August 26, 2016 – DOH:Expand Marijuana Program

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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Aug. 26, 2016
Volume 16, Number 30

MLMIC

Dear Colleagues:

The following letter to the editor was sent to the Buffalo News to clarify several misstatements in an article about I-STOP.

The Medical Society of the State of New York (MSSNY) staunchly supports the need to reduce, prevent, and eliminate opioid addiction.

Several points of the Buffalo News article, (“I-STOP Supporters Urge Cuomo to Veto Bills They Say Would Weaken Pill Prescription Legislation”) at http://bit.ly/2bvehjU need clarification. In fact, the efforts of physicians across New York State complying with I-STOP are a major reason for the huge decrease in “doctor-shopping.”

Current law requires prescribers to consult the State’s prescription medication registry before they prescribe ANY controlled substance. This assures that patients are not “doctor shopping” for controlled substances from multiple prescribers. This I-STOP component of the law has been in effect since August 27, 2013 and remains unchanged by proposed legislation.

On March 27, 2016, an additional component of the I-STOP law took effect.  This portion of the I-STOP law mandates that all prescriptions for both controlled and non-controlled drugs be electronically filed to all pharmacies located in New York. There were allowances for a few exceptions to this mandate, such as: a power failure; or, the script would be filled by a pharmacy out of NYS; or, it would be impractical for a patient to obtain an electronically prescribed drug in a timely manner, and the delay could adversely impact the patient’s medical condition.

However, the law requires that any time a paper or oral prescription is used, the prescriber is obligated to send an email to the NYS Department of Health containing a burdensome amount of information.

MSSNY supported legislation that will ease the administrative burden resulting from the patient’s need for expeditious relief, the patient’s need to fill a script out of state, and/or transmission failures.  Electronic transmission of prescriptions have a 3% to 6% failure rate.  Since 255 million prescriptions are filled each year in NYS, between 7.6 and 15 million are subjected to technological failure.  It is unrealistic to expect prescribers to send an email each time an electronic failure causes a prescription to be handwritten or phoned into the pharmacy.

I would not want to be the patient waiting for a necessary prescription and caught in the limbo of today’s technology.  In addition, if patients are traveling out of state, they may need a paper prescription to take with them to be filled when they reach their destination.

Again, the original purpose of I-STOP— the duty to consult the State’s registry before prescribing any controlled substance— has NOT been modified by the new legislation.

Twelve additional exceptions were announced by the Department of Health that do not require reporting  to the DOH— which include compounded drugs, prescriptions that contain long or complicated directions, prescriptions for patients in nursing homes and residential health care facilities as defined in Article 28 of the Public Health Law.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York
Briarcliff Manor, NY
Thomas Madejski, MD
Vice-President, Medical Society of the State of New York
Medina, NY

 

Please send your comments to comments@mssny.org


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DOH: New Report re Use of Marijuana under Compassionate Care Act
The recommendations in a new report, “Medical Use of Marijuana Under the Compassionate Care Act,” published by the DOH this week, stated that New York’s medical marijuana program should double in size and include a broader range of authorized health providers.

Since the program began operations in January, more than 5,000 patients have been certified with the program while more than 600 physicians were registered across the state. The DOH said that’s more than other states whose programs have been in existence for significantly longer than New York’s program.

The DOH made three recommendations tied to increasing access:

·        Doubling the number of suppliers by registering five more organizations over the next two years; allowing nurse practitioners to certify patients

·        Evaluating the possibility of home-delivery services to allow for expanded distribution

·        Recommended exploring ways to make it easier for health-care facilities and schools to possess and administer medical marijuana for patients.

Among the 10 qualifying medical conditions, neuropathies and cancer make up the two largest categories of patients, with 1,704 or 34.1 percent and 1,238 or 24.8 percent, respectively. Pain is cited by 53.5 percent or 3,737 patients as the qualifying complication, while severe or persistent muscle spasms accounts for another 21.1 percent, or 1,477 patients.

AG: HealthNow Revising Mental Health/Nutritional Counseling Coverage
New York Attorney General Eric Schneiderman announced a settlement with HealthNow this week to address the company’s “wrongful denial of thousands of claims for outpatient psychotherapy and more than one hundreds of claims for nutritional counseling for eating disorders”. The wrongful denials totaled more than $1.6 million in patient claims.  The agreement requires HealthNow to pay members for the wrongfully denied claims, revise its policies, and eliminate a company policy that subjected all psychotherapy claims to review after a member’s 20th visit.

To read the AG’s press release, click here. 

According to the press release, the AG’s Health Care Bureau initiated an investigation last year after receiving patient complaints that HealthNow was improperly requiring all outpatient behavioral health visits be preauthorized after the first 20 visits per year, and by excluding coverage for nutritional counseling for eating disorders.  The investigation revealed that since 2012, HealthNow conducted thousands of wrongful reviews in outpatient behavioral health cases under its 20-visit threshold.  As a result, they denied coverage for outpatient behavioral health services for approximately 3,100 members, even though HealthNow generally did not impose the same type of utilization review process for outpatient medical services.

The AG settlement requires HealthNow to eliminate utilization review for outpatient behavioral health treatment based on set thresholds that trigger review, including but not limited to the 20-visit threshold it has applied since 2010. HealthNow will also cover nutritional counseling for eating disorders, including anorexia nervosa and bulimia nervosa. HealthNow will also reimburse members who paid out of pocket for treatment after their claims were denied under the 20-visit threshold or nutritional counseling exclusion, and retrain its staff regarding these reforms.

Consumers with a complaint regarding health insurance coverage for behavioral health treatment, or any other health care-related complaint, may always contact the Attorney General’s Office Health Care Helpline at 800-428-9071.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!



If You Are Thinking of Retiring, Notify All Participating Plans
For doctors who are considering retirement, please be aware that you should notify any plans that you have done business with of your retirement date.

For Medicare, only:

Please be aware of the following:

SE1617 –  Timely Reporting of Provider Enrollment Information Changes

Reviewing your Medicare provider enrollment in the Provider Enrollment Chain Organization System (PECOS) system, takes about 10 minutes.  https://pecos.cms.hhs.gov

Your password for this system is the one you would have obtained when you created your National Provider Identifier (NPI) number.  If you don’t know your password, please call the National Plan & Provider Enumeration System.  The NPI Enumerator may be contacted at the following:  NPI customer service: 800.465.3203 |800.692.2326 (TTY); or, you can email them here.

For Medicaid:

…..end/terminate my enrollment with the Medicaid Program Send a letter to Computer Sciences Corporation, PO Box 4610, Rensselaer, NY 12144-4610, which includes your NPI (if appropriate) and a contact name and telephone number for questions. When your file has been closed, you will receive a notification letter. Questions? Contact CSC at 800-343-9000.

For any other insurance plans, you should notify them of your retirement date.

Plans should be able to update your provider record with the retirement date; but, still pay you for any dates of care provided before that date.
Regina McNally, VP MSSNY Div. Socio-Medical Economics

Sept. 15 Deadline to Apply for Advanced Primary Care Medical Home Model
Comprehensive Primary Care Plus (CPC+), a multi-payer program that will include 5,000 primary care practices nationwide, begins in January 2017. CPC+ is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support delivery of comprehensive primary care. CPC+ builds upon the CPCI demonstration and offers 2 primary care practice “tracks” with incrementally advanced care delivery requirements and payment options to meet the diverse needs of practices.

CPC+ is specifically identified in the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) as an advanced Alternative Payment Model (APM). Most practices that qualify for CPC+ will receive significant additional payment and, by qualifying as an advanced APM, will be excluded from the upcoming Merit-Based Incentive Payment System (MIPS).

Comprehensive Primary Care Plus (CPC+), the CMS Innovation Center’s new national advanced primary care medical home model, is now accepting applications. New York State is one of only 14 regions selected for this initiative. The deadline to apply is Sept. 15.

Who can apply: CPC+ targets primary care practices with varying capabilities to deliver comprehensive primary care. In order to participate, all CPC+ practices must demonstrate multi-payer support, use Certified EHR Technology (CEHRT), and demonstrate other capabilities. CPC+ will provide financial support and educational resources to assist practices with elements such as data collection and team based care that can have an impact far beyond CPC+. Participants from CPCI are eligible and encouraged to apply. Not all practices who apply will be selected, so this webinar is crucial to obtaining the information you to need to apply.

Why CPC+ is important: Besides the additional payments tied to CPC+, practices that participate in CPC+ and meet certain requirements will be excluded from MIPS and will receive the 5% Advanced APM bonus payment on their fee-for-service payments starting in 2019, as per the MACRA law.

CMS is conducting Open Door Forums throughout August and September, featuring Question and Answer sessions, overviews of key model elements, and step-by-step instructions for completing the CPC+ Practice Application. For more information, go here.

This webinar is being conducted specifically for the designated NYS Region to discuss CPC+ with state officials, those who participated in CPCI, and the payers who will be participating in this initiative.

New Report on Protecting New Yorkers from Zika Virus
NYC’s public advocate, Letitia James, released a report, “Protecting New Yorkers from Zika Virus” on protecting New Yorkers from the Zika virus. Recommendations included allowing Medicaid coverage of mosquito repellent when prescribed by a doctor. As of July 29, there were 387 reported cases of Zika virus, including 45 cases involving women who were pregnant.

The Wall Street Journal (8/25) reports that a survey of state and local laboratories suggests that the US has the capacity to perform between 3,500 and 5,000 Zika tests weekly, considerably less than what is required under the Center for Disease Control and Prevention’s worst-case scenario of a Zika outbreak. According to the WSJ, the survey’s findings are likely to spark a rush to expand lab capacity as Zika continues to spread in the US.

Nursing Homes: Sept. 20 Webinar re Challenges/Successes of Quality Initiatives
During a webinar on September 20, from 11 a.m. to 12:30 p.m., three ETTA leadership teams will discuss their journeys, successes, and challenges implementing very different quality improvement initiatives:  communicating effectively with hospital emergency departments, reducing psychoactive medications, and respiratory rounding in the nursing home.

Each presentation will include lessons learned about the vital role effective communication plays in achieving and sustaining success in nursing home quality improvement.

All nursing homes are welcome to register online for this free webinar.

Medical Direction and Medical Care in Nursing Homes Education, Training, and Technical Assistance (ETTA) is a quality improvement initiative funded by the Department of Health to educate nursing home leadership teams about and facilitate the implementation of Medical Director and Attending Physician Guidelines.

During the ETTA Successes from the Field: Part 2—More Quality Improvement Stories webinar on September 20, ETTA leadership teams from Smithtown Center for Rehabilitation & Nursing Care, Crown Nursing & Rehabilitation Center, and Maria Regina Residence will share stories of each of their quality improvement projects.

ETTA provides tools and resources that helped these teams strengthen communication among facility staff, and between the facility and outside partners, including nursing home medical directors and hospital physicians.

All ETTA project materials are easily used by any organization. ETTA tools, resources, archived webinars, and regional workshop learning materials are all available online.

This webinar is free and open to all nursing facilities across the state. Please register online.

Questions Contact our ETTA Program Director, Debbie LeBarron at dlebarro@hanys.org with any questions or concerns. 

Unique Payment Opportunity for Physicians in the Hudson/Capital Region
MSSNY, along with the NYS Department of Health and participating payers, CDPHP, MVP and Empire Blue Cross Blue Shield, invites you join us on a one-hour webinar to learn more about a unique payment opportunity being offered by CMS.

Two options available:
Webinar 1: Tuesday, August 30th
Time: Noon- 1 pm

Register 

Webinar 2: Tuesday August 30th
Time 6:00 – 7:00 pm

Register


CMS Proposes Expansion of Bundled Payments Program Including Cardiac Care Episodes
The CMS Innovation Center) will host a webinar next Wednesday August 31, 2016 from 12:00 to 1:00 PM to discuss its proposal to create a new Medicare bundled payment model for heart attacks and bypass surgery using 90-day episodes of care.   To register for the important webinar, click here.  MSSNY staff will be participating in this program.

CMS has proposed that the program be applicable in nearly 100 regions across the country, including in the New York City metropolitan statistical area (MSA), as well as in the Elmira, Rochester, Syracuse and Utica MSAs.  The model would be tested for 5-year performance period, beginning July 1, 2017, and ending December 31, 2021.

At the same time, CMS is proposing to expand the existing Medicare Joint Replacement Bundled Payment program adopted by CMS last year (and implemented this past April) to cover surgical hip/femur fracture treatment.  The Joint Replacement bundled payment program is currently applicable to 67 MSAs including the Buffalo and New York City MSAs.

To read the proposed regulation describing this proposal, click here.

To read the CMS fact sheet describing these new programs click here.

According to the CMS fact sheet, once the models are fully in effect, participating hospitals would be paid a fixed target price for each care episode, with hospitals that deliver higher-quality care receiving a higher target price.

While payment would still be made to hospitals and physicians on a fee for service basis, at the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) would be compared to the target price that reflects episode quality for the responsible hospital. Hospitals that work with physicians and other providers to deliver the needed care for less than the quality-adjusted target price, while meeting or exceeding quality standards, would be paid the savings achieved. Hospitals with costs exceeding the quality-adjusted target price would be required to repay Medicare.

As with the current Medicare hip surgery bundle program, upside and downside risk would be limited initially but increase significantly by years 4 and 5 of the program.

According to the CMS Fact sheet, Downside risk to hospitals would as follows:

  • July 2017 – March 2018 (performance year 1 and quarter 1 of performance year 2):  No repayment;
  • April 2018 – December 2018 (quarters 2 through 4 of performance year 2): Capped at 5%;
  • 2019 (performance year 3): Capped at 10%; and
  • 2020 – 2021 (performance years 4 and 5): Capped at 20%

Bonuses (payments from Medicare to hospitals) would be as follows

  • July 2017 – December 2018 (performance years 1 and 2): Capped at 5%;
  • 2019 (performance year 3): Capped at 10%; and
  • 2020 – 2021 (performance years 4 and 5): Capped at 20%.

Importantly, the CMS proposal would permit these bundled payments in certain circumstance to qualify as an Alternative Payment Model (APM) as set forth in the MACRA law passed by Congress last year.  Participation in an APM “pathway” could enable a physician to not have to participate in the Medicare Merit Based Incentive Payment System (MIPS) program as enacted through MACRA and further spelled out in a regulation proposed by CMS earlier this year.

Analysis of this proposal is ongoing and further updates regarding its impact upon patient care delivery will be provided.


CLASSIFIEDS


Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty).  Space is located in concierge building on 3rd Avenue (3 blocks to Grand Central Station).

2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft).  The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable.  Serious inquiries only, may contact us at 201-615-6963 or email us: cahnmd@gmail.com
Midtown1Midtown2



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

August 19, 2016 – MSSNYPAC Needs You

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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Aug. 19, 2016
Volume 16, Number 29

MLMIC

Dear Colleagues:

MSSNYPAC needs you.

As a New York physician, you have already benefited from MSSNY’s legislative advocacy efforts on a wide range of impactful matters that directly affect your ability to continue delivering care to your patients including:

  • defeat of the date of discovery bill which would have caused your liability premium rates to increase by as much as 15%;
  • passage of three bills to address issues which have arisen as a result of our e-prescribing law;
  • passage of legislation to address administrative hassles with insurers, including allowing physician override of insurer step therapy protocols;
  • defeat of changes to the Excess Medical Malpractice program that would have eliminated coverage for over 13,000 physicians across the state who currently receive an additional $1M layer of coverage from New York State
  • defeat of legislation that would have allowed clinics staffed by nurse practitioners to be located in retail establishments owned by publicly traded corporations like CVS Health, Walmart and Walgreen; and
  • defeat of every piece of legislation seeking to expand the scope of practice of non-physician practitioners like psychologists, oral surgeons, optometrists, nurse-anesthetists, and naturopaths  .

As you can see, sustained physician involvement can make a difference! While we win these legislative fights on your behalf year after year, the issues return and must be fought again!  Our opponents do not relent in their efforts. Unfortunately, our ability to fight for needed reforms and against harmful governmental actions is compromised by a decreasing number of physicians willing to join us in these efforts.

While advocacy and grassroots efforts are essential components of success, the stool supporting our advocacy efforts has three legs; the third being political contributions.

If we want to continue to have a seat at the table to discuss the very important issues that we confront, we must have a healthy political action arm.

Please join me in becoming a MSSNYPAC member. Basic membership starts at just $175– just $15/month. But why stop there?  We also have a Chairman’s Club for $1000 (Just $83/month) and a President’s Circle at $2500(Just $208/month).  Membership can be paid in monthly or quarterly installments.

Join MSSNYPAC by going to www.mssnypac.org  to add the weight of your voice to our efforts.

Your colleagues are counting on you.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org


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Aetna to Withdraw from 11 ACA Exchanges in 2017
On Monday, Aetna announced that it will pull back from 11 of the 15 states where it offers individual insurance on the ACA exchanges.

This year, Aetna offers plans on the health insurance marketplace in the following states: Arizona, Delaware, Florida, Georgia, Iowa, Illinois, Kentucky, Missouri, Nebraska, North Carolina, Ohio, Pennsylvania, South Carolina, Texas and Virginia. In 2017, The company will maintain a presence on exchanges in Delaware, Iowa, Nebraska and Virginia only.

In a statement, Healthcare.gov CEO Kevin Counihan said Aetna’s decision does “not change the fundamental fact that the Health Insurance Marketplace will continue to bring quality coverage to millions of Americans next year and every year after that.”

New York City Officials Call for Zika Funding
NYC officials warned this week of the growing threat of the Zika virus. 483 people in New York, including 49 pregnant women, have tested positive for the Zika virus. Five of the victims contracted Zika through sex, while the other 478 are believed to be travel-related cases. And while there has not yet been local transmission of the virus, NYC Mayor Bill de Blasio and Health Commissioner Dr. Mary Bassett this week called on Congress to approve additional funds now. “Failure to address Zika will come to our door,” said Dr. Bassett. “Global is local.”

The officials called on Republicans in Congress to pass a $1.9 billion appropriation bill to fight the virus. “Without federal dollars, we cannot deepen our work and we won’t have the reassurance that other jurisdictions are doing all they can do to fight Zika,” DeBlasio said. “It’s time to take the action to stop this crisis while we can.”

Adult Brain Cells Key to Learning May be Susceptible to Zika, Study Suggests
The Washington Post reports that a study involving mice published in Cell Stem Cell suggests that “adult brain cells critical to learning and memory also might be susceptible to the Zika virus.” Researchers believe that Zika can infect “pockets” of neural progenitor cells in adults, which “replenish the brain’s neurons over the course of a lifetime.” The study authors “admit that the findings represent only an initial step in discovering whether Zika can endanger adult human brain cells,” but these findings “suggest that the Zika virus…may not be as innocuous as it seems for adults.”

The Wall Street Journal reports that researchers believe the findings apply to children as well as adults. The researchers intend to analyze whether infected neural progenitor cells recover over time.

CDC Researchers Take Measurements in Manhattan for National Health Survey
The Wall Street Journal reports that researchers have been collecting data in New York City that will be used to make the National Health and Nutrition Examination Survey, which is designed to offer insights on US health issues – ranging from alcohol consumption to diabetes rates – for use by academics, government agencies, and the public. Researchers will take measurements from approximately 5,000 people, who serve as a cross-section representative of different American demographics.

Nominations Open for Review Committee Positions
Physicians are invited to apply for nomination to leadership positions in key medical education organizations. These are positions appointed by the AMA, Board of Trustees. Take advantage of opportunities to gain valuable leadership experience, enhance your career and make your voice heard in the service of helping shape the future of our profession. Current leadership positions available include opportunities with the American Board of Emergency Medicine, the American Board of Preventive Medicine, the Liaison Committee on Medical Education (LCME) and various Accreditation Council for Graduate Medical Education (ACGME) Review Committees. More information on submitting a nomination can be obtained by going here.

All nominations should be submitted to Mary O’Leary at mary.oleary@ama-assn.org by September 12, 2016.   You must be an AMA member to be considered.   Please feel free to share with your colleagues.

Attention Physicians in the Hudson/Capital Region: Unique Payment Opportunity
MSSNY—along with the NYS Department of Health and participating payers, CDPHP, MVP and Empire Blue Cross Blue Shield—invites physicians in the Hudson/Capital Region to join us on a one-hour webinar to learn more about a unique payment opportunity being offered by CMS. CPC+ is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support delivery of comprehensive primary care.

