September 23, 2016

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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September 23, 2016
Volume 16, Number 33

MLMIC

Dear Colleagues:

E-prescribing has become a fact of life. Over the last few years, most of us have accepted and adapted to issuing prescriptions electronically, except for those who have a waiver. However, we all know that there are times when circumstances beyond our control require exceptions to e-prescribing—and it’s time to reduce the hassles associated with those situations.

Legislation advanced by MSSNY to rectify E-Prescribing issues encountered by physicians passed both Houses in June—and has now been delivered to the Governor for his signature.

We need your help in urging the Governor to sign into law this recently passed legislation (A.9335, Gottfried/S.6779, Hannon).

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. Presently, the Bureau of Narcotic Enforcement (BNE) requires physicians to electronically submit to the department an onerous amount of information about the issuance of each and every paper prescription. The bill on the Governor’s desk affords a much better 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 letter urging the Governor to sign the bill can be accessed by clicking here.

The second bill (A.10448, Schimel/S. 7537, Martins) would authorize a pharmacy that 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. This creates unnecessary burdens on the patient and delays timely access to their medication. The letter urging the Governor to sign the bill can be accessed by clicking here.

The Governor needs to hear from all of us—the New York physicians who take care of our patients every day. Our focus should remain on the patients who depend on us—not on onerous hassles that take us away from patient care. Please take a minute and contact Governor Cuomo now.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Physicians Must Post Nondiscrimination Statements by Oct. 19
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which includes most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.

According to the AMA, the rule does NOT apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court. This new rule is the first federal civil rights law to broadly prohibit discrimination on the basis of sex in federally funded health programs. It also includes important protections for individuals with disabilities and enhances language assistance for people with limited English proficiency.

Covered physicians must comply with the following requirements:

  • Post a notice of nondiscrimination and taglines in the top 15 languages spoken by individuals with limited English proficiency
  • Develop and implement a language access plan
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)
  • Submit an assurance of compliance form to OCR

To assist with implementation, OCR has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rulefactsheets on key provisions and a list of frequently asked questions. 


New Report: New York Leads Nation in Medical Home Adoption
A new report from United Hospital Fund (UHF) titled The Growth of Medical Homes in New York State, 2014 to 2016 examines the continued growth of the medical home model in New York, breaking it out by region, degree of certification, and type of facility. New York State continues to lead the nation in adoption of the medical home model; a notable finding of the report is that much of the overall recent growth of medical homes is occurring in hospital clinics as they expand their primary care programs, the explicit goal of several state initiatives.

The report also explains the number of concurrent and competing medical home models, several of which are being supported by New York State initiatives. The proliferation of models has created some confusion among providers, and raises some logistical questions for the State as it continues to promote primary care: how to align the competing programs, how to encourage multipayer support, how to ensure that medical homes can still start up under value-based payment systems, and how to make sure small practices aren’t left behind in these efforts. 


MSSNY Makes Endorsements for the 2016 November Elections
At the September 15, 2016 meeting of the MSSNY Council, the following legislators/candidates were endorsed for election by the Medical Society of the State of New York.   Each has demonstrated themselves to be champions of issues to preserve the ability of patients to continue to receive needed and timely physician care. 

To see which candidates were endorsed by MSSNY, click here.


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


AMA Releases Updated Competition in Health Insurance Report
The AMA released its 2016 Update to its Competition in Health Care Report this week that once again indicated the need for more competition in health insurance markets, and efforts to block the proposed mergers among four of the nation’s biggest health insurance companies.   To read the press release, click here.

MSSNY President Dr. Malcolm Reid recently presented testimony at a New York Department of Financial Services hearing expressing significant concerns about the impact to patient care if the Anthem-Cigna merger to be approved.  The Anthem-Cigna and Aetna-Humana proposed mergers have been challenged by the US Department of Justice.  New York Attorney General Eric Schneiderman joined the action by the DOJ in seeking to block the proposed Anthem-Cigna merger.

The AMA press release noted that, on an individual basis, the Anthem-Cigna proposed merger would diminish competition in 121 metropolitan areas located throughout the 14 states where Anthem is licensed to provide commercial coverage, including: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. The AMA press release also noted that the Aetna-Humana proposed merger would diminish competition in 57 metropolitan areas located throughout 15 states, including: Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas, Utah, Wisconsin and West Virginia.

On an individual basis, the Anthem-Cigna merger would diminish competition in 121 metropolitan areas located throughout the 14 states where Anthem is licensed to provide commercial coverage, including: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Nine of these 14 states are working to block the Anthem-Cigna merger. States that have yet to take an antitrust position on the merger include: Indiana, Kentucky, Nevada, Ohio and Wisconsin.


Liquidator’s Adjudication of Policy Claims Against Health Republic Insurance
On September 15, 2016, the Supreme Court for the State of New York signed an order setting October 11, 2016 at 10:00 a.m. as the date and time for any interested parties or their attorneys to appear and show cause why an order approving certain procedures (the “Claims Adjudication Procedure”) for adjudicating claims for payment under Health Republic’s insurance policies should not be entered.

If you are a health care provider and have a Policy Claim against Health Republic, you should have submitted your Policy Claim in accordance with the deadlines and procedures set forth in the contract governing your provision of services to former members of Health Republic (your “Health Republic Contract”). If you already properly submitted a Policy Claim in accordance with the requirements of your Health Republic Contract, you do not need to re-submit it.

It is anticipated that EOBs will begin to be mailed to Providers and Members in the first quarter of 2017. If a Provider accepts the EOB, they are not required to take any further action. If a Provider disagrees with the EOB, they will have the opportunity to appeal any and all determinations set forth in the EOB through Health Republic’s website at www.healthrepublicny.org or by paper copy to the address indicated in the Claims Adjudication Procedure. The written appeal and supporting documentation must be submitted within 60 days of the date of mailing of the EOB. The Liquidator and her agents, utilizing the appropriate resources to investigate the appeal, will review each appeal and, within 60 days, either grant the appeal and issue a revised EOB or deny the appeal and provide the reasons for the denial.

If a Provider objects to the determination of the appeal, the Provider will have 30 days from the date the notice of denial is sent to file an objection to the denial of the appeal. PROVIDERS WHO WOULD LIKE TO RECEIVE A HARD COPY OF THE CLAIMS ADJUDICATION PROCEDURE SHOULD CONTACT THE GARDEN CITY GROUP VIA THE HEALTH REPUBLIC HOTLINE at (866) 680-0893. Requests for further information or questions may be directed to (866) 680-0893 or www.healthrepublicny.org.


