Moe Auster: Testimony for State Fiscal Year 2018-2019 

 

Testimony of
the Medical Society of the State of New York
Before the
New York State Assembly Committee
on Ways & Means and Senate Finance Committee
on the Governor’s Proposed Public Health Budget
for State Fiscal Year 2018-2019
 

Good morning. My name is Moe Auster, Esq., and I am the Senior Vice-President/Chief Legislative Counsel for the Medical Society of the State of New York. On behalf of the almost 25,000 physicians, residents and students we represent, let me thank you for providing us with this opportunity to present organized medicine’s views on the proposed budget and how it relates to the future of the health care delivery system in New York State.

It must be noted that this proposed budget is being considered simultaneously with a number of market forces which are threatening the ability of physician practices all across New York State to continue to deliver timely and quality patient care.  Due to an untenable economic squeeze between rising practice costs and reductions in payments, more and more physicians have faced little choice but to close their practices and join large health systems to be able to continue to deliver patient care, sometimes at the expense of long-term patient relationships and the many jobs they provide. According to a recent Avelere study, the number of physicians who have become hospital employees in New York nearly doubled from 2012-2015.

New York recently received the dubious distinction from Wallet Hub as the most anti-doctor state in the country, due to its low payments for care (compared to other states) combined with exorbitant costs. One of the reasons for this designation is the extraordinarily expensive cost for medical liability insurance in New York State.

At the same time, health insurers continue to shrink their networks and cut payments for care delivered, reducing the ability of physicians to pay these exorbitant premiums. Moreover, Medicaid, Medicare and other payors are demanding participation in various value-based payment programs which require extensive infrastructure investment such as upgraded EHR systems. Failure to meet these criteria could result in significant payment cuts.

Not surprisingly, a recent Annals of Internal Medicine study reported that, for every hour a physician spends delivering care, two more hours are spent on paperwork. And a recent study by Milliman noted that health insurers’ use of burdensome prior authorization and step therapy requirements for several categories of prescription medications basically doubled between 2010 and 2015.

Exacerbating these problems are new difficulties brought about by health care reform implementation, including the ridiculously low payments being offered by insurers to participate in New York Health Insurance Exchange products, and a significant increase in physicians’ billing and collection costs due to huge new cost sharing requirements including unaffordable deductibles. Nearly 21% of responding physicians indicated that ¼ – ½ of their patients now face deductibles of $2,500-$5,000.

It is imperative that policymakers understand that, in addition to essential care they provide, physicians are under-recognized engine for the state of New York’s economy.  A recent AMA study concluded that physicians produce directly or indirectly nearly 700,000 jobs in New York, as well as $7.3 in total tax returns.  This of course becomes jeopardized if we make it too difficult for physicians to remain in practice.

It is through the context of this lens that we view the proposed State budget. We urge you to listen to the concerns of New York’s physicians – who are the ones predominately providing the care in our medical infrastructure – and to take action to assure that we create and preserve an economically sensible health care delivery system.

1) Continuation of an Adequately Funded Excess Medical Liability Program

We are grateful that Governor Cuomo has proposed to continue the Excess Medical Liability Insurance Program and to fund it at its historical level of $127.4M. Moreover, we are pleased that unlike past years there have been no proposed new conditions placed on the ability of physicians to receive this coverage.  We urge that the Legislature include this funding for the Excess program in the final budget adopted for 2018-2019.

By way of background, the Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level. The cost of the program since its inception in 1985 has been met by utilizing public and quasi-public monies.

The Excess Medical Liability Insurance Program was created in 1985 as a result of the liability insurance crisis of the mid-1980’s to address concerns among physicians that their liability exposure far exceeded available coverage limitations.  They legitimately feared that everything they had worked for all of their professional lives could be lost as a result of one wildly aberrant jury verdict. This fear continues since absolutely nothing has been done to ameliorate it. The size of verdicts in New York State has increased exponentially and severity of awards continues to grow steadily each year.  This already large problem has recently been made even worse as a result of the recent enactment of changes to New York’s Statute of Limitations law.  These changes are predicted to prompt a significant increase in medical laicity insurance costs, even with the agreed-to amendments to reduce some of the ambiguities of the bill, as well as its retroactive impact.

The severity of the liability exposure levels of physicians makes it clear that the protection at this level is essential, especially today.  Given the realities of today’s declining physician income levels and the downward pressures associated with managed care and government payors, the costs associated with the Excess coverage are simply not assumable by most physicians in today’s practice environment.  Indeed, as mentioned earlier, the ability of a physician to maintain even the primary medical liability coverage is increasingly compromised as a result of escalating costs and decreasing reimbursement. Without Excess, however, many physicians will be unable to continue to practice in this State.

It is important to note that the Excess program is not a solution to the underlying liability problem in New York State. That problem is caused by a dysfunctional medical liability adjudication system and the real solution is reform of that system.

Physicians in many other states have seen their premiums reduced in the last several years, while the liability premiums for New York physicians continue to rise.  Physicians in New York face far greater liability insurance costs and exposure than their colleagues in other states.  By way of example, a neurosurgeon practicing on Long Island have an astounding $338,252 premium for just one year of insurance coverage and an OB/GYN practicing in the Bronx or Staten Island has a premium of $186,630.  By comparison, an Ob-GYN practicing in Los Angeles, CA pays less than $50,000, about 25% of New York’s staggering premiums.

This is not surprising, given that a recent report by Diederich Healthcare showed that once again New York State had by far and away the highest number cumulative medical liability payouts (over $700 million), more than two times greater than the state with the next highest amounts, Pennsylvania ($315 million), and far exceeding states such as California ($235 million) and Florida ($223 million).

Moe Auster Testimony

To be clear, this is not just a product of New York’s population size.  New York again had the dubious distinction of having the 2d highest per capita medical liability payouts in the country – behind New Hampshire, where one aberrant case can significantly affect the ratio.

The problems of the medical liability adjudication system do not just impact physicians – they impact the cost of all health care.  Several studies have shown that billions of dollars are unnecessarily spent each year due to the practice of defensive medicine, such as unnecessary MRIs, CT scans and specialty referrals.  These defensive medicine costs are likely to go up further with the enactment of this new law, as many physicians will believe they have no choice but to recommend patients for additional diagnostic tests or refer to specialists, beyond what they believe is clinically indicated, to better assure the record is “complete” in case they are to be sued many years later.

New York must follow the lead of the many, many other states who have passed legislation to bring down the gargantuan cost of medical liability insurance. We stand ready to discuss any number of proposals that will meaningfully reduce medical liability premium costs for our physicians. Until that discussion occurs, however, we must take all steps necessary to protect and continue the Excess program to ensure that physicians can remain in practice in New York State.

2) Oppose the Inclusion of Language Authorizing Retail Clinics

We are very much opposed to proposal in the Executive Budget that would authorize the delivery of health services in a retail setting such as a pharmacy, grocery store, or shopping malls.  Sponsors could include a for-profit business corporation such as big-box store or drug store chain.  The language would enable these retail clinics to deliver many health care services including treatment of minor episodic illnesses, episodic preventive and wellness services such as immunizations, administration of opioid antagonists, lab tests, and screening and referral for behavioral health conditions.

This proposal, which has been advanced and rejected in previous Budget proposals, has some improvements by having a loose requirement of “collaboration” with various health care providers.  However, it would still fundamentally depart from New York’s long history of rejecting the corporate practice of medical care delivery, and the inherent conflicts of interest that come with it.

This Budget proposal has to be understood in the context of the recent announcement of drug store giant CVS, owner of PBM giant Caremark, to acquire health insurer giant Aetna.  If approved, CVS’ overwhelming presence in the retail pharmacy industry and prescription drug coverage administration would be coupled with dominance in the health insurance market.  As a result, enactment of this proposal would undoubtedly result in an explosion of retail “Minute Clinics” in pharmacies across New York State, which in turn could cause other “cross-sector” acquisitions or mergers to compete.  These developments will jeopardize the viability of the far-less capitalized community primary care “medical homes” who serve patients throughout the State, jeopardizing the continuity of care that these patients receive through these practices.  It also could lead to the closure of even more locally-owned community pharmacies preferred by many patients.   Moreover, it is easy to foresee that numerous community primary care practices could be dropped from the network of the merged entity in favor of these retail clinics.

It is hard to overstate the pivotal role that community primary care and pediatric practices play in managing patient health, through managing chronic conditions such as asthma, diabetes and hypertension, to slow the progression of these diseases and to prevent avoidable hospitalizations.  They also help to coordinate the patient’s care through referrals to needed specialty care physicians, administering immunizations, and reminders to take medications and for follow up care.  They are the patient’s medical home.

Yet the retail clinic proposal would jeopardize these medical homes for many patients.   Far from complementing the delivery of care, as they claim, physicians are very concerned that this proposal will produce an explosion of these big-box store owned clinics that will drive patients away from traditional primary care practices.  Coincidentally, of course, many of these locations will be where patients can have their prescription medications filled.

While such care sites have existed in retail stores in New York, there was always an important distinction that assured that the physician, nurse practitioner, or physician assistant providing care at this retail site not be directly employed by the corporation.  The practitioner pays rent for the space, thereby maintaining it as an “arms length” transaction.  This arrangement helps to protect the independent decision-making of the health care professional against corporate interference.  Of further concern, because the Budget provision states that “retail health services shall not be provided except in accordance with this article,” it would appear that this language would prohibit these existing rental space arrangements in favor of corporate owned care delivery.

To summarize, this proposal would result in a massive accumulation of power in the drug dispensing, drug coverage management, health insurance and medical care delivery areas.  We urge you to stand up against this accumulation of power in our health care system that jeopardizes the ability of patients to continue to receive necessary care from their physicians.  We urge you to reject this proposal as you finalize the Budget for Fiscal Year 2018-19.

3) Oppose the Independent Practice of CRNAs

We urge you to reject this proposal in the 2018-19 Executive Budget that would create the title of “certified registered nurse anesthetist” in New York State.  Specifically, we are very concerned that this proposal would jeopardize the health of  New York patients by permitting Nurse-Anesthetists  to administer anesthesia without adhering to the existing requirement that a physician-anesthesiologist be physically present and immediately available to supervise the nurse anesthetist.

This proposal would render null and void the longstanding standards of anesthesia care (the physician led anesthesia care team) established nearly 30 years ago by the New York State Department of Health for the delivery of anesthesia.  It would eliminate the requirement that, in all medical treatments requiring anesthesia, neither the physician-anesthesiologist nor the operative surgeon must supervise and accept the responsibility for the nurse anesthetist.  Under this proposal, physician supervision of the nurse anesthetist would be discretionary and introduces an untested and ambiguous standard to make a determination whether a case is sufficiently “complex” to require physician supervision.  If physician supervision is not imposed, nurse anesthetists would be permitted to administer anesthesia independently under a collaborative relationship.

We cannot stress enough that the operating room is a unique healthcare environment. If a patient undergoing anesthesia develops life-threatening complications, immediate medical intervention is required which will not be accomplished by a collaborating physician who is not required to be immediately available or present, as proposed.  Anesthesiologists have graduated from four years of medical school, completed 3-8 years in residency and fellowship training, and will have spent between 12,000-16,000 hours treating patients before practicing as specialists in their field.

Independent studies have concluded that the odds of an adverse outcome are 80% higher when anesthesia is provided only by a nurse anesthetist as opposed to a physician anesthesiologist.  Adverse outcomes lead to higher costs for patients in both monetary and physical terms when patients require longer stays in hospitals. Therefore, any suggested cost savings from this proposal is illusory.

It is also important to clarify two misstatements regarding this proposal.  First and foremost, we strongly disagree with the statement that this expansion would allow nurse anesthetists (NAs) to practice to the full extent of their training, in a fashion that is consistent with other states. NAs in New York already work to the full extent of their training. What’s more, there are only four states that allow nurse anesthetists to practice independently and none have the population size of New York. They are Montana, Oregon, Rhode Island and Utah. There are 46 states that require some level of physician oversight of nurse anesthetists, with most, like New York, requiring direct supervision.

It is especially significant to point out that in 2017 the Veterans Health Administration reviewed a similar expansion of scope for nurse anesthetists, ultimately concluding that there was no justification to allow NAs to practice independently.

Moreover, we are very concerned with the assertion that this proposal would save $10 million in healthcare costs. In fact, there is no cost savings associated with this change to the current standard of care. Under Medicare and Medicaid, reimbursement for anesthesia services is exactly the same whether it is administered by a physician anesthesiologist or by a nurse anesthetist who is medically directed by a physician anesthesiologist or supervised by a surgeon.

We urge you to reject this proposal as you finalize the 2018-19 State Budget

4) Funding for the Committee for Physicians’ Health (CPH)

Public Health Law Section 230 authorizes the state medical and osteopathic societies to create a Committee of Physicians to confront and refer to treatment physicians suffering from alcoholism, chemical dependency or mental illness. MSSNY contracts with the Department of Health’ Office of Professional Medical Conduct (OPMC) to provide the services required by law. The program is funded not from a tax but by a $30 surcharge on the physician’s license and biennial registration fee, which is specifically dedicated by statute for this purpose.

To begin with, we are also pleased that the budget will continue the $990,000 appropriation for program operation.   However, as the program has been subject to sunset every three or five years since its inception, we need the Legislature to pass legislation to extend the program beyond its current sunset date of March 31, 2018.  We note that, in 2013, there was language included in the Executive Budget program to make permanent the CPH program and the Legislature ultimately agreed to extend it for another 5 years.

Since the inception of this MSSNY program, CPH has assisted 4445 physicians, routinely monitors the recovery of 450 physicians, and annually reaches out to 175 physicians thought to be suffering from alcoholism, drug abuse or mental illness. We believe that the work of the CPH program is valuable to all physicians and indeed to the state generally. We urge that the Legislature adopt the language to make this program permanent. We also ask that the appropriation of $990,000 be continued.

Moreover, we urge the adoption of the S.2245/A.2703, Hannon-Gottfried legislation that would clarify that the statutory liability protections offered for physician participants in the CPH program extend to the organization who sponsors the program as well as to the employees of the sponsoring program acting without malice and within the scope of its functions for the committee.

To encourage physicians with appropriate expertise to actively participate in efforts to rehabilitate physicians suffering from these conditions, this statute expressly provides them liability protections for serving on these committees for actions taken within the scope of their functions for the committee. However, a recent lower court decision interpreted these liability protections as not applying to the entity creating this physician committee even though the statute expressly provides liability protection for the physician members serving on this committee. Such a conclusion could not have possibly been contemplated when the law was first enacted.  Thankfully, the decision was ultimately reversed on appeal and the case dismissed.  However, because the appellate court did not address the issue of the statutory liability protections, there remain serious concerns that, without clarifying the scope of the liability protections offered in this legislation, the program run by MSSNY and other similar programs in New York State will be unable to continue to function.

Enactment of this legislation will enable physicians in need of treatment and counseling who have not harmed patients to continue to be able to obtain referrals for this needed treatment. 