Two options available:
Webinar 1: Tuesday, August 30th
Time: Noon- 1 pm

Register 

Webinar 2: Tuesday August 30th
Tim: 6:00 – 7:00 pm
Register

Comprehensive Primary Care Plus (CPC+), a multi-payer program that will include 5,000 primary care practices nationwide, begins in January 2017. CPC+ is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support delivery of comprehensive primary care. CPC+ builds upon the CPCI demonstration and offers 2 primary care practice “tracks” with incrementally advanced care delivery requirements and payment options to meet the diverse needs of practices.

CPC+ is specifically identified in the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) as an advanced Alternative Payment Model (APM). Most practices that qualify for CPC+ will receive significant additional payment and, by qualifying as an advanced APM, will be excluded from the upcoming Merit-Based Incentive Payment System (MIPS).

Comprehensive Primary Care Plus (CPC+), the CMS Innovation Center’s new national advanced primary care medical home model, is now accepting applications. New York State is one of only 14 regions selected for this initiative. The deadline to apply is Sept. 15.

Who can apply: CPC+ targets primary care practices with varying capabilities to deliver comprehensive primary care. In order to participate, all CPC+ practices must demonstrate multi-payer support, use Certified EHR Technology (CEHRT), and demonstrate other capabilities. CPC+ will provide financial support and educational resources to assist practices with elements such as data collection and team based care that can have an impact far beyond CPC+. Participants from CPCI are eligible and encouraged to apply. Not all practices who apply will be selected, so this webinar is crucial to obtaining the information you to need to apply.

Why CPC+ is important: Besides the additional payments tied to CPC+, practices that participate in CPC+ and meet certain requirements will be excluded from MIPS and will receive the 5% Advanced APM bonus payment on their fee-for-service payments starting in 2019, as per the MACRA law.

CMS is conducting Open Door Forums throughout August and September, featuring Question and Answer sessions, overviews of key model elements, and step-by-step instructions for completing the CPC+ Practice Application. For more information, go here.

This webinar is being conducted specifically for the designated NYS Region to discuss CPC+ with state officials, those who participated in CPCI, and the payers who will be participating in this initiative.

Studies Suggest Elderly Getting too Many Prescriptions for Chronic Illnesses
Kaiser Health News reports a growing number of elderly patients are being prescribed too many medications to treat chronic illnesses, “raising their chances of dangerous drug interactions and serious side effects.” Furthermore, the piece points out that different drugs are often prescribed by different physicians, “who don’t communicate with each other,” further complicating the situation. Data from the Institute of Medicine show that in 2006, “at least 400,000 preventable ‘adverse drug events’ occur[ed]… in American hospitals.” Similarly, a 2013 study found that nearly 20 percent of patients discharged from hospitals “had prescription-related medical complications during their first 45 days at home.”

Maternal Acetaminophen Use in Pregnancy May be Associated with Behavioral Problems in Offspring
In “Science Now,” the Los Angeles Times reports that a study published online Aug. 15 in JAMA Pediatrics associates acetaminophen with “behavioral problems in children born to mothers who used it during pregnancy.” The findings of the 7,796-mother study revealed that “compared to women who reported no acetaminophen use at 18 weeks of pregnancy, those who took the medication at that point of gestation were 42% more likely to report hyperactivity and 31% more likely to report conduct problems in the children they bore.” Expectant mothers who took the medicine “at 32 weeks of pregnancy were 29% more likely than women who did not to report emotional difficulties in their child at age seven.”


CLASSIFIEDS


Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty).  Space is located in concierge building on 3rd Avenue (3 blocks to Grand Central Station).

2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft).  The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable.  Serious inquiries only, may contact us at 201-615-6963 or email us: cahnmd@gmail.com
Midtown1Midtown2



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

August 12, 2016 – Did You Know MACRA Is Mandatory?

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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Aug. 12, 2016
Volume 16, Number 29

MLMIC

Dear Colleagues:
The alphabet soup continues.

Yesterday, MSSNY had a call with several Medicare officials regarding the government’s proposed rule about MACRA, MIPS and APMs. Surprisingly, they were interested in learning what MSSNY is hearing from our members about the potential roll out of THE new payment proposal.

We asked them what they were hearing about the potential for delay and the rumored 90-day time period of reporting quality measures for compliance with this proposal. Regrettably, all remains up in the air. We do not know if the Final Rule anticipated to be published in November will delay the anticipated effective date of January 1, 2017.

We do know is that the payment proposal is MANDATORY.

We don’t much more than that and neither do they.

We have sent out an email to specialty societies to learn if they have created or developed specialty-specific lists of measures that will coincide with the quality reporting related to the specialty and the physician’s patient population. We are waiting to hear from them.

MSSNY wants to educate our members on CMS’ payment proposal since, I repeat, it is mandatory. Yet, we are in a hurry-up-and-wait mode. We will give you as much information as we can as soon as we are able.

However, since this is a top down operation, we can’t force them to help us to help you.

Stay tuned.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org


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Applications for Primary Care Model (CPC) Now Open
On August 1, CMS opened the application period for practices to participate in the new primary care model, Comprehensive Primary Care Plus (CPC+, which is available to practices in Region II, NY & NJ.  CPC+ is a five-year primary care medical home model beginning January 2017 that will operate in 14 regions across the U.S.

The goal of the model is to give primary care practices more flexibility in caring for their patients in the way they think will deliver the best outcomes and to pay them for achieving results and improving care. CPC+ is an opportunity for practices of diverse sizes, structures, and ownership types who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed CMS Quality Payment Program. CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million Medicare beneficiaries could participate in the model.

Additionally, other payers, including commercial insurers and state Medicaid agencies, are partnering with CMS to provide enhanced support to the primary care practices selected to participate in CPC+.  The practice application period runs from August 1 – September 15, 2016.

More information is available on the CPC+ website.

Other materials your members might be interested in:

General questions about CPC+ can be submitted to CPCplus@cms.hhs.gov.

DFS to Hold September 8 Hearing to Examine Anthem-Cigna Merger Proposal
New York’s Department of Financial Services will hold a hearing in New York City on September 8 to obtain public input regarding the proposal of Anthem (the parent of Empire) to acquire health insurance giant Cigna.

MSSNY’s President Dr. Malcolm Reid is planning to testify at this hearing to express MSSNY’s great concern with the continuing consolidation of the health insurance industry, and its adverse impact on patient care.  Interested physicians are also invited to testify by submitting a request to public-hearings@dfs.ny.gov with the heading “ANTHEM-CIGNA 2016 HEARING”.  To read the full hearing notice, click here.

Last week, DFS Superintendent Maria Vullo public released a letter (http://dfs.ny.gov/about/press/pr160803_anthem_cigna_letter.pdf) noting that DFS has “serious concerns that Anthem’s proposed acquisition of Cigna will adversely impact the competitiveness of the health insurance market and harm consumers in New York”.

This action followed the filing of litigation by the US Department of Justice (See the press release here to block the proposed Anthem takeover of Cigna, as well as the proposed Aetna takeover of Humana.  In announcing the suit, DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country “are unprecedented in their scale and in their scope”.

The DOJ intervention had been strongly supported by the American Medical Association, numerous state medical societies across the country including MSSNY, and several powerful consumer/patient advocacy groups.

The letter from Superintendent Vullo noted the huge market impact if Anthem and Cigna were permitted to merge.  It would increase Anthem’s market share across commercial products to 31.2% statewide, of which Anthem would command 9.8% of New York’s fully insured market and 47.6% of the self-insured market.  The biggest impact would be felt in the New York City metro area, where Anthem would control nearly 70% percent of the commercial self-insured market in the Bronx and Staten Island, 63% in Queens and Brooklyn, and 55% in Putnam County.

“Increased concentration means that insurers are more able to offer non-negotiable rates to providers in a take it or leave it deal. Therefore, the merger likely would limit New Yorkers’ access to healthcare because providers would be forced either to not participate with the dominant insurer or to cut hours or services in order to accommodate a deal they have to accept. This result would be highly problematic for New York consumers.” stated Superintendent Vullo in the letter.

New York Health Insurance Exchange Releases Enrollment Report
The New York State of Health release a report today that show that enrollment through New York’s Health Insurance Exchange increased by 33%, or nearly 700,000 enrollees from the previous enrollment period, and that 92% of those enrolled through the Exchange report that they did not have health insurance at the time they applied.

The full report from NYSOH is available here.

A fact sheet summarizing the demographic data is available here.

According to the report, as of January 31, 2016, 2,833,823 New Yorkers enrolled in coverage through the NY State of Health’s Individual Marketplace. This includes 271,964 people enrolled in Qualified Health Plans (QHP), 379,559 people enrolled in the Essential Plan (EP), 1,966,920 people enrolled in Medicaid, and 215,380 enrolled in Child Health Plus (CHP).

With regard to individual QHPs, Fidelis (26%) garnered the largest market share, followed by Empire, Oscar, Metro Plus and Health First all with 10% market share. As of January 31, 2016, 16% of the enrollees are enrolled in Platinum plans, 14% are in Gold plans, 25% are in Silver plans without cost sharing reductions, 17 % are in a Silver costsharing reduction plan, 26 % are in Bronze plans, and 2 percent are in Catastrophic plans.

CDC: Infants with Neonatal Abstinence Syndrome up 300% in 15 Years
The number of babies being born in the United States addicted to opioids (NAS) has tripled in a 15-year stretch, according” to a CDC report published Aug. 12 in the Morbidity and Mortality Weekly Report. The CDC “said…that the findings, based on hospital data, are likely underestimates of the true problem and point to an urgent need for public health efforts to help pregnant women deal with addiction.” The report revealed that “the incidence of neonatal abstinence syndrome jumped to 6 per 1,000 hospital births in 2013, up from 1.5 per 1,000 in 1999. Maine, Vermont and West Virginia – recorded more than 30 such cases per every 1,000 births by 2013.” New York recorded 3.6 per 1,000 (2013), up from 2.8 (2012); 2.6 in 2011; and 1.9 in 2010.

NYC Medical Schools Will Stop Using Unclaimed Bodies as Cadavers
The NY Times (8/10)  reports “eight medical schools in New York City will no longer accept the city’s unclaimed bodies as cadavers,” the schools announced on Wednesday. Additionally, “a group representing the 16 medical schools in the state is withdrawing its opposition to a recently passed bill that would end the educational use of bodies with no known survivors.”

The bill “passed both houses overwhelmingly in June, a month after a New York Times investigation highlighted provisions in the current law that give families as little as 48 hours to claim a relative’s body before the city must make it available for dissection or embalming practice.” The bill is now awaiting Gov. Andrew Cuomo’s signature.

Medicare Telehealth Services Wednesday, August 31 at 1-2 PM EST
NGS Medicare is holding a 1-hour webinar about Telehealth services.  If you are interested and have the time, click on the GREEN register box below to register for this program. During this webinar we will provide you with insight into covered Medicare telehealth services and coverage requirements. We will discuss originating sites, equipment requirements, and billing and payment guidelines.  Read More

During this webinar we will provide you with insight into covered Medicare telehealth services and coverage requirements. We will discuss originating sites, equipment requirements, and billing and payment guidelines. Read More
REGISTER

Notice Act Went Into Effect on August 6: Must Tell PTs re Out-of-Pocket Costs
The NY Times (8/6) http://nyti.ms/2aEW40Vreports the Notice Act, passed by Congress last year, went into effect on August 6. The new Medicare law “requires hospitals to notify patients that they may incur huge out-of-pocket costs if they stay more than 24 hours without being formally admitted” and the “patients can expect to start receiving the warnings in January.” According to the Times, the Administration “issued rules last week to carry out the new law,” which will let hospitals “keep Medicare patients in observation status,” and while “some of the patients will be responsible for nursing home costs,” they would still get the “time in a hospital under observation [to] count toward the three-day inpatient stay required for Medicare coverage.”

Legislation Enacted Regarding Drugs Used for Detox or Maintenance Treatment of Opioid Addiction in Medicaid Fee-for-Service (FFS) & Medicaid Managed Care
Per changes to Social Services Law section 364j, and Public Health Law section 273, prior authorization is not allowable for initial or renewal prescriptions for preferred or formulary buprenorphine or injectable naltrexone when used for detoxification or maintenance treatment of opioid addiction. Food and Drug Administration (FDA) and Compendia supported frequency, quantity and/or duration limits may continue to be applied.

To obtain preferred/formulary drug listings and plan limitations please see the following websites:

  • Medicaid FFS Preferred Drug List and Pharmacy Prior Authorization Programs- https://newyork.fhsc.com/
  • Medicaid Managed Care Pharmacy Formulary and Benefit Information- http://mmcdruginformation.nysdoh.suny.edu/

Change to Medicaid Payment of Part C Co-payment and Co-insurance Liabilities
Effective April 1, 2016, an amendment to New York State Social Services Law changes Medicaid reimbursement of Medicare Part C (Medicare Advantage or Medicare managed care) co-payment and/or co-insurance liabilities for services provided to dually eligible Medicaid members. Dually eligible members are those individuals having both Medicare and Medicaid coverage.

Presently the Medicaid program pays the full co-payment or co-insurance amounts for Medicare Part C claims. Retro-actively to April 1, 2016, Medicaid will reimburse at the rate of eighty-five percent (85%) of the Medicare Part C co-payment or co-insurance amount. The Department is in the process of making the necessary eMedNY system changes to enable the implementation of the new payment policy. Implementation will be applied retro-actively pending system support. Paid claims will then be adjusted automatically to reflect the new cost-sharing limits.

This change will affect institutional claims and professional claims when submitting claims for Medicaid reimbursement of a Medicare Part C co-payment or co-insurance. This change will also apply to Pharmacy Claims for drugs and supplies when submitted via a NCPDP transaction or as a professional claim.

There is no change to the current reimbursement methodology of Medicare Part C co-payment/co-insurance amounts for ambulance providers and psychologists. Medicaid will continue to reimburse these providers the full Medicare Part C co-payment/co-insurance amounts.

Note: A provider of a Medicare Part C benefit cannot seek to recover any co-payment, or coinsurance amount from Medicare/Medicaid dually eligible individuals. The provider is required to accept the Medicare Part C health plan payment and any Medicaid payment as payment in full for the service. The member may not be billed for any Medicare Part C co-payment/co-insurance amount that is not reimbursed by Medicaid.


CLASSIFIEDS


Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty).  Space is located in concierge building on 3rd Avenue (3 blocks to Grand Central Station).

2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft).  The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable.  Serious inquiries only, may contact us at 201-615-6963 or email us: cahnmd@gmail.com
Midtown1Midtown2


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please email gumd3@aol.com to arrange for a viewing.


Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

August 5, 2016 – Interested in Telemedicine?

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

Aug. 5, 2016
Volume 16, Number 28

MLMIC

Dear Colleagues:

According to Medicare.gov, telemedicine (which may also be referred to as “telehealth,” or “virtual healthcare”) “seeks to improve a patient’s health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.”

With evidence-based telemedicine, clinicians can evaluate, diagnose and treat patients remotely using store-and-forward technology or real-time video conferencing.  Remote practitioners can capture and transmit medical data to share with peers and specialists around the corner or around the world.

About five years ago, I attended a Council meeting where a physician executive from UnitedHealthcare gave us a presentation informing us that telemedicine was in our near future and it was a good idea whose time had come. When the presentation ended, the room was silent until a Council member spoke up and said that this was an outrage and goes against one of the ancient tenets of medicine—that we had to lay our hands on our patients to examine them. An extended lively discussion ensued and finally, one Councilor had the courage to ask what the logistics of payment for a telehealth exam would be.

Today, we are well aware that telemedicine is provided throughout New York and is spreading rapidly. From our current and ongoing research, we know that there are different payment arrangements to practitioners who provide this new and vital service— “vital” as in a mother of four children and one of them has a high fever. She should not be expected to pack up the family car for a trip to the emergency room when her fears can be allayed by speaking to (hopefully) a NY physician. In addition, does a patient really need to make a trip to the office when they all they need is a routine prescription refill?

Many plans pay equally to the level of service based on the documentation contained in the medical record.

On July 18, we sent out a survey regarding telemedicine. Since this is a MSSNY hot topic, we are surprised at the low response rate. As we continue to develop our plans for your benefit, you could help us out by completing our 10-question survey. Even better, you can send it on to your colleagues so that we have a clearer picture of our members’ interest.

Please take it NOW!

10-question  telemedicine survey

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org


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Westchester, LI Medical Groups Team Up for Contract with Empire BCBS
Commack, LI-based Independent Physicians Association of Nassau/Suffolk Counties (IPANS) and Hudson Doctors Independent Physicians Association in Valhalla, N.Y., plan to develop a shared-savings contract with Empire BlueCross BlueShield. John Franco, MD, President and Medical Director of the Nassau Suffolk of Independent Physicians Association of Nassau/Suffolk Counties (IPANS) and a member of MSSNY’s Task Force on Survival of Independent Practice, said, “We here at IPANS are very pleased to affiliate with Hudson IPA. Independent physicians will have greater strength in numbers and receive the necessary support to remain independent and successful.”

The two groups represent about 1,600 physicians generating about $2 billion in annual revenue, said Anthony Demetracopoulos, executive director and general counsel of the Hudson Doctors IPA, based in Valhalla, N.Y. The Hudson Doctors IPA was created in 1996 as an association for medical faculty from New York Medical College in Valhalla, but now it includes mostly non-faculty physicians. In a potential accountable care arrangement with Empire, the entity would be responsible for cost and quality for about 50,000 patients. In all, the doctors involved in the two groups see about 500,000 patients annually. (Crains, Aug 3)

With more doctors, the organizations can more easily afford investments in software that helps physicians track their patients through the health care system and avoid unnecessary duplication of care.

The agreement will give IPANS greater scale, making the combined entity more attractive to managed-care plans, which are increasingly shrinking their networks to include only high-performing providers. Hudson Doctors IPA could also help IPANS improve certain processes, such as credentialing doctors to verify their certifications, malpractice insurance and hospital privileges.

Tom Lee, MD, a board member of Hudson Doctors IPA, and Co-Chair of MSSNY’s Task Force on Survival of Independent Practice and commented, “”Hudson Doctors IPA looks forward to collaborating with IPANS to provide quality integrated services for our physician members’ patients, and keep independent practice a viable option for physicians in the future.”

Fee Waivers for Non-Compensated NYS License Renewal
A point of information for those physicians who have retired and are no longer compensated for medical care provided – a waiver of the fee for the registration of your license as a physician in the State of New York is allowed under the provisions of Section 6524(10) of the New York State Education Law.  This law allows a waiver of the registration fee requirement for physicians who certify to the State Education Department that, for the period of their registration, they will only practice medicine without compensation or the expectation or promise of compensation. The waiver of the registration fee is limited to the duration of the registration period indicated the affidavit.  http://www.mcms.org/sites/default/files/resources/NC-Affidavit11-02.pdf or see attached.

Patient Advocacy Groups Rally to Urge Governor Cuomo to Sign Step Therapy Override Bill Into Law
Dozens of patient advocates rallied at the State Capitol this week to urge Governor Cuomo to sign into law legislation (A.2834-D/S.3419-C) supported by MSSNY and unanimously passed by the State Legislature that would establish specific criteria for physicians to request an override of a health insurer “step therapy” medication protocol when it is in the best interest of their patients’ health.

The rally received significant media attention, including from WNYT,  TWC’s Capital Tonight and Politico-NY.

Las week, MSSNY representatives joined several other patient advocacy groups in a meeting with Governor Cuomo’s top health policy staff last week to urge that he sign this bill into law.   In addition to lobbying staff, MSSNY was also represented by Interspecialty Committee and Committee to End Healthcare Disparities member Dr. Inderpal Chhabra, who spoke regarding the hassles he regularly experiences with some insurers when trying to assure his patients have coverage for the medications they need.  Also joining the meeting were representatives of the NYS Society of Dermatology and Dermatologic Surgery (MSSNY member Dr. Mary Ruth Buchness), the NYS Academy of Family Physicians, the National Psoriasis Foundation, the Global Healthy Living Foundation, National Lupus Foundation, Mental Health Association of New York State, National Alliance on Mental Illness-NY, and the American Cancer Society.

