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Thank you for visiting the website of the New York State Neurological Society (NYSNS)! You can use the top menu to discover who we are and how to join as well as find resources for neurologists and the most recent updates on our 2016 conference. Feel free to contact us if you have any questions or want more information!


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News

CMS Seeks Comment on Patient Relationship Categories

The Center for Medicare and Medicaid Services (CMS) is announcing the public posting of the Patient Relationship Categories draft list as required under section 101(f) of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

What is the purpose of the Patient Relationship Categories?

MACRA requires that CMS post the draft patient relationship categories and codes for public comment. CMS will analyze the public comments received to inform development of the operational list of Patient Relationship Categories and Codes, to be published in April 2017.  CMS will also consider how these may be used in future resource use measure development.  

A summary, which provides draft patient relationship categories for public comment as well as the CMS policy principles used in developing the draft categories, is now available. The posting includes examples that illustrate how clinicians relate to their patients.  We have also included a number of questions for consideration by the public, which will help us in the development of our operational list of Patient Relationship Categories and Codes.   

Would you like to comment?

To view the Patient Relationship Categories draft list, visit:

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-Feedback.html

Please submit any comments to patientrelationshipcodes@cms.hhs.gov  by August 15, 2016.

The final Patient Relationship Categories list will be available in April 2017, in accordance with the MACRA requirements.

Are There Alternatives to ABPN MOC?

Due to pressure from physician groups, the Oklahoma state legislature has passed a bill, which was signed by the governor on April 11, 2016 that states that MOC cannot be required as a condition of licensure, reimbursement, employment or admitting privileges.  Nothing in the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act shall be construed as to require a physician to secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment or admitting privileges at a hospital in this state. For the purposes of this subsection, “Maintenance of Certification (MOC)” shall mean a continuing education program measuring core competencies in the practice of medicine and surgery and approved by a nationally recognized accrediting organization.

For more information: http://www.oklegislature.gov/BillInfo.aspx?Bill=sb1148&Session=1600

Telehealth Law and MSSNY’s Telemedicine Survey

New York recently joined 28 states plus the District of Columbia in adopting a telemedicine/telehealth reimbursement parity law (the “Telehealth Law”).  The new Telehealth Law became effective January 1, 2016, and makes several significant changes to the New York Public Health Law and the New York Insurance Law.  A copy of the law can be found here.

Telemedicine can be as simple as skyping with your patient for a brief follow-up visit or a more complex service, such as discussion of a patient’s care with other physicians. For payment purposes, the patient must be present at the originating site. In addition, CMS limits areas eligible for telemedicine coverage for Medicare by the use of the this tool. NYS Law requires NYS Licensure for telemedicine services provided to NYS residents.

The Medical Society of the State of New York (MSSNY) is exploring the possibility of providing a member benefit for physicians who may be interested in telemedicine services. MSSNY would appreciate your taking a moment to complete a brief survey. Please click here to take the survey.

2016 PQRS GPRO Registration is Now Open

Groups can register to participate in the 2016 Physician Quality Reporting System (PQRS) Group Reporting Option (GPRO) via the Physician Value – Physician Quality Reporting System (PV-PQRS) Registration System. PQRS GPRO is an option available to groups with 2 or more eligible professionals (EPs). Groups must meet the satisfactory reporting criteria through the PQRS GPRO in order to avoid the -2.0% CY 2018 PQRS payment adjustment. More information is available on the PQRS Payment Adjustment Information web page.

Physicians, nurse practitioners, physician assistants, clinical nurse specialists, and certified registered nurse anesthetists in groups of all sizes and those who are solo practitioners are subject to the Value Modifier in 2018, based on performance in 2016. Avoiding the 2018 PQRS payment adjustment by satisfactorily reporting via a PQRS GPRO is one of the ways groups can avoid the automatic downward payment adjustment (-2.0% or -4.0% depending on the size and composition of the group) and qualify for adjustments based on performance under the Value Modifier in 2018.

Groups can participate in the PQRS program for the 2016 performance period by selecting one of the GPRO reporting mechanisms between April 1, 2016 and June 30, 2016 (11:59 pm EDT):

  • Qualified PQRS Registry.
  • Electronic Health Record (EHR) via Direct EHR using certified EHR technology (CEHRT) or CEHRT via Data Submission Vendor.
  • Web Interface (for groups with 25 or more EPs only).
  • Qualified Clinical Data Registry (QCDR)
  • Consumer Assessment of Health Providers and Systems (CAHPS) for PQRS Survey via a CMS-certified Survey Vendor (as a supplement to another GPRO reporting mechanism). See CAHPS for PQRS Made Simple for complete details.