5)  Cuts to Medicaid Payments    

There have been numerous instances over the last several years where the State has tried to balance the Budget by unfairly cutting Medicaid payments to physicians seeking to deliver quality care to their patients.  In past years, physicians have had to absorb significant cuts for care provided their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care.

This year’s Budget contains a very troubling 2-part proposal that would a) slash funding for physicians participating in the State’s Patient Centered Medical Home (PCMH) project from $7 PMPM-$2 PMPM for the months of May and June and b) restore the cut on July 1, but only if physicians enter into a Value-Based contract with a Medicaid Managed Care plan, instead of the existing PCMH standards.  The arbitrary and counterproductive cut would jeopardize the development of PCMH physicians have worked to establish in partnership with the State to enhance the care to patients, and to help reduce avoidable health care costs.  According to DOH, there are now over 8,000 various health care practitioners participating in this program.  While seeking alignment to reduce conflicting treatment and coordination activities is a laudable goal, the proposed PMPM distinction is a slap in the face to tremendous efforts that physicians have undertaken to adopt the PCMH model in an effort to improve patient care.  It is also unknown at this time if these practices have even been approached by Medicaid Managed Care plans requesting that they enter into VBP contracts, yet there requirements would foisted upon these practices with the proverbial gun to their head.  It is grossly unfair and counterproductive to the development of medical homes.

The Patient-Centered Medical Home (PCMH) is a care delivery model whereby patient treatment is coordinated through their primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand.  The objective is to have a centralized setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.  What is incredibly ironic is that the State has spent billions of dollars on DSRIP with the goal of reducing avoidable hospitalization, while they now propose to drive away many whose activities are essential to achieving the goals of DSRIP.

We are also concerned that the proposed State Budget fails to include funding to restore funding for “crossover” payments, cut in previous years, for care provided by physicians to patients who are dually eligible for Medicaid and Medicare.  For many years, New York State paid most or at least some of the cost-sharing payments for Medicare enrolled patients who are also eligible for Medicaid.  However, these payments were completely eliminated in the 2015-16 State Budget.  These cuts have had a disproportionately negative impact on health care practices that treat the poorest and sickest of patients.  For example, community cancer clinics potentially will lose tens of thousands of dollars as a result of these cuts, exacerbating other economic trends that are forcing many of these practices to close or be acquired by hospitals.   As these clinics and physician practices close, patients will have to go to hospitals to receive care that they could be receiving in the community setting.

6) Oppose Increasing Prior Authorization Burdens Through rollback of “prescriber prevails” protections 

We are concerned with a number of different proposals in the Executive Budget that would eliminate the “prescriber prevails” protection given to prescribers to better ensure that their patients covered by Medicaid can obtain the prescription medications without adding on to the extraordinary “hassle factor” most physicians already face in their interactions with insurance companies and government payors.  Physicians are already drowning in paperwork and other administrative burdens in seeking to assure their patients can get the care they need.   In a recent MSSNY survey, nearly 83% of physicians indicated that the time they spend obtaining authorizations from health insurers for needed patient care had increased in the last three years, and nearly 60% indicating it had increased significantly.  As noted above, another study from the Annals of Internal Medicine reported that, for every hour a physician spends delivering care, two is spent on paperwork. Please do not add to this burden by forcing physicians to go through yet another time-consuming hassle. At the same time, we have heard from numerous physicians who have described the hassles Medicaid managed care plan impose on physicians in order to assure their patient receiving needed medications, even within the drug classes where the Legislature has required “prescriber prevails” protections.  Therefore, we urge you to take all possible steps to ensure Medicaid managed care plans follow the law and to address these unnecessary hassles.

7) Support The Taxing of E-cigarettes Similar to Tobacco Cigarettes  

The Medical Society of the State of New York supports the extension of cigarette taxes to e-cigarettes as proposed by the 2018-19 New York State budget.  Electronic cigarettes are electronic devices that deliver nicotine to the user.  The heat up liquid nicotine and emit water vapor together with various chemicals, of which there is very little known.   People are being placed at risk because of the lack of information regarding the chemical makeup of liquid nicotine or the risk to individuals from inhaling the water vapor either directly or through secondhand exposure.

Testing done by the FDA shows that electronic cigarettes can be dangerous because users inhale carcinogens and toxic chemicals, such as diethylene glycol, an ingredient found in antifreeze.  Recent studies have suggested that e-cigarettes may contain more carcinogens than traditional cigarettes, in some instances ten times the carcinogens of traditional cigarettes.

We urge that this provision remain in the State Budget.

8) Concern with Medication Management Programs

We have strong concerns with a provision in the Executive Budget that would permit pharmacists to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust or change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, or are at risk for hospitalization. While many physicians believe that these programs, if structured properly, can be helpful to managing the treatment of a patient, the Budget proposal would go much further than the “collaborative drug therapy” programs that are currently permitted within the hospital environment on a demonstration basis.

The current collaborative drug therapy law was originally established with a “sunset date” in 2015, and was extended by the State Legislature to continue until 2018. However, this proposal goes well beyond this demonstration program.

Currently, only physicians are permitted to enter into such protocols with pharmacists employed within a health care institution. Not only would this proposal expand the existing law to permit NPs to enter into these protocols in a hospital or other article 28 entities, it would permit them to enter into these protocols in any care setting. We are concerned that there has been no demonstration within a specific care setting in New York, such as in a hospital, that nurse practitioners have the sufficient pharmacology background to successfully work with pharmacists on managing patient medications (and potential interactions) on a large scale basis as is contemplated in this proposal.  By contrast, physician-pharmacist CDTM protocols were studied extensively following the enactment of New York’s law, which led to the Legislature extending the existing program in 2015.  As such, it would be premature to now add Nurse Practitioners.  Moreover, while many states across the country have established CDTM programs, very few have permitted these protocols between nurse practitioners and pharmacies.  Additionally, some of those states still require nurse practitioners to maintain a collaborative agreement with a physician.   Finally, we are concerned that there is no specification of specific disease states or medications for which a nurse practitioner would be able to coordinate with a pharmacist.

Again, these programs, if carefully structured, can be helpful to managing the treatment of patients suffering from chronic conditions. However, we are concerned that what is proposed in the State Budget is far too broad and therefore urge that it be removed from the Budget.

9) More Definition Needed for Community Paramedicine

We have concerns with “Community paramedicine” proposal in the Executive Budget to allow emergency medical personnel to provide non-emergency care in residential settings. While the goal of this proposal to expand care options to homebound patients or other at-risk patients is laudable, MSSNY has concerns regarding how the interactions of the EMS workers with homebound patients will be coordinated with the patient’s existing care providers, both in terms of selecting which patients will   receive care through these collaboratives, as well as the specific care that will be provided.  As written, the proposal only requires the collaborative to include in a written plan how they will coordinate with the patient’s treating providers, rather than a specific requirements to communicate with actively treating physicians and other care providers.  At the very least, this proposal should be modified to require specific communications from the collaborative to the patient’s treating providers.  Moreover, some consideration should be given to establishing a demonstration program before enacting such a broad change.

10) Consolidating and Reducing Public Health Appropriations

The Executive proposal would consolidate 30 public health appropriations into four pools and reduce overall spending by 20%.  Under this proposal, important health programs benefitting millions of New Yorkers are threatened with cuts.  Included in this consolidation are programs that reduce the morbidity and mortality of chronic diseases, including: funding for the state’s Asthma Program, Hypertension Funding, and Obesity and Diabetes Programs. The cuts also target maternal and child health programs, rural Health Networks, workforce programs, enriched housing programs serving elderly and disabled individuals, Area Health Education Centers which promote primary care and public health careers to students in underserved communities, the Physically Handicapped Children’s program, and community-based programs focused on improving health outcomes.  Many of these programs, already critically underfunded, were cut in the previous budget by at least 20%. Another cut would have drastic impacts for the health of New Yorkers.  MSSNY is working with other organizations to oppose cuts to public health funding in any form.

Conclusion

Thank you for allowing us, on behalf of the State Medical Society, to identify our concerns and suggestions for your consideration as you deliberate on the proposed budget for state fiscal year 2018-2019. To summarize, we support the continuation and dedication of funding for the Excess medical liability program which is important to facilitate the retention and recruitment of needed primary care and specialty physicians in New York until such time as meaningful tort reform is enacted.  We urge that you reject proposals that would jeopardize safe anesthesia for patient through the independent practice of CRNAs.  We urge you that you protect patient access to community primary care sites by reject the proliferation of big-box store owned retail clinics.  We urge that you extend the CPH program.  We also ask that you remove provisions that would repeal existing “prescriber prevails” provisions, as well as eliminating cuts to payment for the care provided to patients covered by Medicaid.

 

 

 

February 16, 2018

Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE

Charles Rothberg, MD
February 16, 2018
Volume 18
Number 7

Dear Colleagues: 

On December 4, 2017, Anthem issued their 32-page Empire Network eUpdate by email. Under their Professional Reimbursement Policy Update, there were several small paragraphs addressing policy changes. Buried in a small paragraph on page 20, reference was made to a new policy impacting Modifier 25 and same-day procedures. Readers were instructed to review reimbursement changes via a hyperlink. (Who clicks every hyperlink in an article?)

This policy change, which is effective March 1, 2018, originally stated that any practice that bills for an E&M service on the same day as a minor procedure would receive an allowance for the minor procedure and ONLY 50% of the allowance for the E&M visit. MSSNY, along with outraged physicians, brought this to the attention of the AMA. The AMA managed to have Anthem revise their policy so that the allowance for the E&M service would now be reduced by “ONLY 25%” (still a significant cut). Notice of the change was again sent to physicians on January 10, 2018, in another email.

The House of Medicine remains outraged by this Anthem policy. Yes, it would reduce our reimbursement; but, more so it will harm our patients and affect the quality of their care. This new policy requires that the patient make two visits (instead of one) in order for physicians to be properly reimbursed. Rather than providing the visit and xxx the minor procedure on the same day, the physician may need to perform the procedure on a separate day.

This is detrimental to patients on two fronts. One, there is no guarantee that the patient will endure the inconvenience and return for the second encounter. Secondly, if indeed the patient does return, they will experience an additional out-of-pocket co-pay.

When one looks at patient cost share, one notes that copay amounts for specialists have become significantly higher in this era of cost containment. As we well know, the insurers are containing their own costs by shifting costs to the patients. They don’t care how much the patient has to pay.

MSSNY has written to DFS regarding these concerns. We also questioned whether this egregious new policy was considered when Anthem filed with DFS for their premium rate increase this year.

We will advise you immediately when DFS responds to these important questions. 

Presently, we need to know how many surgical specialties know that this policy is being implemented on March 1. As the clock is ticking, let us know by emailing rmcnally@mssny.org ASAP.

Letting this slide will empower other payors to cut their contractual obligations, along with our fees.

Death and Dying Survey

The Bio-Ethics Committee has moved forward and a survey is being tested. When completed, the survey will be sent to the entire membership and the results will be presented at the House of Delegates.

Parkland Mass Murders

Technology and proliferation have made the problem of gun safety an increasingly significant public health threat. While the number of annual gun deaths parallels that of the flu, flu is part of the discourse on public health.  Gun safety should be as well.

Like the opioid crisis, this crisis is not isolated or marginalized. Like the opioids, this crisis demands a public health response.

Whatever your personal perspective, it is unacceptable to hold the view that absolutely nothing can be done to reverse what appears to be an escalating public health crisis. While personal freedom is important to preserve, not many hold the view that mass killing or suicide is a proper exercise of second amendment rights.

I believe that the reason we don’t have better safety policy is because we lack good data. But we have enough to be horrified by a student going into his own school to murder classmates—a case of children killing children.

A multi-pronged approach to this tragic issue requires original thinking.

We should begin immediately.

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

Come to State Legislation Day! Let your voice be heard!


Capital Update

MSSNY’s Lobby Day (3/7) Just 2 1/2 Weeks Away! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reject the Inappropriate scope of practice expansions proposed in the Executive Budget
  • Limit the incursion of big-box store medical clinics that will hurt community primary care delivery
  • Reduce excessive health insurer prior authorization hassles that needlessly delay patient care
  • Reduce the high cost of medical liability insurance
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for our medical students and residents to become New York’s future health care leaders

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Physicians should contact their County Medical Societies which will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.   (HARRING)

MSSNY Testifies at State Budget Hearing
MSSNY staff testified this week at a Joint Assembly-Senate Budget hearing examining the Health care portion of the Governor’s proposed Budget for Fiscal Year 2018-19.

To view our testimony, click here, and go to the 8:08 mark (Note – Testimony from various state agency commissioners occupied the first 7 hours of the hearing).

To read MSSNY’s full written testimony, click here.

During MSSNY’s testimony, concerns were expressed that questions from legislators regarding how best to address physician shortages across New York were greeted with responses by state agency officials of their proposals to expand the role of non-physicians instead of efforts to improve New York’s practice climate.  MSSNY did highlight its support of some proposals in the Executive Budget, including proposals to: continue historical funding levels for the Excess Medical Liability Insurance Program; reduce the interest rate on court judgments; and tax e-cigarettes similar to tobacco cigarettes.

MSSNY also highlighted its very serious concerns with a number of provisions that could adversely affect patient care delivery in the proposed State Budget including:

  • Medicaid cuts to the Patient Centered Medical Home program
  • Legal authority for corporately-owned retail clinics in light of the CVS purchase of Aetna
  • Independent Practice of CRNAs
  • Expansion of the Collaborative Drug therapy program to include Nurse Practitioners
  • Community Paramedicine
  • Elimination of the “prescriber prevails” protection for prescriptions covered by Medicaid.                       (AUSTER)           

Physician Advocacy Needed
Legislators need to hear from physicians concerns on a whole host of adverse provisions contained within the Executive Budget.

Legislators have just gone on their February break and will be in their district offices until February 27th.  Please call your legislator’s district offices, write letters and meet with your elected officials in their offices.  As the Assembly and Senate will finalize their respective one-house budgets in early March, time is of the essence.

MSSNY members are also urged to continue to contact their legislators, and make phone calls, Facebook and Twitter updates, e-mail blasts and other forms of activism.   

  • Oppose Expanding scope of practice for certified nurse anesthetists (CRNAs)

This provision would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the supervision of a physician anesthesiologist or surgeon.  To urge your legislators to protect safe anesthesia care for patients please click here.

  • Oppose Authorizing Health Services Offered In Big Box Stores

This provision authorizes the delivery of health services in a retail setting such as a pharmacy, grocery store, or shopping malls.  Sponsors could include a business corporation.  Services to be offered would include treatment of minor episodic illnesses, episodic preventive and wellness services such as immunizations, administration of opioid antagonists, lab tests, and limited screening and referral for behavioral health conditions.

With the recently announced proposal of drugstore chain giant and PBM operator CVS to purchase health insurance giant Aetna, this could result in an explosion of retail clinics at the expense of community physician practices. To urge your legislators to reject corporate owned retail clinics, please click here.