To assist in our collective efforts to convince Governor Cuomo to sign this important bill into law, we ask you send a letter to him in support of this legislation.  A customizable template is available from MSSNY’s Grassroots Action Site here.

We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

AG Warns Stop False Advertising re Ineffective Products as “Zika-Preventive”
Attorney General Eric T. Schneiderman announced that his office issued cease and desist letters to seven companies that market products with claims that the products prevent or protect against Zika virus even though the products are known to be ineffective for that purpose. The letters demand that the companies selling these products stop advertising them as “Zika-protective” or “Zika-preventive.” The Attorney General also issued a consumer alert warning New Yorkers about the deceptive ads and directing them to evidence-based Zika prevention measures that have been recommended by public health authorities.

“The only products that provide effective protection from mosquito bites contain DEET, picaridin, oil of lemon eucalyptus, and an insect repellent called IR3535 – all other products are a waste of money and may put you at risk of being bitten,” said NYC Health Commissioner Dr. Mary T. Bassett. “We continue to remind women who are pregnant or trying to become pregnant to not travel to a Zika-affected area – that includes most of Latin America and the Caribbean, and a neighborhood in Miami, Florida. Because of the risk of sexual transmission, partners of pregnant women should consider staying away from these areas, too.”
http://www.mssny.org/MSSNY/Public_Health/2016/SCHNEIDERMAN_ISSUES_CEASE_AND_DESIST_LETTERS.aspx

NY DFS Issues Letter Expressing Strong Concerns with Anthem-Cigna Merger Proposal
Noting its “serious concerns that Anthem’s proposed acquisition of Cigna will adversely impact the competitiveness of the health insurance market and harm consumers in New York”, this week the New York Department of Financial Services publicly released a letter from DFS Superintendent Maria Vullo indicating that she intends to call a public hearing to more fully evaluate the proposal.

The DFS announcement comes on the heels of litigation filed by the US Department of Justice two weeks ago (See the press release here  to block the proposed Anthem takeover of Cigna, as well as the proposed Aetna takeover of Humana.  In announcing the suit, DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country “are unprecedented in their scale and in their scope”.

The DOJ intervention had been strongly supported by the American Medical Association, numerous state medical societies across the country including MSSNY, and several powerful consumer/patient advocacy groups.

However, as reported last week, Anthem (the parent of Empire) indicated its intent to fight the DOJ action, including purchasing full-page ads in several national papers including the Washington Post, the USA Today and the New York Times to present a letter to the public from its chair, Joseph Swedish, that it was “surprised and disappointed” by the DOJ’s actions.

The letter from Superintendent Vullo noted the huge market impact if Anthem and Cigna were permitted to merge.  It would increase Anthem’s market share across commercial products to 31.2% statewide, of which Anthem would command 9.8% of New York’s fully insured market and 47.6% of the self-insured market.  The biggest impact would be felt in the New York City metro area, where Anthem would control nearly 70% percent of the commercial self-insured market in the Bronx and Staten Island, 63% in Queens and Brooklyn, and 55% in Putnam County.

“Increased concentration means that insurers are more able to offer non-negotiable rates to providers in a take it or leave it deal. Therefore, the merger likely would limit New Yorkers’ access to healthcare because providers would be forced either to not participate with the dominant insurer or to cut hours or services in order to accommodate a deal they have to accept. This result would be highly problematic for New York consumers.”

We will keep you posted as to when the hearing is scheduled.

CDC Director: Zika Travel Advisory Could Last as Long As a Year
The Center for Disease Control and Prevention’s travel advisory for the south Florida neighborhood experiencing a Zika outbreak could last for as long as a year, according to CDC director Dr. Tom Frieden. “When dengue hit Florida a few years ago, it took over a year to control that outbreak. We certainly hope that doesn’t happen. We saw what happened in the Florida Keys and that did go on for a long time despite extensive efforts,” he said. 

James Hitt, MD to Step Into Dr. Eugene Gosy’s Pain Specialty Practice in Amherst
The Buffalo News reports: “The temporary arrangement to care for Dr. Eugene Gosy’s 9,500 patients ends this week, but another doctor is stepping in to ensure the big pain management practice remains open.” http://bit.ly/2aIpNu7 Dr. Gosy, a neurologist and pain specialist, was indicted in April on federal charges. His large patient load was due to the fact that many physicians referred their patients to Dr. Gosy. Area physicians were very concerned about Dr. Gosy’s practice closing, since he was the only pain specialist in the Amherst area.

Three area physicians volunteered to keep Dr. Gosy’s practice going temporarily. As of August 1, James Hitt, MD, a pain management specialist who had been working with cancer patients at Roswell Park Cancer Institute and veterans at the Buffalo VA Medical Center.

Want to Learn More about Comprehensive Primary Care?
On August 1, CMS opened the application for practices to apply for Comprehensive Primary Care Plus (CPC+), the largest-ever initiative to improve primary care in America. CPC+ rewards value and quality through an innovative payment structure to support comprehensive primary care.

In CPC+, CMS has provisionally selected 57 payer partners, including commercial insurers, state Medicaid agencies, Medicaid managed care organizations, and Medicare Advantage plans in 14 regions across the nation.

Want to learn more about CPC+?

–          Get your questions answered in the Practice FAQs.

–          Register for one of the 20 upcoming CPC+ Practice Open Door
Forums
in August and September.

–          Watch the CPC+ Video Series to get an overview of CPC+
payment innovations and care delivery transformation.

–          Submit a CPC+ application via the online portal today through
11:59pm ET on Thursday, September 15.

–          Download the CPC+ toolkit: CPC+ In Brief, CPC+ Care
Delivery Transformation Brief
, and CPC+ Payment Innovations
Brief and Case Studies
.

At CMS, we believe CPC+ is the future of primary care in America. We are pleased to partner with aligned public and private payers across the country to support up to 5,000 practices delivering the care that best meets the needs of their patients and improves health outcomes.

Timely Reporting of Provider Enrollment Information Changes
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1617.pdf

Reviewing your Medicare provider enrollment in the Provider Enrollment Chain Organization System (PECOS) system, takes about 10 minutes.  https://pecos.cms.hhs.gov  Your password for this system is the one you would have obtained when you created your National Provider Identifier (NPI) number.  If you don’t know your password, please call the National Plan & Provider Enumeration System.  The NPI Enumerator may be contacted at the following:  NPI customer service: 800.465.3203 |800.692.2326 (TTY); or, you can email them at:  customerservice@npienumerator.com

Suicide Among Veterans: 20 Per Day
The suicide rate among U.S. veterans increased by nearly one-third between 2001 and 2014, according to a Veterans Affairs (VA) report released this week. According to the report, an average of 20 veterans died from suicide daily in 2014, totaling about 7,300 suicide deaths that year. VA estimated that the veteran suicide rate increased by 32 percent from 2001 to 2014. In comparison, the suicide rate among the total U.S. population increased by 23 percent during that time.


CLASSIFIEDS


Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty).  Space is located in concierge building on 3rd Avenue (3 blocks to Grand Central Station).

2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft).  The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft).

Price negotiable.  Serious inquiries only, may contact us at 201-615-6963 or email us: cahnmd@gmail.com
Midtown1Midtown2


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please email gumd3@aol.com to arrange for a viewing.


Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777


Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

July 29, 2016 – The Empire Strikes Back

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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July 29, 2016
Volume 16, Number 27

MLMIC

Dear Colleagues:

We can’t declare victory in the battle against anti-competitive health insurance mergers just yet.

In response to last week’s lawsuit by the US Department of Justice challenging the proposed mergers of Anthem/Cigna and Aetna/Humana, this week Anthem (the parent of Empire) purchased full-page ads in several national papers including the Washington Post, USA Today and the New York Times to present a letter to the public from its chair, Joseph Swedish, that it was “surprised and disappointed” by the DOJ’s actions.

“Given the Justice Department’s flawed analysis and misunderstanding of the dynamic, competitive, and highly regulated health care landscape, Anthem is committed to rigorously defending this transaction in court on behalf of all health care consumers,” Swedish’s letter stated.

Unprecedented in Scale

As reported in last week’s e-news, we are pleased that the DOJ took action to block these takeovers.  In announcing the suit, DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country “are unprecedented in their scale and in their scope” (See the press release here.)

Several state Attorneys General, including New York AG Eric Schneiderman, joined in the litigation to block the proposed merger of Anthem and Cigna.  Specifically, AG Schneiderman noted that “By reducing competition, this proposed merger has the potential to significantly increase the merged firm’s power in the marketplace, to the detriment of consumers. Employers will be left with fewer choices, and ultimately consumers could be saddled with higher premium costs, reduced access to providers, and lower quality care.  I stand with my federal and state partners in fighting to stop this merger before it harms New Yorkers.” (See his full statement here.

The action by DOJ shows the power of organized medicine, particularly when we can work proactively with patient advocates.

We Strongly Oppose Merger

MSSNY along with the AMA, state medical societies, hospital associations and consumer groups have opposed these proposed mergers. Specifically, we argued to both DFS and the AG that the merger between Anthem and Cigna would significantly increase health insurer market concentration in the metropolitan New York City area, and in particular on Long Island. This, in turn, would undoubtedly lead to even greater insurer control of health care delivery and further weaken our ability to advocate on behalf of our patients to assure they have coverage for the care they need.

The AMA’s Advocacy Resource Center (which MSSNY staff sits on its Executive Committee) has been extensively involved in a national campaign to prevent these mergers from going forward.  These efforts included written submissions to the US DOJ in opposition to the mergers, a public relations campaign, and assistance to state medical societies including MSSNY with essential background information that has helped to make compelling arguments to state policymakers regarding the mergers’ potentially significant adverse impact on patients and care providers.

These proposed mergers have also been fiercely opposed by the Coalition to Protect Patient Choice, a group comprised of some of the most powerful patient advocacy groups in New York State and in the country, including 1199, Consumers Union, USPIRG, and Health Care for All New York.

Despite all these efforts, the insurers are clearly not going to walk away from these transactions.  The full page ads this week were likely an effort to demonstrate the financial resources they will expend to fight the action of the DOJ, both in court and in the court of public opinion.

Buckle up.  This could become a bumpy ride.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org


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CMS Proposes Expansion of Bundled Payments Program for Cardiac Care Episodes
The use of “bundled payments” in Medicare will likely expand once again.  This week CMS announced a proposed rule to create a new Medicare bundled payment model for heart attacks and bypass surgery using 90-day episodes of care.  The program would be applicable in nearly 100 regions across the country, including in the New York City metropolitan statistical area (MSA), as well as in the Elmira, Rochester, Syracuse and Utica MSAs.  The model would be tested for 5-year performance period, beginning July 1, 2017, and ending December 31, 2021.

At the same time, CMS is proposing to expand the existing Medicare Joint Replacement Bundled Payment program implemented earlier this year to cover surgical hip/femur fracture treatment.  The Joint Replacement bundled payment program is currently applicable to 67 MSAs including the Buffalo and New York City MSAs

To read the proposed regulation describing this proposal, click here.

To read the CMS fact sheet describing these new programs click here.

According to the CMS fact sheet, once the models are fully in effect, participating hospitals would be paid a fixed target price for each care episode, with hospitals that deliver higher-quality care receiving a higher target price.   At the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) would be compared to the target price that reflects episode quality for the responsible hospital. Hospitals that work with physicians and other providers to deliver the needed care for less than the quality-adjusted target price, while meeting or exceeding quality standards, would be paid the savings achieved. Hospitals with costs exceeding the quality-adjusted target price would be required to repay Medicare.

As with the current hip surgery bundle program, upside and downside risk is limited the first few years of the program, with the amounts at risk to hospitals going up significantly by years 4 and 5 of the program.

Importantly, the CMS proposal would permit these bundled payments in certain circumstance to qualify as an Alternative Payment Model (APM) as set forth in the MACRA law passed by Congress last year.  Participation in an APM “pathway” could enable a physician to not have to participate in the Medicare Merit Based Incentive Payment System (MIPS) program as enacted through MACRA and further spelled out in a regulation proposed by CMS earlier this year. The proposed policy, for which the CMS is seeking comment, would be mandatory and would take effect July 1, 2017. It would affect hospitals in 98 randomly selected metropolitan areas.

The CMS also proposed Monday to expand its first and currently only existing bundled payment model to include hip and femur fractures. That program, which took effect in January, currently covers total joint replacements.

In a bundled payment model, the government reimburses providers a set amount per patient for one episode of care, such as a knee replacement, rather than paying for every individual service rendered as part of that procedure. The idea is to create a financial incentive for providers to better coordinate care and keep costs down.

DSRIP Provider Performance Scorecards (PPS) Ready for Viewing
Fourth-quarter reviews and scorecards for each performing provider system, covering activity through March 31 of this year, have been posted online. In DSRIP Year 1, the PPSs earned about 99.44% of the funds available to them, or $1.2 billion. 

DFS Warns Insurers Not To Create More Restrictive Limits for Mental Health
On July 27, in a new guidance, the New York State Department of Financial Services advised health plans that they cannot create financial requirements or treatment limitations for mental health and substance-use disorders that are more restrictive than the same standards applied to medical and surgical benefits.  

Patient Advocacy Groups to Governor Cuomo:  Sign Step Therapy Override Bill Into Law;
MSSNY representatives joined several other patient advocacy groups in a meeting with Governor Cuomo’s top health policy staff this week to urge that he sign into law legislation (A.2834-D/S.3419-C) supported by MSSNY that would establish specific criteria for physicians to request an override of a health insurer “step therapy” medication protocol when it is in the best interest of their patients’ health.  

In addition to staff, MSSNY was represented by Interspecialty Committee and Committee to End Healthcare Disparities member Dr. Inderpal Chhabra, who spoke regarding the hassles he regularly experiences with some insurers when trying to assure his patients have coverage for the medications they need.  Also joining the meeting were representatives of the NYS Society of Dermatology and Dermatologic Surgery (MSSNY member Dr. Mary Ruth Buchness), the NYS Academy of Family Physicians, the National Psoriasis Foundation, the Global Healthy Living Foundation, National Lupus Foundation, Mental Health Association of New York State, National Alliance on Mental Illness-NY, and the American Cancer Society.

To assist in our collective efforts to convince Governor Cuomo to sign this important bill into law, we ask you send a letter to him in support of this legislation.  A customizable template is available from MSSNY’s Grassroots Action Site here.   We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

Specifically, the bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.  While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

Oscar Will Narrow NY Network to Keep Losses Down
Oscar, the health insurance start-up, plans to dramatically narrow its network in New York, a move aimed at keeping premiums and health care costs in check, according to a blog post from the company’s CEO. (Politico 7/27)

Beginning in 2017, the insurer’s network will have 31 hospitals in three systems — Mount Sinai, Montefiore, and the Long Island Health Network — and 20,000 physicians. That’s down from more than 70 hospitals and 40,000 physicians at the beginning of 2016. NYU Langone and Northwell Health are no longer in network. The insurer had 53,000 members at the end of 2015 and saw a 20% increase in membership during the first quarter of 2016, a boost that likely resulted from the collapse of Health Republic Insurance of New York.


CMS Releases Quality Ratings for Hospitals
CMS released its ratings for about 3,500 hospitals. Under CMS’ quality rating system, medical facilities are assigned “one to five stars based on how well they care for patients,” providing consumers with “a new tool for making health-care choices for themselves and loved ones.”
CMS rated 155 hospitals in New York, but only one of them, the Hospital for Special Surgery in Manhattan, got five stars. Of the remaining 142 hospitals, 49 received three stars, 58 got two stars, and 35 were given one star.

US News & World Report says CMS released the “consumer-friendly hospital star ratings over the objections of hospitals and members of Congress, who call the ratings deeply flawed and say they penalize teaching hospitals and those that treat the poor.”

Last week, in an analysis designed to anticipate and blunt criticism, Medicare reported that 102 hospitals would be given five stars, 934 would receive four stars, 1,770 would get three stars and 133 would get just one star. Nearly one out of five U.S. hospitals – 934 – could not be rated because they treat such small numbers of patients the government couldn’t reliably grade them.

CDC Offering One-Hour Zika Virus Webinar Aug. 10 at 7PM
The Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) invite you to join an important webinar focused on Zika virus. CDC Medical Epidemiologist Susan Hills, MBBS, MTH, will present an update on the epidemiological and clinical aspects of the current outbreak. CDC Medical Officer Kiran Perkins, MD, MPH, will present on the implications for pregnant women, including CDC’s updated interim clinical guidance, before fielding questions from webinar participants. Register Here.

Syracuse’s Upstate Medical University announced it will use a five-year, $1 million grant to support a program that seeks to “keep vulnerable populations free of HIV.”

Upstate Med University Granted $1M to Keep Youth Free of HIV
The New York State Department of Health awarded the grant for the school’s new program called “pre-exposure prophylaxis (PrEP) services for general and HIV primary care,” Upstate said in a recent news release.

The program “closely aligns” with Gov. Andrew Cuomo’s “Ending the Epidemic Blueprint2” to reduce the annual number of new HIV infections in New York to 750 by the end of 2020.

The program is available to healthy, HIV-negative adults and adolescents ages 13 and over who are at-risk for HIV and/or sexually transmitted infections (STI).

It is available through Upstate’s Immune Health Services and the pediatric infectious disease/young adult specialized-care center, a program of the Pediatric Designated AIDS Center.

USPSTF: Not enough Evidence for Total-Body Screenings for Skin Cancer
On July 26, the US Preventive Services Task Force [USPSTF] said…that there still isn’t enough evidence to recommend total-body screenings” for skin cancer “and declined to take a position on the practice.” The USPSTF  said “that it could not determine – after reviewing thousands of research papers and studies from around the world – whether the benefits of screening outweighed the potential for harm if unnecessary or excessive procedures were performed.”

Calling Artistic Physicians: Boost Your Clinical Skills with Art!
Join us for MEDICINE AT THE MET: ART IN CLINICAL PRACTICE a new series of ArtMed inSight workshops!

When:  August 12, 2016 from 6 to 8.30pm: Enhancing Observation and Presence

August 13, 2016 from 5 to 7.30pm: Increasing Self-Awareness and Empathic Intelligence

Location: The Met Museum in NYC

Cost:        $125 per;$225 for two

Space is limited! For more information and to register go here. 

Protecting Patient Personal Health Information
Recently, the Centers for Medicare & Medicaid Services (CMS) learned of a potential security breach in which someone was offering for sale over 650,000 records of orthopedic patients. Remember that a covered entity must notify the Secretary of Health and Human Services if it discovers a breach of unsecured protected health information. See 45 C.F.R. § 164.408. Also, keep abreast of any issues that your business associates, especially those entities that provide you with hardware and/or software support for your patient electronic health records. Be sure they are required to report any actual or potential security breaches to you, especially threats that compromise patient PHI.


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please email gumd3@aol.com to arrange for a viewing.


Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

July 22, 2016 – 7-Day Opioid Limitation Begins TODAY!!

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

July 22, 2016
Volume 16, Number 26

MLMIC

Dear Colleagues:

MSSNY will join several other patient advocacy groups next week in a meeting with Governor Cuomo’s top health policy staff to urge that he sign into law legislation (A.2834-D/S.3419-C) supported by MSSNY that would establish specific criteria for physicians to request an override of a health insurer “step therapy” medication protocol when it is in the best interest of their patients’ health.

To assist in these efforts, we ask you to do the following:

  1. Send a letter from MSSNY’s Grassroots Action Site asking Governor Cuomo to sign the bill into law; We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.
  2. Please share with us any recent examples you may have regarding unnecessary hassles health insurance companies have imposed when trying to request an override of such insurer’s step therapy protocol for your patient. Send your examples to mauster@mssny.org. . (Before sending, please remove any patient-identifying information such as patient names, ID numbers or claim numbers.)

Specifically, the bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present:

  • the drug required by the insurer is contraindicated or could likely cause an adverse reaction;
  • the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history;
  • the patient has already tried the required medication, and it was not effective or caused an adverse reaction;
  • the patient is stable on the medication requested by the physician;
  • the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within three days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.

Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org


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Please Take Our 10-Question Telemedicine Survey NOW!
MSSNY developed a brief 10-question survey to measure the membership’s interest in a member benefit related to telemedicine.