 “When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

The Medical Society of the State of New York designates this live 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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly. 


YP/Resident Leadership Seminar Slated for Syracuse Oct 21-22
Following an exciting Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has now slated a Leadership program for upstate physicians in Syracuse from late afternoon Friday, Oct 21 through Saturday, Oct 22.

The program is scheduled for the Doubletree Inn at Syracuse Thruway exit 36. A renowned faculty from Brandeis and Harvard University will lead the program, which 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 covered under a grant from The Physicians Foundation.  For further information, contact MESF Executive Director at Tom Donoghue tdonoghue@mssny.org. 


Pediatrics Group: “Time to Say ‘No’” to Codeine for Children
The American Academy of Pediatrics is urging clinicians and parents to stop giving codeine to children, citing risks for respiratory depression and death.

Highlights of the clinical report, published in Pediatrics, include:

  • Genetic variation in codeine metabolism can lead to excessive morphine levels in some children, and is a particular concern in those with sleep-disordered breathing. From 1965 to 2015, the FDA Adverse Event Reporting System recorded 64 children with severe respiratory depression and 24 deaths associated with use of codeine.
  • Despite warnings from the FDA and international groups, codeine continues to be used widely for pediatric pain and cough. In 2011, it was prescribed to more than 800,000 U.S. children younger than 11 years. Codeine is available in over-the counter cough medicines in 28 states.
  • Among the limited alternatives for pediatric analgesia, other opioids are not recommended due to similar safety concerns. Nonopioid options, chiefly nonsteroidal anti-inflammatory agents and acetaminophen, may be effective for mild-to-moderate pain.

Pediatrics online-first page

Full NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of AAP clinical report


CLASSIFIEDS


Well-Established Nassau County Internal Medicine Practice Available for Acquisition
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to surendralal1@yahoo.com


Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

Office Space – 1185 Park Ave. (94th St.) Full-time
Ideal for busy medical subspecialty.  Exclusive use of consult, exam room. Stress test, echo available.  Beautiful décor.  Public transportation nearby.  Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

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

A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 16, 2016 – What Is Really Discussed at Council?

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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September 16, 2016
Volume 16, Number 32

MLMIC

Dear Colleagues:

Yesterday, the Council meeting to plan for 2016-2017 activities met in Westbury. The six meetings we convene in a year’s time are usually quite lively in spite of the fact we always have an ambitious agenda. Yesterday’s was 127 pages.

The following items were deliberated and voted upon:

  • Council voted to sign-on to the Pennsylvania Medical Society MOC letter making the official declaration of No Confidence in the ABIM. The voting was preceded by an informative presentation by Dr. Parag Mehta outlining the case against the necessity of MOC requirements and highlighting the growing protest over the MOC process.
  • Council approved the following resolution as amended: Whereas CMS is permitting a process of “seamless conversion” wherein seniors are transitioned from traditional MCR insurance products into Medicare Advantage options with seniors having little understanding of the implications, MSSNY will prepare a simple, easy to read modifiable model letter for physician members to provide their Medicare enrollees this month as well as a poster for physicians to post. Additionally, MSSNY will work with appropriate stakeholders to collaborate with senior groups to raise awareness among physicians and seniors on the implications of the practice of seamless conversion and will work with appropriate stakeholders to advocate with legislators and CMS to implement an immediate moratorium on the practice of seamless conversion. MSSNY will bring the resolution to the AMA.
  • Council approved an in-person, rather than a virtual meeting, for the January 2017 Council meeting.
  • Council approved the Congressional, State Senate and State Assembly candidates for MSSNYPAC endorsement http://bit.ly/2cPkoUb
  • The 2017 House of Delegates will be held April 21-23 at the Westchester Marriot in Tarrytown. Speaker of the House Dr. Geraci-Ciardullo announced the Resolution deadlines for the 2017 House of Delegates: February 17, 2017 and March 17, 2017 (final deadline).

Your Councilors make a concerted effort to attend these meetings on their own time and take their posts very seriously. Your interests as a practicing physician are utmost in their minds when issues come up for discussion. You can read your county report that was submitted on behalf of your geographic area. You might want to call your Councilor to discuss your issues and concerns about your practice. You might even want to thank your Councilor for their service to your county and the personal time spent on our pressing issues. They are:

  1. Kings/Richmond Report– Parag H. Mehta, MD
  2. Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
  3.  Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
    (no written report submitted)
  5. Suffolk County Report – Maria A. Basile, MD, MBA
  6. Third District Branch Report – Brian P. Murray, MD
  7. Fourth District Branch Report – John J. Kennedy, MD
  8.  Fifth District Branch Report –Howard H. Huang, MD
  9. Sixth District Branch Report – Robert A. Hesson, MD
  10.  Seventh District Branch Report – Mark J. Adams, MD
  11. Eighth District Branch Report – Edward Kelly Bartels, MD
    (no written report submitted)
  12. Ninth District Branch Report – Thomas T. Lee, MD
  13.  Medical Student Section Report –Christina Kratschmer
  14.  Organized Medical Staff Section Report –Richard A. Ritter, MD (no written report submitted)
  15. Resident & Fellow Section Report – Robert A. Viviano, DO
  16. Young Physician Section Report – L. Carlos Zapata, MD(no written report submitted)
  17. Resident & Fellow Section Report– Robert A. Viviano, DO16.
  18. Young Physician Section Report – L. Carlos Zapata, MD (no written report submitted) 

We are all working hard for you and your practice.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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MSSNY Makes Endorsements For The November Elections
At the September 15, 2016 meeting of the MSSNY Council, the following legislators/candidates were endorsed for election by the Medical Society of the State of New York.   Each has demonstrated themselves to be champions of issues to preserve the ability of patients to continue to receive needed and timely physician care. 