  • Oppose Patient-Centered Medical Home cuts

This proposal would slash the Patient-Centered Medical Home (PCMH) add-on Medicaid payment that many primary care practices receive to help manage and coordinate needed patient care services.  Moreover, it would potentially require all PCMH primary care practices to have a Level 1 Value-Based payment contract on July 1, 2018, or face further steep cuts in PMPM payments. To send a letter click here.

Additional budget items of great concern include:

  • Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.
  • Eliminating the Empire Clinical Research Investigator Program (ECRIP).
  • Consolidating 30 public health appropriations into four pools, and reduce overall spending by 20 percent.
  • Comprehensive Medication Management Protocols

This proposal allows nurse practitioners and pharmacists to provide comprehensive medication management to patients with a chronic disease or diseases who have not met clinical goals of therapy and are at risk for hospitalization.  Urge your legislators to reject this inappropriate scope of practice expansion.  Click here to send a letter to your legislator.

  • Community Paramedicine

This proposal would allow emergency medical personnel to provide non-emergency care in residential settings.  While a laudable goal, the bill language only includes general references to collaboration with the patient’s treating providers, rather than specific requirements to communicate with actively treating physicians and other care providers.     To protect proper continuity and coordination of patient care with treating providers, please click here to send a letter to your legislator.
(DIVISION OF GOVERNMENTAL AFFAIRS) 



Governor Proposes Measure to Increase Summary Suspension Power For Physicians Charged with Felonies
As part of the “30-day amendments” to the Governor’s proposed Budget, proposals were contained to expand the ability of the Commissioner to summarily suspend a physician where such physician is charged with a criminal felony and the “alleged conduct may present a risk to patients or to the public”.   The Budget proposal would also authorize the Commissioner of Health to obtain a warrant from a judicial officer that would allow the Department to search a residence, vehicles, workplace and seize documents and computers where relevant.  Moreover, the proposal would shorten the period of time allowed to respond to the Commissioner’s request for relevant information from 30 days to 10 days.  Current law grants the Commissioner power to summarily suspend a physician’s license for a variety of reasons, but with regard to crimes, a conviction is necessary.

MSSNY is analyzing the proposed changes, but upon initial review has expressed concerns to agency officials and legislators regarding the possibility of adverse license actions being taken without sufficient due process based upon allegations rather than conviction or a finding of misconduct.  (AUSTER)

Governor’s 30 Day Budget Amendments Call For Pharmacists to Immunize Children For Flu
In the 30 day amendments to the New York State budget, Governor Cuomo proposed to allow pharmacists to immunize 2-18 years olds for influenza.   Currently, education law prohibits pharmacists from immunizing children, unless the governor issues an executive order during a public health emergency.   Earlier this month, the Governor issued such an order.

The proposed budget bill would allow the pharmacist to provide the immunization with a non-patient or patient specific order from a physician or nurse practitioner.   The pharmacist would be required to have educational materials on influenza vaccinations for children as determined by the commissioner of health and would be required to have anaphylaxis for emergency.  The pharmacists would be required to notify the patient’s attending primary health care practitioner and be available to discuss the outcome of the immunization, including adverse reactions, with the physicians.   The pharmacist is also required to provide to the patient (or the patient’s guardian) a sheet on the importance of having a primary care physician.  MSSNY is reviewing this proposal but has long opposed having pharmacists give immunizations.  (CLANCY)

MSSNY Physician Leaders Advocate for the Profession and Their Patients in the Nation’s Capitol

(left to right): Dr. John Kennedy; US Representative Joseph Crowley (D-NY); Dr. Robert Goldberg; Dr. Tom Madejski

(left to right): Dr. Willie Underwood; Phil Schuh; Dr. Charles Rothberg; US Senate Minority Leader Charles Schumer (D-NY); Dr. Tom Madejski; Dr. John Kennedy; Moe Auster, Dr. Robert Goldberg

Several MSSNY physician leaders and staff traveled to Washington DC this week for meetings with key members of New York’s Congressional delegation as well as CMS Administrator Seema Verma.  Physicians advocated for several measures to improve patient access to physician care, including:

  • Reducing administrative hassles and increasing exemption levels under the Medicare Quality Payment Program;
  • Raising the current statutory limitation on Graduate Medical Education slots;
  • Enacting badly needed medical liability reform including “good Samaritan” protections for volunteering in a disaster area;
  • Increasing funding and insurance coverage to combat opioid addiction; and
  • Closely scrutinizing proposed mergers across the health care industry, including CVS’ proposed purchase of Aetna.

Among the attendees included: MSSNY President and Patchogue ophthalmologist Dr. Charles Rothberg; MSSNY President-elect and Medina internist Dr. Tom Madejski; past-MSSNY President and NYC physiatrist Dr. Robert Goldberg; MSSNY Councilor and Schenectady ophthalmologist Dr. John Kennedy; and Erie County Medical Society President and Roswell Park urologist Dr. Willie Underwood.                                            (AUSTER)

Senator Hannon Introduces Needed Liability Reform Legislation
Working with MLMIC and other stakeholders, MSSNY helped to get a bill, S.7728, introduced by Senate Health Committee Chair Hannon.  This bill includes provisions to expand requirements for expert witnesses in medical malpractice actions and strengthens our watered-down statutory Certificate of Merit requirement.  MSSNY needs all hands on deck to help implement comprehensive liability reform.

We need to take the necessary steps to enact needed reforms across many areas to help preserve patients continued access to needed primary and specialty physician care in New York.  These include becoming a member of the Physician Advocacy Liaison (PAL) Program, meeting with your legislators, attending MSSNY events, and getting involved politically such as by joining MSSNYPAC.  (BELMONT)

MSSNY and AMA Working Together to Educate Physicians on Prediabetes
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has created two free CME programs to educate New York State physicians on prediabetes prevention and the CDC’s National Diabetes Prevention program.  To share your current knowledge of the diabetes prevention program, click here to take a quick survey.

Live Webinar: Bending the Diabetes Curve
Tuesday, February 20th at 7:30am
Registration for this webinar is required, click HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

House of Delegates Live Seminar: Bending the Diabetes Curve
Thursday, March 22nd, 2-3pm
Adams Mark Hotel, Buffalo, NY, Grand B
Pre-Registraion for this live seminar is strongly suggested, click HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

* Must attend in person at the House of Delegates.

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

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

The Medical Society of the State of New York designates each of these live activities 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.

Additional information or assistance with registration may be obtained by contacting Carrie Harring at charring@mssny.org. (HARRING)

Commissioner’s Grand Round on Antibiotic Use and Resistance to Be Held Feb 28
New York State Department of Health Commissioner Howard A. Zucker, MD, JD, will host a Commissioner’s Grand Rounds on “Antibiotic Use and Resistance for the Practicing Physician”  on Wednesday, Feb. 28, 2018 from 8-10 a.m. at the Conference Center, Maria Fareri Children’s Hospital, Westchester Medical Center Campus, 100 Woods Road, Valhalla, NY 10595.   The presentation will strengthen clinicians’ understanding of antibiotic resistance, review recommended guideline-based approaches to antibiotic use for common outpatient adult and pediatric conditions, and describe evidence-based tools and approaches to assist providers in communication to patients about optimal antibiotic use. 

Faculty are:  Jeffrey Gerber, MD, PHD, Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine, Division of Infectious Diseases, Children’s Hospital of Philadelphia; Saul R. Hymes, MD, Medical Director, Pediatric Antimicrobial Stewardship, Assistant Professor of Clinical Pediatrics, Stony Brook University School of Medicine, Stony Brook Children’s Hospital and Belinda Ostrowsky, MD, MPH, Field Medical Officer, NY Division of Healthcare Quality Promotion (DHQP) Centers for Disease Control and Prevention.  Advance registration is requested and additional information and a link to the flyer can be found here.   (CLANCY) 

Nuclear Radiation and Blast Injuries” CME Webinar on February 21, 2018; Registration Now Open
The next Medical Matters continuing medical education (CME) webinar program is: Nuclear Radiation and Blast Injuries”.  This webinar will take place on Wednesday, February 21, 2018 at 7:30 a.m.   Arthur Cooper, MD, MS, Professor of Surgery at the Columbia University College of Physicians & Surgeons, Director of Trauma & Pediatric Surgical Services at the Harlem Hospital Center, and Affiliate Faculty at the National Center for Disaster Preparedness of the Columbia University Mailman School of Public Health will serve as faculty for this webinar 

Register for this webinar here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are:

  • Acquire a basic understanding of nuclear radiation and blast injuries.
  • Identify different types of nuclear exposure and blast injuries.
  • Describe the pathophysiology of nuclear exposure and blast injuries.
  • Explore treatment methods for blast injuries and nuclear radiation exposure. 

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

The Medical Society of the State of New York designates this 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.  (HOFFMAN)

D’Youville College Physician Assistant Program Conducting Research Survey on Suboxone Use in Adolescents
Several students at D’Youville College Physician Assistant Program is conducting a research survey in an effort to complete assistant students completing research project requirements for their master’s degree.  The project is titled ‘Attitudes and Barriers to Prescribing Suboxone for Adolescents’, and the students are hoping to identify some of the most common barriers primary care providers have against suboxone therapy but specifically in the pediatric population (aged 12-17).

This survey is designed to identify barriers that New York State providers have to prescribing suboxone to adolescent patients aged 12-17. Upon completion of this survey, a short list of supportive resources for adolescent suboxone treatment will be provided after the “submit survey” option is chosen. The survey can be accessed here.
(CLANCY)


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

pschuh@mssny.org   mauster@mssny.org  pclancy@mssny.org  

eNews
DFS Will Probe Reports of Gay Men Who Are Denied Insurance Policies
The New York Times (2/14) reports that New York state financial regulators said on Wednesday “that they would investigate reports that gay men have been denied insurance policies covering life, disability or long-term care because they were taking medication to protect themselves against H.I.V.Maria T. Vullo, DFS’ superintendent, said “such denials would amount to illegal discrimination based on sexual orientation, and the companies doing so could be penalized.” The investigation “was triggered by an article published Tuesday by The New York Times, she said.” The Times “reported that various insurers around the countryhad denied policies to gay men after learning they took Truvada, a cocktail of two anti-AIDS drugs, to avoid catching H.I.V. through sex,” and that “to get insurance, some men even stopped taking the protective drugs.” The practice, “known as ‘pre-exposure prophylaxis,’ or PrEP,” is “recommended by the Centers for Disease Control and Prevention.”

Concern Re Proposal to Expand Nurse Anesthetists Scope of Practice
POLITICO New York (2/13) reported some physicians are concerned about New York “Gov. Andrew Cuomo’s proposal to expand the scope of practice for nurse anesthetists, a move the state expects will save $5 million but one that anesthesiologists say threatens patient care.” MSSNY member Dr. Rose Berkun, the former president of the New York State Society of Anesthesiologists, “argued that nurses do not have the adequate training necessary to handle emergencies, should they arise.”

Purdue to End Oxycodone Promotional Visits with Physicians
The Wall Street Journal (2/10) reported that many public healthofficials contend that Purdue’s aggressive marketing of OxyContin after its launch in 1996 encouraged lax prescribing and widespread addiction for many patients who later became addicted to heroin and other illicit drugs.

Mayo Clinic: Kidney Stones May Be Increasing among US Men and Women
Mayo Clinic Proceedings published research that suggests “kidney stones may be increasing among both men and women in the US.” Investigators found that “between 1984 and 2012, kidney stones diagnoses increased more than fourfold among women and twofold among men.”

Before-School Exercise May Make Young Kids Healthier, Happier
The American Journal of Preventive Medicine reports a “supervised exercise program that gets young children running and playing for an hour before school could make them happier and healthier, while also jibing with the needs and schedules of parents and school officials, according to a new study involving two dozen elementary and middle schools.” The program has “gained a formal curriculum, a name and acronym, Build Our Kids’ Success (BOKS).”

Complimentary Dinner Symposium for Physicians in Independent Practice
Join PrescRXptive Communications, LLC for an informative dinner symposium packed with insights on how independent medical practices can thrive. “Toolkit for Independence: Tips and Techniques for a Successful Medical Practice” will be held on Tuesday, February 27, from 5:30 – 9:30 p.m. at Verona Ristorante in Farmingdale, Long Island. The evening’s featured speaker is James Bavoso, Manager, Provider Outreach and Education, National Government Services who will offer a “2018 Medicare Update.” The symposium is free for physicians and office managers who are accompanied by a physician. The evening includes a cocktail hour and sit-down dinner. There are limited seats available. For additional information, call 631-606-0525. To register, click here.
AMA

AMA Briefing Re New Medicare Card
The AMA is hosting a CMS briefing on the new Medicare card on February 21st from 3-4pm eastern time.  The new Medicare card is a result of MACRA’s requirement that CMS issue Medicare cards that do not display Social Security Numbers to address the risk of beneficiary identity theft.  New Medicare cards will be issued beginning in April 2018 and physician offices must be prepared to accept the new Medicare identification number at that time.  As the new Medicare cards will significantly impact physician practices’ workflows, we strongly encourage state and specialty society staff, as well as physicians and their office staff, to attend this webinar.  It will include time for Q & A and will be recorded for those who are unable to attend.  Use this link to register.

CMS

CMS Rule Change Reduced Physicians’ Medicare Opt-Outs
The D Healthcare Daily (TX) (2/8) reports that after 7,400 physicians submitted paperwork to opt-out of Medicare in 2016, “the number cut in half last year, according to new data from the Centers for Medicare and Medicaid Services.” The piece attributes the decrease “to the end of a stipulation that required providers to renew their opt-outs every two years.” Dr. Charles Rothberg, president of the Medical Society of the State of New York, says clinicians in wealthier areas feel they can opt out because they can fill their practice with patients who have commercial insurance or can pay out-of-pocket.

Performance Scores for 2017 Claims Data Available on QPP Website
MIPS Eligible Clinicians can now view performance scores for 2017 Claims Data on www. qpp.cms.gov If you’re an eligible clinician who submitted 2017 Quality performance data for MIPS via claims, you’ll now be able to view your performance scores through the MIPS data submission feature. Reminder: claims data submission is only an option if you’re participating in MIPS as an individual (not as part of a group).

Submitting Quality Performance Data via Claims

If you’ve already submitted quality data via claims, you don’t have to take any additional action. Claims-based quality measures are calculated automatically by CMS based on the Quality Data Codes (G-codes) submitted on your 2017 claims. You can simply login at qpp.cms.gov and view your calculated individual measures’ scores and category score for Program Year 2017.

Please note, scoring of claims data is subject to change monthly based on the processing of any additional 2017 claims and adjustments up to 90 days after the end of 2017. It is possible that claims or adjustments that were submitted towards the end of 2017 have not yet processed. Please check back after March 31st, 2018.

