9.18.18: NYACP Ethics Committee Releases Paper, "What NYACP Members Need to Know About Withholding and Withdrawing Life Sustaining Therapies for Adult Patients Without Capacity"
Medical decision-making on behalf of adult, incapacitated patients can be challenging for physicians. This paper, from the NYACP Ethics Committee, reviews medical decision-making when patients lack capacity, and the 2010 New York State Family Healthcare Decisions Act (FHCDA), a law that governs surrogate decision-making in hospitals as well as nursing homes in the state of New York. In addition, it provides information about a 2015 amendment to this law that allows physicians to provide hospice-eligible, incapacitated patients with no surrogate hospice care in a way that was not previously permissible under the FHCDA, and provides details on the steps that must be taken. The Committee’s guidance is offered to assist Chapter Members as they face difficult patient challenges.
Wewould like to thank the following NYACP Ethics Committee members on producing this timely paper: Ellen C. Meltzer, MD, FACP, Jack P. Freer, MD, FACP, Cynthia S. Pan, MD, FACP, Daniel Pomerantz, MD, FACP, Timothy E. Quill, MD, MACP and Elaine Schattner, MD, FACP, with input from the rest of the Ethics Committee. We especially want to thank Joseph J. Fins, MD, MACP, Division of Medical Ethics Chief at Weill Cornell Medical College and Robert Swidler, Esq., for their guidance and input .
9.18.18: ACP Comments on Medicare Payment Proposal, Offers Alternate Way Forward
The Centers for Medicare & Medicaid Services (CMS) released the proposed rule for the 2019 Medicare physician fee schedule and Quality Payment Program on July 12, 2018, which would change documentation requirements and how physicians are paid for office visits. Since that time, ACP has been reviewing the proposed rule in detail and evaluating potential short- and long-term effects on Internal Medicine specialists, subspecialists, and their patients.
ACP strongly supports CMS easing documentation of E/M services. As ACP has long advocated and asserted, the proposed changes can and should be implemented starting next year, without resulting in reductions in pay for the most complex visits.
The College strongly opposes the proposed change to pay the same for complex cognitive care as more basic care, which would adversely affect internal medicine specialists, subspecialists, and their patients and urges CMS to test alternatives to their proposed flat fee structure.
ACP's comments offer an alternative way forward for CMS to immediately implement changes that will address the adverse impacts of documentation on patient care while preserving the principle that more complex cognitive care must be valued more than less complex care. If CMS eases documentation of E/M services without devaluing complex cognitive care, it would be a big step forward for ACP members and ACP's Patients Before Paperwork initiative.
In its official comment letter to CMS last week addressing the proposed rules, ACP detailed concerns and made recommendations for change. You can read the letter here.
9.18.18: Make Your Voice Heard: Take this Survey on Reducing Administrative from ACP
ACP is continuously working on your behalf to reduce administrative burdens and improve the Medicare payment system, as well as press legislators and regulators for changes that can successfully improve your daily work experience and patient care.
As part of that work, ACP is looking for members to complete this survey on Administrative Tasks and Best Practices. This survey will better assist the College in advocating for reform.
8.15.18: Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session – August 22
On Wednesday, August 22, 2018 from 1:30 p.m. to 3 p.m. ET, the Centers for Medicare & Medicaid Services (CMS) will host a webinar on the CY 2019 Physician Fee Schedule proposed rule.
Proposed changes to the CY 2019 Physician Fee Schedule would increase the amount of time doctors and other clinicians spend with their patients by reducing the burden of Medicare paperwork. During this listening session, CMS experts will briefly cover three provisions from the proposed rule and address clarifying questions to help practitioners formulate written comments for formal submission:
8.15.18: 2017 MIPS Performance Feedback and Payment Adjustment Update
If you submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program website, you can now view your performance feedback and MIPS final score.
CMS originally displayed a single payment adjustment amount, which included an additional adjustment for exceptional performance available to MIPS eligible clinicians and groups with a final score of 70 or greater. However, based on feedback from various clinicians and groups, CMS has updated the system so that the MIPS payment adjustment, and additional adjustment for exceptional performance (if applicable) are now displayed separately. The system will continue to display the total MIPS payment adjustment, which is a sum of MIPS performance and exceptional performance.
How to Access Your Final Score and Feedback
You can access 2017 MIPS performance feedback and final score by:
Upcoming Office Hours
CMS will be hosting an office hours session on August 14 to provide a brief overview of MIPS 2017 performance feedback and targeted review and to answer frequently asked questions.