NEW YORK STATE ASSEMBLY

  • Kevin Cahill (D, 103rdAD – Dutchess and Ulster counties)
  • Michael Cusick (D, 63rd AD- Richmond County)
  • Deborah Glick (D, 66th AD, NY County)
  • Richard Gottfried (D, 75th AD, NY County)
  • Charles Lavine (D, 13th AD, Nassau County)
  • Joseph Morelle (D, 136thAD, Monroe County
  • Robin Schimminger (D, 140th AD, Erie and Niagara counties)

NEW YORK STATE SENATE

  • Tom Croci (R, 3rdSD, Suffolk County
  • Kemp Hannon (R, 6th SD, Nassau County)
  • Robert Ortt (R, 62ndSD, Monroe, Niagara and Orleans Counties)
  • Michael Ranzenhofer (61stSD, Erie, Genesee and Monroe Counties)
  • James Seward (51stSD, Cayuga, Chenango, Cortland, Delaware, Herkimer, Otsego, Schoharie, Tompkins and Ulster counties)
  • James Tedisco (Candidate For 49thSD, Fulton, Hamilton, Herkimer, Saratoga and Schenectady Counties)
  • Catherine Young (57thSD, Allegany, Cattaraugus, Chautauqua and Livingston Counties)

US CONGRESS

  • Chris Collins (R, 27thCD – Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans and Wyoming Counties)
  • Joseph Crowley (D, 14thCD – Bronx and Queens counties)
  • Elise Stefanik (R, 21stCD – Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, St. Lawrence, Saratoga, Warren and Washington counties)
  • Paul Tonko (D, 20thCD – Albany, Montgomery, Rensselaer, Saratoga, and Schenectady counties)  

NEW YORK STATE ASSEMBLY

Assembly Member Kevin Cahill 103rd AD (Ulster and Dutchess counties)  Chairs the Assembly Insurance Committee, and a member of the Health, Higher Education and Ways & Means Committee. Assemblyman Cahill works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.  This past legislative session, he led efforts to assure that the Assembly rejected cuts to the Excess Medical Malpractice program proposed in the Executive Budget, which preserved coverage for 13,000 physicians across New York who otherwise would have been dropped from the program.  He also was a forceful vocal opponent to legislation rejected by the Assembly proposed in the State Budget and on a “stand-alone” basis that would have permitted corporate-owned retail clinics.  Moreover, as Chair of the Assembly Insurance Committee, he was integral in helping to shape legislation supported by MSSNY and passed by the Legislature that provides physicians with a mechanism to override a health insurer step therapy medication protocol.  He is also one of the principal co-sponsors of legislation to permit physicians to collectively negotiate with health insurers.

Assembly Member Michael Cusick 63rd AD (Richmond County) Sits on the Assembly Higher Education and Ways & Means Committees. Assemblyman Cusick works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.   He was chief sponsor of legislation that passed the Legislature to hasten the time for insurers to complete review of applications for physicians to participate in the insurer’s network.  Despite his sponsorship of the I-STOP legislation, hHis efforts were critical in helping to greatly improve the final version bill of the I-STOP bill over earlier versions, including working to assure a physician could delegate the “duty to consult” to staff.  He also was very helpful in efforts to help shape legislation so as to reduce the hassles to physicians associated with required CME for pain management, and limitations on specific opioid medications. In 2015-16, he supported a number of bills of importance to MSSNY in floor votes, including legislation to require health insurers to use similarly trained physicians before denying patient care, and legislation to assure due process protection for physicians when health plans do not renew physician participation contracts with them.   He is also a co-sponsor of legislation to permit physicians to collectively negotiate with health insurers.

Assembly Member Deborah J. Glick (D) 66th AD New York County) Assemblywoman Glick chairs the Assembly’s Higher Education Committee.   She has been tenacious in opposing legislation to permit corporate owned “retail clinics” and has been a strong advocate in opposition to CME mandates.    She has been a fierce opponent to inappropriate scope of practice expansion bills, including those that the Senate had passed in recent years such as the podiatric, athletic trainer and a bill to allow chiropractors to co-own medical practice in contravention of the corporate practice of medicine doctrine.  She and her staff have an outstanding working relationship with MSSNY.

Assembly Member Richard Gottfried 75th AD (New York County). Chairs Assembly Health Committee and sits on the Assembly Higher Education Committee. In that capacity, Assemblyman Gottfried has introduced and secured passage of legislation to protect physician and patient concerns with e-prescribing.  He also the long time sponsor of numerous MSSNY priority bills, including legislation to provide peer review confidentiality protections and to permit physician collective negotiations. He also opposed changes to the Excess Medical Liability Insurance program. He works closely with MSSNY staff and has a good record of taking action consistent with MSSNY’s positions.

Assembly Member Chuck Lavine 13th AD (Nassau County). Sits on the Assembly Codes, Health, Higher Education, Insurance, and Judiciary Committees. Assemblyman Lavine works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.  In 2015-16, he sponsored multiple bills to address concerns raised by physicians, including legislation (which passed the Assembly) to assure due process protection for physicians when health plans do not renew physician participation contracts with them, and legislation that would prohibit health insurers from using extrapolation when they audit physicians (which also passed the Assembly). In 2015-16, he supported a number of bills of importance to MSSNY in committee and floor votes, including legislation to permit physicians to collectively negotiate with health insurers (he is a co-sponsor), and legislation to require health insurers to use similarly trained physicians before denying patient care.  He also voted against multiple bills opposed by MSSNY, including stand-alone legislation to require physicians to take pain management CME and legislation that would have imposed a 5-day limit on medications to treat acute pain.

Assembly Majority Leader Joseph Morelle 136th AD (Monroe County). Assembly Majority Leader. Assemblyman Morelle was instrumental in efforts to delay passage of an overbroad pain management CME mandate and helped to assure that the final opioid legislation enacted addressed many concerns raised by physicians.  He was also helpful in efforts to prevent passage of legislation to permit corporate owned retail clinics. He is also opposed to most scope of practice changes and supports legislation to provide additional protections for physicians and patients to prevent insurers from denying or delaying necessary medical care. He opposed proposed changes to the Excess program and opposed changes to the workers compensation program that would have added certain non-physician providers to provide care to injured workers and a proposal to eliminate the county medical society role in review of applications to the workers’ compensation program.

Assembly Member Robin Schimminger 140th AD (Erie and Niagara counties) Sits on the Assembly Health, Codes and Ways and Means Committees.  Assemblyman Schimminger works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.    He is the long-time sponsor of the Medical Liability Reform Act, legislation which contains a number of provisions to address the high cost of medical liability insurance, including:

  • A cap on non-economic damages
  • Reducing joint and several liability
  • Identification of expert witnesses in medical liability cases
  • Identification of physician providing certification for Certificate of Merit

Assemblyman Schimminger also sponsored legislation to prohibit hospitals from requiring board certification as a condition of staff privileges, and health insurers from requiring board certification as a condition of participation. In 2015-2016, he supported a number of bills of importance to MSSNY in committee and floor votes, including the Collective Negotiation legislation, and legislation to assure due process protection for physicians when health plans do not renew physician participation contracts with them.   He also voted in opposition to a number of bills also opposed by MSSNY, including legislation to extend the medical liability statute of limitations, legislation to require physicians to complete CME for pain management, and legislation that would have imposed a 5-day limit on medications to treat acute pain

NEW YORK STATE SENATE

Senator Tom Croci (R) 3rd SD (Suffolk County). Chairs Senate Ethics, Veterans and Homeland Security & Military Affairs. In his capacity as chairman of the Senate Veterans Committee, Senator Croci worked with the Committee on Mental Hygiene to secure for MSSNY, NYSPA and NASW a grant to assist in the development and presentation of continuing medical education programming on the diagnosis and treatment of PTSD and TBI in returning veterans.

