 years and older regardless of past episodes of herpes zoster or receipt of the zoster vaccine live (Zostavax). In addition, for adults who previously received zoster vaccine live, it recommends that two doses of the recently approved recombinant zoster vaccine be administered two to six months apart at least two months after vaccination with the first vaccine. Finally, for adults ages 60 years or older, the ACIP recommends that either vaccine be administered, although the recombinant zoster vaccine is preferred.
For MMR, the ACIP updated its recommendations to include use of a third dose of a mumps-containing vaccine in adult patients who previously received two doses of a mumps-containing vaccine and are identified as being at increased risk during a mumps outbreak by a public health authority.
Vaccine recommendations in the 2018 schedule, based on age, medical conditions, and other indications, are summarized in two figures and detailed footnotes. A table of contraindications and precautions is also included, as is information on considerations for special populations (for example, pregnant women) and instructions for reporting adverse events and suspected reportable vaccine-preventable diseases, among other topics. The schedule was published by Annals of Internal Medicine on Feb. 6.
A series of videos from ACP explaining the ACIP's 2018 adult immunization schedule is available online.
1.12.18: ADA Releases Updated Standards of Diabetes Care Recommendations
The American Diabetes Association (ADA)'s 2018 update to its Standards of Medical Care in Diabetes makes several notable new recommendations, including a target blood pressure below 140/90 mm Hg for most patients with hypertension, integration of continuous glucose monitoring into care, and routine screening for type 2 diabetes in high-risk youth.
The standards of care were published online Dec. 8 and are available as a supplement to the January 2018 Diabetes Care.
Important changes and updates for patients with diabetes and cardiovascular disease include the following:
12.22.17: Reporting Patients Who Should Not Drive: An FAQ
Laurie Cohen, Esq. of Nixon-Peabody, NYACP's Legal Counsel has developed as list of Frequently Asked Questions updating members on how to handle patients who should not be driving due to temporary or permanent impairment.
The New York State Department of Motor Vehicles (DMV) may suspend or place restrictions upon an individual’s driver license or learner permit if it has reason to believe the individual has a medical condition that may interfere with his or her ability to safely operate a motor vehicle. To that end, the DMV solicits reports by individuals, including police officers, licensed physicians and others, of individuals with medical conditions that may affect his or her driving. Before making such a report, you should review this guidance to ensure that doing so does not violate your patient’s privacy rights, including those pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Forms for such cases are available through the DMV and can be accessed here.
Below is a sample of the frequently asked questions:
Q: Do I have a duty to report to the DMV when I have a patient whose medical condition could affect his or her driving?
A: No. In New York State, a physician is not required to report to the DMV any patient’s medical condition and should not do so in the absence of the patient’s written consent or unless otherwise permitted or compelled to do so, for example, pursuant to a court order.
Q: Am I permitted to make a report to the DMV if I have a patient whose medical condition could affect his or her driving?
A: It depends. If your patient consents in writing, you may disclose his or her protected health information. This circumstance could arise if your patient is involved in a motor vehicle accident, after which time he or she is asked to supply medical documentation to demonstrate his or her fitness to drive. Without your patient’s written consent, and in the absence of one or more circumstances for which disclosure without patient consent is expressly permitted, you may not disclose his or her protected health information.
12.22.17: New York State Department of Health Announces New Medical Marijuana Regulations
On December 8, 2017, the New York State Department of Health announced the filing of regulations that will improve the state's Medical Marijuana Program for patients, practitioners and registered organizations. These regulations, which will go into effect on December 27, 2017, allow for the sale of additional medical marijuana products, an improved experience for patients and visitors at dispensing facilities and the ability for the Department to approve new courses that will allow prospective practitioners to complete their training in a shorter amount of time.
Under the new regulations, registered organizations (ROs) are allowed to manufacture and distribute additional products including topicals such as ointments, lotions and patches; solid and semi-solid products, including chewable and effervescent tablets and lozenges; and certain non-smokable forms of ground plant material. All products are subject to rigorous testing, and the Department reserves the right to exclude inappropriate products or those which pose a threat to public health.
The new regulations also allow prospective patients and practitioners to enter dispensing facilities to speak directly with RO representatives, learn about products and get information about the medical marijuana program. In addition, people other than designated caregivers may accompany patients to dispensing facilities.
Physicians will soon be able to take a shortened version of the currently available four-hour courses required to certify patients for medical marijuana. The Department will work with course providers to offer a two-hour course, which is a typical length for other medical education courses.
The regulations also streamline the manufacturing requirements for medical marijuana products, broaden the capability of registered organizations to advertise, amend security requirements and clarify laboratory testing methods.
Other recent enhancements to New York's Medical Marijuana Program include authorizing five additional registered organizations to manufacture and dispense medical marijuana, adding post-traumatic stress disorder and chronic pain as qualifying conditions, empowering nurse practitioners and physician assistants to certify patients and permitting home delivery.
As of December 8, 2017, there are 38,642 certified patients and 1,358 registered practitioners participating in the program.
For more information on New York's Medical Marijuana Program, please click here.