Still Time to Submit Claims for 2017

If you still have 2017 claims you’d like to submit for the Quality performance category, make sure to submit them now. Claims, which are processed by Medicare Administrative Contractors (MACs) (including claims adjustments, re-openings, or appeals), must get to the national Medicare claims system data warehouse (National Claims History file) by March 1, 2018 to be analyzed. The MACs can provide you with specific instructions on how to bill.

Submission Resources

To prepare for 2017 submission, review the following resources on the Quality Payment Program website:

MIPS Claims Data Submission Fact Sheet

MIPS Data Submission Video

MIPS Data Submission Fact Sheet

QPP Service Center (Call: 1-866-288-8292 or TTY: 1-877-715-6222; Email: qpp@cms.hhs.gov) 

CMS Hosting MACRA Patient Relationship Categories and Codes
CMS is hosting an educational webinar on Wednesday, February 21st from 2:00 3:30 p.m. ET on the MACRA Patient Relationship Categories and Codes. CMS will provide guidance for clinicians and stakeholders in classifying patient relationships, for which CMS has implemented an initial voluntary reporting period that began on January 1, 2018. Presenters will also address questions from participants.

Webinar Details

Title: MACRA Patient Relationship Categories and Codes
Date:Wednesday, February 21st, 2018
Time: 2:00-3:30 p.m. ET
Registration Link: https://engage.vevent.com/index.jsp?eid=3523&seid=131

The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion. If you cannot hear audio through your computer speakers, please contact: CMSQualityTeam@ketchum.com.

If you have any questions about the webinar or MACRA Patient Relationship Categories and Codes, please contact macra-episode-based-cost-measures-info@acumenllc.com.


Classified

RENTAL/LEASING SPACE


For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed build out 4 exam rooms with sinks and wall cabinets
Waiting and reception areas, windows throughout.
Street and private entrances, two bathrooms and storage/lab/staff room.
One block to bus and two blocks to Presbyterian Medical Center and subway.
$1900-$7900/ month for one to 4 exam rooms.
Drdese@gmail.com or 917.8618273


For Share – Plastic Surgeon’s Office Facing Central Park Ground Floor Lobby Entrance/Private exit
One to three exam rooms, consult/private office and procedure room for full or part time use.
Elegant, modern and spacious secretarial, waiting and two exam rooms.
Accredited operating rooms and recovery rooms on site.
One block to bus and 20 feet to subways.
$1275-$3750/day monthly for one to three exam rooms.
Drdese@gmail.com or 917.861.8273


Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org


Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com


For Rent or Share (Half days or Full) – Union Turnpike, Queens
A brand new state of the art, beautifully appointed medical building has availability for turnkey share or rent on a busy artery of Queens. Smartly located in the area bounded by the LIE to the north, Grand Central Parkway to the south, Clearview Expressway to the West and the Cross Island to the East, this office is easily accessible by car with ample parking available at all times of the day.  The building is located on the Q46 bus line with a stop only steps away.  Easy access to all major Queens and western Nassau county hospitals.  There is already in-house patient traffic so this is a great opportunity to build a satellite practice or to start a practice with potential cross-referral benefits.  Very reasonably priced starter options available. Please email queensmedicalhealth@gmail.com or call (917) 860-8307.


PHYSICIAN OPPORTUNITIES

Hypertension Initiative Coordinator
In collaboration with relevant DOHMH bureaus and the intra-agency HTN workgroup, support the research, development, planning and implementation of HTN initiative projects.

    • Oversee Initiative Plan activities and partner activity implementation, including year-to-year activity development and management.
    • In partnership with stakeholders, provide direct support and management of HTN activity implementation among coalition member organizations.
    • In partnership with the HTN Initiative Manager and other staff, contribute to evaluation tracking, data collection, metrics and monitoring, especially as relates to activity implementation.
    • Assess Initiative Plan activities for evidence base; conduct literature reviews and other relevant research to identify evidence-based strategies for activity implementation.
    • In collaboration with programs, develop new project ideas and programming; contribute to grant writing and fundraising for new programming.
  • As part of the HTN team, direct strategic growth and development of a citywide hypertension coalition.
  • Establish and maintain relationships with key stakeholders across New York City, including strategic engagement and management of technology and entrepreneurial stakeholders.
  • As part of the HTN team, represent the initiative at various community or key stakeholder programs; serve as liaison with outside offices as required.
  • Contribute to research-driven manuscripts, memos, reports as well as give presentations reporting data analysis and evaluation results. 
  • Preferred Skills: Experience working across multiple sectors and with diverse stakeholders, experience and ability to critically review and assess the scientific literature, exceptional written and oral communication skills, keen ability to prioritize and handle multiple assignments; keen attention to detail and logistics management, ability to work independently and exercise a high degree of initiative, apply project management strategies, accomplish tasks and solve problems; excellent interpersonal, collaborative and team skills.View full job description / apply online at http://ow.ly/Ox6b30inpLh

Hypertension Initiative Director The Division of Prevention and Primary Care is seeking a high-level director for a new citywide hypertension initiative. Hypertension (HTN) is one of the leading contributors to death and a key driver of health inequities. This initiative will create collaborations across the work of multiple stakeholder groups engaged in clinical, community or population approaches to reducing hypertension, to enhance and expand hypertension efforts across the city.

Reporting to Deputy Commissioner, the Citywide Hypertension Initiative Director will guide the strategic development, planning, and implementation of this new initiative. The team consists of a Hypertension Initiative Manager and a Coordinator, as well as short-term staff. The Director will establish high-level relationships and oversee the initiative’s work, including coalition engagement and activity implementation. Leadership, supervision of program design and evaluation, fundraising, and staff management are key components of this position. The Director will also be responsible for engaging stakeholders within the Health Department and external to the Health Department to achieve the initiative’s goals. The Director’s responsibilities include the following:

  • Guide and oversee the strategic development, planning, and implementation of the Citywide Hypertension Initiative including program design and structure, evaluation, needs assessments and other data and research needs.
  • Manage an initiative team consisting of the Hypertension Initiative Manager, Coordinator(s), and short-term staff; liaise with other staff within the Agency contributing to the Hypertension Initiative.
  • Lead and facilitate internal and external meetings and other convenings with Coalition members, DOHMH staff, and prospective partners.
  • Oversee launch of yearly Coalition meeting or summit with Coalition stakeholders from across NYC.
  • Lead reporting and communication efforts with both internal and external partners; oversee outreach and communication with Steering Committee and Coalition members
  • Draft and oversee the development of memos and reports, as well as give presentations.
  • Establish high-level relationships with key stakeholders across New York City, including recruitment for the initiative advisory panel and steering committee and other clinical and community working groups.
  • Lead fundraising efforts to expand initiative activities by identifying and developing new funding opportunities; serving as the principal lead for key grants and funding, where appropriate; and leading development of a fundraising plan to achieve long-term initiative goals.
  • Along with the team, represent the initiative at various community or key stakeholder programs; serve as liaison with outside offices as required.

Preferred Skills: Clinical training a plus, strategic thinker, strong manager, public health training; content expertise in heart disease, stroke, chronic disease a plus; ability to work independently, project manage strategies, accomplish tasks and solve problems; exceptional writing and communication skills; experience working on high-profile strategic campaigns; experience interpersonal, collaborative and team skills is a must.

View full job description / apply online at http://ow.ly/3vAO30inpXU


Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to jobs@hhchc.org. www.hometownhealthcenters.org


Pediatric Medical Director , NY State Office of Health Insurance Programs
The position of Medical Director of Pediatric Policy in the Office of Health Insurance Programs will focus on 4 primary initiatives over the next year, to include the First 1000 Days on Medicaid initiative, Value-Based Payment (VBP) Clinical Advisory Groups on Children’s Health and Maternity Care,  Children’s Health Homes and the Behavioral Health Transition into Managed Care, and Performance Measurement in the various quality programs. The Medical Director will collaborate with colleagues in the Department’s Office of Public Health and serve as a resource for Division staff who are seeking expert advice concerning medical and behavioral health issues involving children. For more information on how to apply, please go to this link: https://www.facebook.com/FuscoPersonnel/?sk=app_127890887255323&app_data=job-3059994


NYC Office of School Health PT and FT Positions for MDs and DOs
The New York City Office of School Health has both part-time and full-time job openings in the five boroughs for board certified/board eligible Physicians (MD, DO) specializing in Pediatrics, Adolescent Medicine, and Family Medicine with an emphasis on the school-aged population (K through 12) and/or Reproductive Health.

New York City School Health Physicians have flexible schedules (Minimum 20hrs/week to Maximum 35hrs/week).  Physicians working 20 or more hours per week receive comprehensive health insurance and other employment benefits.  Duties involve a balance of clinical work in New York City schools, administrative tasks, and public health assignments.  Work days are generally 9am to 5pm with no evening or weekend calls.  Physicians have the option to work or be furloughed during holidays and summers when schools are not in session. For more information, please send email inquiries to osh@health.nyc.gov. To apply directly online and for job descriptions, please upload your resume and cover letter to https://a127-jobs.nyc.gov. For the Field Doctor positions, School Health Physician (K – 8), enter Job ID 319959

For the CATCH Reproductive School Health Physician (High School) positions, enter Job ID 297081
For the Supervising School Health Physician Positions, enter Job ID 307390


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


 

February 9, 2018 – Keep Calm and Carry On!

Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE

Charles Rothberg, MD
February 9, 2018
Volume 18
Number 6

Dear Colleagues: 

While traveling the state over the last year, I have had the pleasure of talking to physicians from different specialties as well as medical students—who are the future of our society.  The unique element that unites MSSNY is the passion and expertise that every physician brings to our society. That is why MSSNY continues to be one of the premier physician organizations in the world.   If our organization is going to compete with other interest groups that will continue to undermine and hurt our profession, this passion and vigor must continue.

Many of you are aware that a statute of limitations expansion bill has been signed over the strong objections of MSSNY.  While there is no way to sugarcoat the fact that this bill is not the comprehensive malpractice reform we aimed to achieve, there is no mistaking that without our activism, phone calls, letters and op-eds, this bill would have been far more damaging.

I am disheartened to hear that some physicians want to take their ball and go home. Some have indicated that they will end their participation in the legislative and political process. I urge them instead to redouble our efforts!

This counterproductive mindset will not improve our ability to improve medical care delivery in New York. Instead, it will make it far more difficult.  Now, more than ever, it is important to be involved.  I kindly ask you to think of one part of your practice and profession that isn’t impacted by laws or regulations decided on the federal or state level.  Healthcare proposals are constantly being introduced and debated that would impact reimbursement rates, expand the scope of practice for various professions, increase unworkable mandates on physicians and change the delivery of patient care.

It is for these reasons that many physicians continue to be active in the legislative and political process. This week, I attended a political event with several key elected officials, staff, lobbyist and other stakeholders along with our Immediate Past President Dr. Malcolm Reid, New York County Medical Society President-Elect Dr. Naheed Asad Van de Walle, Past NY County President Dr.  Michael Goldstein as well as other physician members and leaders.  We discussed a myriad of issues with other stakeholders as to how we can achieve our common goals and interests.

MSSNY continues to work with the Governor and both houses of the legislature to achieve a number of important reforms, to reduce our exorbitant liability costs, and to enact reforms that address various health insurer hassles. As noted below, we still have several adverse proposals that we need to rally to defeat.

To achieve these efforts, we need all of your help.

While MSSNY’s input is valued by many of our elected officials, various interest groups and their lobbyists are also out in force lobbying hard for their respective interests.  War chests from the trial lawyers and corporate interests are funding tremendous portions of political activity.  MSSNYPAC continues to be outspent nearly 5-1 by the trial lawyers. Moreover, we are outspent almost 3-1 by the dentists!

We need to educate our legislators on the reform we aim to achieve.  In order to continue all of our efforts and to remain a force to be reckoned with, we need your help.  MSSNYPAC is what gives physicians the political clout and resources we need to make a difference.  It is imperative that we all do a better job of trying to recruit members to MSSNY and to MSSNYPAC.

It is your future.  Together we really can make a difference.  Please join us in our efforts to make New York a better place to deliver needed care to our patients.


Charles Rothberg, MD

MSSNY President

Please send your comments to comments@mssny.org

Come to State Legislation Day! Let your voice be heard!


Capital Update

Physician Advocacy Day in Albany March 7-  Just 3 Weeks Away! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

We thank the many physicians who have already committed to come to Albany that day to join us in our advocacy efforts to improve patient care delivery across New York State.  We also thank the New York State Osteopathic Medical Society for integrating their physician Lobby Day with MSSNY’s.  If you have not yet registered, we urge you to join your colleagues from all around New York State and come to Albany to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Here are some our top issues for March 7:

  • Rejecting the Inappropriate scope of practice expansions proposed in the Executive Budget
  • Preventing big-box store owned medical clinics that will hurt community primary care delivery
  • Reducing excessive health insurer prior authorization hassles that needlessly delay patient care
  • Reducing the high cost of medical liability insurance
  • Rejecting unfair and counterproductive proposed Medicaid cuts to Patient-Centered Medical Homes
  • Preserving opportunities for our medical students and residents to become New York’s future health care leaders

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Please contact your County Medical Societies, which will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org. (HARRING)


Please Contact Your Legislators To Oppose Various Misguided State Budget Proposals
The Senate and Assembly have been holding joint budget hearings over the last few weeks to examine Governor Cuomo’s proposed budget.  On February 12th, MSSNY will testify before the Senate Finance Committee and Assembly Ways and Means Committee regarding healthcare issues contained in the proposed budget.

MSSNY members are urged to continue to contact their legislators, and make phone calls, Facebook and Twitter updates, e-mail blasts and other forms of activism.  Please contact your legislators to urge them to oppose the following proposals contained in the proposed State Budget for 2018-19.

  • Expanding scope of practice for certified nurse anesthetists (CRNAs) This provision would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the supervision of a physician anesthesiologist or surgeon.  To urge your legislators to protect safe anesthesia care for patients please click here.
  • Authorizing Health Services Offered In Big Box Stores
    This provision authorizes the delivery of health services in a retail setting such as a pharmacy, grocery store, or shopping malls.  Sponsors could include a business corporation.  Services to be offered would include treatment of minor episodic illnesses, episodic preventive and wellness services such as immunizations, administration of opioid antagonists, lab tests, and limited screening and referral for behavioral health conditions.

With the recently announced proposal of drugstore chain giant and PBM operator CVS to purchase health insurance giant Aetna, this could result in an explosion of retail clinics at the expense of community physician practices. To urge your legislators to reject corporate owned retail clinics, please click here.