Senator Kemp Hannon (R) 6th SD (Nassau County). Chairs Senate Health Committee. Senator Hannon has, at the request of MSSNY, carried and successfully passed a number of bills including three bills to address issues with e-prescribing, standard prior authorization request forms, physician collective negotiation (2011) and has introduced medical liability reform legislation including a cap on noneconomic loss and peer review confidentiality legislation while advocating within his conference on behalf of MSSNY against the date of discovery bill.

Senator Robert Ortt (R) 62nd SD (Monroe, Niagara, Orleans Counties). Chairs Senate Mental Hygiene & Developmental Disabilities Committee. In his capacity as chair of the Mental Hygiene Committee, Senator Ortt, worked with the Committee on Veterans to secure for MSSNY, NYSPA and NASW a grant to assist in the development and presentation of continuing medical education programs on the diagnosis and treatment of PTSD and TBI in returning veterans.

Senator Michael Ranzenhofer (R) 61st SD (Erie, Genesee, Monroe Counties), is the Deputy Majority Leader for Economic Development and Chairs the Corporations, Authorities & Commissions Committee, and is a member of the Senate Finance Committee.  During the Senate caucus on the Date of Discovery Statute of Limitations bill in the final hours of session, Senator Ranzenhofer is reported to have stridently argued against the bill thereby aiding in its defeat.

Senator James Seward (R) 51st SD (Cayuga, Chenango, Cortland, Delaware, Herkimer, Otsego, Schoharie, Tompkins and Ulster counties), is the Chair of the Senate Insurance Committee, and member of the very powerful Senate Finance, Health and Rules Committees.  Senator Seward has long been a champion of medical liability reform and staunch opponent of liability expansion legislation.   He has also been a regular participant at MSSNY’s Annual Albany Physician Advocacy Day.  This year, as Chair of the Senate Insurance Committee, he was integral in helping to shape legislation supported by MSSNY and passed by the Legislature that provides physicians with a mechanism to override a health insurer step therapy medication protocol.

Jim Tedisco (R) Running to fill vacant 49th SD (Fulton, Hamilton, Herkimer, Saratoga and Schenectady Counties). Assemblyman Tedisco has represented voters in Schenectady and Saratoga Counties since 1982. He is very well known in his District and has been a long-time friend of medicine. He served as Minority Leader of the Assembly from 2005 to 2009. He has had a long and very good working relationship with MSSNY DGA staff and MSSNY physicians. He supported the step therapy override bill and legislation that would eliminate the requirement for physicians to report to the State each time they write a prescription in lieu of an e-prescription.

Senator Catherine Young (R) 57th SD (Allegany, Cattaraugus, Chautauqua, and Livingston Counties). Senator Young chairs the Finance Committee, as well as the Senate Republican Campaign Committee. As Chair of the Senate Finance Committee, working with the Chair of the Senate Health Committee, Senator Young steadfastly opposed the Governor’s proposal to reduce funding of the Excess program substantially reducing the number of physicians eligible for such coverage, opposed the retail clinic proposal and opposed the workers compensation proposal to add certain non-physician providers to provide care to injured workers and a proposal to eliminate the county medical society role in review of applications to the workers’ compensation program. She also sponsored legislation that would empower physicians to override step therapy protocols to assure that their patients have timely access to medically necessary medication.

US CONGRESS

Representative Chris Collins (R) CD 27 (Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Wyoming) Representative Chris Collins is running for his 3rd term.  He serves on the very powerful House Energy & Commerce Health Subcommittee. Representative Collins and his staff work closely with local physicians and MSSNY staff, and he has a strong record of advocating for policies consistent with the concerns of physicians and patients.  He is a co-sponsor of the Fair Medical Audits Act of 2015 which would restore some fairness in the conducting of audits by Medicare Recovery Audit Contractors.  He also signed unto a letter to CMS that expressed strong opposition with a CMS proposal that would significantly cut the payments to physicians for medications administered to patient under Medicare Part B.  Moreover, at a Congressional hearing last December, he aggressively questioned CMS Acting Administrator Slavitt regarding CMS response to the collapse of Health Republic and its impact on local physicians.

Representative Joe Crowley (D) 14th CD (Bronx and Queens Counties) Congressman Crowley is running for his 10th term. He serves on the very powerful House Ways & Means committee, which has jurisdiction over much of the health care policy considered by Congress. Representative Crowley and his staff work closely with local physicians and MSSNY staff, and he has a strong record of advocating for policies consistent with the concerns of physicians and patients. He is lead sponsor of legislation that would significantly increase the number of residency slots to address doctor shortages in New York and across the country. He was also very vocal in support of efforts that ultimately led to a repeal of the flawed Medicare Sustainable Growth Rate formula, including leading a bi-partisan effort to use the Overseas Contingency Operations (OCO) funds to pay for its repeal.  Moreover, he recently signed unto a letter to CMS that expressed strong concerns with a CMS proposal that would significantly cut the payments to physicians for medications administered to patient under Medicare Part B. 

Representative Paul D. Tonko (D) CD 20 (Albany, Schenectady and parts of Montgomery, Rensselaer and Saratoga Counties) He is serving his fourth term, and is one of New Yorkers on the very powerful House Energy and Commerce Committee – one of the Committees with health care jurisdiction.  Congressman Tonko served for over 20 years in NYS Assembly prior to running for Congress, and was the sponsor of the Mental Health Parity bill.    He has carried his advocacy for mental health parity to Congress.  He has also been a strong advocate to expand opioid treatment capacity for community caregivers – legislation that in May, passed the U.S. House of Representatives. Congressman Tonko is the vice co-chair of the Congressional Addiction, Treatment and Recovery Caucus.  He has an excellent working relationship with local physicians and with MSSNY staff.