Title: Performance Feedback and Targeted Review Office Hours Session
8.3.18: FDA Approves Cannabis-Derived Drug
Excerpt Courtesy of Nixon-Peabody
On June 25, the Food and Drug Administration (FDA) approved Epidiolex, the first drug derived from cannabis in the United States. Epidiolex, produced by GW Pharmaceuticals (in the United Kingdom), is derived from cannabidiol (CBD), a non-psychoactive part of cannabis, which is intended to treat patients with Dravet and Lennox-Gastaut syndromes, two rare forms of epilepsy. Clinical trials have demonstrated that patients taking Epidiolex experience 40% less seizures.
Having been approved by the FDA, Epidiolex will now have to be approved by the Drug Enforcement Administration (DEA) before becoming available in jurisdictions that have legalized medical cannabis use. While legislation has been and is being introduced to change cannabis’s current classification as a Schedule I drug with no medical value, CBD, like cannabis, requires DEA reclassification, which is expected to occur within the next 90 days.
While other drugs have been approved to treat Lennox-Gastaut syndrome, Epidiolex is the first also specifically approved for Dravet syndrome. Analysts anticipate that Epidiolex will also be prescribed off-label (for purposes it has not been officially approved for) to treat many epileptic diseases besides Dravet and Lennox-Gastaut syndromes. Additionally, experts believe that Epidiolex’s approval will increase patient safety because it provides a regulated medication with standard dosing and supply to patients who were previously being treated with CBD at home, some without dosage guidance.
8.3.18: New Medicare Card Mailing Update: Wave 4 Begins, Includes New York
CMS started mailing new Medicare cards to Medicare recipients who live in Wave 4 states: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont. CMS will continue to mail new cards to people who live in Wave 3 states, as well as nationwide to those who are new to Medicare.
To ensure that people with Medicare continue to get care, health care providers and suppliers can use either the former Social Security number-based Health Insurance Claim Number or the new alpha-numeric Medicare Beneficiary Identifier (MBI) for all Medicare transactions through December 31, 2019.
Check the mailing strategy as the mailings progress. Continue to direct people with Medicare to Medicare.gov/NewCard for information about the mailings and to sign up to get email about the status of card mailings in their state.CMS is committed to mailing new cards to all people with Medicare by April 2019.
Information on the transition to the new MBI:
8.3.18: In Case You Missed It - Recording of Panel Discussion on E/M Coding Reform
In case you missed it last week, see below for a link to the webcast of the panel discussion on Evaluation & Management Coding:
CMS Administrator Seema Verma, Dr. Rucker, National Coordinator for Health Information Technology, Dr. Kate Goodrich, CMS Chief Medical Officer and Director of CCSQ, Dr. Anand Shah, CMMI Chief Medical Officer, and Dr. Thomas Mason, ONC Chief Medical Officer host an informative live telecast on E/M Coding Reform. Many stakeholders maintain that current CMS evaluation and management documentation guidelines are outdated, complex, ambiguous, and that they fail to distinguish meaningful differences among code levels. CMS has acknowledged that the current guidelines create an administrative burden and increased audit risk for some providers. In response, CMS announced its intention to undertake a multi-year effort—with the input of providers and other stakeholders—to revise the current E/M documentation guidelines.
8.3.18: ACP Publishes Paper on Social Determinants of Health
ACP has published a paper in the Annals of Internal Medicine that examines ways to reduce health care disparities. Addressing Social Determinants to Improve Patient Care and Promote Health Equity provides a set of recommendations aimed at improving patient care and health outcomes, and overcoming the special challenges associated with adverse conditions in which people are born, grow, work, and live. The Chapter's Council reviewed this paper in a lively discussion led by Maria Carney, MD, FACP, NYACP Long Island Governor.
Social determinants of health are non-medical factors that can impact an individual’s overall health and health outcomes. These include conditions that shape a patient’s daily life, such as income, social status and education, their physical environment including access to safe water and clean air; the safety and conditions of their workplace and home; employment opportunities and social support networks; and access to health services. The Council has made several suggestions to ACP to create meaningful resources for our physician members.