12.22.17: NYACP Manhattan/Bronx Governor Election Results
Jitendra Barmecha, MD, FACP has been elected by the members Manhattan/Bronx Region to serve as Governor-elect Designee.
Dr. Barmecha is Vice President of Medical Informatics and the Chief Medical Informatics Officer at St. Barnabas Health in the Bronx. He has been an active participant in ACP and the New York Chapter for over a decade, serving as the Bronx District President, Bronx District Councilor, and as the Chair for the former ACO/PCMH Committee. In addition, he was awarded the NY Chapter Laureate Award in 2010 for outstanding commitment to excellence in medical care, education, and service to the community and the College.
Louis Morledge, MD, FACP, ran for the Governorship as well, and we applaud him for his past and continuing service to the Chapter. He is a general internist in private practice as part of the three provider practice in midtown Manhattan, and is the Honorary Police Surgeon for the New York City Police Department. As a leader in ACP and NYACP, he has been a member of the Health and Public Policy Committee, the Small Practices Committee, and the Budget and Finance Committee. He served as the Manhattan District President and is currently Councilor for the Manhattan/Bronx District-at-Large.
Dr. Barmecha will start his term as Governor-elect after the Annual Business Meeting in New Orleans, LA on April 21, 2018. Dr. Barmecha will take office as Governor in April of 2019.
Please join us in congratulating both Dr. Barmecha and Dr. Morledge for their dedication and continuing commitment to their colleagues.
12.11.17: High Value Care: Complete CME and MOC Requirements at Home from the ACP Online Learning Center!
HVC cases aim to improve health, avoid harms, and eliminate wasteful practice and can be completed in 30 to 60 minutes on your computer, tablet, or smart phone. You can review the clinical cases online, answer the associated questions, and read through critiques, as well as download take-home tools that will help you incorporate HVC principles into your practice. Both adult and pediatric cases are available.
Topics covered include:
Don't Delay! 2018 is right around the corner! Find out More About ACP High Value Care here.
11.22.17: ACP Updates "Living with Diabetes" Patient Guidebook
ACP has updated its popular guidebook, “Living with Diabetes: An Everyday Guide for You and Your Family,” with new visuals and a redesigned layout that’s easier for patients to read. This award-winning guidebook helps patients learn about and manage diabetes. Topics include diet, exercise, monitoring blood sugar, the importance of foot exams, and managing insulin and other medicines.
9.15.17: Stand Together to Prevent Falls: Annual Falls Prevention Day is September 22
Resources for Patients:
9.15.17: Information for Physicians and Patients on New York’s Step Therapy/Fail First Reform Law
Governor Cuomo signed legislation on December 31, 2016 that would add new protections for patients when their health insurance plans require them to go through “step therapy” or “fail first” protocols when accessing prescriptions drugs to treat a medical condition(s). The new law took effect on January 1, 2017 but was applicable to “health insurance plans delivered, issued for delivery, or renewed after that date”.
Through stakeholder collaborations, several resource fact sheets have been prepared for both physicians and patients. These documents were created in a Q&A format for the purpose of explaining the law, providing details about requirements and compliance by health insurance plans, and dispensing valuable information about the appeals process.
To read these Fact Sheets, click on the following:
These documents have been provided through a joint collaboration with Reid, McNally, and Savage LLC, and Cary Collaborative Strategies.
8.3.17: New York Establishes a No-Cost Pilot Drug Take-Back Program
Nationwide, 80% of lakes, rivers and streams now contain low levels of pharmaceuticals. Chronic exposure to low levels of medications in the environment, even expired medications, has been shown to harm the fertility of fish and other aquatic animals. Most current municipal wastewater treatment technology is ineffective in intercepting drugs when they are flushed down the toilet. Moreover, unwanted prescription drugs that remain in consumers’ homes are at risk of being abused.
For these reasons, New York State is funding a one million dollar drug take-back program to encourage health care entities to provide for the safe, convenient and effective collection of unused drugs. Health care entities who sign up early can get the costs of their drug take-back programs covered for the first two years of operation.
7.20.17: Acronym List
Below is an acronym list detailing various acronyms in the medical field.
7.18.17: New Medical Marijuana Course from the New York State Department of Health
The New York State Department of Health (NYS DOH) has approved a second course for practitioners on the medical use of marijuana. The four-hour course will be offered by The Medical Cannabis Institute (TMCI Global). The first course was approved in October 2015 and is provided by The Answer Page.
Both courses are available online so that practitioners can take them at their convenience, and both provide continuing medical education (CME) credits. Practitioners are only required to complete one of these courses in order to register with the Department to certify patients for the medical marijuana program.
Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete one of the available approved courses. The Department also streamlined the process for practitioners to register with the program. All practitioners who newly register with the Department will be listed publicly online, unless they opt-out during the registration process, in order to help patients find participating practitioners.
A list of practitioners registered with New York's Medical Marijuana Program who have consented to be publicly listed is available on the Department's website.
For more information on New York's Medical Marijuana Program, visit: https://www.health.ny.gov/regulations/medical_marijuana/.
Last Updated 5.22.18