December 7, 2018

Your Chapter in Action!

NYACP Announces the Steven Walerstein, MD, MACP Advocacy Internship

The Chapter will be honoring the memory of Steven Walerstein, MD, MACP, former Governor and leader of NYACP who passed on September 5th, by changing the very popular and educational Advocacy Internship to the “Steven Walerstein, MD, MACP, Advocacy Internship.”

This internship, which began almost 16 years ago, allows between 4 and 6 medical student students and residents to spend a month rotating in Albany with our Executive Director researching policy, reviewing proposed legislation, meeting with regulators and legislators and understanding how to best represent patient interests as healthcare policy is formulated. To date we have had 45 students and residents rotate through this program.  With Steve’s passion for education and advocacy and his years mentoring students and residents, our Executive Committee felt this would be an appropriate tribute.

We would like to offer any member orleader the opportunity to contribute to a fund that has been established to support the “Steven Walerstein, MD, MACP, Advocacy Internship.” You can send a check, payable to New York ACP Services Inc. to 744 Broadway, Albany, NY 12207, attention Linda Lambert with a notation that it is for the Walerstein Advocacy Internship or use this link to make an online contribution with your credit card. Names of all who make a donation in any amount will be listed as supporters of the Steven Walerstein Advocacy Internship, and his family will be notified of your generosity.

All who knew Steve will remember his tireless efforts on behalf of our profession and his passion for medicine and teaching.  We appreciate your contributions to the Chapter to allow Steve’s spirit to live on.

Practice Management

Opportunities for Financial Sustainability for Behavioral Health Integration Into Physician Practices

With the increasing emphasis on total cost of care and BH Integration being included in many reform initiatives (DSRIP, NYSPCMH, MIPS/MACRA), physicians are looking for ways to address BH issues in their practices. Historically, the reimbursement for BH Integration has been lacking, making sustainability difficult, but recent changes at the state and federal level provide additional reimbursement for primary care practices providing evidence-based integrated care.

The Collaborative Care Model (CC) is the most evidence-based approach to integrating Behavioral Health services into Primary Care. CC is based on the chronic care model, applying the chronic disease framework of treat to target to BH diagnoses. In the same way you would monitor the A1c of a patient with diabetes, you monitor a patient’s PHQ-9 over time. This provides a framework for both patients and providers to see improvement or identify when a treatment isn’t working. All of this is done with the support of an embedded BH professional. This provider works with the PCP as part of the primary care team to provide care management and brief therapeutic interventions.  CC practices also have the support of a psychiatric consultant that can provide input on patients that are not improving and provide PCPs with support for psychopharmacology.

The CC model, though very effective, does not fit into most traditional reimbursement models. The NYS Office of Mental Health developed a new reimbursement mechanism to address some of the challenges of the current financing system. The NYS Collaborative Care Medicaid Program provides a monthly case rate reimbursement for primary care providers following the CC model of integration. The monthly payment of $112.50 allows physicians to cover costs of the services involved in integrated care that are not otherwise billable. This monthly rate can be layered on top of other services provided such as screening. As of 2018, CMS announced Medicare CPT codes for Collaborative Care as well, and many commercial plans are paying for these CPT codes now. These CPT codes are also a monthly rate, like the NYS Medicaid Program. 

A breakdown of the Medicare payment can be found here

The NYS OMH also offers free implementation training and support to help practices get up and running with the CC model and take advantage of these payment opportunities. For more information, contact amy.jones@omh.ny.gov

Medications: A Practical Way to Get Comfortable with Cost Conversations

Are cost conversations still uncomfortable and awkward? Starting with a familiar topic is a practical way to make these conversations comfortable for physicians, staff and patients.

So, let’s start with medications! The review and reconciliation of medication lists is already a familiar and necessary routine during visits. Cost concerns can be uncovered by making a simple shift in the types of questions being asked.

We are only scratching the surface with medication costs considering the extent to which it affects adherence. One physician found that 65% of his patients did not fill their prescriptions due to cost (48%) or coverage (38%) reasons.¹ Another study found that abandonment didn’t just occur with high out-of-pocket costs. Even medications less than $10 were left behind by 10% of patients.² Cost conversations provide the opportunity to identify barriers and improve medication adherence. 