Seven Day Initial Opioid Prescribing Limitation Effective On Friday, July 22nd
TODAY, Friday, July 22, 2016 prescribing limitations will go into effect for prescribers under a new law signed as part of New York State’s efforts to curb opioid abuse.   The measure limits to seven days the prescription of Schedule II, III, or IV opioid upon initial consultation or treatment of acute pain.

  • Under the NYS Public Health law “acute pain” is defined to mean pain, whether resulting from disease, accidental or intentional trauma or other cause that the practitioner reasonably expects to last only a short period of time. Such term SHALL NOTinclude chronic pain, pain being treated as part of cancer care, hospice or other end-of-life- care or pain being treated as part of palliative care practices.
  • The new limitation applies to the initial prescription ONLY.  The measure gives flexibility to the prescriber to, upon any subsequent consultations for the same pain, issue  any appropriate renewal, refill or new prescription for the opioid or any other drug consistent with existing 30-day or 90-day statutory limits for Schedule II, III and IV medications.
  • The measure also limits application of co-pays for the limited initial prescription of an opioid to either (i) proportionate amount between the copayment for a thirty day supply and the amount of drugs the patient was prescribed or the equivalent to the copay for the full thirty-day supply provided that no additional copays may be charged for any additional prescriptions for the remainder of the thirty-day supply.
  • The New York State Department of Health has put into place temporary procedure for billing for the Medicaid Fee for Service Program.   The department’s letter can be found HERE.
  • The letter does stipulate that pharmacists are NOT required to verify with the prescriber whether an opioid prescription writer for greater than a seven-day period.
  • Additional information on opioids and this law may be obtained by contacting the NYS Department of Health’s Bureau of Narcotic Enforcement at 1-866-811-7957 or click HERE.
  • For billing questions please contact CSC at 1-800-343-9000.
  • Questions specific to Medicaid FFS policy can be directed to ppno@health.ny.gov or call 518-486-3209. 

Federal Government, New York AG Seeks to Block Health Insurance Mega-Mergers
Noting that the proposed mergers involving four of the five largest health insurance companies in the country “are unprecedented in their scale and in their scope”,  the US Department of Justice announced this week that it was initiating litigation to block the proposed mergers of Anthem (the parent of Empire) and Cigna, as well as Aetna and Humana.

MSSNY, along with hospital and consumer groups, have opposed the proposed merger between Anthem and Cigna as it would significantly increase health insurer market concentration in the metropolitan New York City area, and in particular on Long Island. MSSNY’s letter of opposition here.

Since Humana has very little market penetration in New York (aside from Medicare Advantage), MSSNY had concerns but did not issue a formal statement of opposition to its proposed merger with Aetna.  However, last week, while the New York DFS approved the merger between Aetna and Humana, it imposed several significant conditions including: approval by DOJ; requiring the combined entity to continue offering the same health insurance products; prohibiting acquisition costs from being passed on to consumers and providers; and assuring robust networks.

Several state Attorneys General, including New York AG Eric Schneiderman, joined in the litigation with the US DOJ to block the proposed merger of Anthem and Cigna.  To read AG Schneiderman’s statement, click here:.  Specifically, AG Schneiderman noted that “By reducing competition, this proposed merger has the potential to significantly increase the merged firm’s power in the marketplace, to the detriment of consumers. Employers will be left with fewer choices, and ultimately consumers could be saddled with higher premium costs, reduced access to providers, and lower quality care.  I stand with my federal and state partners in fighting to stop this merger before it harms New Yorkers.”

The AMA’s Advocacy Resource Center was extensively involved in both making arguments to DOJ in opposition to the mergers, as well as in assisting states with essential background information that better enabled state medical societies including MSSNY to make compelling arguments to state policymakers why these proposed mergers would have adverse impact on patients and care providers.

Bloomberg reports (7/20): “Aetna Inc. is ready to go to court if necessary to proceed with its $37 billion takeover of health insurance rival Humana Inc., the company said Wednesday. … The insurer is prepared to argue that there are several ways to ensure there’s enough competition in the market for health plans for the elderly, known as Medicare Advantage, according to a person familiar with the matter. In addition, it has already presented two separate divestiture proposals to U.S. officials, said the person, who spoke on condition of anonymity because the matter is private.” http://bloom.bg/29PB4of

JAMA: Medicare Beneficiaries Have Highest Rate of “Opioid Use Disorder”
research letter published Wednesday in JAMA Psychiatry found Medicare beneficiaries had the highest and most rapidly growing rate of ‘opioid use disorder.’” Data show six out of every 1,000 Medicare beneficiaries “struggle with the condition, compared with one out of every 1,000 patients covered through commercial insurance plans.” In addition, the letter suggested “Medicare beneficiaries may face a treatment gap,” because figures indicate that in 2013, physicians “prescribed a high number of opioid prescription painkillers for this population – which put patients at risk for addiction – but far fewer prescriptions for buprenorphine-naloxone, the only effective drug therapy for opioid use disorder covered by Medicare Part D.” 

Additional Information Regarding CMS Proposed 2017 Medicare Payment Rule
As reported last week, CMS has released its proposed revisions to the Medicare Part B payment system for 2017.  To read a summary prepared by the AMA of the highlights, click here.

Budget Neutrality Impact of “Add on” Codes

Of perhaps greatest significance, CMS is proposing an “add-on” code that could be billed with E/M codes for physicians treating people with mobility-related impairments.  While there is of course great merit in expanding access to patient care through increasing certain Medicare payments, this proposal is funded with an across-the-board cut in payment rates that would (due to “budget neutrality” requirements) completely nullify the 0.5% increase in Medicare payments that was required by MACRA.

2017 Potentially Misvalued Codes List

CMS has identified 83 services for reductions as “misvalued”.   This was required by the Protecting Access to Medicare (PAMA) and Achieving a Better Life Experience (ABLE) Acts of 2014 that set a 0.5% target for reductions for both 2017 and 2018.   To develop the list, CMS identified 0-day global codes that were billed with an E/M code 50 % of the time or more, on the same day of service, with the same physician and same beneficiary.  To prioritize its review, CMS identified codes that have not been reviewed in the last five years and have greater than 20,000 allowed services.

New York GPCI Adjustments

As is required every 3 years, CMS proposes changes to the Geographic Adjustment Factors (GAF) that   differentiates Medicare payments for over 100 different regions throughout the country, including within the 5 Medicare payment localities in New York State.  An initial review of the proposed revised GAFs shows that New York’s 5 payment localities would experience slight reductions in these regional adjustments, almost entirely due to a reduction in the malpractice cost component that helps to determine Medicare fees.  While there has been some leveling in recent years, New York’s malpractice premium costs still continue to far exceed almost all other states, calling into question CMS’ data.  Therefore, MSSNY has asked Senator Schumer’s office to question whether CMS’ data is accurate.

Other Highlights

  • Expand the duration and scope of the Diabetes Prevention Program (DPP), and changes the name to the Medicare Diabetes Prevention Program (MDPP).
  • Recognizing two new CPT codes for separate payment for non-face-to-face prolonged E/M services, which are currently considered to be bundled.
  • Require claims-based reporting regarding the number and level of pre- and post-operative services furnished for 10- and 90-day global services. Specifically, physicians would be required to report a set of time-based, G-codes that distinguish between the setting of care (hospital, office, email/telephone) and whether the services are furnished by a physician or by their clinical staff.
  • Expanding telehealth payment related to the use of a new place of service code specifically designed to report services furnished via telehealth, including for End-stage renal disease (ESRD) related services for dialysis, Advance care planning services; and Critical care consultations
  • changes to the quality measure set that ACOs are required to report to better align the MSSP quality measure set with the measures recommended by the Core Quality Measures Collaborative

To read the entire 856-page rule, click here:.  A chart detailing the specialty by specialty impact of the proposed changes to the Medicare fee schedule are on pp. 788-789.

MSSNY will be working with the AMA and the federation of medicine to review the rule and to make comments on key components. 

Congratulations to 61 NY Practices in the Million Hearts® Risk Reduction Model
The Centers for Medicare and Medicaid Services announced Thursday that 61 groups in New York State were selected for a new program that aims to reduce the risks for heart attacks and strokes among Medicare fee-for-service patients by applying select preventive measures.

The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model is a randomized controlled trial that seeks to bridge a gap in cardiovascular care by providing targeted incentives for health care practitioners to engage in beneficiary CVD risk calculation and population-level risk management. Instead of focusing on the individual components of risk, participating organizations will engage in risk stratification across a beneficiary panel to identify those at highest risk for atherosclerotic cardiovascular disease (ASCVD).

There are a total of 516 participating organizations (List) involved in the Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model. 

Court Case Examines Telemedicine Safety Regulations
A case before a United States Court of Appeals could restrict a state medical board from protecting patient safety through the regulation of telemedicine in that state.

At stake in Teladoc, Inc. v. Texas Medical Board is whether the Texas Medical Board has demonstrated immunity from federal antitrust laws.

The Court of Appeals is being asked to determine whether the Board may be held liable under the antitrust laws for its rule requiring a “defined physician-patient relationship to exist before a physician may prescribe dangerous or addictive medications. The necessary relationship is defined as established through either an in-person examination or an examination by electronic means with a health care professional present with the patient.

Teladoc, which uses telecommunications to connect patients and physicians, provides services in a way that would allow physicians to prescribe medications without the establishment of the required patient-physician relationship. Teladoc alleges that if the Board’s rule is valid, Teladoc would be limited in the way it could carry on business in Texas. It contends that this rule is anticompetitive and seeks to hold the Board liable under federal antitrust laws.

Telemedicine is advancing rapidly as a tool to improve access to care and reduce the growth in health care spending. Last month the AMA House of Delegates adopted new ethical ground rules for telemedicine. But the telemedicine standards of care and practice guidelines are constantly evolving and vary based on specialty and the services provided. It is important that state medical boards remain free to regulate the practice of medicine to ensure patient safety and appropriate prescribing.

“Telemedicine offers significant potential benefits to patients, including expanded access to medical care,” the Litigation Center of the AMA and State Medical Societies said in an amicus brief (log in). “At the same time, telemedicine is inappropriate for certain medical conditions, and it carries risks. Because a physician treating a patient remotely may be called upon to act with limited information, the quality of care may suffer, and a potential exists for fraud and abuse.”

“Given the complex and evolving state of telemedicine,” the brief said, “Texas’ balance of reliance on the expert board to act in the first instance, with state supervision as needed, is entirely appropriate—and should not be subject to second-guessing under the federal antitrust laws.”

Why Telemedicine Regulation Matters

Patient safety is the guiding force behind the Texas Board’s rule. With telephonic consultations, there may be no observation or physical examination of the patient, and there may be no laboratory or other diagnostic work that the physician can use to determine a diagnosis and course of treatment.

One patient case detailed in the brief offers an example of how telephonic consultation, without an in-person examination to establish a patient-physician relationship, led to treatment errors.

“There can be real, material risk of harm from treatment without any physical examination,” the brief said. “That risk is amplified where, as in this complaint, treatment is provided to a patient who cannot even communicate his or her own condition but must rely solely on characterizations by a layperson.”


Telehealth Poised To Revolutionize Health Care
University of Rochester Medical Center, 07/20/2016
Telehealth is growing rapidly and has the potential to transform the delivery of health care for millions of persons. That is the conclusion of a review article appeared in the New England Journal of Medicine. The piece, co–authored by Ray Dorsey, MD, MBA, with the University of Rochester Medical Center and Eric Topol,MD, with the Scripps Research Institute, argues that the growth of telehealth over the next decade and beyond will have profound implications for health care delivery and medicine. This delivery of virtual care over a distance could help address long–standing concerns about the distribution and number of physicians and provide greater flexibility to both patients and clinicians. Telehealth holds the potential to disrupt established patterns of care, the authors argue, because it provides access in a manner that is convenient to the patient and at potentially lower cost.

Many entities, from traditional medical providers to newer start–up companies, now offer virtual visits with a physician around the clock and at an average cost of less than $50 per visit.
By contrast, it takes on average 20 days to secure a 20–minute appointment with a physician that, with travel and waiting, can consume two hours of an individual’s time. The authors identify three trends that are reshaping telehealth. The first is driven by the potential of telehealth to make care more accessible, convenient, and reduce cost. The second is the expanded application of telemedicine from its tradition use in acute conditions, such as telestroke programs that connect neurologists with physicians in distant emergency departments, to episodic conditions, such as a consultation between a pediatrician and a school nurse to diagnose an ear infection in a child, to the ongoing management of chronic conditions.


FDA approves first single injection PCSK9 inhibitor delivery system American College of Cardiology News, 07/18/2016
The U.S. Food and Drug Administration (FDA) has approved Amgen’s evolocumab (Repatha) Pushtronex system, which delivers a proprotein convertase subtilisin kexin 9 (PCSK9) inhibitor once per month. The hands–free system is the first of its kind and delivers 420 mg of evolocumab in a single dose. Evolocumab received FDA approval in August 2015 as a treatment to lower low–density lipoprotein cholesterol – in addition to diet and maximally–tolerated statin therapy – in patients with heterozygous familial hypercholesterolemia, homozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please email gumd3@aol.com to arrange for a viewing.


Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

July 15, 2016 – Possible MACRA Delay

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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July 15,  2016
Volume 16, Number 25

Dear Colleagues:

We received some modestly good news this week suggesting that CMS is beginning to hear our concerns about the overwhelming complexity of the soon to be implemented Medicare Merit Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) programs.  As many of you know, these programs have the potential to significantly cut or increase Medicare physician payments.

CMS Acting Administrator Andy Slavitt stated publicly that the agency is considering delaying the January 1, 2017 start date for implementation of the MIPS and APM programs, and creating a shorter reporting period for physicians. The comments were made at a US Senate Finance Committee hearing this week examining CMS’ implementation of the MACRA law passed by Congress in 2015 to repeal the SGR and creating the MIPS and APM programs.

You can watch the roughly 90 minute hearing here 

We were pleased that Acting Administrator Slavitt, the only hearing witness, repeatedly stated that the success of small and rural practices under MACRA is a “very high priority” for CMS, and that CMS is considering policy measures to ensure that these providers are “set up for success” under the finalized MACRA rule.

Of course, the proof will be in the final rule that gets released by CMS in the fall.

Delaying the start date and creating a shortened reporting period were among the many suggestions offered by MSSNY and many other medical associations in their comments to CMS last month regarding how to revise the proposal.  MSSNY noted that the proposal by CMS to implement the MIPS and APM programs required by MACRA are “far too complex for many physicians who are already drowning in required paperwork from public and private payers”.  You can read MSSNY’s comments here

In addition, MSSNY has joined on to letters to CMS with the Coalition of State Medical Societies  and with 110 state and specialty medical societies initiated by the AMA .  Both joint letters stress to CMS the physician community’s strong concerns with the overwhelming complexity of this proposal, and the need to assure that physicians are exempted who have little possibility of earning more than it takes to comply.

While MACRA provides that payment adjustments under the MIPS and APM programs are not applied until 2019, it will be based upon care delivered to Medicare patients in 2017.  Under MIPS, Medicare payments could be adjusted up or down by 4% beginning in 2019, and up to +/ – 9% by 2022, with additional bonus payments possible.

Of course, it all comes down to whether our patients can continue to receive the timely and quality care they expect and deserve.  MSSNY and other advocacy associations have raised concerns that seniors’ access to needed physician care could be harmed if some or many physicians are forced to leave the Medicare program due to excessive administrative hassle.

Maybe, just maybe, policymakers are starting to understand this.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org

MLMIC


enews large

NYC: First Suspected Woman-to-Man Zika Infection Reported
The first case of sexual transmission of Zika virus from a woman to a man appears to have occurred in New York City, health officials there reported today.

The unnamed woman “engaged in a single event of condomless vaginal intercourse with a male partner the day she returned to NYC from travel to an area with ongoing Zika virus transmission,” according to Alexander Davidson, MPH, and colleagues in the city’s Department of Health and Mental Hygiene, during which she had already begun to show symptoms of infection.

A week later, the male partner also developed Zika symptoms, including fever, rash, joint pain, and conjunctivitis, the officials said in an early online release from Morbidity and Mortality Weekly Report. By this time, the woman had already tested positive for Zika infection, and subsequent testing in the man confirmed that he, too, had contracted the virus.

Because the man appeared to have no other opportunity to acquire the infection, Alexander and colleagues concluded that it must have been transmitted during the sex act.

“This case represents the first reported occurrence of female-to-male sexual transmission of Zika virus,” the researchers wrote in MMWR.

The Deadline for Nominations to Leadership Positions Is August 1
The deadline for nominations for MSSNY Councilors, Officers, Trustees and AMA Delegates is August 1. There is a link to the nomination form on the home page at www.mssny.org.

Physicians Urged to Send Letters of Support to Governor for ERX Changes
All physicians are urged to send letters to Governor Cuomo in support of 2 bills to address issues which have arisen with the implementation of the e-prescribing mandate.

The first bill, S. 6779, Hannon/A.9335-B, Gottfried would ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription in lieu of e-prescribing.  The letter urging the Governor to sign the bill can be accessed by clicking on this link.

In March, the Bureau of Narcotics Enforcement announced that when a physician invokes one of the three statutory exceptions and writes/faxes or calls in a paper script because:  their technology or power has failed; the prescription will be filled outside of New York; or it would be impractical for the patient to obtain medications in a timely manner, they must electronically submit to the department an onerous amount of information about the issuance of the paper prescription. DOH asks that each time a paper/fax/oral prescription is issued, the prescriber must electronically inform the DOH of their name, address, phone number, email address, license number, patient’s initials and reason for the issuance of the paper prescription.

This creates an onerous burden for all physicians, particularly in situations where there is a protracted technological failure, and the physician needs to report dozens upon dozens of paper prescriptions. In fact, Surescripts has stated publicly that there is a 3-6% e-prescription transmission failure rate. This means that in the state of New York anywhere between 7.6 million to 15 million e-prescriptions will fail every year and each prescriber involved with these failures who subsequently write a paper prescription will need to file this information with the state.  In some small communities, even the patient’s initials can convey information that will enable others who access this information to identify the patient who will receive the medication.

The bill passed by the Legislature affords a much more preferable alternative by allowing physicians and other prescribers to make a notation in the patient’s chart indicating that they have invoked one of the three statutory exceptions.

The second bill (A.10448, Schimel/S. 7537, Martins) would authorize a pharmacy which does not have a particular medication in stock to transfer the prescription to another pharmacy. The letter urging the Governor to sign the bill can be accessed by clicking on the following link.

Currently, e-prescriptions cannot be transferred by one pharmacy to another thereby requiring the patient to return to or call the prescriber’s office to ask that he/she transmit the e-prescription to another pharmacy creating unnecessary burdens on the patient and delaying timely access to their medication.

Urge Governor Cuomo to Sign Step Therapy Override Bill
All physicians are urged to send a letter to Governor Cuomo requesting that he sign into law a bill (A.2834-D/S.3419-C) that would establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health.

MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations, specialty societies, hospitals, and pharmaceutical manufacturers to achieve passage of this legislation.      We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

Long Island Newsday recently had an editorial in strong support of the bill.

The bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

DFS Approves Aetna’s Purchase of Humana with Conditions to Reduce Impact on Consumers and Health Providers; Still Requires DOJ Approval
The New York Department of Financial Services has reportedly sent a letter to Aetna indicating that it conditionally approved its proposal to acquire Humana.  While Humana has very little market penetration (limited almost exclusively to Medicare Advantage) in New York, DFS imposed several significant conditions in its approval of the purchase.  While a formal publication of the agreement or a summary has not yet been publicly released, several media reports (including Crains and Bloomberg) note that these conditions will include:

  • That the purchase must first be approved by the federal Department of Justice (DOJ), whose review is still ongoing;
  • No assets from New York insurance products can be used to finance the transaction;
  • None of the acquisition costs including executive compensation can be passed along to New York consumers or providers;
  • No dividends (ordinary or extraordinary) for 3 years from the date of the closing of the transaction;
  • The companies would be prohibited from reducing benefits within plans for 3 years except as required by Medicare
  • The companies would be prohibited from eliminating products for 3 years;
  • The companies would maintain adequate networks “as determined by the Department” for all plans including Medicare Advantage with additional levels of concerns in adequacy for rural and underserved areas.