    • Comprehensive Medication Management Protocols
      This proposal allows nurse practitioners and pharmacists to provide comprehensive medication management to patients with a chronic disease or diseases who have not met clinical goals of therapy and are at risk for hospitalization.  Urge your legislators to reject this inappropriate scope of practice expansion.  Click here to send a letter to your legislator.
    • Community Paramedicine
      This proposal would allow emergency medical personnel to provide non-emergency care in residential settings.  While a laudable goal, the bill language only includes general references to collaboration with the patient’s treating providers, rather than specific requirements to communicate with actively treating physicians and other care providers.     To protect proper continuity and coordination of patient care with treating providers, please click here to send a letter to your legislator.          
    • Patient-Centered Medical Home cuts
      This proposal would, for the period of 5/1/18-6/30/18, slash from $7.50 PMPM to $2 PMPM the Patient-Centered Medical Home (PCMH) add-on Medicaid payment that many primary care practices receive to help manage and coordinate needed patient care services.  Moreover, it would potentially require all PCMH primary care practices to have a Level 1 Value-Based payment contract on July 1, 2018, or face further steep cuts in PMPM payments. MSSNY together with the NY Academy of Family Physicians, NY Chapter of the American Academy of Pediatrics, and NY Chapter of the American College of Physicians, as well as the Community Health Care Association of New York, have expressed great concerns with these proposed changes.
    • Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.
    • Eliminating the Empire Clinical Research Investigator Program (ECRIP).
    • Consolidating 30 public health appropriations into four pools, and reduce overall spending by 20 percent.  (DIVISION OF GOVERNMENTAL AFFAIRS)



Congressional Budget Bill Repeals IPAB, Extends CHIP and Reduces 2019 Medicare Increase
The Continuing Resolution passed overnight Thursday into Friday by the US House and Senate to keep the federal government operating until March 23 contained a number of important health care provisions to help with with multi-year implications, including

  • Repeal of the Independent Payment Advisory Board (IPAB) – The IPAB was a Medicare cost-cutting Board that MSSNY, the AMA and many other physician associations had urged be repealed;
  • Extending the Medicare Geographic Index (GPCI) floor until 2020, which helps to prevent Medicare physician payment cuts to services provided across much of Upstate New York;
  • Extending funding for states for the Child Health Insurance Program for an additional 4 year. On top of the 6-year extension in funding that was enacted two weeks ago.
  • Extending flexibility to CMS in MIPS implementation, including:
    • Excludes Medicare Part B drug costs from MIPS payment adjustments;
    • Eliminates improvement scoring for the cost performance category for the second, third, fourth and fifth years of MIPS;
    • Allows CMS to reweight the cost performance category to not less than 10 percent for the second, third, fourth, and fifth years of MIPS;
    • Allows CMS flexibility in setting the performance threshold for years two through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;
    • Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback on models regarding the extent to which they meet criteria and an explanation of the basis for the feedback.
  • Extending funding for Community Health Centers for 2018 and 2019
  • Preventing cuts to Disproportionate Share Hospital (DSH) Funding for 2018 and 2019
  • Increases funding for Graduate Medical Education for 2018 and 2019

The final package also contains a problematic “pay-for” that would reduce the Medicare Part B conversion factor increase slated for 2019 from +0.5% to +0.25%. However, that is an improvement from a more adverse proposal that had been close to adoption earlier this week that could have produced Medicare physician payment cuts in both 2019 and 2020 as well as future years as a result of a direction to CMS to reduce “Mis-Valued Codes” in Medicare.  After extensive physician advocacy to their members of Congress, including from many MSSNY and County Medical Society leaders, this compromise provision for 2019 only was adopted. (AUSTER)

Bill to Prohibit Mid-Year Formulary Changes Passes Assembly
Legislation (A.2317-B, Peoples-Stokes) passed the Assembly this week supported by MSSNY and several other patient advocacy groups that would protect patients from unforeseen changes in prescription drug formularies during a health insurance policy year.  This bill would protect New Yorkers by preventing the imposition of higher out of pocket costs due to formulary and tier changes after the policy year begins.  The bill would prohibit a mid-year formulary switch or change to a higher cost-sharing tier  unless a) an AB-rated generic equivalent drug is added to the formulary at the same time; or b) the drug has been removed from the market.   In addition, it requires insures to provide notice to policyholders of the intent to remove a prescription drugs from a formulary or alter deductible, copayment or coinsurance requirements in the upcoming plan year, 30 days prior to the open enrollment period for the consecutive plan year.

Identical legislation has been introduced by Senator Sue Serino (S.5022-B), and has referred to the Senate Insurance Committee. (AUSTER)


Governor’s Budget Amendment Adds 11 Fentanyl Analogs to the Controlled Substance List
Governor Andrew M. Cuomo announced a 30-day budget amendment will be advanced to add 11 fentanyl analogs to the state controlled substances schedule and provide the New York State Health Commissioner the authority to add any new drugs that have been added to the federal schedule, to the state controlled substances schedule.  In recent years, fentanyl analogs have been increasingly found pressed into pill form to resemble name-brand prescription opioids, and in heroin and cocaine being sold in New York State.  The  30-day budget amendment will add these fentanyl analogs to Schedule 1 of the controlled substance schedules of New York State Public Health Law §3306. The 11 types of fentanyl to be added include: AH-7921; Acetyl Fentanyl; ButyrylFentanyl; Beta-Hydroxythiofentanyl; Furanyl Fentanyl; U-47700; and Acryl Fentanyl (or Acryloylfentanyl); N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide; Ortho-Fluorofentanyl; Tetrahydrofuranyl Fentanyl; Methoxyacetyl Fentanyl.  The amendment also includes a provision to allow the New York State Health Commissioner has the authority to add to the state controlled substances schedule any new drugs that have been added to the federal schedule.  The proposed budget, including these amendments, must be voted on by the New York State Legislature. (CLANCY)


Learn More on Reducing Your Patients’ Risk of Radon Exposure
Health care providers play a key role in reducing their patients’ exposures to unnecessary radiation. With the rate of medical imaging and related radiation exposure increasing, it is even more crucial to reduce radiation exposure from other sources, including radon.  NYSDOH announces a new Radon guide for Healthcare Providers titled Reducing the Risk From Radon: Information and Interventions.  Please take a look at this valuable guide and help increase your patient’s knowledge about radon exposure. (HOFFMAN)

 

Nuclear Radiation and Blast Injuries” CME Webinar on February 21, 2018; Registration Now Open
The next Medical Matters continuing medical education (CME) webinar program is: Nuclear Radiation and Blast Injuries”.  This webinar will take place on Wednesday, February 21, 2018 at 7:30 a.m.   Arthur Cooper, MD, MS, Professor of Surgery at the Columbia University College of Physicians & Surgeons, Director of Trauma & Pediatric Surgical Services at the Harlem Hospital Center, and Affiliate Faculty at the National Center for Disaster Preparedness of the Columbia University Mailman School of Public Health will serve as faculty for this webinar.  Register for this webinar here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are:

  • Acquire a basic understanding of nuclear radiation and blast injuries.
  • Identify different types of nuclear exposure and blast injuries.
  • Describe the pathophysiology of nuclear exposure and blast injuries.
  • Explore treatment methods for blast injuries and nuclear radiation exposure.

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

The Medical Society of the State of New York designates this 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.  (HOFFMAN)


MSSNY and AMA Working Together to Educate Physicians on Prediabetes
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has created two free CME programs to educate New York State physicians on prediabetes prevention and the CDC’s National Diabetes Prevention program.  To share your current knowledge of the diabetes prevention program, click here to take a quick survey.

Live Webinar: Bending the Diabetes Curve
Tuesday, February 20th at 7:30am
Registration for this webinar is required, click HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

House of Delegates Live Seminar: Bending the Diabetes Curve
Thursday, March 22nd, 2-3pm
Adams Mark Hotel, Buffalo, NY, Grand B
Pre-Registration for this live seminar is strongly suggested, click HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

* Must attend in person at the House of Delegates.

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

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

The Medical Society of the State of New York designates each of these live activities 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.
Additional information or assistance with registration may be obtained by contacting Carrie Harring at charring@mssny.org. (HARRING)


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

pschuh@mssny.org   mauster@mssny.org  pclancy@mssny.org  

eNews
CMS Rule Change Reduced Physicians’ Medicare Opt-Outs
The D Healthcare Daily (TX) (2/8) reports that after 7,400 physicians submitted paperwork to opt-out of Medicare in 2016, “the number cut in half last year, according to new data from the Centers for Medicare and Medicaid Services.” The piece attributes the decrease “to the end of a stipulation that required providers to renew their opt-outs every two years.” Dr. Charles Rothberg, president of the Medical Society of the State of New York, says clinicians, in wealthier areas, feel they can opt out because they can fill their practice with patients who have commercial insurance or can pay out-of-pocket.

CDC Data: One in Four Aged 45/Older Who Made 2015 ED Visits Had Diabetes
Findings published in the CDC’s National Center for Health Statistics Data Brief No. 301 state, “About one in four people aged 45 and older who made emergency department (ED) visits in 2015 in the United States had diabetes,” data from the 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) indicate. In fact, “an estimated 12 million ED visits that year were by patients aged 45 and older, representing 24% of ED visits by people in that age group and 80% of all ED visits by people with diabetes,” the data reveal.

Life Expectancy Falls for Second Consecutive Year: Substance Use and Suicides
“Life expectancy in the US has fallen for the second year in a row, thanks to a combination of drug and alcohol use and suicides, according to a study released online Feb. 7 in the British Medical Journal The drop in life expectancy was especially “large among middle-age white Americans and those living in rural communities, experts” found after examining “2016 data from the World Bank.”

AMA Warns Not to Divulge Social Security Number to Physicians

According to a 2016 annual survey from the Ponemon Institute, “about half of all health care organizations had little or no confidence that they could detect the loss or theft of patient data, and the majority lack the budget to secure their data.” The American Medical Association states on its website, “Our AMA policy is to discourage the use of Social Security numbers to identify insureds, patients, and physicians, except in those situations where the use of these numbers is required by law and/or regulation.” According to the Department of Health and Human Services, in 2015, “113.2 million health care-related records were stolen.”

Paying For Ridesharing Services May Not Reduce No-Shows
The findings published in JAMA Internal Medicine found that paying for poor patients to use “ridesharing services like Uber and Lyft” to reach “doctor appointments doesn’t make them any less likely to become no-shows than patients who have to find their own way there.”

2018 House of Delegates

Any 2018 HOD Resolutions Not in by Today Will Go to Convention Committee
Resolutions to be considered at the MSSNY House of Delegates meeting are due this week on FRIDAY, (FEBRUARY 9) AT 5 PM. This is a firm, no excuses deadline. Any items of business received after 5 PM will be forwarded to the Convention Committee on Rules, Credentials and Order of Business.  Authors, or their duly appointed representatives, must then attend the Rules Committee meeting on Thursday, March 22 at 3:00 PM, to explain why the resolution was submitted after the deadline.  The merits of the resolution are not discussed. Resolutions should be sent to lmayer@mssny.org, as an electronic document in WORD format.  Pdf files are not acceptable.  For guidance on the proper formatting of resolutions, see the MSSNY website under the 2018 HOD tab.

OTHER DEADLINES you may want to be reminded of:

    • Hotel reservations must be made by Sunday, February 18 in order to be assured of the MSSNY rate.
    • Dinner Dance reservations need to be made by Friday, March 9.
    • Information for booking your hotel room and making a reservation for the dinner dance is included on the MSSNY website.

Questions should be directed to Laurie Mayer lmayer@mssny.org


MSSNY Poster Symposium at HOD in Buffalo Needs Judges
We are looking for volunteer judges for MSSNY’s 13th annual Poster Symposium, which will be held on Friday, March 23, 2018, from 2:00 – 4:00 pm at the Adam’s Mark Hotel in Buffalo.

Each judge evaluates 10 posters among the 70 exhibited. Evaluation is based on a scoring system and generally takes about 1½ hours. Judges who wish to help choose the final winners may also attend a meeting at 4:30. You need not be an HOD delegate to be a judge. For guest judges who arrive before 1:30, lunch will be available.

Please contact sbennett@mssny.org or 516-488-6100 x 383

Conference

Medical Professionals’ Conference on Opioid Medication-Assisted Treatment

Including buprenorphine waiver training for MDs, NPs, PAs

When:        SATURDAY, MARCH 17

Where:       Cold Spring Harbor Laboratory, Cold Spring Harbor, NY

Program:   10:00-12:00 Overview of overdose prevention & MAT

                   12:00-1:00 Lunch & networking

                   1:00-5:00 Buprenorphine waiver training

                   1:00-3:00 Collaborative workshop for waivered prescribers

EVENT IS FREE – REGISTRATION REQUIRED BY MARCH 9

Across Long Island and across the United States, opioid users are dying because of the

inadequate infrastructure for buprenorphine and other medication-assisted treatments. More medical professionals are urgently needed who are committed and qualified to provide MAT –and more education and support are needed for these practitioners. This conference will include training that fulfills 4 hours of the in-person requirements for medical professionals to receive a DEA waiver to prescribe buprenorphine. Speakers and workshop Presenters: Lloyd Sederer, MD, Medical Director, NY State Office of Mental Health; Michael Delman, MD, President-Elect, NY Society of Addiction Medicine; Patrick O’Shaughnessy, MD, Medical Director, Catholic Health System of L.I.;  Adam Bisaga, MD and  Leslie Marino, MD, Columbia University Medical Center,

For more information, contact Dr. Marino at leslie.marino@nyspi.columbia.edu

FDA, CMS, CDC

FDA Commissioner: “Kratom Is an Opiate”
The FDA launched the latest attack on February 6 in a drawn-out war between regulators and patients over the safety of a popular herbal supplement called kratom, branding the plant a dangerous drug.

“Compounds in kratom make it so it isn’t just a plant — it’s an opioid,” FDA commissioner Scott Gottlieb declared in a statement.

Some users have argued that kratom is a safe way to treat pain and wean oneself off opioids, but the agency concluded otherwise — based on case reports and a computer analysis of the molecular structure of kratom ingredients. “Claiming that kratom is benign because it’s ‘just a plant’ is shortsighted and dangerous,” Gottlieb said. “After all, heroin is an illegal, dangerous, and highly-addictive substance containing the opioid morphine, derived from the seed pod of the various opium poppy plants.”

Gottlieb warned of side effects that could be caused by kratom, such as changes in neurological and cardiovascular function. He also cited 44 reported deaths “associated with the use of kratom.” In the past, advocates for the herbal supplement have argued that many of these cases involved other drugs besides kratom. While the DEA has already received the report it had requested from the FDA, this newly released evidence may influence the decision as to whether the substance should remain legal, the agency said Tuesday. A spokesperson could not say when that would be determined. “For any substance that goes through this process, it can be months, or it can be years,” said spokeswoman Katherine Pfaff. She added that a number of states have banned kratom, but for the time being, “federally, it is still a legal substance.”