NYACP has 4 simple ways for you to improve cost conversations regarding medications:

1. Invite:  Let patients know that the conversation is welcomed.  Make screening for everyone part of the normal routine.  When something is normal, it becomes comfortable.  Screening all patients is important because socio-economic status can change at any time.  At check-in, give the patient their medication list along with screening questions.  They can update and answer them in the waiting room.  
   
   Adjust the questions being asked at the visit.  Avoid questions with a yes/no answer.  Focus on “how” and “when” medications are taken instead of “IF” they are taken.
    
2. Respond:  Thank the patient for sharing.  Reassure them that you will work together to help them.  Focusing on circumstances that are similar to other patients will help.  For example, “Many people have trouble [filling or] taking their medications on a regular basis.  Do you find this is the case for any of your medications?”
    
3. Act:  Use available tools and look up formulary information in the EHR or FormularyLookup.com.  Provide cost vs. convenience options to the patient (i.e. cut pills to save cost or take one pill for convenience).  Refer patients to tools and provide them with a backup plan.  Doctor R. Adams Dudley, a pulmonologist in San Francisco, frequently explains to his patients, ‘I think I’m giving you a low-cost regimen, given your insurance. If you get to the pharmacy and it’s not, tell them to come back to me with what a low-cost regimen would be.’³
    
4. Share:  Compile a list of resources and at least one person or organization that the patient can contact to resolve unanswered questions.  This will help you keep the visit focused appropriately and assist the patient with addressing their concerns. 

NYACP’s Cost of Care Conversation guide for Medications contains a list of resources, medication price transparency tools and a tip sheet for patients. It outlines what you can do, say, use and give for each of the steps listed above. Use it to improve medication adherence conversations and to ease into the topic of cost. Chances are, if your patient is concerned about medications costs, they have concerns about other costs too. Once you are comfortable, you can apply cost conversations to other topics without it being awkward!

CITED WORKS

1. Kronemyer, B. (2018, May 1). Cost is a barrier to medication adherence. Dermatology Times. Retrieved November 27, 2018, from http://www.dermatologytimes.com/current-and-emerging-treatments-acne/cost-barrier-medication-adherence

2. Jalpa A. Doshi, P. L. (2018). Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents. Research Brief, Leonard Davis Institute of Health Economics. Retrieved November 27, 2018, from https://ldi.upenn.edu/brief/association-patient-out-pocket-costs-prescription-abandonment-and-delay-fills-novel-oral

3. Kelley, T. (2018, June 3). When the Cost of Medications Keeps Patients from Taking Them. Managed Care. Retrieved November 2018, 2018, from https://www.managedcaremag.com/archives/2018/6/when-cost-medications-keeps-patients-taking-them

NYACP Hudson Valley Region Governor Election Results

Daniel Pomerantz, MD, FACP has been elected by the members of the Hudson Valley Region to serve as NYACP Hudson Valley Governor in 2020.

Daniel Pomerantz, MD, FACP, is the Director of Ambulatory Care and Palliative Care, as well as the Associate Program Director of Internal Medicine for Montefiore New Rochelle Hospital (MNR). He has been an active participant in ACP and the New York Chapter for over a decade, serving as the Hudson Valley South District Councilor, a judge for several Poster Competitions, as well as being a member of the Pain Management Task Force. In addition, he was awarded the NY Chapter Laureate Award in 2017 for outstanding commitment to excellence in medical care, education, and service to the community and the College. Dr. Pomerantz will start his term as Governor-elect after the Annual Business Meeting in Philadelphia, PA on April 10, 2019. Dr. Pomerantz will take office as Governor in April of 2020.

We want to acknowledge Kelly Ramsey, MD, FACP, for her leadership and willingness to be nominated, and to run for this role. We applaud her for her past and continuing service to the Chapter. She is the Medical Director for Substance Use Disorders at HRHCare. As a leader in ACP and NYACP, she has been a member of the Health and Public Policy Committee, the Pain Management Task Force, and received the NY Chapter Laureate Award in 2017. She currently serves as the Councilor for the Hudson Valley Region-at-Large, and will be leading the buprenorphine training course for the Chpater in February 2019. 