Representative Elise Stefanik (R) 21st SD (Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, St. Lawrence, Saratoga, Warren, Washington). Running for second term, the Congresswoman serves on the House Armed Services Committee and the Committee on Education and the Workforce.   She authored the Be Open Act – legislation that was signed into law by the President to fix a flaw in ObamaCare by repealing the auto-enrollment mandate that reduces choices in health coverage and has created confusion that can lead to significant tax penalties on both the employer and employee. She also signed onto a House Republican Delegation letter to CMS in opposition to a Medicare Demonstration program that would significantly impair seniors’ access to care by reducing physician reimbursement for injectable medications.   She has worked closely with many local physicians, including several MSSNY leaders.

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.

The bill has not as of yet been delivered to the Governor.

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.

Over the summer, MSSNY representatives and several other patient advocacy groups met with the Governor’s office to urge that this bill be signed into law.  Moreover, in Augusts, dozens of patient advocates rallied at the State Capitol in support of this 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.

Gov. Signs Laws to Improve Voluntary Organ Donation
New York State has the third highest need for donors – with 10,000 residents currently waiting for organ transplants – but the lowest number of registered donors. Governor Cuomo has now signed three laws that will help improve voluntary organ donation in New York.

  • Lauren’s Law, which requires individuals who apply for a New York State Driver’s License to affirmatively decide whether or not to participate in the state’s organ donor registry, was extended for four years.
  • The Organ Donor Registration Opportunity/Health Benefit Exchange law requires applications for insurance coverage through the State’s Health Benefit Exchange to include an opportunity for individuals to participate in New York’s Donate Life Registry.
  • Another new law lowers the minimum age for organ donation designation to 16 years old. The law, taking effect February 14, 2017, allows individuals age 16 and older to enroll in the New York State Donate for Life Registry and to consent to making lifesaving organ and tissue donations. The vast majority of other states have this law. 


Empire Bluecross/Blueshield to Participate in CMS Multi-Payer Initiative
Empire BlueCross BlueShield has been selected to participate in the Centers for Medicare and Medicaid Services’ Comprehensive Primary Care Plus program, a five-year multi-payer model.

The program, according to CMS, is designed to bolster primary care through regionally-based multi-payer payment reform by bringing different payers, like CMS, commercial insurance plans and state Medicaid agencies, together to make changes to health care delivery.

CPC+ will have two primary care tracks with “incremental advanced care delivery requirements” and payment options, in the hopes each will have better infrastructure to deliver care to patients, according to CMS. Practices will be centered on certain functions, like access and continuity, care management, comprehensiveness and coordination, patient and caregiver engagement and planned care and population health, according to CMS.

Providers that want to participate in CPC+ need to apply through CMS and will be announced later this year.


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


NYSDOH Offering “A September 2016 Series of Zika Virus Webinars”

  • Zika Virus: An Update for Obstetric and Neonatal Providers and the Birth Facility Team
    When: Tuesday, September 20, 12 – 1 p.m.
    Speakers: Lou Smith, MD, MPH, Medical Director, Bureau of Communicable Disease                       

Control

  • Zika Virus: An Update for the NYS Healthcare Provider             When: Wednesday, September 21, 12 – 1 p.m.
    Speakers:
    P. Bryon Backenson, MPH, Director of Vector-Borne Diseases and   Elizabeth Dufort, MD, FAAP, Medical Director, Division of Epidemiology, NYSDOH
  • Zika Virus: An Update on Transplant Associated Concerns             When: Thursday, September 22, 12 – 1 p.m.
     Host: NYSDOH and the NYS Transplant Council
    Speakers: Kirsten St. George, MAppSc, PhD, Chief Viral Diseases, Wadsworth Center,                                                                        NYSDOH; Lewis Teperman, MD, FACS, Vice Chair of Surgery & Director of Organ Transplantation at Northwell Health, Manhasset NY and Region 9 Councillor to the United Network for Organ Sharing (UNOS); Marian Michaels, MD, MPH, Professor of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Disease Transmission Advisory Committee (DTAC) Vice Chair, United Network for Organ Sharing (UNOS)
  • Zika Virus: An Update for the Pediatric Provider
    When: Wednesday, September 28th 2016, 12 – 1 p.m.

Please click here for more information and to register.

UnitedHealthcare Physician Advocacy Council: Any Questions to Ask Them?
As part of the last legal settlement with United that was concluded in 2015, United agreed to the formation of a Committee referred to as the PAC – Physician’s Advisory Council.  The Medical Society of the State of New York has 4 physician members who are on the UHC PAC.  The Committee meets 4 times a year with similarly named physicians from United.  One criteria for being on this group is that the physician must be participating with United.

The Committee is charged with addressing any issue of contention, either operational or administrative, that might be encountered in dealing with United. While issues are discussed at length, the agreement stipulates that UHC is there to listen and report back to the UHC leadership on items discussed.  United does not present new policy matters to the PAC.  However, the group could discuss United policy issues that cause concern and these concerns would then be taken back the leadership for their thoughts and/or action.  The spirit of the settlement agreement is that MSSNY could share subject matters at a high level to garner a better relationship with UHC.

In this spirit, MSSNY is asking members if they have specific issues with United that we can address and advocate for your behalf.  If you have a concern, please send an email to Regina McNally, VP, Socio-Medical Economics.  Please state the subject as UHC PAC Item and send your email to rmcnally@mssny.org  MSSNY email is not HIPAA-secure, so please do NOT include any PHI!

Many Seniors Wrongly Denied Medicare Coverage
The New York Times (9/13,) reports that beneficiaries are often told Medicare will no longer cover physical therapy or nursing home stays because they are “stable and chronic,” or have reached “maximum functional capacity,” or they have plateaued.

Seniors “with chronic and progressive diseases – dementia, Parkinson’s, heart failure” – are typically given this incorrect assessment, even though a 2013 settlement of a class-action suit mandated that Medicare “cover skilled care and therapy when they are ‘necessary to maintain the patient’s current condition or prevent or slow further deterioration.’”

In addition, last month, a Federal judge ordered CMS “to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect.” The judge said that while CMS does not have to further update its manuals, it must do a better job of educating the medical community about these changes. 

YP/Resident Leadership Seminar Slated for Syracuse Oct 21-22
Following an exciting Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has now slated a Leadership program for upstate physicians in Syracuse from late afternoon Friday, Oct 21 through Saturday, Oct 22.