At the same time, MSSNY, along with hospital and consumer groups, continues to strongly oppose the proposed merger between Anthem and Cigna, which would if approved have a far greater impact in New York’s health insurance market than the Aetna purchase of Humana.  This merger is still under review by DFS and the DOJ.  To read MSSNY’s letter in opposition to DFS, click here.  To read a letter in opposition to DFS from the Coalition to Protect Patient Choice, click here.

Congress Passes Comprehensive Addiction and Recovery Act (CARA) to Address Opioid Epidemic
Early this week, Congress reached agreement and passed the Comprehensive Addiction and Recovery Act (CARA) to address the opioid epidemic. This measure provides a comprehensive framework that includes prevention, treatment and recovery support and also recognized that addiction is a disease.

The legislation calls for the creation of a task force on pain management and calls upon the Secretary of Health and Human Services to advance an educational and awareness campaign regarding prevention and detection of opioid abuse.  In addition, the bill will:

  • improve access to overdose treatment and allow prescribers to co-prescribe naloxone.
  • provide grants to states to establish, implement and improve state-based prescription drug monitoring programs (PDMPs).
  • expand drug take back locations with state and local law enforcement agencies, manufacturers and distributors of prescription medications, retail pharmacies, narcotic treatment programs, hospitals with one site pharmacies and long term care facilities.
  • authorize nurse practitioners and physicians’ assistants to prescribe buprenorphine in an office based setting for up to 30 patients in the first year and 100 patients after the first year.
  • Clarifiy that a doctor or patient may request that a Schedule II prescription be “partially filled.”

A full summary of CARA can be found HERE.

MSSNY has advocated for many of these provisions and has worked with the American Medical Association’s Task Force to Reduce Opioid Abuse in developing positions on many of these issues related to opioids. MSSNY’s Assistant Treasurer, Frank Dowling, MD and Pat Clancy, Vice President for Public Health and Education, are MSSNY’s representatives to the AMA’s Task Force.

In support of the passage of CARA, MSSNY signed onto a joint thank you letter to Congress and also urged that Congress build upon CARA’s achievement by ensuring that appropriate funding is made available for providers to have the resources they need to “prevent opioid addiction from claiming more livers and causing more devastation to families and communities.” MSSNY and 77 other health care advocacy organizations signed this letter. A copy of the letter can be found HERE.

CMS Releases Proposed Medicare Rule for 2017
Late last week, CMS released its proposed rule to update the Medicare Part B physician fee schedule effective January 1, 2017.  To read the CMS summary of highlighted changes, click here.

To read the entire 856-page rule, click here.  A chart detailing the specialty by specialty impact of the proposed changes to the Medicare fee schedule are on pp. 788-789.

In its press release, CMS has highlighted the following proposed changes to Medicare payment:

  • Primary Care and Care Coordination: The rule proposes revisions to payment for chronic care management, including payment for new codes and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health:CMS is proposing to pay for specific behavioral health services furnished using the Collaborative Care Model, in which patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also proposing to pay more broadly for other approaches to behavioral health integration services.
  • Cognitive Impairment Care Assessment and Planning: CMS is proposing a new code to pay for cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s).
  • Care for Patients with Mobility-Related Impairments: CMS is proposing to pay physicians more accurately for furnishing services to beneficiaries with mobility-related impairments.

As is required every 3 years, CMS also proposes changes to the Geographic Adjustment Factors that specify how to differentiate Medicare payments in over 100 different regions throughout the country, including within the 5 Medicare payment localities in New York State.

MSSNY will be working with the AMA and the federation of medicine to review the rule and to make comments on key components.

WHY NICE PEOPLE COLLECT BAD DEBT
Learn how to collect from the experts! This information-packed webinar assists office management in preventing and recovering past due accounts.

Live online Jul 19 11:00 am United States – Chicago or after on demand (45 mins) https://www.brighttalk.com/webcast/10535/212633

MLMIC Advice: Treating Patients with Whom You Have a Close Relationship
The Risk: Physicians are often asked by close friends, relatives, or colleagues for medical advice, treatment, or prescriptions both inside and outside of the office. At times, these individuals may be seen at no charge as a courtesy. Although the American Medical Association advises physicians not to treat immediate family members except in cases of emergency, or when no one else is available, this practice continues to exist.

Unfortunately, over the years, we have seen a number of lawsuits filed against physicians by close friends, colleagues, and even their own family members because of care provided by our insureds. The defense of these suits is frequently hampered by the fact that there are often sparse or entirely non-existent medical records for the patient. The failure to maintain a medical record for every patient is defined as professional medical misconduct in Education Law § 6530(32). Providing care under these circumstances may pose unique risks. Here are some suggestions on how to handle these situations:

Recommendations:

  1. Always create a medical record for friends, relatives, and colleagues for whom you provide care of any kind.
  2. All patient encounters must be documented in the medical record, including those that occur outside the medical office.
  3. A thorough medication history should be obtained to avoid potential drug interactions and identify any contraindications.
  4. Take a complete history when seeing friends, relatives, or colleagues as patients. If indicated, this should include issues that may be uncomfortable to discuss such as the use of psychotropic medications and sexual history.
  5. Perform a thorough physical examination. Sensitive portions of a physical examination should not be deferred when pertinent to the patient’s complaints. These may include a breast, pelvic, or rectal examination. A chaperone may be necessary for those portions of the exam.
  6. Do not write prescriptions for individuals with whom you do not have an established professional relationship and always document the reasons for prescribing the medication and dose. If narcotics are prescribed, the Prescription Monitoring Program (I-STOP) must be checked.
  7. If a surgical procedure is to be performed, a signed informed consent must be present in the record, with accompanying documentation that the requisite risks, benefits, and alternatives to the treatment have been discussed with the patient.

This risk management tip was published in the spring 2016 issue of Dateline.  For a more detailed analysis of the subject of treating friends and family, including two pertinent case studies, please visit MLMIC.com to review the summer 2016 issue of Case Review.

This article has been reprinted with permission from: MLMIC Dateline (Spring 2016, Vol. 15, No. 2), published by Medical Liability Mutual Insurance Company, 2 Park Avenue, Room 2500, New York, NY 10016.  

MSSNY’s Dr. Frank Dowling and AMA Panel Offer Recommendations to Treat Chronic and Acute Pain
At the AMA Annual Meeting last month, a panel of physician experts—which included MSSNY’s Dr. Frank Dowling—offered actions every physician can take to appropriately treat patients with acute or chronic pain, including using PDMPs to improve care and managing chronic pain by focusing on the patient’s goals.

The panel was comprised of physician representatives from the AMA Task Force to Reduce Prescription Opioid Abuse. In light of the opioid epidemic, the task force has put forth recommendations for physicians. “These recommendations come from our colleagues,” Patrice A. Harris, MD, psychiatrist and chair of the AMA Board of Trustees, said. “We are better physicians when we learn from one another.”

Dr. Dowling specifically addressed NY’s PDMP—called I-STOP—and noted that the tool is not just for when a physician plans to prescribe but can also aid in treatment.  “Any time I’m assessing and making a treatment decision, I can look up that information that may be useful, even if I’m not going to prescribe,” Dr. Dowling said. “Some docs will look up all patients in their practice who may be on the schedule … others may look up only when they feel it’s clinically indicated because of a suspicion or a worry or they’re considering a prescription.”

To read the full story, go here.

Governor Announces Crackdown on Synthetic Marijuana after Massive Overdose
The AP (7/14) reports New York Gov. Andrew Cuomo (D) said on Thursday that the state will take steps to crack down on the illegal sale of the drug K2, a type of synthetic marijuana, after 33 people were hospitalized in Brooklyn after overdosing on the drug. Gov. Cuomo said state police, health officials, and others will focus on stopping sales of the drug in bodegas and other shops.

MSSNY IN THE NEWS
·        AMA Wire – 06/22/16
3 things every physician should do when treating pain
(MSSNY Assistant Treasurer, Dr. Frank Dowling, MD quoted)

(MSSNY Mentioned)

Dr. Michael Goldstein, President of the New York County Medical Society quoted)

(MSSNY Mentioned)

Also ran in:

WFXG FOX 54

Syracuse.com – 07/08/16
·        Company News: David Moorthi joined St. Joseph’s Physicians Spine Care
(MSSNY member Dr. David Moorthi mentioned)

·        Politico Pro Health Newsletter – 07/14/16
Listen Up! – Zika Press Release picked up


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please call 516-259-1877 to arrange for viewing.



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

July 8, 2016 – Keep Up Advocacy for More Victories!

 

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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July 8,  2016
Volume 16, Number 24

Dear Colleagues:

With your grassroots efforts and working together with strong allies, your MSSNY was able to achieve a number of important legislative victories this past legislative session to reduce your administrative hassles.

However, the need for our continued advocacy on these issues did not end with the Senate and Assembly passing these bills.

We must now turn our attention to pressing the Governor to sign these important bills into law.  We need you to send letters to the Governor urging that he sign into the law following bills:

  1. Legislation that would establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health. A letter can be sent here.
  2. Legislation that would ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription in lieu of e-prescribing.  A letter can be sent here.
  3. Legislation to permit a pharmacy to transfer an e-prescription to another pharmacy, such as when the initial pharmacy does not have the medication in stock. The letter can be sent here.

The step therapy bill (S.3419-C, Young/A.2834-D, Titone) would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.   An insurer decision must be made within 3 days, 24 hours where the patient’s health is in serious jeopardy if they do not receive the physician requested medication.

We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

The e-prescribing exception reporting simplification bill (S. 6779-B, Hannon/A.9335-B, Gottfried) would allow physicians and other prescribers to make a notation in the patient’s chart when they have had to invoke one of the three statutory exceptions to the mandatory e-prescribing law in lieu of having to report such information to DOH every single time they must write a paper prescription.  Currently, DOH asks that each time a paper/fax/oral prescription is issued, the prescriber must electronically inform the DOH of their name, address, phone number, email address, license number, patient’s initials and reason for the issuance of the paper prescription.

This creates an onerous burden for all physicians, particularly in situations where there is a protracted technological failure, and the physician needs to report dozens upon dozens of paper prescriptions.  This legislation would address this needless burden.

The e-prescription transfer bill (A.10448, Schimel/S. 7537, Martins) would address the situation where a physician must re-submit e-prescriptions to multiple pharmacies if the initial pharmacy receiving the e-prescription is out of stock of the requested for the medication for the patient.   Currently, e-prescriptions cannot be transferred by one pharmacy to another thereby requiring the patient to return to or call the prescriber’s office to ask that he/she transmit the e-prescription to another pharmacy creating unnecessary burdens on the patient and delaying timely access to their medication.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org

MLMIC


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MSSNY Files Class Action Suit against United Healthcare re Facility Fees
On July 1, MSSNY and other plaintiffs filed a class action complaint against United Healthcare and its subsidiary and affiliate companies (United) alleging that United has unlawfully refused to pay facility fees to physicians and other health care professionals who perform outpatient surgeries at accredited office based surgery (OBS) practices.  The lawsuit was filed in the United States District Court Southern District of New York.

Most United plans allow United insureds to receive insurance benefits from in-network (INET) providers and out-of-network (ONET) providers.  The lawsuit concerns United’s handling of ONET claims, and alleges that United’s refusal to pay facility fees to OBS practices violates the terms of United’s plan documents, including the United plan’s “Certificate of Coverage.”

The Certificate of Coverage sets forth the basic terms under which the United plan provides medical/surgical benefits.  According to the complaint, United’s standard Certificate of Coverage contains a lengthy list of “Covered Health Services,” including “Surgery-Outpatient,” which is defined in the Certificate as “surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician’s office.” In such cases, the Certificate states that the benefits not only include coverage for physician services, but also includes coverage for “facility charge and the charge for supplies and equipment.” According to the complaint, the typical United Plan promises to pay for OBS facility charges, and makes no distinction between facility charges of OBS practices and facility charges of hospitals or other facilities.

According to the complaint, until recently, United honored these plan terms.  When a United insured received medically necessary ONET outpatient surgery, United caused the insured’s United Plan to make payment for the surgeon’s services,  and another for the facility fee, and the facility fee was paid regardless whether the entity performing the outpatient surgery was a hospital, ambulatory surgery center (“ASC”) or an OBS practice. More recently, however, United has adopted a uniform policy to refuse to pay OBS facility fees, despite the fact that the overwhelming majority of United plans have not changed the terms of the plan’s Certificate of Coverage with respect to ONET outpatient surgeries. The complaint refers to the policy as United’s “Uniform Refusal to Pay.”

The class action complaint alleges that:

  • United has systematically violated the terms of the United Plans by adopting its Uniform Refusal to Pay and, among other violations of law;
  • United  has systematically violated ERISA by failing to honor plan terms and adopting the Uniform Refusal to Pay that violates plan terms.

MSSNY President Malcolm Reid, M.D. stated that United’s Uniform Refusal to Pay is unfair to the many MSSNY physician members who operate OBS practices and the patients they serve, by failing to adequately reimburse OBS practices for the expenses incurred to operate the operating room.  In the end, the patients are hurt when the OBS practice is not reimbursed for its facility costs, said Dr. Reid.

The other plaintiffs in the lawsuit include the Society of New York Office Based Surgery Facilities (“NYOBS”) and Podiatric OR of Midtown Manhattan, P.C.  MSSNY and NYOBS are seeking injunctive and declaratory relief on behalf of their respective members and patients.

Among the relief requested by the plaintiffs, it is requested that:

  • the court issue an order to require United to reprocess all denied OBS claims in compliance with ERISA and the plan terms; and
  • to notify all Class Members and all  MSSNY and NYOBS members of the right to resubmit claims for services provided through an OBS practice for which facility fees were not submitted in which such facility fees should be covered under the plan terms, and ordering United to reprocess such claims in compliance with ERISA and the plan terms.

The firms Zuckerman Spaeder, LLP and Buttaci & Leardi, LLC represent MSSNY and the other plaintiffs in this action.  MSSNY wishes also to thank its general counsel Kern Augustine, P.C. for its advice and counsel.

If you have any questions concerning the litigation, or have issues relating to coverage for OBS fees, please contact Anant Kumar at Zuckerman Spaeder, LLP at akumar@zuckerman.com or by telephone at 646-746-8841.” 

New: Survival of Independent Practice Section on the MSSNY Website
MSSNY’s Task Force on Survival of Independent Practice, co-chaired by Thomas T. Lee, MD, and Paul Lograno, MD, was formed last fall based on a directive from the House of Delegates. It was charged with exploring options for independent physicians to collaborate and create practice models to deal with current challenges for independent practices and to achieve the goals of diversity of service, economy of scale and collective negotiations.

The Task Force has put together a series of recommendations on options physicians can consider in order to practice successfully in an independent environment. These are real practice models that have been employed successfully by task force members in different specialties and in different parts of the state and that have made them financially successful and free from many administrative frustrations. They are offered as options for MSSNY members to consider, modify or build on.

Please take a look at the new Survival of Independent Practice site here.

Leadership Seminar Slated for Syracuse Oct 21-22
Following a highly successful Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has slated a Leadership program for upstate physicians in Syracuse October 21-22.

The program will be held at the Doubletree Inn at NYS Thruway (Syracuse Exit 36). A renowned faculty from Brandeis and Harvard University will lead the program that is focused on management techniques needed by physicians in an integrated health care environment.

Attendees at the April downstate Leadership Seminar gave the program rave reviews. The program is limited to 40 physician attendees aged 40 and under with all costs are covered under a grant from The Physicians Foundation.  MESF Chairman Joseph Maldonado MD termed the program a “unique opportunity to hear from an outstanding faculty” and better understand the direction of health care delivery in the next 10 years. To see the agenda and faculty click here.  For application forms, contact MESF Executive Director at tdonoghue@mssny.org. 

CMS’ Slavitt to Testify Before Senate Finance Re MACRA Implementation
Next Wednesday, July 13, at 10 AM, US Senate Finance Committee Chair Orrin Hatch (R-Utah) will convene a hearing on to examine CMS’ implementation of the MACRA law passed by Congress in 2015 to repeal the SGR and creating the MIPS and APM Medicare value-based payment programs.   The sole witness for the hearing will be CMS Acting Administrator Andy Slavitt.  Video of the hearing will be available here.

Noting that the proposal by CMS to implement the MIPS and APM Medicare value-based payment programs required by MACRA are “far too complex for many physicians who are already drowning in required paperwork from public and private payers”, MSSNY recently submitted extensive comments to CMS to urge significant changes before the rule is finalized.  To read MSSNY’s comments, click here. 

In addition, MSSNY has joined on to letters to CMS with the Coalition of State Medical Societies and with 110 state and specialty medical societies initiated by the AMA .  Both joint letters stress to CMS the physician community’s strong concerns with the overwhelming complexity of this proposal, and the need to assure that physicians are exempted who have little possibility of earning more than it takes to comply.

While MACRA provides that payment adjustments under the Merit Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) are not applied until 2019, it will be based upon care delivered to Medicare patients in 2017.  Under MIPS, Medicare payments could be adjusted up or down by 4% beginning in 2019, and up to +/ – 9% by 2022, with additional bonus payments possible.

The key points made by MSSNY and other associations in its comments included:

  • The need to significantly raise the MIPS exemption threshold from 100 Medicare patients and $10,000 in Medicare revenue.
  • The need to postpone the implementation start date to at least several months after January 1, 2017, and for a shorter “performance period”
  • The need for a mechanism for physicians to receive comprehensive periodic feedback from CMS as to how they are performing in each of the 4 categories before a “performance period” ends
  • The need to assure that the MIPS program for determining bonuses or penalties compares physicians practicing in similar specialties, and practice sizes rather than all being lumped into one big pool. 


HHS Announces Measures to Address Opioid Abuse
This week HHS announced a series of measures to address the opioid epidemic including:

  • a proposal by CMS that would remove the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey pain management questions from the hospital payment scoring calculation in order to “eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions;”
  • a final rule issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) that would increase from 100 to 275 the number of patients a physician can treat with buprenorphine; and
  • a new policy that would require Indian Health Service (IHS) prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain.

To read the full press release, click here.

House Passes Legislation to Overhaul Mental Health System
The House passed legislation on July 6 to overhaul the nation’s mental health system, the first effort by lawmakers to specifically tackle federal policies on serious mental illness. The bill passed 422-2, overwhelming support that reflected a decision by sponsors to defer debates on some of its most controversial aspects. The bill would reorganize the federal agency overseeing mental health policy, direct funding to combat serious mental illness as opposed to general mental health programs, and change Medicaid reimbursements for treating patients with illnesses like schizophrenia.

The bill passed Wednesday would require the Health and Human Services Secretary to seek public comment and write new regulations on how to handle privacy law in cases of serious mental illness. It would also reauthorize grants for states that already run compelled treatment programs and largely drop restrictions on patient advocacy groups’ work.

It would also boost requirements for private insurers to cover mental health care on an equal footing with physical health, and open official studies on other areas that could support changes in the future. One boost for the House bill came Tuesday from the Congressional Budget Office, which said the measure wouldn’t increase federal spending, and would reduce spending on the Medicaid program by $5 million over 10 years. (Modern Healthcare, 6/28) 

Important Reminder about Billing Requirements for Certain Dual-Eligibles
As part of the AMA’s ongoing work with the Centers for Medicare & Medicaid Services on issues affecting Medicare providers and beneficiaries, the AMA would like to remind physicians that balance billing is prohibited for Medicare beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program. CMS has conveyed their concern that some physicians are still billing QMB beneficiaries, despite the existing prohibition.

The QMB program is a Medicaid program that helps very low-income dual eligible beneficiaries—e.g., individuals who are enrolled in both Medicare and Medicaid—with Medicare cost-sharing.  Beneficiaries in the QMB program have annual incomes of less than $12,000.  Federal law protects QMBs from any cost-sharing liability and prohibits all original Medicare and Medicare Advantage providers—even those who do not accept Medicaid—from billing QMB individuals for Medicare deductibles, coinsurance, or copayments. 

All Medicare and Medicaid payments that physicians receive for furnishing services to a QMB individual are considered payment in full.  It is important to note that these billing restrictions apply regardless of whether the state Medicaid agency is liable to pay the full Medicare cost-sharing amounts (federal law allows state Medicaid programs to reduce or negate Medicare cost-sharing reimbursements for QMBs in certain circumstances).  Physicians may be subject to sanctions for failing to follow these billing requirements, and CMS has indicated that they may start conducting more frequent audits to address this practice. 