Please join us in congratulating both Dr. Pomerantz and Dr. Ramsey for their dedication and continuing commitment to their colleagues.

New Federal Legislation Addresses Opioid Crisis: Are You Ready for the Changes?

The SUPPORT Act is a wide-reaching federal law addressing many issues intrinsic to tackling opioid use disorder—including treatment, research, funding and reporting. This alert highlights changes that impact health care providers, pharmaceutical companies, laboratories and pharmacies.

An excerpt: "In summary, the act increases Medicare and Medicaid coverage of various forms of treatment and services related to substance use disorders and focuses on improving treatment options for certain at-risk populations (i.e., seniors, pregnant and postpartum women, infants and children). With respect to telehealth treatment for Medicaid beneficiaries, the Centers for Medicare and Medicaid Services (CMS) will have one year to establish state guidelines to receive federal reimbursement for substance use disorder treatments, including medication-assisted treatments, counseling, medication management and medication adherence with prescribed medication regimes. The legislation also expands Medicaid coverage for services such as medication-assisted treatments (i.e., combating opioid use disorder through prescribing buprenorphine, suboxone and methadone), short-term inpatient treatment programs, bundled payment packages for care and e-health requirements. Individual states will be required to cover medication-assisted treatments, including methadone and counseling services."

Full article on nixonpeabody.com here »

CMS: Program Year 2017 Open Payments Data Available for Review and Dispute Through December 31, 2018

On June 29, 2018 the Centers for Medicare and Medicaid Services (CMS) published Program Year 2017 Open Payments data along with updated and newly submitted data from previous program years (2013-2016). Program Year 2017 data and newly submitted payment records are actively available for review and dispute through December 31, 2018. You can learn more about reviewing and disputing public data here.

Review Now (login required)

Physician and teaching hospital review of the data is voluntary, but strongly encouraged. If you have not previously reviewed the Program Year 2017 data visit this site to review the publicly available data. If you believe any records attributed to you are inaccurate or incorrect in any way you may initiate a dispute and work with the reporting entity to reach a resolution. Please note: CMS does not mediate disputes.

For more information on the review, dispute and correction process visit the Open Payments resource page here.

Access to Quality and Resource Use, PQRS Feedback Reports Available Until December 31, 2018
 

The final performance period for the Value Modifier and Physician Quality Reporting System (PQRS) programs was 2016 and the final payment adjustment year is 2018, and these reports will no longer be available after the end of 2018. All Quality and Resource Use Reports (QRURs) and Physician Quality Reporting System (PQRS) Feedback Reports provided under these programs will remain available for download until December 31, 2018.

Authorized representatives of groups solo practices can access their QRURs and PQRS Feedback Reports here using an Enterprise Identity Management (EIDM) system account with the correct role. The QRURs can be downloaded as PDF or Excel files, and the PQRS Feedback Reports can be downloaded as Excel files. For instructions on signing up for an EIDM account and accessing the QRURs and PQRS Feedback Reports, please visit the How to Obtain a QRUR webpage.

For access to PQRS Taxpayer Identification Number (TIN) or National Provider Identifier (NPI) reports from program year 2013 or earlier, please contact the QualityNet Help Desk, Monday - Friday; 7:00 a.m. - 7:00 p.m. Central Time (CT) as they are no longer available from the “Communication Support Page” section of the QualityNet Secure Portal.

The Merit-based Incentive Payment System (MIPS) under the new Quality Payment Program replaced the Value Modifier and PQRS programs. We encourage everyone to learn more about the Quality Payment Program by visiting qpp.cms.gov. Please note that the QRURs and PQRS Feedback Reports are not the same as the MIPS Performance Feedback that is available under the Quality Payment Program.

Questions:

• For information on your PQRS Feedback Report, visit the Analysis and Payment webpage.
• For information on your QRUR, visit the Value Modifier webpage.
• For assistance with Enterprise Identity Management or PQRS Feedback Reports, contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715- 6222) or qnetsupport@hcqis.org.
• For assistance with the QRURs or Value Modifier, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 4).
• Both help desks are available from 7:00 a.m. to 7:00 p.m. CT, Monday through Friday.