The program is scheduled for the Doubletree Inn at Syracuse Thruway exit 36. A renowned faculty from Brandeis and Harvard University will lead the program, which 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 covered under a grant from The Physicians Foundation.  For further information, contact MESF Executive Director at Tom Donoghue tdonoghue@mssny.org. 

“When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

The Medical Society of the State of New York designates this live 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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.

22% of Generic Drugs Billed to Part D Had 100% Increase between 2010-2015
About 22 percent of generic drugs billed to Medicare Part D had at least one price increase of 100 percent or more between 2010 and 2015, states a new GAO report titled, “Generic Drugs Under Medicare Part D Generic Drug Prices Declined Overall, but Some Had Extraordinary Price Increases.”  http://www.gao.gov/assets/680/679022.pdf

Exercise in Self-Assessment of Your Orthopaedic Knowledge: Preparation for MOC
The 2016 Annual New York State Society of Orthopaedic Surgeons Symposium will take place on Saturday, September 24, 2016 from 7:00am – 4:30pm at the NYU Langone Medical Center – Hospital for Joint Diseases in the Loeb Auditorium (301 East 17th Street, NY NY 10003).

NYSSOS is committed to designing programs that help orthopaedists achieve and comply with educational requirements. This one-day event features presentations on topics including sports, pediatrics, trauma, adult reconstruction, spine, geriatrics, metabolic bone disease, upper extremity, foot & ankle and hand surgery.

Participants who purchase and pass the AAOS OKU 11 exam will receive up to 20 SAE credits. Participants who review the AAOS OKU 11 educational material and complete and pass the AAOS OKU 11 exam will be eligible to receive up to 70 CME credits. AAOS OKU 11 products will be available for purchase at the time of registration.  Pre-registration is required to attend.

Residents and Fellows are encouraged to attend. Three discounted registration packages are available. Register Online or download the Brochure. 

 “Light the Path” Walk at LI’s Sunken Meadow State on October 6
The Long Island Health Collaborative is hosting a “Light the Path” walk for Behavorial Health Awareness on Thursday, October 6 at 4:00PM at Sunken Meadow State Park, Rte. 25A and Sunken Meadow Parkway, Kings Park, NY 11754. Parking is available in Field 2. Register to receive updates here. For questions or more information visit www.LIHealthCollab.org


CLASSIFIEDS



Considering Outsourcing Your Billing?
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Office Space – 1185 Park Ave. (94th St.) Full-time
Ideal for busy medical subspecialty.  Exclusive use of consult, exam room. Stress test, echo available.  Beautiful décor.  Public transportation nearby.  Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

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

A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 9, 2016 – Reject Anthem-Cigna Merger

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

September 9, 2016
Volume 16, Number 31

MLMIC

Dear Colleagues:

The following is a summary of my testimony at the Department of Financial Services hearing yesterday strongly opposing the proposed Anthem-Cigna merger:

On behalf of our over 20,000 members, I thank you for the opportunity to present our concerns regarding the impact to patient care if Anthem, the parent of Empire Blue Cross/Blue Shield, is permitted to acquire Cigna. The recent litigation initiated by the US Department of Justice to block this proposed merger as well the proposed Aetna-Humana merger validated the very serious concerns held by many physician and patient advocacy groups in New York State and across the country.   Specifically, the DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country were “unprecedented in their scale and in their scope.”

Greatest Impact on Smaller Practices

We agree that this proposed merger could have serious adverse implications for care delivery, with the greatest adverse impact upon smaller physician practices, which are already reeling from the profound changes arising from policy advanced from both the federal and state governments.  Indeed, these concerns regarding insurer market concentration have been made by physicians and physician advocacy groups for years as many insurers have merged or have been purchased, or converted to for-profit status.  More specifically, this concern was expressed by many of our physician members when we sought their feedback on this proposed merger of these two insurance giants.  Many physicians already feel powerless to negotiate for fairer treatment by existing insurance behemoths, and believe that this merger will exacerbate an already extremely difficult practice environment. Many feel they have no choice but to become employees of large systems, which can cause disruptions to existing physician-patient relationships.

Based upon information reported by the American Medical Association within its 2015 Competition in Health Insurance report, this proposed merger would substantially increase the market share of the combined entity in several New York State regions. We believe this would have a serious detrimental impact on patient access to care, as Empire has a mixed record in assuring patients can receive the care they need based upon DFS’ own 2015 Guide to Health Insurers.

Based upon data contained in the AMA’s 2015 Competition report, if Anthem were to purchase Cigna, the market share for Empire could:

  • increase from 17% to 27% in the Lower Hudson Valley and New York City;
  • increase from 21% to 27% in Long Island; and
  • increase from 20% to 26% in the mid-Hudson Valley.

Another AMA report, written specifically to assess the market impact of this proposed merger across the country, notes that the resulting Anthem-Cigna entity “would be presumed to likely enhance the market power” of the combined entity in Long Island, and “raises significant competitive concerns” and “warrants scrutiny” for the combined entity in New York City and the Hudson Valley.  The report makes these determinations using the Horizontal Merger Guidelines developed by the U.S. Department of Justice and Federal Trade Commission.

Merger Would Increase Anthem’s Market Share Considerably 

Additionally, the DFS Superintendent’s letter highlighted the impact of this takeover on the large employer health insurance market. She noted that it would increase Anthem’s market share across commercial products to 31.2% statewide, of which Anthem would command nearly 10% of New York’s fully insured market and nearly 50% 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. United, which purchased Oxford, and Emblem, which formed from the merger of HIP and GHI, have been publicly reported in the last few years to have drastically reduced their physician networks, reducing patient access for many.

Moreover, it is important to note that, according to DFS’ public data, Empire has at best a mixed record with regard to addressing the care needs of their insureds. Specifically, the 2015 Consumer Guide to Health Insurance prepared found that in 2014:

  • Empire had the worst overall consumer complaint ratio among HMO products offered in New York State;
  • Empire had the worst overall prompt payment complaint ratio among HMO products offered in New York State; and
  • Empire had the highest number of external appeals taken against it (705) among any health insurer operating in New York State.

It stands to reason that with less competition, there will be less incentive for Empire and the remaining health insurers to have comprehensive physician networks and to fix prior authorization abuses identified by physicians and patients.