Groups with 2 or more EPs that choose not to report via the PQRS GPRO in 2016 must ensure that the EPs in the group participate in the PQRS as individuals in 2016 and at least 50 percent of the EPs meet the criteria to avoid the 2018 PQRS payment adjustment in order for the group to avoid the automatic downward payment adjustment and qualify for adjustments based on performance under the Value Modifier in 2018.

The Registration System can be accessed using a valid Enterprise Identify Management (EIDM) account. Instructions for obtaining an EIDM account with the correct role are provided on the PQRS GPRO Registration web page. Instructions for registering to participate in the 2016 PQRS GPRO are provided in the 2016 PQRS GPRO Registration Guide.

2016 PQRS Educational Materials

CMS is pleased to announce the posting of several 2016 PQRS educational materials. Some highlights include:

  • The “2016 Implementation Guide,” available on the PQRS How To Get Started webpage, contains information for individual eligible professionals and PQRS group practices participating in 2016 PQRS.
  • The 2016 PQRS measures documents, for those reporting via the claims and registry reporting mechanism, are located on the PQRS Measures Codes webpage.
  • The 2016 group practice reporting option (GPRO) Web Interface measures documentation is available on the PQRS GPRO Web Interface webpage.
  • The PQRS Spotlight webpage contains a list of all recent documents and resources. Please check this page regularly for updates.

Be sure to look at the reporting mechanism-specific pages for “Made Simple” documents as well as other 2016 PQRS information. 2015 PQRS resources will be transferred to a separate webpage following the 2015 submission period.

For questions regarding 2016 PQRS reporting, please contact the QualityNet Help Desk at1-866-288-8912 (TTY 1-877-715-6222) from 7:00 a.m. to 7:00 p.m. Central Time Monday through Friday, or via e-mail at qnetsupport@hcqis.org.

ICD-10: Maintaining Your Progress

The Centers for Medicare & Medicaid Services (CMS) released a new infographic based on the Next Steps Toolkit to help you analyze your ICD-10 progress. By keeping your systems and resources updated, you can ensure that your organization continues to move forward. Today, we will explore how to maintain your progress.

Keep Your Coding Tools Up to Date

  • ICD-10 updates take place annually on October 1, following the same timeline used for ICD-9 updates. Be sure to keep all your systems and coding tools up to date, and to review the ICD-10-CM and ICD-10-PCS General Coding Guidelines on a regular basis. With quality reporting and other requirements, it�s more important than ever that you update your coding resources at least annually.
  • Led by CMS and CDC, the ICD-10 Coordination and Maintenance (C&M) Committee is responsible for updates to ICD-10. You can submit proposals (sample proposals from September 2015) for diagnosis code updates to CDC at nchsicd10@cdc.gov. The ICD-10 C&M Committee reviews proposals for potential presentation at its March and September meetings.

Keep Up to Date on ICD-10

Visit the CMS ICD-10 website and Roadto10.org for the latest news and official resources, including the Next Steps Toolkit, ICD-10 Quick Start Guide, and a contact list for provider Medicare and Medicaid questions.


Federal Legislative Updates

Medicare currently only reimburses for telestroke consultations in rural areas. The AAN, working jointly with the American Stroke Association, has had legislation introduced in the House to expand this coverage regardless of location. As a result of these efforts this legislation was incorporated into a pending telehealth package developed by a group of bipartisan Senators led by Sen. Brian Schatz (D-HI), and was included in the small list of potential changes being considered to improve care for chronic conditions by the Senate Finance Committee. HR 2799 the Furthering Access to Stroke Telemedicine Act, now has 71 cosponsors and has been included as part of several other larger telemedicine bills. This Neurology on the Hill (NOH) priority has a good chance of passing before the end of 2016.

Another top priority at Neurology on the Hill was gathering congressional support for the BRAIN Initiative. A letter signed by 55 US House members and two Senate members was sent to members of the Appropriations Committee, which will determine funding levels for 2017.

The Senate HELP Committee has passed 19 bills in an effort to create legislation similar to the House passed 21st Century Cures Act. One of the key provisions is the Neurosurveillance Act, which will give the Centers for Disease Control (CDC) the ability to better track incidents of neurological disease in hopes of finding trends and patterns.