2018 Adult Immunization Schedule for Includes Changes for Shingles/MMR

The CDC’s Advisory Committee on Immunization Practices has released its 2018 immunization schedule for adults in the Annals of Internal Medicine. Among the notable changes from last year:

  • Shingles: Two doses of the newly approved, recombinant zoster vaccine (RZV; Shingrix) is recommended for adults aged 50 and older regardless of their zoster or vaccine history. Those who’ve received the live zoster vaccine (Zostavax) may receive their first RZV dose at least 2 months later. Adults aged 60 and older may receive either vaccine, but RZV is preferred.
  • Mumps: Adults who have received two or fewer doses of a mumps-containing vaccine and are at risk for contracting mumps during a local outbreak should receive a dose of the measles, mumps, and rubella (MMR) vaccine.

Immunization schedule in Annals of Internal Medicine

Physician’s First Watch coverage of 2017 adult immunization schedule


CMS Proposal: Initial Opioid Scripts Limited to Seven Days
CMS is proposing that beginning in 2019, initial opioid prescriptions for acute pain be limited to 7 days. The agency is also suggesting in the 2018 Draft Call Letter that Medicare Part D prescription drug plans monitor patients who take medications considered to be “potentiators” of opioid misuse and opioid-related adverse events — specifically, gabapentin and pregabalin.

Noting an alarming increase in gabapentin use to treat pain and concurrent opioid and gabapentin use, CMS is asking for comment on whether it is useful to more closely monitor beneficiaries receiving these prescriptions.

The CMS proposal came as a US House committee took a closer look at Medicare’s oversight of opioid use. At the February 6 hearing, members of the Ways and Means Health Subcommittee said there are few data on opioid use among older Americans and that Medicare has done a poor job of encouraging prevention and treatment.

The agency said in its latest announcement that the system has reduced “very high risk overutilization of prescription opioids in the Part D program,” but “given the urgency and scope of the continuing national prescription opioid epidemic, we will propose new strategies to more effectively address this issue for patients in Part D.”

CMS proposes the following:

  • To have the OMS identify high-risk beneficiaries who use “potentiator” drugs (such as gabapentin and pregabalin) in combination with prescription opioids to ensure that plans provide appropriate case management. The agency noted in its proposal that in just 2 years (2015 to 2017), the rate of gabapentin users in Part D plans increased by 14%: from 93 to 108 users per 1000 enrollees. Opioid users had even higher gabapentin use.
  • To create a new quality measure that would track how well Part D plans flag concurrent use of opioids and benzodiazepines. The OMS already flags concurrent benzodiazepine use, but there is no follow-up mechanism. According to CMS, in late 2016, when the OMS began tracking concurrent use, 64% of beneficiaries flagged as potential opioid overusers had a benzodiazepine prescription. In 2017, after monitoring, the number had dropped to 62%.
  • That Part D plans to have a pharmacy point-of-sale edit that prohibits dispensing of any prescription that is more than a 90 morphine milligram equivalent, or a 7-day supply.
  • That all sponsors implement soft point-of-sale edits that alert when there is duplicative therapy of multiple long-acting opioids.

CMS is taking comments on the proposal until March 5 and will publish the final requirements on April 2.



Classified

RENTAL/LEASING SPACE


Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org


Medical Office Space Available – Levittown, NY
Prime location in a busy medical building at 2920 Hempstead Turnpike in Levittown, New York. 4,000 sq. ft. available on the first floor and 6,000 sq.ft. available on the lower level. Spaces can be rented together or divided. 64 parking spots, including handicap on premises.

FIRST FLOOR SPACE:

  •  Large waiting area
  • 10 examination rooms
  • Spacious reception area with large file storage area
  • 2 bathrooms
  • Separate consult rooms
  • X-Ray ready room
  • Handicap accessible
  • Elevator to all floors
  • Security Cameras
  • Close to public transportation and major highways

LOWER LEVEL SPACE:

  • Divided into 2 usable spaces; can be made into one
  • Private billing office space
  • 4 Bathrooms
  • 8 examination rooms
  • 3 consult rooms
  • 1 Kitchenette on one side of the space
  • 1 large kitchen and dining area on the other side of the space
  • Tenant to design open spaces to your liking

CONTACT:  Kathleen 631.833.4949 or kgunsberger@gmail.com


Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com


For Rent or Share (Half days or Full) – Union Turnpike, Queens
A brand new state of the art, beautifully appointed medical building has availability for turnkey share or rent on a busy artery of Queens. Smartly located in the area bounded by the LIE to the north, Grand Central Parkway to the south, Clearview Expressway to the West and the Cross Island to the East, this office is easily accessible by car with ample parking available at all times of the day.  The building is located on the Q46 bus line with a stop only steps away.  Easy access to all major Queens and western Nassau county hospitals.  There is already in-house patient traffic so this is a great opportunity to build a satellite practice or to start a practice with potential cross-referral benefits.  Very reasonably priced starter options available. Please email queensmedicalhealth@gmail.com or call (917) 860-8307.


PHYSICIAN OPPORTUNITIES

Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to jobs@hhchc.org. www.hometownhealthcenters.org


Pediatric Medical Director , NY State Office of Health Insurance Programs
The position of Medical Director of Pediatric Policy in the Office of Health Insurance Programs will focus on 4 primary initiatives over the next year, to include the First 1000 Days on Medicaid initiative, Value-Based Payment (VBP) Clinical Advisory Groups on Children’s Health and Maternity Care,  Children’s Health Homes and the Behavioral Health Transition into Managed Care, and Performance Measurement in the various quality programs. The Medical Director will collaborate with colleagues in the Department’s Office of Public Health and serve as a resource for Division staff who are seeking expert advice concerning medical and behavioral health issues involving children. For more information on how to apply, please go to this link: https://www.facebook.com/FuscoPersonnel/?sk=app_127890887255323&app_data=job-3059994

NYC Office of School Health PT and FT Positions for MDs and DOs
The New York City Office of School Health has both part-time and full-time job openings in the five boroughs for board certified/board eligible Physicians (MD, DO) specializing in Pediatrics, Adolescent Medicine, and Family Medicine with an emphasis on the school-aged population (K through 12) and/or Reproductive Health.

New York City School Health Physicians have flexible schedules (Minimum 20hrs/week to Maximum 35hrs/week).  Physicians working 20 or more hours per week receive comprehensive health insurance and other employment benefits.  Duties involve a balance of clinical work in New York City schools, administrative tasks, and public health assignments.  Work days are generally 9am to 5pm with no evening or weekend calls.  Physicians have the option to work or be furloughed during holidays and summers when schools are not in session. For more information, please send email inquiries to osh@health.nyc.gov. To apply directly online and for job descriptions, please upload your resume and cover letter to https://a127-jobs.nyc.gov. For the Field Doctor positions, School Health Physician (K – 8), enter Job ID 319959

For the CATCH Reproductive School Health Physician (High School) positions, enter Job ID 297081
For the Supervising School Health Physician Positions, enter Job ID 307390


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


 

Retail Clinics Would Spell Disaster for Community Medical Homes

MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
http://www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

 

Retail Clinics Would Spell Disaster for Community Medical Homes

Patient access to quality and timely physician care could get even worse if big box store chains are permitted to open medical clinics, as proposed in the New York State Budget.

New York doctors already face an untenable economic squeeze between rising practice costs—led by our notoriously high malpractice costs—and a continued squeeze in payments by health insurers, particularly for primary care services.

Exacerbating these challenges is the de facto requirement that a medical practice invest tens of thousands of dollars for electronic record systems to better manage patient care.

These factors have forced more and more physicians into closing their community practices and joining large health systems to be able to continue to deliver care.  In fact, a recent Avalere study reported the number of physicians who have become hospital employees in New York nearly doubled from 2012-2015.

The loss of independent practice for physicians may sever many long-time patient relationships, as an employment arrangement may bring with it a change in practice patterns dictated by the employer.

It is hard to overestimate the pivotal role that community primary care and pediatric practices play in managing patient health, either managing chronic conditions such as asthma, diabetes and hypertension, or slowing the progression of these diseases to prevent avoidable hospitalizations.  Primary care physicians also coordinate the patient’s care through referrals to needed specialty care physicians, administer immunizations, and remind patients to take their medications and schedule follow-up care.

Simply put, primary physicians are the patient’s “medical home,” a place for patients to trust and depend on for their well-being. Yet the retail clinic proposal would jeopardize these medical homes for many patients.   Far from complementing the delivery of care, as they claim, the medical community is very concerned that this proposal will produce an explosion of these big-box, store-owned clinics that will drive more primary care physicians out of practice.

These concerns are exacerbated by the proposed acquisition of health insurer giant Aetna by drug store and drug benefit manager CVS Health. If the merger is approved, it could push the merged entity to selectively contract with these Minute Clinics at the expense of community medical practices.

Coincidentally, of course, these locations will be where patients can have their prescription medications filled. While such care sites have existed in retail stores in New York, there was always an important distinction that assured that the physician, nurse practitioner, or physician assistant providing care not be directly employed by the corporation.  The practitioner pays rent for the space.

This arrangement, which protects the independent decision-making of the health care professional against corporate interference, works perfectly fine in many regions of the state.

However, the Budget proposal would break down these walls, enabling the corporation to directly employ health care providers to deliver services to the public, breaking a long-standing New York State tradition of prohibiting corporate practice of medical care delivery.

The accumulation of power in our health care system across the pharmaceutical and medical delivery sectors will be harmful for our patients.  The New York State Legislature must step up to prevent this proposal from going forward.

 

Charles Rothberg, MD

President, Medical Society of the State of New York

865 Merrick Ave.

Westbury, NY 11590

(516)488.6100 x340

 

 

 

February 2, 2018 – Turning Anger into Action

Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE

Charles Rothberg, MD
February 2, 2018
Volume 18
Number 5

Dear Colleagues: 

Like you, I am angry at the final result of the Lavern’s Law malpractice issue.

As you have read, the final version addressed some problematic parts of the bill but it’s still a punch to the gut that many of our elected officials clearly do not understand how difficult it is be a doctor in New York, and how that affects availability of care in New York.

Our collective advocacy resulted in some needed changes to limit the retroactive impact and the cases to which the new rules apply, but it will still produce an increase in lawsuits and an increase in our already too-high liability premium costs.

Moreover, health care costs will go up as well because many physicians will believe they have no choice but to recommend to their patients additional diagnostic tests or referrals to specialists, beyond what they believe is clinically indicated, simply because such steps would need to be documented in the patient’s chart. We must re-double our efforts to be sure our policymakers are aware of New York’s physicians’ efforts to keep New Yorkers healthy, and to be an economic engine for our communities.  And to be sure—they are aware that there are practice opportunities in other states that are far more welcoming of doctors and of the services they provide to their communities.

There has never been a better time to step up our involvement in politics and advocacy. Please plan to be in Albany for Lobby Day on March 7 to demand needed liability reform as well as to assure that the Legislature address the problems we face assuring health insurers will cover the care our patients need.  Legislation has been introduced in the both the Assembly and the Senate to enact comprehensive reform including caps on non-economic damages similar to what has been enacted in many other states.

Please also be in Albany to help fight the numerous adverse proposals in the Governor’s proposed Budget that would jeopardize patient care by permitting independent practice for nurse anesthetists, patient drug management protocols between nurse practitioners and pharmacists, and medical care delivery by big corporations.

To register for Lobby Day, click here.

Whether you can attend the Albany event or not, we need more physicians involved in grassroots advocacy.  MSSNY has created a new program, the Physicians Advocacy Liaison (PAL) program, where physicians are “assigned” legislators to be their key contacts on pressing healthcare issues.  In fact, many of you may already have strong relationships with your local legislators that can aid us in our collective advocacy efforts. To join us in this important effort, please contact jbelmont@mssny.org

And, finally please join our PAC.  You may not want to hear it, but it must be understood that some of the challenges we face are the result of physician PACs being badly outspent by our adversaries.  Click here to join MSSNYPAC or to increase your contribution

There has never been a more important time to be involved in organized medicine.  Like me, you may be very angry at what’s transpired, but let’s turn that anger into action, and to make a difference in improving our practice climate.

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

Come to State Legislation Day! Let your voice be heard!


Capital Update

MSSNY’s Lobby Day (3/7) Just 4 Weeks Away! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reject the Inappropriate scope of practice expansions proposed in the            Executive Budget
  • Prevent big-box store owned medical clinics that will hurt community primary care delivery
  • Reduce excessive health insurer prior authorization hassles that needlessly delay patient care
  • Reduce the high cost of medical liability insurance
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for our medical students and residents to become New York’s future health care leaders

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Physicians should coordinate with their County Medical Societies, which will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.  (HARRING)

MSSNY’s 2018 Budget Opposition Advocacy Priorities
Your participation in the legislative and political process remains critical.  While MSSNY’s input is valued by many of our elected officials, various interest groups will also be lobbying for their respective interest.  Please send a letter or call you legislators to urge them to oppose the following proposals contained in the proposed State Budget for 2018-19.

  • Expanding scope of practice for certified nurse anesthetists (CRNAs)

This provision would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the supervision of a physician anesthesiologist or surgeon.  To urge your legislators to protect safe anesthesia care for patients please click here.

  • Authorizing Health Services Offered In Big Box Stores

This provision authorizes the delivery of health services in a retail setting such as a pharmacy, grocery store, or shopping malls.  Sponsors could include a business corporation.  Services to be offered would include treatment of minor episodic illnesses, episodic preventive and wellness services such as immunizations, administration of opioid antagonists, lab tests, and limited screening and referral for behavioral health conditions.

With the recently announced proposal of drugstore chain giant and PBM operator CVS to purchase health insurance giant Aetna, this could result in an explosion of retail clinics at the expense of community physician practices. To urge your legislators to reject corporate owned retail clinics, please click here. 

  • Comprehensive Medication Management Protocols

This proposal allows nurse practitioners and pharmacists to provide comprehensive medication management to patients with a chronic disease or diseases who have not met clinical goals of therapy and are at risk for hospitalization.  Urge your legislators to reject this inappropriate scope of practice expansion.  Click here to send a letter to your legislator.

  • Community Paramedicine

This proposal would allow emergency medical personnel to provide non-emergency care in residential settings.  While a laudable goal, the bill language only includes general references to collaboration with the patient’s treating providers, rather than specific requirements to communicate with actively treating physicians and other care providers.  To protect proper continuity and coordination of patient care with treating providers, please click here to send a letter to your legislator.

Other issues of concern in the proposed Budget for which MSSNY will be opposing:

  • Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.
  • Eliminating the Empire Clinical Research Investigator Program (ECRIP).
  • Consolidating 30 public health appropriations into four pools, and reduce overall spending by 20 percent. (BELMONT)

Governor, Legislature Agree To Revised Lavern’s Law Statute of Limitations Expansion
This week, the Governor and the Legislature reached an agreement and enacted “chapter amendments” to the “Lavern’s law” legislation (S.6800) that had passed the Legislature last June to expand the date to bring a malpractice lawsuit based upon an “alleged failure to diagnose cancer or a malignant tumor”. While under current law the plaintiff would have 2.5 years from the date of alleged negligent act to bring a lawsuit, under the new law, a patient would have 2.5 years from the date they discover or should have reasonably discovered the alleged negligence to file a malpractice lawsuit, up to 7 years from the date of the alleged negligent act.