For further information, see MLN Matters, Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program.

FDA Approves First Hepatitis C Drug That Treats All Six Strains
The Wall Street Journal (6/28) reports that the Food and Drug Administration has approved Gilead Sciences Inc.’s Epclusa (sofosbuvir/velpatasvir), the first drug that treats all six strains of hepatitis C. According to Gilead, the drug’s list price will be $74,760 for a course of treatments, which is lower than its older hepatitis C treatments. The AP (6/28, Perrone) reports that Epclusa “cures 95 percent of patients in three months, according to clinical trial data reviewed by the FDA.” It is “designed to be used in combination with ribavirin, an older antiviral drug.”

Additional coverage is provided Bloomberg News (6/28), MedPage Today (6/28).

Oxford pulls more plans from NY market
Oxford Health Plans is leaving the individual market in New York in 2017, and also plans to discontinue its small and large group products, UnitedHealthcare announced in a notice to brokers last Friday. While United indicated in the letter that few large groups currently offer an Oxford plan, the loss of the Liberty Network HMO plans and Oxford Metro Network plans will likely leave significant gaps in the small-group and individual markets, respectively, said Alex Miller, a partner at Millennium Medical Solutions, an employee-benefits consulting agency based in Westchester County. “In the last five years, the Liberty HMO has been our most popular product,” he said. But Oxford has requested high premium increases for its small-group plans in recent years, including an average rate hike of 10.58% for 2016.

Instead, the state approved an average increase of 3.9%. BlueCross BlueShield exited New York’s small-group market a few years ago, but is considering re-entering to pick up Oxford’s members, Miller said.

EmblemHealth and 13 oncology practices across New York State are participating in an experimental care delivery model, the U.S. Department of Health and Human Services announced Wednesday. Read the HHS press release here. 

New York’s Zika Numbers on the Rise
The State Health Department reported that as of Tuesday, there were 260 confirmed cases of Zika in New York City, and 74 in the rest of the state. State health officials said there are no cases of reported microcephaly in the state. Speaking on a conference call with reporters on July 1, Dr. Bassett said 24 of those cases were pregnant women for whom Zika can be especially dangerous because of the virus’ effects on the fetus.

FDA: Do Not Eat Raw Cookie Dough Due to E.coli Contaminated Flour
On July 6, the FDA issued a message warning people not to eat raw dough because of a recent outbreak of E. coli linked to contaminated flour.

So far, a reported 38 people in 20 states have been infected by a strain of bacteria called Shiga toxin-producing E. coli O121 found in flour. The infections began last December, and 10 of those infected have been hospitalized.

Symptoms of the bacterial infection include severe stomach cramps, diarrhea (often bloody), and vomiting. Most people get better within a week, but in some cases, infections can lead to a type of kidney failure called hemolytic uremic syndrome. Those who are most vulnerable to severe illness include children under 5, older adults and people with weakened immune systems.

Investigations by the Centers for Disease Control and Prevention and the FDA traced the source of the outbreak to flour that was produced in November 2015 at the General Mills facility in Kansas City, Mo. General Mills has issued a voluntary recall of 10 million pounds of flour produced between Nov. 14 and Dec. 4, sold under three brand names: Gold Medal, Signature Kitchens and Gold Medal Wondra. Flour that is part of the recall should be thrown away.

Unlike other raw foods, like eggs or meat — which many people recognize as contamination risks — “flour is not the type of thing that we commonly associate with pathogens,” said Jenny Scott, a senior adviser in the FDA’s Center for Food Safety and Applied Nutrition.

In this case, investigators believe that the grain became contaminated in the field, where it is exposed to manure, cattle, birds and other bacteria. “E. coli is a gut bug that can spread from a cow doing its business in the field, or it could live in the soil for a period of time; and if you think about it, flour comes from the ground, so it could be a risk,” said Adam Karcz, an infection preventionist at Indiana University Health in Indianapolis.

MACRA Rule Raises Patient Privacy Concerns
Physicians and healthcare organizations have flooded the CMS with concerns about MACRA, the proposed changes to the way Medicare pays providers. They say the rule puts patient data at risk and could actually push providers away from participating in payment models meant to lower costs while increasing quality of care. (Modern Healthcare 6/28)

The Medicare Access and CHIP Reauthorization Act aims to consolidate three existing payment models: the Physician Quality Reporting System, the Physician Value-based Payment Modifier and Medicare’s incentive program for achieving meaningful use of electronic health records.

Agency officials said the new consolidated program will offer physicians greater simplicity and flexibility, providing two paths for physician payments when it goes into effect in 2019. Physicians can choose to participate in the Merit-based Incentive Payment System, or MIPS, or have a significant amount of their revenue generated under a qualifying alternative payment model, or APM.

The agency received nearly 4,000 comments by the June 27 deadline. The majority of comments were critical of the proposed rule.

Several providers said a requirement to submit quality information via a registry or EHR oversteps by asking providers not only for data on Medicare patients, but patients with other forms of coverage as well. Experts say providers are raising a valid point.

Others say the rule could discourage providers from participating in value-based purchasing initiatives. For instance, to quality for a 5% bonus, providers must participate in models that require significant financial risk.

“Although the clinicians participating in shared savings-only models are working hard to support CMS’s goals to transform care delivery, under CMS’s proposal they will not be recognized for those efforts,” Tom Nickels, the American Hospital Association’s executive vice president of government relations and public policy, said in a statement

“We fear this could have a chilling effect on experimentation with new models of care among providers that are not yet prepared to jump into two-sided risk models.”

Providers across the country said the 963-page rule is simply too complex to understand, making it difficult to adhere to.

The rule is expected to be finalized by Nov. 1.

NIH Awards $55 Million to Build Million-Person Precision Medicine Study
The National Institutes of Health announced $55 million in awards in fiscal year 2016 to build the foundational partnerships and infrastructure needed to launch the Cohort Program of President Obama’s Precision Medicine Initiative (PMI). The PMI Cohort Program is a landmark longitudinal research effort that aims to engage 1 million or more U.S. participants to improve our ability to prevent and treat disease based on individual differences in lifestyle, environment and genetics. The project is expected to launch later this year.

The awards will support a Data and Research Support Center, Participant Technologies Center and a network of Healthcare Provider Organizations (HPO). An award to Mayo Clinic, Rochester, Minnesota, to build the biobank, another essential component, was announced earlier this year. All awards are for five years, pending progress reviews and availability of funds. With these awards, NIH is on course to begin initial enrollment into the PMI Cohort Program in 2016, with the aim of meeting its enrollment goal by 2020. The PMI Cohort Program is one of the most ambitious research projects in history and will set the foundation for new ways of engaging people in research. PMI volunteers will be asked to contribute a wide range of health, environment and lifestyle information. They will also be invited to answer questions about their health history and status, share their genomic and other biological information through simple blood and urine tests and grant access to their clinical data from electronic health records. In addition, mobile health devices and apps will provide lifestyle data and environmental exposures in real time. All of this will be accomplished with essential privacy and security safeguards. As partners in the research, participants will have ongoing input into study design and implementation, as well as access to a wide range of their individual and aggregated study results. (NIH News, 07/08/2016


CDC Issues Alert on Multidrug-Resistant Yeast
U.S. healthcare facilities should be alert for Candida auris — an emerging multidrug-resistant yeast that causes invasive disease and carries a high mortality rate — the CDC has warned.

Since 2009, C. auris infections — including bloodstream, wound, and ear infections — have been identified in Africa, Asia, Europe, and South America. In addition, an isolate was identified in the U.S. in 2013. Patients usually become infected several weeks into their hospital stay. The organism appears to spread within healthcare facilities, although the exact mechanism is unknown. Some 60% of infected patients have died, the CDC reports. However, this figure is based on limited case numbers, and many patients had other conditions that put them at increased mortality risk.

Almost all tested isolates have been resistant to fluconazole, more than half resistant to voriconazole, one-third resistant to amphotericin B, and several resistant to echinocandins. Some isolates have been resistant to all three major classes of antifungal drugs.

Commercially available biochemical tests cannot differentiate C. auris from other Candida species; accordingly, the CDC offers advice on laboratory diagnosis at the link below. The agency also advises healthcare facilities on case reporting, patient isolation, and appropriate environmental cleaning.
CDC clinical alert (Free)
CDC Q&A on C. auris (Free)


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please call 516-259-1877 to arrange for viewing.



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Medical Office For Rent – 715 West 170 Street
Two to five examination rooms available plus Reception,secretarial areas. Two bathrooms and entrances. Ethernet and cable ready. $4000 – $9500/ month. 917.861.8273 drdese@gmail.com Can build to suit including accredited O.R.s


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

June 24, 2016 – MACRA: More Alphabet Soup

 

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

June 24,  2016
Volume 16, Number 23

Dear Colleagues:

The federal Government came up with MACRA in answer to the dissolution of the horrible SGR. While MSSNY, along with the AMA, was pooling our forces to override SGR fee cuts, other Medicare problems popped up. In an effort to address some of these problems, MACRA consolidated and revised Medicare’s Physician penalty and incentive programs, hoping to simplify and improve them. It appears that the result will be neither simplified nor improved.

What MACRA is supposed to do is alleviate the burdens of PQRS and MU.  Oh yes, we are still in alphabet soup. MACRA= Medicare Access and CHIP Reauthorization Act of 2015; PQRS= Physician Quality Reporting System; MU= Meaningful Use.

Now, under MACRA we now have MIPS and APMs.  MIPS=Merit-based Incentive Payment System and APMs= Alternative Payment Models.  MIPS allows Medicare clinicians to be paid for providing high value care through success in four performance categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost.

Clinicians who participate in APMs such as the new Comprehensive Primary Care Plus (CPC+) model, the Next Generation ACO model, and other Alternative Payment Models  would be exempt from MIPS reporting requirements and qualify for financial bonuses.  Under APMs, clinicians accept both risk and reward for providing coordinated, high-quality care.

For more information about MACRA, MIPS and APMs, please look at CMS’ website.

CMS’ PRESS release.

Oh yes, we are still in the soup –alphabet soup that is.

See article below regarding MSSNY’s comments on the CMS’ proposal.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org

MLMIC


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MSSNY, Many Other Physician Organizations Comment on MACRA Implementation
Noting that the proposal by CMS to implement the MIPS and APM Medicare value-based payment programs are “far too complex for many physicians who are already drowning in required paperwork from public and private payers”, this week MSSNY submitted extensive comments to CMS to urge significant changes before the rule is finalized.  To read MSSNY’s comments, click here.  

In addition, MSSNY has signed on to a letter initiated by the American Medical Association with medical societies across the country, and is working with the Coalition of State Medical Societies on a joint letter.  These letters all stress to CMS the physician community’s strong concerns with the overwhelming complexity of this proposal, and the need to assure that physicians are exempted who have little possibility of earning more than it takes to comply.

With the comment deadline this Monday, June 27, physicians are encouraged to send their own comments to CMS by clicking here.

The comments were in response to the proposal announced by CMS in early May to implement the value-based payment programs contained in the MACRA legislation enacted by Congress in 2015 that repealed the Medicare SGR methodology.  While payment adjustments under the Merit Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) are not applied until 2019, it will be based upon care delivered to Medicare patients in 2017.  Under MIPS, Medicare payments could be adjusted up or down by 4% beginning in 2019, and up to +/ – 9% by 2022, with additional bonus payments possible.

The key points made by MSSNY and other associations in its comments included:

  • The need to significantly raise the MIPS exemption threshold from 100 Medicare patients and $10,000 in Medicare revenue.
  • The need to postpone the implementation start date to at least several months after January 1, 2017, and for a shorter “performance period”
  • The need for a mechanism for physicians to receive comprehensive periodic feedback from CMS as to how they are performing in each of the 4 categories before a “performance period” ends
  • The need to assure that the MIPS program for determining bonuses or penalties compares physicians practicing in similar specialties, and practice sizes rather than all being lumped into one big pool.
    (AUSTER)


Urge Governor Cuomo to Sign Step Therapy Override Bill
With the Legislature’s passage of a bill (A.2834-D/S.3419-C) last week to establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health, all physicians are urged to send a letter to Governor Cuomo to ask that he sign this important bill into law.  A letter can be sent here.

MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations, specialty societies, hospitals, and pharmaceutical manufacturers to achieve passage of this legislation. We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

This week, Long Island Newsday had an editorial in strong support of the bill.

The bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.
(AUSTER, DEARS)                                                                                           

Governor Signs Opioid Package
In a three city whirlwind tour of the state, Governor Cuomo this week signed into law legislation designed to arrest the growing opioid epidemic. The effective date of each provision of law varies and is set forth below for your information. Importantly, the new seven day limit on the number of days for which opioids can be prescribed for the initial onset of acute pain will go into effect on July 22, 2016.

  1. Mandate to complete three hours of CME training on pain management must be completed by July 1, 2017. Course standards and regulations are being developed. MSSNY in conjunction with OASAS and DOH, has already developed such a course—currently on its website. MSSNY will apply to assure that this course meets the standards developed by the agency.
  1. Inpatient residential coverage without utilization review limitations becomes effective on January 1, 2017.
  1. Requirements that DOH must create and pharmacies must make available information materials regarding the dangers of misuse and the potential for addiction to controlled substances to the public at the time of dispensing controlled substances will go into effect on October 22, 2016.
  1. Requirements that hospitals must coordinate discharge planning for individuals with suspected substance use disorder with SUD programs go into effect on December 22, 2016.
  1. Required use of utilization review tools designate by OASAS goes into effect on January 1, 2017.
  1. Required access to a five day supply for emergency use of medication for substance use disorder and access to buprenorphine and naltrexone for detoxification without prior authorization goes into effect on January 1, 2017.
  1. Involuntary commitment of a person incapacitated for drug or alcohol abuse for up to 72 hours goes into effect on September 22, 2016.
  1. The new seven day limit on the number of days for which opioids can be prescribed for the initial onset of acute pain will go into effect on July 22, 2016.
    (DEARS, CLANCY, AUSTER) 


Physicians Urged To Send Letters of Support to Governor for ERX Changes
As reported in last week’s Capitol Update, two measures passed which will address issues which have arisen with the implementation of the e-prescribing mandate. Physicians are encouraged to send letters of support for each of these bills to the Governor to urge that he sign the bills into law.

The first bill, S. 6779, Hannon/A.9335-B, Gottfried would ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription in lieu of e-prescribing.  The letter urging the Governor to sign the bill can be accessed by clicking on this link.

In March, the Bureau of Narcotics Enforcement announced that when a physician invokes one of the three statutory exceptions and writes/faxes or calls in a paper script because:  their technology or power has failed; the prescription will be filled outside of New York; or it would be impractical for the patient to obtain medications in a timely manner, they must electronically submit to the department an onerous amount of information about the issuance of the paper prescription. DOH asks that each time a paper/fax/oral prescription is issued, the prescriber must electronically inform the DOH of their name, address, phone number, email address, license number, patient’s initials and reason for the issuance of the paper prescription.

This creates an onerous burden for all physicians, particularly in situations where there is a protracted technological failure, and the physician needs to report dozens upon dozens of paper prescriptions. In fact, Surescripts has stated publicly that there is a 3-6% e-prescription transmission failure rate. This means that in the state of New York anywhere between 7.6 million to 15 million e-prescriptions will fail every year and each prescriber involved with these failures who subsequently write a paper prescription will need to file this information with the state.  In some small communities, even the patient’s initials can convey information that will enable others who access this information to identify the patient who will receive the medication.

The bill passed this week affords a much more preferable alternative by allowing physicians and other prescribers to make a notation in the patient’s chart indicating that they have invoked one of the three statutory exceptions.

The second bill A.10448, Schimel/S. 7537, Martins would authorize a pharmacy which does not have a particular medication in stock to transfer the prescription to another pharmacy. The letter urging the Governor to sign the bill can be accessed by clicking on the following link.

Currently, e-prescriptions cannot be transferred by one pharmacy to another thereby requiring the patient to return to or call the prescriber’s office to ask that he/she transmit the e-prescription to another pharmacy creating unnecessary burdens on the patient and delaying timely access to their medication.                                             (DEARS, AUSTER) 

HHS Announces Funding Opportunity to Assist Small Practices Prepare  for Value-Based Payment Programs
The U.S. Department of Health and Human Services announced this week an initiative to financially assist small practices preparing for Quality Payments under the Medicare Program.The $20 million funding will support “on-the-ground training and education” for physicians and other participating Medicare clinicians in both individual and small group practices of 15 clinicians or fewer – especially in historically under-resourced areas including rural and medically underserved areas.

“Doctors and healthcare providers in small and rural practices are critical to our goal of building a health care system that works for everyone,” said HHS Secretary Sylvia M. Burwell in a statement. “Supporting local health care providers with the resources and information necessary for them to provide quality care is a top priority for this administration.”

To read the HHS press release, click here.

The funding was allocated in the MACRA legislation passed by Congress in 2015 that repealed the SGR and established the MIPS and APM value-based payment programs (as replacements for the existing PQRS, meaningful use and VBM programs).   The press release notes that “organizations receiving the funding would support small practices by helping them think through what they need to be successful under the Quality Payment Program, such as what quality measures and/or electronic health record (EHR) may be appropriate for their practices’ needs. Organizations would also train clinicians about the new clinical practice improvement activities and how these new activities could fit into their practices’ workflow, or help practices evaluate their options for joining an Alternative Payment Model.”

HHS will announce the awardees by November.
(AUSTER)

Six Months Before You Re-Register License with NYS Department of Education, You Must Update Your Physician Profile
Physicians are required under New York State Public Health Law §2995-a and Education Law §6524, to update their Physician Profile in the six (6) months prior to the expiration of their current registration and submission of his/her biennial registration.  There has been recent email notification to physicians whose re-registration is due within the next six months from New York State Department of Health informing them that they must update their physician profile.  If a physician plans on renewing his/her registration with the State Department of Education, the Physician Profile must be updated.  If a physician is not renewing his/her registration no action is required.

To update the Profile please log on to the Health Commerce System (HCS) account here.

The Physician Profile icon is in the menu on the left of the screen.  If you need assistance in order to access your HCS account, please call 1-866-529-1890, Monday – Friday 8:00 am – 4:45 pm. If you need assistance or have questions specific to the Physician Profile, please call 1-888-338-6998, Monday – Friday 8:30 am – 4:45 pm.

If the profile is up to date, a physician must still log into the Physician Profile through his/her HCS account in order to confirm the information is current and accurate.

The Health Commerce System (HCS), accessible via the Internet, is the secure website for web-based interactions with the New York State Department of Health.  Besides being required to update a physician profile through the HCS, physicians need an HCS to order prescription pads; to check the Prescription Monitoring Program (PMP); tumor and cancer reporting and to access the Immunization Registry, etc.

Physicians who do not have a Health Commerce System account are urged to do so.  A paperless HCS account application can be found here.

Reported cases of Zika in New York City: 197

  • 20 of the 197 cases were pregnant at the time of diagnosis;
  • All cases contracted Zika while visiting other countries; and
  • All patients have recovered.
  • To date, 3,605 people in the city have been tested for the virus for a 5% infection rate. All of the confirmed cases of Zika in the city are from a result of traveling abroad. There have also been two cases of Guillain-Barré, a syndrome that has been associated with the virus, according to the CDC.
  • The Zika statistics for New York City were reported in the Morbidity and Mortality Weekly Report as part of an effort to determine which demographic populations were getting tested. Officials from the city’s Department of Health and Mental Hygiene used Census data to cross-reference testing — rates with neighborhoods that have residents from regions at the center of the Zika crisis — Brazil, the Caribbean, Central America.

For More Information


Medicare Trustees Report Shows Continued Slow Cost Growth
The Medicare Trustees projected that the trust fund financing Medicare’s hospital insurance coverage will remain fully funded until 2028, 11 years longer than they projected in 2009 before the passage of the Affordable Care Act.

Per-enrollee Medicare spending growth has been low, averaging 1.4 percent over the last five years, slower than GDP per capita (2.9 percent) and overall health expenditures per capita (3.4 percent). And over the next decade, per-enrollee Medicare spending growth (4.3 percent) is expected to continue to be lower than the growth in overall per capita national health expenditures (4.9 percent). Total Medicare spending is projected at a faster 6.9 percent average annual rate over the next decade, reflecting continued enrollment growth driven by the growth of the over-65 population.