In summary, we are very concerned that these problems will only get worse as insurers’ market shares increase. We appreciate that the DOJ, the DFS and the NY AG have recognized these concerns and urge that this proposed merger be rejected on the grounds that it would harm patient access to needed care.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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CMS Announces Flexibility Options for MACRA Participation for 2017
This week CMS Acting Administrator Andrew Slavitt  announced in a blog posting its plans to provide some flexibility to physicians complying with the MACRA Medicare value-based payment programs scheduled to begin January 1, 2017.   While the final rule will not be released until later this fall, CMS announced that the final MACRA regulation will exempt physicians from any risk of Medicare payment penalties for 2019 within the Merit Based Incentive Payment System (MIPS) program if they choose one of three distinct reporting options in 2017, in addition to the option of participating in an advanced APM:

  • Full-year reporting that begins on January 1;
  • Partial year reporting for a reduced number of days; and
  • A “test” option under which physicians can report minimal amounts of data.

Physicians who report in 2017 may be eligible for bonus payments in 2019, depending on which option they choose.  According to the blog posting, those who opt for full-year reporting will be eligible to receive a “modest positive payment adjustment;” and those who choose partial year reporting will be eligible for a “small positive payment adjustment.”  Physicians who choose the “test” option will not be eligible for a bonus, but also not subject to any payment penalties.  Qualified participants in advanced APMs will be eligible for 5 percent incentive payments in 2019.

AMA President Dr. Andrew Gurman praised the action taken by the federal government, stating it “strongly applauds Secretary Burwell and Acting Administrator Slavitt – and their teams – for listening to physicians’ concerns about the timeline that was originally proposed for MACRA.  By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA.  This approach better reflects the diversity of medical practices throughout the country.  “The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.” 

CMS Offers Session on PQRS Feedback Reports on September 27 at 1PM
The Centers for Medicare & Medicaid Services (CMS) announced a Virtual Office Hours (VOH) session regarding Physician Quality Reporting System (PQRS) feedback reports for program year 2015 results. This VOH session will include information on the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.

The session, titled “2015 PQRS Feedback Reports,” will take place on Tuesday, September 27, 2016 from 1:00 – 2:00 p.m. ET. Topics to be discussed in this session include information about how the 2017 PQRS negative payment adjustment is assessed and how and where to access 2015 PQRS feedback reports depicting payment adjustment results. Additionally, this PQRS VOH session will allow stakeholders an opportunity to ask a CMS representative questions about the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.

Event Registration:

You must register to participate in this session, and spots are limited. Registration begins on Tuesday, September 13, 2016 at 12:00 p.m. ET. Click here to access the registration page.

A few notes about this VOH session:

  • You will only be able to register on or after 12:00 p.m. ET on September 13, 2016. If you attempt to register before this time you will receive an error message.
  • Only a limited number of participants will be allowed to register.
  • Only questions related to the 2015 PQRS feedback reports and 2017 negative payment adjustment will be addressed on this call. All other questions, including questions regarding program requirements and policy or reporting specifics, should be directed to the QualityNet Help Desk.

Complete information about PQRS is available on the CMS PQRS website.

For questions about PQRS or the VOH registration process, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. – 7:00 p.m. Central Time.


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


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.

The bill has not as of yet been delivered to the Governor.

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.

Over the summer, MSSNY representatives and several other patient advocacy groups met with the Governor’s office to urge that this bill be signed into law.  Moreover, in August, dozens of patient advocates rallied at the State Capitol in support of this bill, which received significant media attention, including from WNYT. TWC’s Capital Tonight and Politico-NY.

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.

Decline In Teenage Pregnancy Due to Use of Contraceptives, Study Suggests.
The New York Times (9/1) reports a new study published in the Journal of Adolescent Health found the “sharp decline in American teenage pregnancy and birthrates in recent years was driven exclusively by the use of contraceptives.” The study of a “nationally representative sample of more than 3,000 women ages 15 to 19” in 2007, 2009 and 2012 concluded “that sexual activity in the last three months of each time period did not vary — about one-third of the young women had had sex during that time.” However, the “percentage of teenagers who reported using contraception increased to 86 percent from 78 percent, and the share using more than one method increased to 37 percent from 26 percent

Zika Virus Commissioner’s Grand Rounds to Be Held on September 29
The 2016-2017 Commissioner’s Medical Grand Rounds series first session will be held Thursday, Sept. 29th from 6-8 p.m.   The program, entitled, “From A to Zika: An Update on Zika Virus for Primary Care Providers” will be presented as a live seminar and webinar at Stony Brook Medicine, Health Science Center, Level 2, Lecture Hall 2, 101 Nicolls Road, Stony Brook NY. The presentation will inform clinicians on current evidence about transmission, best practices for laboratory testing and evaluation, potential health effects and prevention of Zika virus infection. 

Presenters will be Samuel Stanley, MD, president, Stony Brook University and Chair, National Science Advisory Board for Biosecurity; Burton Rochelson, MD, Chief of Maternal Fetal Medicine at Northwell Health, Director of Maternal-Fetal Medicine Fellowship Program, Northwell Health; Philip Kurpiel, PhD, MPH; Program Supervisor, MARO Regional Epidemiology Program, NYS Department of Health; Louis Manganas, MD, PhD, Assistant Professor, Department of Neurology, Stony Brook University Medical Center.   The program is free of charge for all providers in New York State and advance registration is required.  To register, please see the flyer HERE.

The program will be streamed as a live webcast for those unable to attend in-person and will also be archived for future viewing.   Participants are eligible for CME credits whether they view in-person, via the live webcast, or the archived webcast. More Info.

Medicine at the Metropolitan Museum: Art in Clinical Practice
Learn how to use art to enhance your observation and communication skills in order to strengthen your clinical practice! 

When:
September 16, 2016 from 6 to 8.30pm:
Enhancing Observation and Presence
September 18 from 10.30am to 1pm:
Expanding Point of View and Creative Thinking
Location: The Met Museum in NYC

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

From the participants:
“Fantastic course. Therapeutic, informative and reformative.”
“Very interesting and I think it’ll make me a better doctor.”

MSSNY in the News

The Buffalo News – 08/27/16
Opinion – Another Voice: I-STOP changes won’t hurt fight against opioid abuse
(Letter to the Editor from MSSNY president Dr. Malcolm Reid, MD & VP, Dr. Thomas Madejski)
Healthcare Business Daily News – 09/07/16
AMA and MSSNY urge New York State officials to reject Anthem-Cigna merger as anticompetitive
(MSSNY President, Dr. Malcolm Reid quoted)
Becker’s Hospital Review – 09/08/16
AMA, physicians press NY state to reject Anthem-Cigna deal
(MSSNY President, Dr. Malcolm Reid quoted)
The Canadian Business Journal – 09/08/16
AMA and MSSNY: Anthem-Cigna Deal Is Bad Medicine For New York State
(MSSNY President, Dr. Malcolm Reid quoted)
Modern Healthcare – 09/08/16
AMA, consumers urge N.Y. regulators to reject Anthem-Cigna merger
(MSSNY President, Dr. Malcolm Reid quoted)


CLASSIFIEDS


Office Space – 1185 Park Ave. (94th St.) Full-time
Ideal for busy medical subspecialty.  Exclusive use of consult, exam room. Stress test, echo available.  Beautiful décor.  Public transportation nearby.  Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

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!