Updates to the ACP Physician and Practice Timeline
^{Courtesy of ACP Advocate}

The Physician and Practice Timeline is an online tool to help physicians stay on top of important dates and track deadlines for a variety of regulatory, payment, educational, and delivery system changes, requirements and opportunities. Recent updates include:

• Quality Payment Program (QPP) 2017 Performance Results Are Out: 95% of eligible clinicians avoid MIPS payment penalties under Pick your Pace, but positive adjustments are “modest.” To learn more, click here.
• QRUR's and PQRS Feedback Reports Access Ends December 31: The final payment adjustment year for the Value Modifier and Physician Quality reporting System (PQRS) is 2018. If you need these reports, download them through December 31, 2018, from the CMS Enterprise Portal here using an Enterprise Identity Management (EIDM) system account.

Access the Physician and Practice Timeline here

NY Department of Health Influenza Surveillance

The New York State Department of Health (NYSDOH) collects, compiles, and analyzes information on influenza and produces this weekly report during the influenza season (October through the following May).

During the week ending November 24, 2018:

• There were 120 laboratory-confirmed influenza reports, a 14% increase over the previous week.
• Of the 1,628 specimens submitted to NYS WHO/NREVSS laboratories, 7 (0.43%) were positive for influenza. 5 were for influenza A, and 2 were influenza B
• Of the 5 specimens submitted to the Wadsworth Center, none were positive for influenza.
• Reports of percent of patient visits or influenza-like illness (ILI³) from ILINet providers was 1.27%, which is below the regional baseline of 3.10%.
• The number of patients hospitalized with laboratory-confirmed influenza was 37, an 19% increase over last week.
• There were no influenza-associated pediatric deaths reported this week, and one pediatric death so far this season.

Read the entire report here.

Education

Brooklyn District Event - earn up to 1 CME Credit!
Wednesday, Dec. 12, 2018
6:30 pm-Registration • 7:00 pm Dinner and Educational Program
Scottadito Osteria Toscana
788A Union Street • Brooklyn, NY
Register Online • Additional Information

Queens District Event - earn up to 1 CME Credit!
Thursday, Dec. 13, 2018
6:30 pm-Registration • 7:00 pm Dinner and Educational Program
Vetro's Restaurant
164-49 Cross Bay Boulevard • Howard Beach, NY
Register Online • Additional Information

NYACP Sponsored
Buprenorphine Waiver Eligibility Training
Friday, February 22, 2019
12:00 pm - 5:00 pm
Desmond Hotel
660 Albany Shaker Road • Albany, NY  12211
Register Online

Save-the-Date
NYACP Annual Scientific Meeting
Saturday, October 12, 2019
More information will be Available soon!

Commissioner's Grand Rounds:
The Science of Aging and Alzheimer's
Friday, December 14th, 2018
2:30pm -4:30pm
Brass Chandelier Room • Monroe Community Hospital
435 East Henrietta Road, Rochester, NY 14620

A growing segment of the New York State population is impacted by Alzheimer's disease but gaps in clinical care remain, particularly around early diagnosis and entry into care. There are numerous benefits to an early diagnosis and quality care management across disease progression.

This session offers clinicians information from leading New York State experts on best practices for diagnosis, care management, and referral to
community support, along with the latest trends in dementia research.

Click here to register to attend in-person or via live webinar.

Submission for CME/MOC Credit on MKSAP 17 Part B is Expiring December 31

You can earn up to 103 CME AMA PRA Category 1 Credits™ for completing all of the 5 MKSAP 17 Part B sections (Endocrinology and Metabolism, General Internal Medicine, Infectious Disease, Nephrology, Pulmonary and Critical Care Medicine) by December 31, 2018.  If you are registered for Maintenance of Certification with the American Board of Internal Medicine, you can use MKSAP 17 to apply for 103 MOC points.

Important Dates

• March 31, 2019: CME and MOC for MKSAP 17's Virtual Dx will expire
• July 31, 2019: CME and MOC for MKSAP 17 Updates 1 will expire
• January 13, CME and MOC for MKSAP 17 2020 Updates 2 will expire
• July 31, 2020 CME and MOC for MKSAP 17 Updates 3 will expire
• January 16, 2021 CME and MOC for MKSAP 17 Updates 4 will expire