The Medicare Trustees did highlight an area of spending growth, however, noting that that growth in the costs of prescription drugs paid by Medicare continue to exceed growth in other Medicare costs and overall health expenditures. Medicare Part D expenditures per enrollee are estimated to increase by an average of 5.8 percent annually through 2025, nearly 50 percent higher than the estimated increase in GDP per capita (3.9 percent) and higher than the combined per-enrollee growth rate for Medicare Part A and B (4.0 percent). The report found that these costs are trending higher than previously predicted, particularly for specialty drugs. A prior Department of Health and Human Services report also provided a detailed analysis of high cost prescription drug spending trends.

Based on early data showing the potential for a small Social Security cost of living adjustment, the Trustees Report projects that Medicare’s “hold harmless” protection will be triggered again this year. This would result in a small increase in Part B premiums for about 70 percent of Medicare beneficiaries, with increases in Part B costs spread over the remaining 30 percent, which includes individuals enrolling in Part B for the first time in 2017, those that do not receive a Social Security benefit or who are directly billed for their premium, Medicare and Medicaid dual-eligible beneficiaries, and current enrollees who pay an income related higher premium.

However, this a projection based on preliminary data. The final Social Security cost of living adjustment will be announced in the fall based on updated data. The 2017 Medicare Part B premiums, which typically differs from these projections, will be announced later in the year.

The report is available here.


MSSNY Members Save 25% Off Paychex Payroll Processing Services and HR Setup Fees
Eliminate the time-consuming chore of payroll and benefits administration with expert, confidential services from Paychex.  Our cost-effective payroll and HR outsourcing solution allow you to focus on what you’re an expert at –your practice. Call for more information.

516-488-6100, ext. 302. Mention code 5756. 

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The 2016 MSI Survey Is Here!
CMS is once again conducting their annual survey of Medicare Administrative Contractors (MAC) performance and requesting feedback from the provider community NGS Medicare serves through the MAC Satisfaction Indicator (MSI). This survey should only take about 10 minutes of your time and helps NGS understand how they can better service you.

NGS Medicare encourages all Medicare Providers of service as well as their office staff members who work with National Government Services Medicare to participate in the survey!

  1. What is the MAC Satisfaction Indicator (MSI)? The MSI is a tool used by CMS to measure provider satisfaction with their MAC. This survey is presented once a year and includes questions on services the MAC provides in these functional areas: Provider Outreach and Education, Provider Telephone Inquiries, Claims Processing, Electronic Data Interchange (EDI) Help Desk, Reopenings and Redeterminations (Appeals), Provider Enrollment, Medical Review, Self-Service Portal and Cost Report and Reimbursement.
  1. Who is eligible to participate in the MSI? Medicare providers who receive services from their MAC can participate. This includes Medicare fee-for-service physicians, suppliers, health care practitioners and institutional facilities who serve Medicare beneficiaries across the country.
  1. What does this mean to NGS? The MSI allows providers the opportunity to influence CMS’s understanding of Medicare contractor performance. In addition to monitoring NGS’s performance, CMS will use the results for monitoring trends, to improve oversight, and to increase efficiency of the Medicare program. CMS will incorporate the results into our MAC incentive plans. The MSI also provides NGS with more insight into our provider communities and it allows us to make process improvements based on this provider feedback.

To take the survey, click: here.


For Residents: Introducing NEJM Resident 360
NEJM Resident 360, a new website and discussion platform from NEJM Group, gives residents the information, resources, and support they need to approach each rotation with confidence. Create a profile now. Access to premium content is free with any NEJM Group individual or institutional subscription. 

Federal Panel Says Nasal Spray Flu Vaccine Should Not Be Used Next Flu Season
The AP (6/22, Stobbe) reports research presented at a medical meeting in Atlanta showed the nasal spray FluMist vaccine “was somewhat effective, but still not did not work as well as flu shots,” according to the maker of the vaccine, AstraZeneca. However, Centers for Disease Control and Prevention flu expert Dr. Joseph Bresee said, “We could find no evidence (the spray) was effective.” The nasal spray accounts for just 8 percent of the total flu vaccine doses produced each year. But because it’s mainly used in kids, about a third of the flu vaccinations of children were done with FluMist, health officials say.


CLASSIFIEDS



Medical Office Space For Sale in Prime Bay Ridge Co-op Building
Recently renovated Medical Office
Bay Ridge, Brooklyn You will be sure to impress your patients with this move-in condition over 2500 square foot professional space in a prime Bay Ridge Coop Building.  Office space has a separate private entrance. Low maintenance of $866.67 includes heat, water and real estate taxes.  Currently set up as a medical office so little work to do.  You have two reception areas; large waiting room; four large offices/exam rooms and plenty of extra work areas.   The outer rooms have windows facing Shore Road. Easy to park and accessible by bus.  Go to the link below to see the virtual tour of this great space. Asking $675,000.00.
http://tours.tourfactory.com/tours/tour.asp?t=1512876&guid={4A6DD20B-CF78-432D-B56F-19CF4BC55DF6}

Liz Hammann                                                Keller Williams Realty Empire                    Licensed Associate Real Estate Broker
Cell:    646-773-2785      lizhamm15@gmail.com
www.lhammann.kwrealty.com   
                           
 Michelle Epstein, CBR  Keller Williams Realty Empire
Licensed Associate Real Estate Broker
Cell:    917- 359-0721
michellerealestate1@gmail.com
www.epstein.kwrealty.com                        


Recently renovated Medical Office Space available June, 2016 in desirable midtown Manhattan building located between Park and Madison Avenues.Please Call Mr Mel Farrell at 212. 696.7107 for further information.



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Office Rental 30 Central Park South 
Two fully equipped exam rooms, two certified operating rooms, bathrooms and consultation room. Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1300 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com


Medical Office For Rent – 715 West 170 Street
Two to five examination rooms available plus Reception,secretarial areas. Two bathrooms and entrances. Ethernet and cable ready. $4000 – $9500/ month. 917.861.8273 drdese@gmail.com Can build to suit including accredited O.R.s

 


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

June 17, 2016 – Gun Violence Is a Crisis

 

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

June 17,  2016
Volume 16, Number 22

Dear Colleagues:

This week, the American Medical Association’s House of Delegates approved a resolution to identify gun violence as a public health crisis. The AMA will lobby Congress to repeal the 20-year ban on funding CDC research into gun violence as a public health problem.

The resolution was sponsored by Joshua Cohen, MD, MPH, a member of the Medical Society of the State of New York’s AMA delegation.  “Thousands of Americans are injured or die each year as a result of gun violence,” Dr. Cohen told the group. “America is looking to its physicians for our voice on this public health crisis and for our leadership in addressing it.  As such, we also ask in this resolution that our AMA actively lobby to end the 20-year ban on gun violence research.” Though President Barack Obama lifted the research ban through executive order nearly three years ago, Congress has blocked funding for these studies.

Dr. Cohen continued with an impassioned plea for action. “As scientists, we understand that we must study a problem in order to discover ways to solve it.  Now is the time to act,” he said. “We will not stand idly by and watch our fellow Americans be slaughtered by the thousands.  We will lead the charge to promote the public health and safeguard our family, friends, and neighbors against such horrific acts.  Please stand with me and call for an end to this public health crisis.”

Early co-sponsors of the resolution included GLMA and the Young Physicians Section. In total, 56 delegations signed on as co-sponsors, an unprecedented coalition of state medical societies and specialty societies.

In a dramatic show of solidarity, it was passed almost unanimously by the AMA House of Delegates.

Following the vote, the delegation applauded their decision with a standing ovation.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org

MLMIC


Capital_Update_Banner


Dear MSSNY and Alliance Members:

The 2016 legislative session concluded early this morning. Through your efforts guided by MSSNY leadership and the collective efforts of MSSNY staff, MSSNY has had a very successful legislative year. 

As we did when the budget negotiations concluded, your lobby team would again like to acknowledge each and every County and Specialty Medical Society, MSSNY leadership, and the many rank-and-file physicians who answered the call for grassroots action and met locally with their representatives or wrote a letter and/or took a day away from their practice to travel to Albany to personally meet with their elected representatives on issues of importance to all of medicine. 

Sustained physician involvement can make a difference.  Because of your efforts, we list the many successes that together we have achieved. It is our hope that you will share this newsletter with your colleagues so that we may continue to build membership in MSSNY to support even greater legislative accomplishments in the future. 

Your Lobby Team                                                                                                                    Liz, Moe, Pat, and JP

Legislature Does Not Pass Proposed Statute of Limitations Changes
The State Legislature left Albany without taking action on legislation (A.285-A and A.10719-A/S.6596-B) that would have substantially lengthened New York’s medical liability statute of limitations.  We thank the thousands of physicians who contacted their legislators over the last several weeks to express their concerns regarding the adverse impact to patient access to care if this legislation were to be enacted without corresponding tort reforms to offset the huge premium increase this legislation would have required.  Conversations will be continuing over the summer and fall regarding comprehensive changes that are necessary to correct our dysfunctional medical liability adjudication system.
(DIVISION OF GOVERNMENTAL AFFAIRS)


Legislation Advanced By MSSNY to Rectify E-Prescribing Issues Encountered By Physicians Passes Both Houses
MSSNY is pleased to report the passage of three bills by both Houses of the Legislature which, if enacted into law, would address many concerns which have arisen as a result of the e-prescribing law.  The first bill, S. 6779, Hannon/A.9335-B, Gottfried would ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription in lieu of e-prescribing.

In March, the Bureau of Narcotics Enforcement announced that when a physician invokes one of the three statutory exceptions and writes/faxes or calls in a paper script because:  their technology or power has failed; the prescription will be filled outside of New York; or it would be impractical for the patient to obtain medications in a timely manner, they must electronically submit to the department an onerous amount of information about the issuance of the paper prescription.

DOH asks that each time a paper/fax/oral  prescription is issued, the prescriber must electronically inform the DOH of their name, address, phone number, email address, license number, patient’s initials and reason for the issuance of the paper prescription. This creates an onerous burden for all physicians, particularly in situations where there is a protracted technological failure, and the physician needs to report dozens upon dozens of paper prescriptions. In fact, Surescripts has stated publicly that there is a 3-6% e-prescription transmission failure rate. This means that in the state of New York anywhere between 7.6 million to 15 million e-prescriptions will fail every year and each prescriber involved with these failures who subsequently write a paper prescription will need to file this information with the state.  In some small communities, even the patient’s initials can convey information that will enable others who access this information to identify the patient who will receive the medication.

The bill passed this week affords a much more preferable alternative by allowing physicians and other prescribers to make a notation in the patient’s chart indicating that they have invoked one of the three statutory exceptions.

The second bill, A.9837, Gottfried/S. 7334, Hannon, would allow for the transmissions of e-prescriptions to a secure centralized site from which they can be downloaded by a pharmacy when the patient presents. This would lessen the pressure on the patient to decide during the office visit which pharmacy he or she will use, enable a patient to shop around and change his or her mind for whatever reason. If a patient requests, the prescriber would print out a copy of the prescription to make it easier for the pharmacy, and be useful for the patient as a reminder.

The third bill, A.10448, Schimel/S. 7537, Martins would authorize a pharmacy which does not have a particular medication in stock to transfer the prescription to another pharmacy. Currently, e-prescriptions cannot be transferred by one pharmacy to another thereby requiring the patient to return to or call the prescriber’s office to ask that he/she transmit the e-prescription to another pharmacy creating unnecessary burdens on the patient and delaying timely access to their medication.

Each of these measures will be sent to the Governor for his consideration. MSSNY will keep you apprised of the action taken on each of these very helpful proposals.
(DEARS, AUSTER,CLANCY)

Legislative Package Approved to Address and Arrest Opioid Abuse in NYS
Three measures were introduced and approved by the legislature to comprehensively address and arrest the opioid epidemic in NYS. While MSSNY expressed strong concerns regarding some aspects of these proposals, MSSNY was able to secure modifications that protect clinical discretion and allow for the recognition that every physician practice and the needs of our patients are unique. In addition, the Legislature places new requirements on insurers to provide coverage for needed treatment and on hospitals and pharmacists to disseminate information.

CME Mandate

The legislation requires prescribers authorized to prescribe opioids by the U.S. Drug Enforcement Administration and every prescribing resident under a facility registration to complete three hours of coursework on pain management, palliative care, and addiction by July 1, 2017 and every three years thereafter. With regard to the course, the legislation:

  • recognizes that the course must be approved by commissioner who shall establish standards and review and approve course work; MSSNY this year with the OASAS medical director and representatives from the nurse practitioner and physician assistant associations developed and offered a course – already available through MSSNY’s website (mssny.org)– which MSSNY will seek to have approved in order to assure that its members may comply with July 1, 2017 deadline;
  • establishes that the coursework may be taken online;
  • requires that, upon completion of course, must document by attestation on a form prescribed by the commissioner that he/she has completed the course; and
  • requires the department to allow for an exception process for those (1) who can demonstrate to the department’s satisfaction that there would be no need to complete the course; or (2) that he/she has completed course work deemed by the department to be equivalent to the course work approved by the department. 

While MSSNY was not able to secure a one-time course or sunset we were able to assure that the course can be completed online and that the department would allow for an exception process to be utilized to exempt those for whose practice such a course is not applicable and those who have already taken a course. 

Opioids Limits

The legislation would establish limits on the prescription of a seven-day supply of any schedule II, III, or IV opioid upon initial consultation or treatment of acute pain. The bill gives flexibility to the prescriber to, upon any subsequent consultations for the same pain, issue (up to a thirty day supply) by appropriate renewal, refill or new prescription for the opioid or any other drug. In addition, the legislation:

  • defines “acute pain” to mean pain, whether resulting from disease, accidental or intentional trauma or other cause that the practitioner reasonably expects to last only a short period of time. Such term shall not include chronic pain, pain being treated as part of cancer care, hospice or other end-of-life- care or pain being treated as part of palliative care practices; and
  • limits application of co-pays for the limited initial prescription of an opioid to either (i) proportionate amount between the copayment for a thirty day supply and the amount of drugs the patient was prescribed or (ii) the equivalent to the copay for the full thirty-day supply provided that no additional copays may be charged for any additional prescriptions for the remainder of the thirty-day supply. 

MSSNY advocacy assured that the prescriber, upon any subsequent consultations, has flexibility in prescribing appropriate renewals, refills or new prescription beyond the initial period.Importantly, the term ”consultation” is intended to not require in person examination but can include a phone conversation between prescriber and patient at the conclusion of the initial 7-day supply. 

Insurance Coverage for Substance Abuse Treatment

The legislation requires insurers to afford coverage currently not afforded for substance abuse and treatment services including provision to:

  • require insurers to  (i) provide insurance coverage, without prior authorization, for inpatient services for the diagnosis and treatment of a substance use disorder as long as needed; and (ii) only conduct a utilization review, including retrospective review, commencing on or after the fifteenth day;
  • require insurers to use an objective diagnostic tool approved by the New York State Office of Alcoholism and Substance Abuse Services (OASAS) and consistent with the treatment service levels within the OASAS system (gives insurers until December 31, 2016 to ensure their review tools comply with OASAS standards);
  • require insurers to provide at least five days of coverage, without prior authorization, for medications necessary for the treatment of a substance use disorder;
  • eliminate prior authorization under Medicaid and by commercial carriers for access to buprenorphine or injectable naltrexone;
  • require insurers to provide coverage for the prescription of opioid antagonists to any person (e.g.parent, guardian, sibling) under the same policy as the treated addicted individual; and
  • extend the period individuals may be held at treatment facilities for drug treatment from 48 to 72 hours. During such time, patients must be reevaluated regularly. Under the bill, patients must also be given a discharge plan upon their discharge from the facility in order to ensure a continuum of care, including information on how to access additional treatment services. 

Generally speaking MSSNY policies support timely access to medical care and treatment. These provisions are consistent with the direction taken in those policies.

Information to Patients

The legislation seeks to assure that patients are made aware of the risks associated with controlled substances and of addiction services that are available in their community. The bill would:

  • require the commissioner of the office of alcoholism and substance abuse services (OASAS)to create educational materials that would be disseminated by a pharmacist to a consumer at the time the consumer receives his or her prescription of controlled substances concerning the risks of using controlled substances, the warning signs of addiction and contact numbers for HOPELINE; and
  • require hospitals to develop discharge protocol for services for individuals suffering from substance use disorder which include distribution of informational materials to patients upon their discharge and procedures for the identification, assessment, and referral of individuals with a substance use disorder.

MSSNY was successful in eliminating a proposal that would have placed a duty on a prescriber to provide consultation regarding the addictive nature of opioids and eliminated the proposed requirement to have the patient sign a form attesting that they received such counseling from their prescriber.
(DEARS, AUSTER, CLANCY, MCPARTLON)

Legislation to Enable Physician Override of Insurer “Step Therapy” Medication Protocols Passes Legislature
Legislation (A.2834-D, Titone and S.3419-C, Young) passed the Assembly and Senate this week to articulate a process for physicians to request and be granted an override of an insurer medication step therapy protocol when it is in the best interest of their patients’ health.    MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations, specialty societies, hospitals, and pharmaceutical manufacturers to achieve passage of this legislation.   The bill will must be approved by the Governor for it to become law.

The bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.
(AUSTER, DEARS)

Legislative Session Produces Administrative Simplification Bills
In addition to passage of the “step therapy” bill, the Legislature also approved other bills prior to adjourning designed to reduce the administrative burden on physicians in their dealings with health insurers.

The Assembly and Senate passed legislation (A.501-E, Cusick/S.2545-D, Lanza) this week that would reduce from 90 to 60 days the time within which a health insurer must complete its review of the application of a physician to participate in the network of a health insurer, as well as reducing from 90 to 60 days the time within which a physician in some situations can become “provisionally credentialed” if the plan does not complete its review.

The bill also would eliminate some ambiguous statutory language that currently gives discretion to a health insurer to delay a decision on a physician’s application after these deadlines have passed.   The Assembly and Senate also recently passed legislation (A.6983-A, McDonald/S.4721-A, Hannon) that would direct the Commissioner of Health and Department of Financial Services to create standards to provide greater uniformity among health insurers when physicians request insurers to cover their patients’ needed prescription medications.

MSSNY worked closely with the New York Chapter of the American College of Physicians in support of the legislation.  Both bills must be signed by the Governor to become law.                                                                 (AUSTER, DEARS)

CVS Health’s Retail Clinic Bill Fails- Again
CVS HEALTH which operates CVS Pharmacies, a pharmacy benefit manager, mail order and specialty pharmacies, and retail-based health clinic subsidiary, MinuteClinic, attempted to secure passage of legislation (S. 5458, Hannon and a similar bill A. 1411, Paulin) which would allow the establishment of corporate owned retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law

MSSNY had previously succeeded against an effort to defeat the retail clinic proposal that had advanced as part of the executive budget.  Subsequently, a similar proposal (S. 5458, Hannon) was passed by the Senate in May. Just this week, a similar bill was considered by the Assembly but it failed to garner the necessary votes. MSSNY working closely with the Nurses Association and other specialty medical societies succeeded in beating back this additional effort defeating the bill for the second time this year.

Convenience care clinics’ or ‘retail clinics’ operate in states outside New York in big box stores such as Walgreens or CVS retail pharmacies. They are a growing phenomenon across the nation, particularly among upper class young adults who live within a one mile radius of the clinic. These clinics are usually staffed by nurse practitioners and focus on providing episodic treatment for uncomplicated illnesses such as sore throat, skin infections, bladder infections and flu.  Physicians feel strongly that retail based clinics pose a threat to the quality of patient care and to the ability of physician practices to sustain financially and should not be allowed to propagate in New York.                                                       

Another significant concern is the potential conflict of interest posed by pharmacy chain ownership of retail clinics which provides implicit incentives for the nurse practitioner or physicians’ assistant in these settings to write more prescriptions or recommend greater use of over-the-counter products than would otherwise occur. The same self-referral prohibitions and anti-kickback protections which apply to physicians are not applicable to retail clinics, raising the concern for significant additional cost to the health care system. Rather than bend the cost continuum, we are concerned that costs will increase and   quality of care will be negatively impacted.