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 3rdAvenue (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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

Council – September 15, 2016

AGENDA
Council Meeting
September 15, 2016, 9:00 am
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590

A.Call to Order and Roll Call

B. Approval of the Council Minutes of June 2, 2016

C. New Business (All New Action & Informational Items)

   1. President’s Report

a.  Resolution 2016-200, Combine MSSNY HOD with Legislative Day in Albany (For Discussion)

b.  Pennsylvania Medical Society Sign-On MOC Letter (For Council Approval)

c.  Medicare Advantage Resolution Submitted by
Joseph R. Maldonado, MD, MSc, MBA, DipEBHC
(For Council Approval)

d. Minutes of the Executive Committee Teleconference,
August 17, 2016 (For Council Information)

e.  AMA Response Letter re Resolution 2016-263, Continued Surgical Care (For Council Information)

f. AMA Response Letter re Resolutions 111 & 115, Electronic Health Records and Resolve E-Prescribing Problems
(For Council Information

    2.  Board of Trustees Report  – Minutes of the Board of Trustees
Teleconference
  August 23, 2016.
Dr. Leah McCormack will present the BOT report at
Council (handout)

    3. Secretary’s Report – Dr. Arthur Fougner will present the report
for Nominations for Life Membership & Dues Remissions

    4. MLMIC Report – Mr. Donald Fager will present a verbal report

    5.  AMA Delegation Update Dr. John Kennedy will present the
report

   6.  MSSNYPAC Report – DrJoseph Sellers will present the report

   7. Commissioners (All Action Items)

Commissioner of Governmental Relations, Gregory Pinto, MD,
MSSNYPAC Executive Committee Action Items
 MSSNY Council Approval of Congressional Candidates for
MSSNYPAC Endorsement;
MSSNY Council Approval of State Senate Candidates for
MSSNYPAC Endorsement;
MSSNY Council Approval of  State Assembly Candidates for
MSSNYPAC  endorsement

 
   8. Councilors  (All Action Items from County Societies and District
Branches) (No written reports submitted)

D. Reports of Officers (Informational)
1. Office of the President – Meetings attended:

Gottfried Legislative Breakfast
Presentation at the Westchester Academy of Medicine
Television interview with Marcia Kramer (Channel 2 News)
Westchester County Annual Meeting
IPRO Meeting
New York County Annual Meeting
National Medical Association Meeting
Richmond County Medical Society Annual Meeting
Andrew Cuomo’s Reception/Gala Fundraiser
New Jersey Annual Gala
Fundraiser for Senator Hannon
MLMIC Executive Committee Meeting
Bronx County Annual Meeting

 

  1. Office of the President Elect – Charles Rothberg, MD
  2. Office of the Vice President – Thomas J. Madejski, MD
  3. Office of the Treasurer – Joseph R. Sellers, MD, Financial Statement for the period  January 1, 2016  to July 31, 2016
  4. Office of the Speaker  –  Kira A. Geraci-Ciradullo, MD, MPH DRAFT – Proposed Revisions to MSSNY Bylaws

E. Reports of Councilors (Informational)
1. Kings/Richmond Report – Parag H. Mehta, MD
2. Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
3. Nassau County Report – Paul A. Pipia, MD
4. Queens County Report – Saulius J. Skeivys, MD
                  (no written report submitted)
5. Suffolk County Report – Maria A. Basile, MD, MBA 
6. Third District Branch Report – Brian P. Murray, MD
7. Fourth District Branch Report – John J. Kennedy, MD
8. Fifth District Branch Report –Howard H. Huang, MD
9. Sixth District Branch Report – Robert A. Hesson, MD
10. Seventh District Branch Report – Mark J. Adams, MD
11. Eighth District Branch Report – Edward Kelly Bartels, MD
                     (no written report submitted)
12. Ninth District Branch Report – Thomas T. Lee, MD
13. Medical Student Section Report
Christina Kratschmer 
14. Organized Medical Staff Section Report –
Richard A. Ritter, MD (no written report submitted)
             15. Resident & Fellow Section Report – Robert A. Viviano, DO 16. Young Physician Section Report – L. Carlos Zapata, MD
                     (no written report submitted) 

F. Commissioners (Committee Informational Reports/Minutes)
   
Commissioner of Communications
Joshua M. Cohen, MD, MPH
         1. Report of the Division of Communications      

Commissioner of Socio Medical Economics,
         Howard H. Huang, MD
         2. Interspecialty Committee Minutes, June 30, 2016

G. Presentations
     1 Update on the activities of the Long Island Health
Collaborative
Bruce Berlin, MD, President-Elect
Suffolk County Medical Society

2.  Patient-Centered Medical Home Practice
Salvatore Volpe, MD

H. Report of the Executive Vice President, Philip Schuh, CPA, MS
      Membership Dues Revenue Schedule

I. Report of the General Counsel, Donald Moy, Esq.
United Class Action Complaint

J. Report of the Alliance – Valerie Semeran
    Alliance Report 

K. Other Information/Announcements

  1. Final Version of the Sunshine Act Letter
  2. Sign-On Coalition of State Medical Societies VA Letter
  3. Sign-On VHA APRN Letter
  4. Letter to Andrew Slavitt, Acting Administrator, re Refinement Panel Process
  5. Sign On MACRA Letter
  6. AMA Amicus Brief, National Restaurant Association v. NYC Department of Health
  7. Physician Foundation Minutes, August 2016
  8. MSSNY Letter to CMS re MIPS and APM Incentive Under the Physician Fee Schedule
  9. EpiPen Letters & News Release
  10. Letter to United States Congress re Comprehensive Addiction & Recovery Act (CARA)
  11. Letter to Honorable Burwell re MACRA

L. Adjournment

 

August 26, 2016 – DOH:Expand Marijuana Program

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

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


enews large

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
asset.find.us.on.facebook.lgTwitter_logo_blue1

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
asset.find.us.on.facebook.lgTwitter_logo_blue1

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
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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.


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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