State Legislative Updates


AAN Monthly Updates

The 2016 AAN Neurology Compensation and Productivity Survey is now open. By submitting your data confidentially, you will receive later this summer the compiled aggregate results in a complete report and an online customizable results dashboard that allows you to compare your practice characteristics on a national and local level—for FREE. Complete the survey—and encourage your colleagues to fill theirs out as well.

Next month, the AAN kicks off the 2016 Practice Management Webinar series. AAN members get access to all 10 webinars for only $189. Attend the live presentation and ask the expert your questions, or view the recording at your convenience. The 2016 Practice Management Webinar Series will help you gain valuable insight and tools to help navigate through the changes that lay ahead in the new health care landscape.

For more information on AAN practice resources visit our webpage.


MSSNY Monthly Updates

NYS Budget is Victory for MSSNY: State Budget for 2016-17 Finalized

Working through Thursday night into Friday, the Legislature was finalizing the passage of a $147 billion budget for the 2016-17 fiscal year. Importantly, it rejected several proposals that had been of great concern to physicians across New York State. Moreover, the final Budget also provides additional opportunities for certain physicians to receive e-prescribing waivers and leaves open the door to further action to address unpaid Health Republic claims.

The Governor’s crowning achievement was the enactment of an increase in the state’s minimum wage and paid family leave proposals. The latter proposal affords New Yorkers 12 weeks of paid family leave  (to be collected through an employee payroll deduction similar to disability benefits) allowing employees to be paid up to two-thirds of their weekly wage or two-thirds of the state average, whichever is lower.

Among issues on which MSSNY strongly advocated:

  1. Eligibility for Excess Coverage Preserved. The Legislature rejected the programmatic changes advanced by the Executive which would have resulted in over 13,000 physicians who currently have Excess coverage being dropped from the program. Moreover, the Legislature restored the $25M cut to the appropriation for the Excess program thereby continuing funding for the program at its historical level of $127.4M. Also continued was the authority for the Superintendent to set the rate for medical liability premiums.  MSSNY is thankful to leaders and members of both the Senate and Assembly for strongly supporting the restoration of funding for the Excess program and rejecting proposed programmatic changes that would have resulted in over 13,000 physicians losing Excess coverage.
  2. Retail Clinic proposal defeated; at least for now. The final budget does not include language to enable the establishment of ‘limited service’ clinics in retail stores owned by publicly traded corporations such as CVS, Walmart and Walgreens. MSSNY worked with other primary care and specialty medical societies in the defeat of this proposal. MSSNY will remain vigilant to oppose the proposal should it resurface toward the end of session.
  3. Changes to the Workers Compensation program rejected; role of County Medical Societies preserved! The Legislature rejected the Executive’s proposal to expand the list of providers eligible to deliver (and receive payment directly form the W/C program) to include acupuncturists, nurse practitioners, physician assistants, and social workers. Significantly, the Legislature also rejected the proposal to eliminate county medical society review and assistance for physicians looking to be authorized to deliver care. We thank the many county medical society leaders across New York State who took the time to contact their local Senators and Assembly members to express their concerns with this proposal.
  4. Health Republic. The budget expressly articulated the establishment of a fund to be known as the “health republic insurance of New York fund” which “shall consist  of transfers as authorized by the director of the budget, in his or her  sole  discretion,  between  April first,  two thousand sixteen and March thirty-first, two thousand nineteen, from amounts collected as a result of  a  judgement,  stipulation, decree, agreement to settle, assurance of discontinuance, or other legal instrument  resolving  any  claim  or  cause of action, whether filed or unfiled, actual or potential, and  whether  arising  under  common  law,  equity,  or  any  provision  of  law, and all other monies appropriated, credited, or transferred thereto from any other fund or source  pursuant to law”. Any payments to be made from this fund would be made after distribution of Health Republic’s remaining assets in a liquidation proceeding. We are seeking further clarification regarding which monies could be potentially assigned to this fund, and will continue to work with hospital associations to assure the deposit of sufficient monies to fully reimburse physicians and other providers for care provided to patients covered by the now defunct Health Republic. Despite being proposed in the Senate one-House Budget, the final Budget did not contain any provision to eliminate the DFS prior approval of health insurance rates.   We thank the many State Legislators who fought to assure that the State Budget articulate a dedicated funding stream to assure these claims are paid.
  5. No Regressive Tort Measures Included in Budget. Despite renewed attention on certain regressive tort bills including a date of discovery statute of limitations and repeal of the limitations on attorney contingency fees in medical liability cases, the measures were not included as part of the budget. MSSNY has been working collaboratively with GNYHA, HANYS and MLMIC to oppose these measures in the context of the budget. It is anticipated, however, that discussion on these issues will resume as MSSNY seeks to achieve meaningful tort reforms this legislative session.
  6. Elimination of prescriber prevails rejected. The Legislature rejected proposals that would have eliminated “prescriber prevails” protections for prescribing medications to all patients insured through fee for service Medicaid, as well as for several classes of medications for patients insured under Medicaid managed care. The Executive’s proposal would have eliminated these protections for medications for patients covered in the Medicaid program, except for atypical antipsychotic and anti-depressants.
  7. E-Prescribing Exception for Low Volume Prescribers approved.Eprescribing will not be required of prescribers who issue twenty five prescriptions or less each year provided that they submit a certification to that effect to the Department of Health. A certification may be submitted on or before July 1, 2016 and retroactively apply to March 27, 2016. A prescriber who has made a certification on or before the expiration of the current twelve month period may do so for a maximum of three twelve month certifications. While this is a very positive development for low-volume prescribers, the 3-year limit will require this issue to be revisited by MSSNY and the Legislature in 2019. At the same time, the Legislature considered but ultimately did not include language to address concerns raised by MSSNY regarding the onerous and burdensome requirements for physicians without waivers who issue paper prescriptions through the invocation of one of three statutory exceptions and who must submit their name, contact information, patient initials and the reason for which they issued the appear script to an email address  (erx@health.ny.gov) maintained by the bureau of narcotics enforcement. Many state legislators remain interested in addressing this issue, and MSSNY will continue to strongly advocate to reduce or eliminate altogether the requirement for submission of this information.
  8. Modifications to Doctors Across New York (DANY) Program Approved. Changes to the DANY (physician loan repayment and physician practice support) program were made to equalize awards to up to $40,000 per year, reduce the service commitment from five to three years and to allow recipients to receive one but not both awards. MSSNY has been working with other healthcare stakeholders including HANYS, GNYHA, Iroquois Hospital System and ACP to secure these legislative changes to this important program. Allocations to the program added $1M above the historical $8M to provide 25 new DANY slots at $40,000/year each.
  9. Restoration of Medicaid Benefits 30 days Prior to Release from Prison/Jail. The Legislature authorizes the provision of Medicaid benefits, for ‘high needs” inmates who were on Medicaid prior to incarceration in a state prison or local jail, for the 30 days prior to release to pay for transitional services including medical, prescription, and care  coordination services. This authority is contingent on NY applying for and getting CMS approval for offer federal share Medicaid for such services.
  10. Additional funding ($35M) to combat heroin and opioid epidemic. These funds will continue to support prevention, treatment and recovery programs targeted toward chemical dependency, residential service opportunities, and public awareness and education activities.
  11. Prior Authorization for Medicaid Opioid Prescriptions. The final Budget requires Medicaid managed care plans to impose prior authorization requirements for patients with more than 4 opioid analgesic prescriptions in a 30-day period.
  12. Joint Ownership of LLCs by Chiropractors and MDs defeated.The final budget did not incorporate language that had been advanced by the Senate to allow chiropractors and physicians to jointly own and share revenue from their joint partnerships and businesses.
  13.  New monies allocated to MSSNY programs. MSSNY’s Committee for Physicians’ Health (CPH) was  allocation $990,000 to continue its operations and MSSNY was allocated $150,000 under the Veterans Mental Health Training Initiative through which MSSNY, NYSPA and NASW have offered training initiatives for physicians on the diagnosis and treatment of PTSD and TBI in returning veterans and will offer additional training in the future on substance abuse, suicide prevention and appropriate opioid prescribing and pain management for returning veterans
    (DEARS,AUSTER, CLANCY, MCPARTLON)

Survey for Physicians: Start up NY

NY launched Start Up NY in 2011 to stimulate job growth by waiving business, corporate, sales, property, state or local taxes or franchise fees for ten years for companies that relocate or expand in NY. Physician and other health professional practices are excluded from the program. MSSNY and the NYS Academy of Family Physicians are considering support for legislation to allow medical practices and other health care providers to participate in Start Up NY.

We would appreciate your help by completing and returning the following survey.

Please click here to take the five question survey.

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