We thank all physicians and county and specialty medical societies who took the time this week to contact their Assembly representatives to urge defeat of the bill. Your efforts and that of your lobby team proved successful.
(DEARS, AUSTER, CLANCY)

Extended Hours for Breast Cancer Screening
In his State of the State Message in January, Governor Cuomo announced his initiative to expand access to mammography services. Initially, the proposal presented to the Legislature would have applied this new mandate beyond the hospital and extension clinic setting to the private physician practice. MSSNY, working with the NYS Radiological Society, were able to block application of this mandate to private physician practices.

In effect, the legislation adopted by both Houses of the Legislature this week will put into statute regulations adopted earlier this year that:

  • Require hospitals and extension clinics to offer extended hours for screening mammography services on at least two days each week for at least two hours each day offered for a total of at least four hours each week including: (a) M-F between 7-9AM (b) M-F between 5-7PM or (c) Saturday or Sunday between 9AM-5PM.
  • Eliminate annual deductibles, co-payments, and co-insurance payments (“cost-sharing”) for screening and diagnostic imaging for the detection of breast cancer. This includes mammograms, breast ultrasounds, and MRIs covered under a patient’s insurance policy.
  • Eliminate cost-sharing for all screening mammograms, including those provided to women who may not meet current federal screening guidelines but need screening.
  • Provide four hours of paid annual leave for breast cancer screening for public employees in New York City.

We thank the many county medical society Executive Directors who provided us with important information regarding the hours of local mammography providers.
(DEARS, AUSTER)

Midwifery-Led Birthing Center Bill Passes Both Houses
Legislation which would allow for the establishment of midwifery-led birthing centers passed both Houses of the Legislature over the objection of ACOG and MSSNY. The bill would authorize the Commissioner to issue regulations relating to their establishment, construction and operation, using state and national professional association standards in consultation with industry and midwives. MSSNY expressed its strong concern over the fact that the bill does not require these centers to be supervised by a physician and would in fact, allow a midwife to supervise care provided at these centers. In the event that the bill is signed into law by the Governor, MSSNY will work with ACOG and the Department of Health on the development of regulations to implement this legislation.                        (DEARS)

Legislation to Assure Proactive Discipline and Fingerprinting of Health Professionals Fails
Well-intended legislation (S.7791, LaValle and A.10532, Glick) was introduced this year to address media attention that developed over the alleged lax disciplinary procedures of the Office of Professions in the State Education Department which disciplines all licensed health professionals except physicians, physician assistants and specialist assistants. Initially, the bill would have required fingerprinting and background checks by SED of all newly licensed health professionals including physicians.

These provisions were discarded. Other provisions, however, were retained which would have established a process for summary suspension and would have required disciplinary action to be taken in NY where similar action was taken in another state. These provisions would have been put in place for all health professions including physicians PAs and SAs which are already subject to such processes under OPMC. At MSSNY’s request, the Senate amended its bill to remove applicability to physicians. The bill was passed. The Assembly, however, did not make those amendments and did not advance the bill. It is anticipated that the bill will be re-introduced next year.


NYS Legislature Passes Opioid Abuse Deterrent Coverage Bill in Effort to Combat Abuse/Diversion of Opioid Drugs
Legislation has passed both houses that would require insurance companies to cover abuse-deterrent opioid analgesic drugs.   S. 6962A/A.10478, sponsored by Senator Kemp Hannon and Assemblymember Michael Cusick,  is intended  to ensure that  patients are not able to take an abuse deterrent opioids due to lack of insurance coverage.   The Food and Drug Administration (FDA) has stated that abuse-deterrent technologies are important in the creation of safer opioid analgesics. Abuse deterrent technologies make it harder to crush or liquefy a drug in order to snort or inject.  (CLANCY)


Legislature Passes HIV-Related Bills as Part of Governor’s End the Epidemic Efforts
Legislation (S. 8129, Hannon/A. 10724,Gottfried) to expand the requirement for patients ages 13 and above to receive an offer for HIV test, has passed the New York State Legislature.   This measure amends the 2010 law which required physicians and other health care practitioners to offer an HIV test to any individual ages 13 to 64.  

The change eliminates the upper age limit.  Importantly, at the same time, the bill simplifies consent procedures by allowing physician and other health care practitioners to orally advise the patient that an HIV test will be performed and that if the patient objects, than that objection shall be noted in the patient’s chart.  Additionally, the bill also would allow a nurse to screen persons at increased risk for syphilis, gonorrhea and chlamydia pursuant to not-patient specific order.   It also would allow a physician or a nurse practitioner to prescribe and order a patient specific or non-patient specific order to a pharmacist for dispensing a seven day starter kit of post-exposure prophylaxis (PEP) for the purposes of preventing HIV.   The measure will also allow a pharmacist to dispense a seven day starter kit. 

Another measure, S. 7505/A. 9834, sponsored by Senator Hannon and Assembly Gottfried, also passed both houses and would allow for disclosure of HIV/AIDS related medical information to qualified researches who have received approval from a human research review committed or an institutional review board (IRB).   Both measures are part of Governor Cuomo’s recommendations stemming from his task force to End the Epidemic.                                          (CLANCY)

MSSNY Efforts Prevail on Scope of Practice & Allied Health Provider Bills
With the final remarks and closing gavel of the extended 2016 Legislative Session in Albany— MSSNY, our physicians, and specialty societies succeeded in defeating numerous scope of practice and allied health provider bills. Our combined efforts helped to ensure that the following bills will not become law this year:

  • Athletic Trainers Scope Bill – A.1266 (LAVINE)/ S.4499 (FUNKE), would have established licensure requirements and expanded the scope of practice for athletic trainers to include the ability to examine, evaluate, assess, manage, treat and rehabilitate neuromusculoskeletal injuries, including concussions and spinal cord injuries. This bill passed the Senate, but died in the Assembly Higher Education Committee.
  • Podiatry Scope Bill – A.719 (PRETLOW)/ S.6990 (AMEDORE), would have expanded the scope of practice for a podiatrist to include care of any wound, up to the knee, “related to” a condition of the foot or ankle, and removed the requirement for podiatrist to be “directly supervised” by an advanced NYS-licensed podiatrist  or physician.  The bill remains in the Higher Education Committees in the Assembly and Senate.
  • Two Corporate Practice bills which would have allowed non-physician providers to form Limited Liability Partnerships with physicians were defeated:
    • 8153 (PEOPLES-STOKES)/ S.5862 (LAVALLE), would have permitted non-physician title eight licensed health professionals to form limited liability companies with physician. This bill remains in the Assembly Higher Education Committee and the Senate Corporations, Authorities, and Commissions Committee.
    • 4391 (O’DONNELL)/ S.215 (MARTINS), would have permitted doctors of chiropractic to form limited liability companies with physicians. This bill remains in the Assembly Higher Education Committee and the Senate Corporations, Authorities, and Commissions Committee.
  • Nurse Anesthetist “Title Bill” – A.140 (PAULIN)/ S.7166 (GALLIVAN), 3835 (MORELLE)/ S.35 (DEFRANCISCO), A.3941 (GOTTFRIED)/ S.2048 (HASSELL-THOMPSON), would have provided for the certification by the NYSED of certified registered nurse anesthetists (CRNAs) and further supported CRNA efforts to apply to CMS for a waiver to the requirement of physician supervision. With the exception of A.140 which advanced to 3rd reading in the Assembly, the various bills remain in their respective house’s Higher Education Committee.
  • Nurse Anesthetist Reimbursement Bill – A.7722 (CAHILL)/ S.2955 (RITCHIE), would have authorized health insurance reimbursement for certified nurse anesthetists providing anesthesia services and further supported CRNA efforts to apply to CMS for a waiver to the requirement of physician supervision. The bill remains in both the Senate and Assembly Insurance Committees.
  • Optometry Prescribe bill – A.9961 (PAULIN)/ S.7440 (FUNKE), would have allowed optometrists to prescribe certain oral prescriptions. Negotiations produced an agreement between the New York State Ophthalmological Society (NYSOS) and the New York State Optometric Association (NYSOA). Therefore, MSSNY took no position on this legislation. While the bill passed the Senate, it did not pass the Assembly.

As in years past, the majority of the legislation is likely to return next year. As this year brings to an end the two-year session cycle, bills will need to be re-introduced next year upon which time they will assigned a new bill number.  They will also be assigned to their committee of origin and so begins the process again.
(MCPARTLON, DEARS, CLANCY, AUSTER)


DOH Announces Updates to Medical Marijuana Course
The New York State Department of Health has announced updates to the four hour department-approved online medical use of marijuana course developed by TheAnswerPage, an established online medical education provider. The course has been updated to include additional information regarding the use of medical marijuana in each of the conditions covered in the Compassionate Care Act, based on available scientific evidence.

The cost to take the course is $249. Practitioners taking the course will earn 4.5 hours of CME credit upon successful completion of the course. The new material is also accessible through TheAnswerPage’s website at no extra cost for those who have already taken the medical use of marijuana course.

The course may be accessed here.

Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course.

For further information, visit the department’s web page for more information about becoming a registered practitioner:
(CLANCY)


MSSNY’s Opioid Webinars Series Now Available Online
The Medical Society of New York has archived its opioid webinar series on its continuing medical education website at http://cme.mssny.org.  

The course was developed by MSSNY and the NYS Office of Alcoholism and Substance Abuse Services (OASAS) and the New York State Department of Health’s Bureau of Narcotic Enforcement.  The webinars are:

  • Webinar 1 Pain Management at the Crossroads: A Tale of Two Public Health Problems
  • Webinar 2 Rational Opioid Prescribing: Is this Possible for Chronic Pain?
  • Webinar 3 Treatment of Opioid Use Disorders and Webinar For Pain Patients w/Substance Use Disorders.
  • Webinar 4 Pain Patients w/Substance Use Disorders

The MSSNY CME site requires new users to register, but once registered physicians and other health care providers will have a personalized training page to take the webinars and other course work located on the site.

New registrants to the site will create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.

Click on the tool bar menu located at the top right of the page and click on “My training” to view the physician’s individualized training page. The courses are listed under: A Webinar Series on Opioid Use, Treatment, and Addiction. 

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org.
(CLANCY, DEARS)

PTSD and TBI in Returning Veterans:  June Webinar
MSSNY will be holding the last in a series of CME webinars on PTSD and TBI in returning veterans on Monday, June 20. The faculty presenter will be Joshua Cohen, MD.

Course objectives:

  • Explore the two most prevalent mental disorders facing American veterans today, their causes, symptoms, and comorbidities
  • Outline treatment options including evidence-based psychotherapy and pharmacotherapy
  • Discuss barriers to treatment, including those unique to military culture, and how to overcome them
  • Outline the process of recovery and post-traumatic growth

To register for this program, click on the date below and fill out the registration form
Monday, June 20, 6-7 PM                                                                                 (ELPERIN, DEARS)

MSSNY Joins Other State Medical Societies to Express Strong Opposition to VA Rule to Eliminate Physician Supervision Requirements
This week MSSNY joined the Coalition of State Medical Societies in a letter to the Veterans’ Administration to express deep concerns with the Veterans Administration (VA) proposed rule that would allow all Advanced Practice Registered Nurses (APRNs) to practice independently in the VA Health System.

In particular, the letter noted the Coalition’s strong concerns about the impact on quality of care for veterans as it would, among other concerns, permit nurse anesthetists to practice independently in the VA system, despite state scope of practice that do not permit this.  Specifically, the letter notes that “while nurse anesthetists are an important part of the anesthesia care team, they do not have the 12,000 to 16,000 hours of clinical training and nearly a decade of formal post-graduate education and residency training that enables anesthesiologists to prevent and respond competently and swiftly in critical emergencies before, during and after surgery.”

Instead, the letter urges that the VA “continue to advance veterans’ health care by maintaining physician leadership of the health care team”. In addition to MSSNY, the Coalition of State Medical Societies consists of the medical societies of the states of Arizona, California, Florida, Louisiana, New Jersey, North Carolina, Oklahoma, South Carolina and Texas.

To read letter click here.                                                                                                    (AUSTER) 

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:       

pschuh@mssny.org ldears@mssny.org      mauster@mssny.org  
pclancy@mssny.org jmcpartlon@mssny.org    

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NEJM: Birth Defects Noted in 3 U.S. Infants Born to Zika-Infected Women
Three children of U.S. women infected with the Zika virus were born with birth defects, the CDC reported on Thursday. In addition, in three pregnancy losses in Zika-infected women, the fetuses had signs of birth defects.

This is the first time the CDC is releasing specific pregnancy outcome counts. As of June 9, some 234 pregnant women in the U.S., not including U.S. territories, have laboratory evidence of Zika infection.

Birth defects include microcephaly, calcium deposits in the brain that point to possible brain damage, excess fluid in brain cavities and the area surrounding the brain, missing or malformed brain structures, abnormal eye development, or other conditions from brain damage that affects nerves, muscles, and bones (e.g., clubfoot or inflexible joints).

A study published in the NEJM suggests that pregnant women who contract the Zika virus during the third trimester could face a lesser risk of birth defects. According to scientists in Colombia and at the US Centers for Disease Control and Prevention, no microcephaly or brain abnormalities were present in the babies of 616 Colombian women who were diagnosed during their third trimester.

The study’s author’s emphasized that their research was “preliminary.” Most of the women “followed by researchers were still pregnant at the time the report was completed” and the researchers only considered live births, so it is unknown “how many Zika-affected pregnancies developed birth defects but ended in stillbirth, miscarriage or abortion.”

USPSTF Changes Guidance on Colon Cancer Screening Tests
Adults should pick the colon cancer screening test they feel the most comfortable with, according to a new recommendation from the US Preventive Services Task Force. The new recommendation differs from past guidance, which recommended screenings for colon cancer “on a specific time table using one of four tests.” The new recommendation published in JAMA reaffirmed that patients should be screened for colon cancer beginning “at age 50 and continue until at least age 75.” 

Reminder: July 1 deadline to Apply for EHR Incentive Program Hardship Exception
Hospitals, critical access hospitals and eligible professionals who did not achieve meaningful use in the Medicare Electronic Health Record Incentive Program for the 2015 reporting period can apply through July 1 for a hardship exception from the 2017 payment adjustment. CAHs that have already submitted a form for 2015 are not required to resubmit. For instructions and applications, visit www.cms.gov.


All Providers Must Take Action by July 1, 2016 to Avoid Payment Adjustments
Hardship exception applications are due by July 1, 2016 for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs).

Applications and Instructions
The Medicare EHR Incentive Program 2017 hardship exception instructions and application for EPs and eligible hospitals are available on the Payment Adjustments & Hardship Information webpage of the EHR Incentive Programs website. Please visit the EHR Incentive Programs FAQs page for answers to specific hardship exception questions.

Please note: CAHs should use the form specific for the CAH hardship exceptions related to an EHR reporting period in 2015. CAHs that have already submitted a form for 2015 are not required to resubmit.

Register for MIPS Webinars Today and Don’t Forget to Comment by June 27, 2016
CMS invites the public to join the final listening sessions in our ongoing webinar series designed to help the public learn more about the Merit-Based Incentive Payment System (MIPS) proposed in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Notice of Proposed Rulemaking (NPRM). These webinars will focus on the proposed Clinical Practice Improvement Activities (CPIA) performance category and the MIPS scoring system.
Register Now

MIPS: Clinical Practice Improvement Activities (CPIA) Performance Category Overview

Dates: June 22, 2016

Time: 12:00-1:00 p.m. ET

Register: To participate, visit the June 22 registration webpages.

Details: The webinars will provide an overview of the MIPS CPIA performance category, as outlined in the key provisions of the recently released MACRA NPRM. The new CPIA performance category accounts for 15% of the first year MIPS score, and rewards clinical practice improvement activities focused on care coordination, beneficiary engagement, and patient safety.

MIPS Scoring Overview

Dates: June 24, 2016

Time: 12:00-1:00 p.m. ET

Register: To participate, visit the June 24 registration webpages.

Details: The webinars will provide an overview of the proposed MIPS performance category scoring and how a composite performance score (CPS) will be calculated based on each performance score. CMS subject matter experts will review the proposed scoring system for MIPS, and also discuss how payment adjustments will be determined based on the composite performance score, as outlined in the key provisions of the MACRA NPRM. The information will pertain to MIPS participants in the first year of the program and


CLASSIFIEDS



Medical Office Space For Sale in Prime Bay Ridge Co-op Building
Recently renovated Medical Office
Bay Ridge, Brooklyn You will be sure to impress your patients with this move-in condition over 2500 square foot professional space in a prime Bay Ridge Coop Building.  Office space has a separate private entrance. Low maintenance of $866.67 includes heat, water and real estate taxes.  Currently set up as a medical office so little work to do.  You have two reception areas; large waiting room; four large offices/exam rooms and plenty of extra work areas.   The outer rooms have windows facing Shore Road. Easy to park and accessible by bus.  Go to the link below to see the virtual tour of this great space. Asking $675,000.00.
http://tours.tourfactory.com/tours/tour.asp?t=1512876&guid={4A6DD20B-CF78-432D-B56F-19CF4BC55DF6}

Liz Hammann                                                Keller Williams Realty Empire                    Licensed Associate Real Estate Broker
Cell:    646-773-2785      lizhamm15@gmail.com
www.lhammann.kwrealty.com   
                           
 Michelle Epstein, CBR  Keller Williams Realty Empire
Licensed Associate Real Estate Broker
Cell:    917- 359-0721
michellerealestate1@gmail.com
www.epstein.kwrealty.com                        


121 EAST 60TH ST – 6TH FL OFFICE ROOM FOR RENT
Professional Co-op office in an established part time Doctors office. Recently re-done, waiting area with a full time receptionist for your clients. The elegant lobby is attended 24-hours and offers live operator answering service for your clients, and more. Available Monday through Sunday (Monthly $2,000). Please call to schedule an appointment. 212-355-7017121 E 60thst


Recently renovated Medical Office Space available June, 2016 in desirable midtown Manhattan building located between Park and Madison Avenues.Please Call Mr Mel Farrell at 212. 696.7107 for further information.


Spacious, Newly Renovated Medical Office to Sublet Near the United Nations
Handicapped accessible, Wi-Fi ready, separate reception area 1 to 3 rooms rooms available, 1 to 7 days per week Ideal for ophthalmologist/optometrist with onsite optical dispensary Could easily suit other specialties Excellent value, long-term lease available if desired Contact Dr. Scott Weissman email scott.weissmanmd@gmail.com  cell 914 772-5581



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Office Rental 30 Central Park South 
Two fully equipped exam rooms, two certified operating rooms, bathrooms and consultation room. Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1300 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com


Medical Office For Rent – 715 West 170 Street
Two to five examination rooms available plus Reception,secretarial areas. Two bathrooms and entrances. Ethernet and cable ready. $4000 – $9500/ month. 917.861.8273 drdese@gmail.com Can build to suit including accredited O.R.s


Physician Opportunities

Columbia University – Associate Vice President for Health Services
Reporting to the Vice President for Campus Services, the Associate Vice President for Health Services (AVP) provides leadership for health policy, programs, outreach, facilities, finances, and health programming on the Morningside Campus of Columbia University. Serving the total health, health information, disability, sexual assault, sexual misconduct, and wellness needs of over 25,000 students, the AVP serves as a principal advisor on health affairs to the Vice President for Campus Services, the Executive Vice President for Facilities & Operations, and the Senior Executive Vice President.

The position requires a minimum of 10 years experience in health/human services or a related setting with at least five years of senior leadership at a director level or above. MD, DO, PhD, or equivalent clinical degree in a health related field is required. Additional requirements include: experience in crisis management coupled with ability to manage confidential information in a sensitive manner and use of sound judgment; ability to manage and lead collaboration with diverse constituencies, including traditionally underserved communities; demonstrated ability to provide leadership in complex institutions and to work with health providers and a wide range of University and contracted personnel; and evidence of strong customer service orientation with proven methods of soliciting, responding to, and managing feedback.

Review of applications will begin June 6, 2016, and will continue until the position is filled. The full position announcement, including application instructions, is available on the Spelman Johnson website at http://www.spelmanandjohnson.com/position/associate-vice-president-health-services 

Columbia University is an equal opportunity/affirmative action — Race/Gender/Disability/Veterans employer.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355