After substantial advocacy from MSSNY, hospital associations, specialty societies, MLMIC, and individual physician and hospitals all across the State, amendments were made to lessen the adverse impact of the bill by a) fixing ambiguous language in the bill that could have greatly expanded the time to bring lawsuits for all potential medical malpractice cases, not just cancer cases; and b) to limit the retroactive impact of the bill.  However, despite the urging of MSSNY and other allied associations of the need to include needed reforms to our tort system, no such reforms were included in the final agreement.

While the changes to this legislation will help lessen the cost impact of this legislation, MSSNY President Dr. Charles Rothberg issued a statement calling the passage of this one-sided legislation that will still drive up physician liability and “Defensive Medicine” costs, a “lost opportunity by the Legislature and the Governor to address our longstanding dysfunctional medical malpractice adjudication system”.  His critical comments of the final result were reported in numerous papers, including the Daily News, Crains Health Pulse, and Politico-NY

Specifically, the amendments:

  • Clarify ambiguous language that would have applied the expanded the Statute of Limitations for all potential claims of malpractice, not just the alleged failure to diagnose cancer; and
  • Eliminate provisions that would have allowed plaintiffs to revive already-expired claims based on alleged acts of negligence that occurred up to 7 years prior to suit being filed. Instead, the effective date is for acts or occurrences up to 2.5 years prior to the effective date (January 31, 2018) – in other words, claims which had not yet expired. It would, however, provide a limited re-opener for claims that expired after March 31, 2017 under the old non-“Date of Discovery” rules, which must be filed by July 31, 2018.

MSSNY thanks the many physicians who took the time to send a letter or call the Governor, or write one of the numerous op-eds or Letter to the Editor that appeared in papers throughout the State raising concerns with the enactment of one-sided legislation when New York physicians and hospitals already pay exorbitant medical liability costs.

Once again, this highlights how essential it is for physicians to be part of the advocacy and political process.  Many physicians participate in grassroots efforts, but far more need to participate.  MSSNY has created a new program for physicians, the “Physicians Advocacy Liasion” for physicians to be assigned legislators to maintain ongoing grassroots contact.  Please contact jbelmont@mssny.org for more information.  Moreover, it is essential for physicians to be involved politically to help elect candidates for political office who better understand the concerns of physicians and the patients they serve.  Please click here for more information and to join MSSNYPAC.  (DIVISION OF GOVERNMENTAL AFFAIRS)


Governor, AG, Announce Lawsuit Against Federal Government To Protect Essential Health Plan Funding
Governor Andrew Cuomo and New York Attorney General Eric Schneiderman announced a lawsuit this week against the US Department of Health and Human Services (HHS) for ending $1 billion in federal funding for New York’s Essential Plan, which provides health insurance coverage for over 700,000 lower income New Yorkers who earn too much to qualify for Medicaid.  The lawsuit was also joined by the Attorney General of Minnesota, the only other state in the country with a similar health insurance coverage program.  The lawsuit, filed in the U.S. District Court for the Southern District of New York, alleges that HHS withheld legally-required funding owed to New York and Minnesota to operate their insurance program without adequate justification and in disregard of lawful procedure.

New York’s Essential Plan provides comprehensive health insurance coverage to over 700,000 New Yorkers who earn between 138% and 200% of the Federal Poverty Level.  Depending on income, some enrollees do not pay any premiums for this coverage, while others pay at most $20 per month.   There is no deductible for this coverage, and the plan covers preventive care without cost sharing.

MSSNY has written to the New York Congressional delegation on numerous occasions, both individually and in conjunction with other provider and patient associations, to urge continued funding for this program.  Bi-partisan legislation sponsored by Senator Lamar Alexander (R-Tennessee) and Senator Patty Murray (D-Washington), has been introduced that would continue necessary cost sharing reduction (CSR) health insurance subsidies including those that support New York’s Essential Plan. (AUSTER)

Commissioner’s Grand Round on Antibiotic Use and Resistance to Be Held Feb 28
New York State Department of Health Commissioner Howard A. Zucker, MD, JD, will host a Commissioner’s Grand Rounds on “Antibiotic Use and Resistance for the Practicing Physician”  on Wednesday, Feb. 28, 2018 from 8-10 a.m. at the Conference Center, Maria Fareri Children’s Hospital, Westchester Medical Center Campus, 100 Woods Road, Valhalla, NY 10595.   The presentation will strengthen clinicians’ understanding of antibiotic resistance, review recommended guideline-based approaches to antibiotic use for common outpatient adult and pediatric conditions, and describe evidence-based tools and approaches to assist providers in communication to patients about optimal antibiotic use. 

Faculty are:  Jeffrey Gerber, MD, PHD, Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine, Division of Infectious Diseases, Children’s Hospital of Philadelphia; Saul R. Hymes, MD, Medical Director, Pediatric Antimicrobial Stewardship, Assistant Professor of Clinical Pediatrics, Stony Brook University School of Medicine, Stony Brook Children’s Hospital and Belinda Ostrowsky, MD, MPH, Field Medical Officer, NY Division of Healthcare Quality Promotion (DHQP) Centers for Disease Control and Prevention.  Advance registration is requested and additional information and a link to the flyer can be found here(CLANCY)

MSSNY and AMA Working Together to Educate Physicians on Prediabetes
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has created two free CME programs to educate New York State physicians on prediabetes prevention and the CDC’s National Diabetes Prevention program.

Live Webinar: Bending the Diabetes Curve
Tuesday, February 20th at 7:30am
Register for this webinar HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

House of Delegates Live Seminar: Bending the Diabetes Curve
Thursday, March 22nd, 2-3pm
Adams Mark Hotel, Buffalo, NY, Grand B
Pre-Register for this live seminar HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

* Must attend in person at the House of Delegates.

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

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

The Medical Society of the State of New York designates each of these live activities 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.

Additional information or assistance with registration may be obtained by contacting Carrie Harring at charring@mssny.org.                                                                        (HARRING, CLANCY)

NYS Osteopathic Medical Society and CEI Will Present Four Programs at Annual Conference
The NYS Osteopathic Medical Society, the NYS Department of Health, and Mount Sinai Institute for Advance Medicine  will present four discussions at the Osteopathic Medical Society’s Conference on April 15, 2018.   The four topics are:  “The Role of the Primary Care Clinician in HIV Care”; “PrEP for Women: Prevention Opportunities in Clinical Practice”; “Cirrhosis: What Clinicians Need to Know” and “Naloxone: Preventing Opioid Overdose in the Community”.  The programs will be held from 8 a.m. – 1:15 pm. At the Hyatt Regency Long Island, 1717 Motor Parkway, Hauppauge, NY  11788.  Registration is available here.

Further information is available by contacting nysoms@nysoms.org or (800) 841-4131 or Robert Walsh at robert.walsh@mountsinai.org or (212) 731-3791.  (CLANCY)

MSSNY’s CME LIVE Seminar “Current Concepts in Concussion in Pediatric and Adult Populations” in Syracuse on February 15th @ 6:30pm Registration Now Open
The Medical Society of the State of New York will hold a live Continuing Medical Education (CME) seminar entitled “Current Concepts in Concussion for Pediatric & Adult Patients” on Thursday, February 15, 2018 at 6:30pm, with light refreshments at 6:00pm, for all physicians and other health care providers.  Registration for the webinar is now open HERE, or contact Onondaga Medical Society at oncms@oncms.org or call (315) 424-8118.

Faculty for the course will be Robert Dracker, MD, MHA, MBA, CPI.

Educational objectives are:

  • Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology;
  • Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol;
  • Describe methods for the primary and secondary prevention of concussion;
  • Identify patients who would benefit from referral to a concussion specialist.

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

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

For assistance in registering, please contact Melissa Hoffman at mhoffman@mssny.org      (HOFFMAN, CLANCY) 

Substance Use Disorders in Veterans” and “Suicide in Veterans” CME webinars on February 27 and March 26, 2018 Registration Now Open
Did you know that in a recent report, the New York State Health Foundation discovered that nearly HALF of veterans prefer to receive their care OUTSIDE of the VA system?

The Medical Society has created a free CME program series entitled Veterans Matters to assist New York State physicians in recognizing the unique health problems faced by veterans and the best way to provide care to veterans.  Two webinars are scheduled.

Register for Veterans Matters: Substance Use Disorders in Veterans on February 27th at 7:30a.m. here
Faculty: Frank Dowling, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention, and treatment options
  • Identify barriers to identification and treatment in military culture and methods to overcome them

March 26th at 7:30am – Veterans Matters: Suicide in Veterans
Register for this webinar here
Faculty: Jack McIntyre, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention and treatment options
  • Identify barriers to identification and treatment and methods to overcome them

To view all of MSSNY’s scheduled programs, click here and select “Upcoming”.

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

The Medical Society of the State of New York designates each of these live activities 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.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.                                                                  (HOFFMAN, CLANCY)

Nuclear Radiation and Blast Injuries” CME Webinar on February 21, 2018; Registration Now Open
The next Medical Matters continuing medical education (CME) webinar program is: Nuclear Radiation and Blast Injuries”.  This webinar will take place on Wednesday, February 21, 2018 at 7:30 a.m.   Arthur Cooper, MD, MS, Professor of Surgery at the Columbia University College of Physicians & Surgeons, Director of Trauma & Pediatric Surgical Services at the Harlem Hospital Center, and Affiliate Faculty at the National Center for Disaster Preparedness of the Columbia University Mailman School of Public Health will serve as faculty for this webinar.  Register for this webinar here. 

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are:

  • Acquire a basic understanding of nuclear radiation and blast injuries.
  • Identify different types of nuclear exposure and blast injuries.
  • Describe the pathophysiology of nuclear exposure and blast injuries.
  • Explore treatment methods for blast injuries and nuclear radiation exposure. 

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

The Medical Society of the State of New York designates this 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.                          (HOFFMAN, CLANCY)


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

pschuh@mssny.org   mauster@mssny.org  pclancy@mssny.org  

eNews

DSRIP Networks Reap More Than $3B
Participating in DSRIP, the state’s multibillion-dollar Medicaid reform effort, had earned performing provider systems a total of $3.01 billion as of Sept. 30, according to a summary of results through DSRIP Year 3 released by the state Health Department on January 30. The 25 performing provider systems were awarded 95% of all available funds during that period and 81% of all performance-related funds.

“One indicator of PPS efforts in implementing their DSRIP projects is the number of patient engagements reported in the PPS quarterly reports,” the Health Department said in its summary. More than 3 million Medicaid patients were engaged in the projects in some capacity through the second quarter of DSRIP Year 3, the state said.

PPSs have so far completed projects related to such goals as integrating behavioral and primary health care, developing a comprehensive strategy for reducing the transmission of HIV/AIDS and expanding a home-based self-management program for asthma. 

State Marketplace Enrollments Hit New Record
The state’s open enrollment period concluded Wednesday with a record 4.3 million New Yorkers signing up for insurance through the New York State of Health marketplace—about 700,000 more than were enrolled in marketplace plans on Jan. 31, 2017, the state reported Thursday.

“The marketplace worked to get its message out and counter consumer confusion about coverage and enrollment deadlines,” the state said in its announcement.

After dropping by 10.7% last year, enrollment in Qualified Health Plans crept back up by 4.2% to 253,102 this year. Of those who signed up for Qualified Health Plans, some 59% qualified for financial assistance.

Meanwhile, Medicaid enrollment reached nearly 3 million as of Jan. 31, up 22.2% from the previous year. Despite federal cuts to Essential Plan funding, the state has continued advertising the plan, which now boasts about 738,850 members, up 11.1% from the end of the 2017 open enrollment period. Child Health Plus, which faced threats to its federal funding in 2017, enrolled 374,577 as of Jan. 31, up 25.2% from the previous year.

Enrollment in Medicaid, the Essential Plan and Child Health Plus is open throughout the year. (Crain’s 2/2)

New York’s AG Accuses Insys of Deceptively Marketing Opioid
On February1, New York’s Attorney Genera Eric Schneiderman filed a lawsuit seeking at least $75 million from the Insys Therapeutics Inc., which he said deceptively promoted a fentanyl-based cancer pain medicine for unsafe uses. He alleged that the drugmaker recklessly marketed its product Subsys for wider uses than the U.S. Food and Drug Administration approved and bribed doctors to prescribe it. “At a time when the opioid epidemic was ravaging New York, Insys Therapeutics allegedly marketed a drug illegally by blatantly disregarding the grave risks of addiction and death that opioids pose,” Schneiderman said in a statement.

Insys said it sought to address the challenge related to the misuse and abuse of opioids that has led to addiction and unnecessary deaths around the country. “We intend to continue working collaboratively and constructively with all relevant authorities to resolve our outstanding governmental investigations,” the company said in a statement late Thursday.

Insys has found itself at the center of several lawsuits and investigations focused on Subsys, an under-the-tongue spray intended for cancer patients that contains fentanyl, a synthetic opioid. Federal prosecutors in Boston have accused seven former executives and managers at Insys including billionaire founder John Kapoor of participating in a scheme to bribe doctors to prescribe Subsys and to defraud insurers. Prosecutors said that beginning in 2012, Kapoor, former Insys Chief Executive Michael Babich and others schemed to bribe medical practitioners by paying them to participate in sham speaker program events. Insys has said it is in settlement talks with the U.S. Justice Department and has estimated the minimum amount it may have to pay is $150 million.

The company has said that it has taken steps to prevent past mistakes from happening again and has stressed that Subsys made up 0.02 percent of opioid prescriptions in 2016. Insys previously agreed to pay $9.45 million to resolve investigations by attorneys general in Oregon, New Hampshire, Massachusetts and Illinois. It also faces lawsuits by attorneys general in North Carolina, Arizona, New Jersey and New Mexico. (Reuters, 2/1)

CMS, CDC, FDA, CMS

CMS Issues Update on Transition to Medicare Beneficiary Identifiers
Beginning in October and continuing through the transition period for the new Medicare beneficiary identifiers, the CMS will return both the Health Insurance Claim Number and MBI on the remittance advice when a provider submits a claim with a valid and active HICN, according to new CMS guidance. CMS plans to begin mailing new Medicare cards to beneficiaries in April, which will replace the Social Security-based number on the current cards with an MBI. Providers will have until Dec. 31, 2019 to transition to the new identifier for billing and other Medicare transactions. For more on the initiative, see the AHA’s July Regulatory Advisory for members. 

People Using Imodium to Get High: FDA Asking for Repackaging
Increasingly, people addicted to opioid painkillers are using dangerously high doses of the diarrhea drug Imodium (loperamide) either to get high or to help ease withdrawal.  On Tuesday the U.S. Food and Drug Administration said it’s putting new restrictions on the packaging of the medication, dubbed by some as “the poor man’s methadone.”