7.19.2018: Health Advisory: Outbreak of Hepatitis A Virus (HAV) Infections Among Persons Who Use Drugs and Experiencing Homelessness
The Centers for Disease Control and Prevention (CDC) and state health departments are investigating hepatitis A outbreaks in multiple states among persons reporting drug use and/or homelessness and their contacts. This Health Alert Network (HAN) Advisory informs public health departments, healthcare facilities, and practices providing services to affected populations about these outbreaks of hepatitis A infections and provides guidance to assist in identifying and preventing new infections.
7.3.2018: The Sunshine Act: CMS Posts 2017 Financial Data
The Centers for Medicare & Medicaid Services (CMS) has made available the Open Payments Program Year 2017 data, along with newly submitted and updated payment records for previous program years. The data is accessible here.
Open Payments is a national disclosure program that promotes transparency and accountability by making information about the financial relationships between applicable manufacturers and group purchasing organizations (GPOs) and physicians and teaching hospitals available to the public. Through this program, health care consumers have access to a more transparent healthcare system.
In Program Year 2017, applicable manufacturers and GPOs reported $8.40 billion in payments and ownership and investment interests to physicians and teaching hospitals. This amount is comprised of 11.54 million total records attributable to 628,214 physicians and 1,158 teaching hospitals.
Payments are reported in three payment categories: general payments, research payments, and ownership or investment interests. Payments in the three major reporting categories for Program Year 2017 are:
Over the course of the Open Payments program, CMS has published 53 million records, accounting for $33.42 billion in payments and ownership and investment interests. For more information, please visit: https://www.cms.gov/openPayments/
7.3.2018: What's the Fastest and Easiest Way to Correct a Claim or Request an Appeal?
Recently, National Government Services (NGS) created a chart to assist the provider community in knowing the differences between an appeal Reopening and a Redetermination.
Understanding the differences and the process are very important for quick reimbursement.
There is a substantial difference between a reopening and a redetermination and this guide will assist Part B providers in determining which to use. Please refer to the Reopening versus Redetermination guide to learn the fastest and easiest methods.
7.3.2018: New Medicare Card Mailing Update – Wave 3 Begins, Wave 1 Ends
CMS has been mailing new Medicare cards to Medicare recipients who live in Wave 3 states: Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota and Wisconsin. They will continue to mail new cards to Medicare recipients who live in Wave 2 states and territories (Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon), as well as nationwide to people who are new to Medicare.
CMS has finished mailing most cards to Medicare recipients who live in Wave 1 states: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia. If a Medicare recipient states they did not get a card:
All Medicare Administrative Contractor (MAC) secure portal Medicare Beneficiary Identifier (MBI) look-up tools are ready for use. If you do not already have access, sign up for your MAC’s portal to use the tool. Once we mail the new Medicare card with the MBI to your patient, you can look up MBIs for your Medicare patients when they do not or cannot give them. If the tool indicates the card has not been mailed for your Medicare patient who lives in a geographic location where the card mailing is finished, tell your patient to call 1-800-Medicare (1-800-633-4227).
To ensure people with Medicare continue to get health care services, continue to use the Health Insurance Claim Number (HICN) through December 31, 2019 or until your patient brings in their new card with the new number.
Check this website as the mailings progress. Continue to direct people with Medicare to Medicare.gov/NewCard for information about the mailings and to sign up to get email about the status of card mailings in their state.
CMS is committed to mailing new cards to all people with Medicare by April 2019.
Information on the transition to the new Medicare Beneficiary identifier:
6.21.18: Become a Price Transparency Pioneer Today with NYACP's Early Adopter Incentive Program
Would you like to lead the way? As part of the Helping Physicians Empower Patients initiative, NYACP has an opportunity for members interested in becoming transparency pioneers to apply for an Early Adoption Incentive Program Grant. Practices who agree to participate will receive:
This initiative aims to spread awareness and use of currently available transparency tools. We will provide the skills to facilitate constructive quality and cost conversations with your patients. The overall goal is to help you empower your patients to make informed decisions to improve outcomes. Early adopters are a critical piece in providing key insights and measuring progress. The requirements are simple. We expect participating practices to:
We will kick off the year-long program this summer and spots are limited! To be considered for an Early Adopter Incentive Program Mini Grant Award, please submit an application for each practice location by June 30, 2018.
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 systematic 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: 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:
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.
9.15.17: Stand Together to Prevent Falls: Annual Falls Prevention Day is September 22
Resources for Patients:
7.20.17: Acronym List
Below is an acronym list detailing various acronyms in the medical field.
Last Updated 9.18.18