“When higher than recommended doses are taken we’ve received reports of serious heart problems and deaths with loperamide, particularly among people who are intentionally misusing or abusing high doses,” FDA commissioner Dr. Scott Gottlieb said in an agency news release.

Because opioid abusers are using the drug in greater numbers, the FDA is requesting that makers “change the way they label and package these drugs, to stem abuse and misuse,” Gottlieb said.

The FDA already slapped a warning on OTC loperamide labeling in the spring of 2017, cautioning users about the dangers of misuse. The latest changes relate to the drugs’ packaging. Specifically, packaging of Imodium should now only “contain a limited amount of loperamide appropriate for use for short-term [‘Traveler’s’] diarrhea according to the product label,” Gottlieb said. For example, that might mean a package would only contain eight 2-milligram capsules of the diarrhea drug in a blister pack, the FDA said. Taking more than prescribed or listed on the label can cause severe heart rhythm problems or death.

The new rules will also seek to eliminate the sale of loperamide in large bottles — sales that typically occur via the Internet, Gottlieb said.

Birth Defects Increased in U.S. Regions with Local Zika Transmission
The prevalence of birth defects potentially related to Zika virus increased in US areas with local Zika transmission in 2016, according to findings in MMWR.

Using birth defect surveillance systems in 15 U.S. jurisdictions, including Puerto Rico, researchers identified nearly 3000 infants and fetuses with birth defects potentially related to Zika in 2016. About half the defects were brain abnormalities such as microcephaly.

In areas with local Zika transmission, the prevalence of birth defects increased from the first to the second half of the year: After exclusion of neural tube defects (which aren’t strongly linked to Zika), the prevalence of defects rose from 2.0 to 2.4 per 1000 live births. This translated to 29 more defects than expected in those areas.

Increases were not seen in areas with only travel-related or no Zika transmission.

In a JAMA viewpoint, CDC director Dr. Brenda Fitzgerald and colleagues write, “The CDC continues to recommend that pregnant women not travel to areas with risk of Zika including US areas with endemic transmission. Furthermore, health care professionals should remain vigilant and consistently consider possible exposure to Zika virus during pregnancy.”

FDA Issues Educational Blueprint for Opioid Risk Mitigation Strategy
On, January 30, the FDA released a blueprint for educating health care providers that treat or monitor patients with pain under its forthcoming Risk Evaluation and Mitigation Strategy for companies that make opioid pain relievers. Accredited continuing education providers will use the blueprint to develop educational materials and activities for the REMS. FDA Commissioner Scott Gottlieb, M.D., said the revised blueprint includes more information on pain management and pharmacologic treatments for pain, including non-opioid pain relievers. 

DEA Targeting ‘Unusual or Disproportionate’ Opioid Dispensers Next 45 Days
The Drug Enforcement Administration will focus over the next 45 days on pharmacies and prescribers who are dispensing “unusual or disproportionate amounts” of prescription opioid drugs, Attorney General Jeff Sessions announced this week. “DEA collects some 80 million transaction reports every year from manufacturers and distributors of prescription drugs,” Sessions said. “These reports contain information like distribution figures and inventory. DEA will aggregate these numbers to find patterns, trends, statistical outliers – and put them into targeting packages. That will help us make more arrests, secure more convictions – and ultimately help us reduce the number of prescription drugs available for Americans to get addicted to or overdose from these dangerous drugs.” In August, Sessions announced the Opioid Fraud and Abuse Detection Unit, a new data analytics program focused on opioid-related health care fraud. 

ONC Webinar on the Draft Trusted Exchange Framework and Common Agreement (TEFCA)

February 15, 1:30-2:30 PM ET
Featured speaker: ONC Principal Deputy National Coordinator Genevieve Morris

Register here.

The Office of the National Coordinator for Health IT (ONC) recently released the Draft Trusted Exchange Framework for public comment. The 21st Century Cures Act requires ONC to develop or support a trusted exchange framework, including a common agreement among health information networks nationally. The Draft Trusted Exchange Framework focuses on policies, procedures, and technical standards that build from existing health information network capabilities.  The intent is to provide a single “on-ramp” to patient information regardless of what health IT developer, health information exchange or network is used, or how far across the country the patients’ records are located. Please join ONC for a webinar that will provide an overview of the Draft Trusted Exchange Framework and question and answer session with ONC Principal Deputy National Coordinator Genevieve Morris. Comments for the draft Trusted Exchange Framework need to be submitted to exchangeframework@hhs.gov before 11:59 pm ET on February 20, 2018. 



 

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RENTAL/LEASING SPACE


Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org


Medical Office Space Available – Levittown, NY
Prime location in a busy medical building at 2920 Hempstead Turnpike in Levittown, New York. 4,000 sq. ft. available on the first floor and 6,000 sq.ft. available on the lower level. Spaces can be rented together or divided. 64 parking spots, including handicap on premises.

FIRST FLOOR SPACE:

  •  Large waiting area
  • 10 examination rooms
  • Spacious reception area with large file storage area
  • 2 bathrooms
  • Separate consult rooms
  • X-Ray ready room
  • Handicap accessible
  • Elevator to all floors
  • Security Cameras
  • Close to public transportation and major highways

LOWER LEVEL SPACE:

    • Divided into 2 usable spaces; can be made into one
    • Private billing office space
    • 4 Bathrooms
    • 8 examination rooms
    • 3 consult rooms
    • 1 Kitchenette on one side of the space
  • 1 large kitchen and dining area on the other side of the space
  • Tenant to design open spaces to your liking

CONTACT:  Kathleen 631.833.4949 or kgunsberger@gmail.com


Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com


For Rent or Share (Half days or Full) – Union Turnpike, Queens
A brand new state of the art, beautifully appointed medical building has availability for turnkey share or rent on a busy artery of Queens.  Smartly located in the area bounded by the LIE to the north, Grand Central Parkway to the south, Clearview Expressway to the West and the Cross Island to the East, this office is easily accessible by car with ample parking available at all times of the day.  The building is located on the Q46 bus line with a stop only steps away.  Easy access to all major Queens and western Nassau county hospitals.  There is already in-house patient traffic so this is a great opportunity to build a satellite practice or to start a practice with potential cross-referral benefits.  Very reasonably priced starter options available. Please email queensmedicalhealth@gmail.com or call (917) 860-8307.


PHYSICIAN OPPORTUNITIES

Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to jobs@hhchc.org. www.hometownhealthcenters.org


Pediatric Medical Director , NY State Office of Health Insurance Programs
The position of Medical Director of Pediatric Policy in the Office of Health Insurance Programs will focus on 4 primary initiatives over the next year, to include the First 1000 Days on Medicaid initiative, Value-Based Payment (VBP) Clinical Advisory Groups on Children’s Health and Maternity Care,  Children’s Health Homes and the Behavioral Health Transition into Managed Care, and Performance Measurement in the various quality programs. The Medical Director will collaborate with colleagues in the Department’s Office of Public Health and serve as a resource for Division staff who are seeking expert advice concerning medical and behavioral health issues involving children. For more information on how to apply, please go to this link: https://www.facebook.com/FuscoPersonnel/?sk=app_127890887255323&app_data=job-3059994

NYC Office of School Health PT and FT Positions for MDs and DOs
The New York City Office of School Health has both part-time and full-time job openings in the five boroughs for board certified/board eligible Physicians (MD, DO) specializing in Pediatrics, Adolescent Medicine, and Family Medicine with an emphasis on the school-aged population (K through 12) and/or Reproductive Health.

New York City School Health Physicians have flexible schedules (Minimum 20hrs/week to Maximum 35hrs/week).  Physicians working 20 or more hours per week receive comprehensive health insurance and other employment benefits.  Duties involve a balance of clinical work in New York City schools, administrative tasks, and public health assignments.  Work days are generally 9am to 5pm with no evening or weekend calls.  Physicians have the option to work or be furloughed during holidays and summers when schools are not in session. For more information, please send email inquiries to osh@health.nyc.gov. To apply directly online and for job descriptions, please upload your resume and cover letter to https://a127-jobs.nyc.gov. For the Field Doctor positions, School Health Physician (K – 8), enter Job ID 319959

For the CATCH Reproductive School Health Physician (High School) positions, enter Job ID 297081
For the Supervising School Health Physician Positions, enter Job ID 307390


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


 

Statement by MSSNY President Charles Rothberg, MD re: Revised Lavern’s Law


MSSNY Seal


Medical Society of the State of New York

865 Merrick Ave. Westbury, NY 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

For Immediate Release

Statement by MSSNY President Charles Rothberg, MD re: Revised Lavern’s Law

Revised Law Makes Improvements But Still Harmful to Patient Care Delivery

“New York’s physicians are very disappointed in the soon to be enactment of a one-sided law that will drive up already exorbitant liability premiums, increase defensive Medicine costs, and discourage doctors from practicing in New York. The amendments to S.6800 reduce some of the many problems with this legislation but it was a lost opportunity by the Legislature and the Governor to address our longstanding dysfunctional medical malpractice adjudication system. It is shocking that, at a time when New York hospitals and doctors continue to have the highest liability costs in the country, and we have been labeled the worst state to be a doctor, a law has been enacted to increase lawsuits and costs even further.

Even with the amendments, this new law is going to make New York an even more difficult place to keep and retain physicians to deliver patient care, particularly in rural and inner city areas most of need of specialty care physicians. Patients may be recommended to receive more diagnostic testing and more specialty referrals, that the doctor may not believe is clinically necessary, so that the doctor may be better able to defend themselves if a suit were to happen years later.

Again, the final agreement failed to achieve the balance so needed between preserving rights to the courts for injuries caused by negligence while at the same time assuring that our health care institutions and providers will be able to continue deliver the care expected in the communities we serve.

We urge the Legislature and the Governor to now work together to take steps to enact needed reforms to help preserve patients continued access to needed primary and specialty physician care in New York.”

# # #

Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

Media Contact:
Roseann Raia
Medical Society of the State of New York
516.488.6100 x 302
rraia@mssny.org

 

 

 

January 26, 2018 – Allscripts Ransomware Attack!

 

Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE


Charles Rothberg, MD
January 26, 2018
Volume 18
Number 4

Dear Colleagues: 

On the morning of Thursday, January 18, 2018, Allscripts was hit by a ransomware attack.  MSSNY was alerted to this by our physicians. In trying to gain some specifics, MSSNY staff searched the Allscripts website and found nothing about the incident. There were news reports about the attack and the NYS DOH posted the following notice on January 19, which MSSNY conveyed to its members:

The Department of Health (DOH) is aware that a cyber incident regarding AllScripts has occurred. This may have an impact on the ability for hospitals, clinics, nursing homes, individual prescribers and pharmacies to transmit and receive prescription(s) electronically. It is permissible for those impacted to use paper official prescriptions in accordance with New York State regulations. Should you have urgent questions in this regard, please contact DOH at (866) 811-7957 or off-hours at (866) 881-2809.

At 11:48PM on January 18, Allscripts sent an email alert to their clients. To view this email as a web page, go here.

On Friday morning, our members began to inform us that they were unable to send electronic prescriptions. By Monday, January 22, our members were reporting to us that they could not access their appointments, charts, billing or anything associated with their Allscripts’ EMR. When calling Allscripts, physicians were told that the problem was the result of ransomware and that Allscripts was working to get their systems back up. Five days after the attack, physicians reported that no progress had been made.

Yesterday, in response to the concerns of many, the DOH coordinated a conference call with MSSNY, the DOH, HANYS, GNYHA, NY-ACP and Allscripts. When Allscripts was asked if the ransomware attack resulted in data loss, it was disappointing that Allscripts immediately shifted the burden to their clients, stating that the client would be in a better position to discern whether or not data was missing by doing their own analysis.

This problem must be fixed immediately. Our patients’ care is depending on it. 

As noted above, the initial focus was the impact on electronic prescribing. However, we also made sure they were aware that we have heard from our physicians that this incident was not just limited to prescriptions, but to their entire medical records system as well. As a result, the DOH has provided MSSNY with direct access to Allscripts’ staff. Now, MSSNY can assist our physicians with following up with Allscripts until all disruptions are resolved.

We have urged Allscripts to much more forthcoming about when physicians can expect their records systems to be fixed. As of this writing, the Allscripts website still has no information about the attack. However, their last website update lists a news alert about their January 8 acquisition of Practice Fusion for $100 million in cash. (Practice Fusion is under investigation for cheating on their certification.)

While technology holds the promise to improve care delivery, events like this validate concerns held by many physicians that EMR use interferes with care delivery more than it helps. 

If you need to contact Allscripts directly, please use this email address: incidentresponse@allscripts.com

In closing, technology companies need to demonstrate that they can both anticipate and handle these situations. Allscripts’ responses to this attack were suboptimal. This industry needs more serious oversight.

In this case, silence was definitely not golden.

Please read the following update from Allscripts that we received at press time (4:30PM)

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

Come to State Legislation Day! Let your voice be heard!



Capital Update

MSSNY’s Lobby Day (3/7) will be here before You Know it! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reduce excessive health insurer prior authorization hassles that needlessly            delay patient care
  • Reduce the high cost of medical liability insurance
  • Preserve choice of physician for our patients
  • Reject corporate owned retail clinics
  • Preserve opportunities for our medical students and residents to become New        York’s future health care leaders
  • Reject inappropriate expansion of scope of practice

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Physicians should contact their County Medical Societies which will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.  (HARRING)

Action on One-Sided Medical Malpractice Legislation Required Next Week – Take Action Now!
Governor Cuomo has only a few days remaining to take action on legislation (S.6800/A.8516) that would significantly expand the medical malpractice statute of limitations.  While thousands of physicians and others have already contacted the Governor to express their great concerns about the potential impact of this legislation, physicians are urged to continue to contact the Governor to request that he pursue comprehensive legislation that addresses the many deficiencies of New York’s malpractice adjudication system instead of signing this one-sided bill into law.

This week several MSSNY Physician leaders had a call with Govenor Cuomo’s staff to reiterate the significant adverse consequences of this legislation. You can send a letter to the Governor here and/or call 518-474-8390.

Given that there are ongoing discussions with the State Legislature regarding the ultimate disposition of S.6800, physicians are also urged to contact their local senators and assembly members to:

  • share their concerns about the impact of this legislation to access to patient          care in their communities, and
  • urge them to work towards the enactment of comprehensive medical liability reform. New York overwhelmingly has the highest medical liability costs in the country and was recently designated by WalletHub as the worst state in the country to be a physician.
    (DIVISION OF GOVERNMENTAL AFFAIRS)

A letter can be sent from here

Contact your Legislators Regarding the 2018-19 Executive Budget
Last week, Governor Cuomo released his 2018-19 Executive Budget.  MSSNY has been pouring through thousands of pages to determine the budget’s impact on physicians.

Please take action on the important budget issues facing physicians and their patients as linked below:

The Medical Society of the State of New York:

Supports:

  • Extending the provisions of the Excess Medical Malpractice program through          June 30, 2019.
  • Continued funding for the Committee for Physician’s Health
  • Taxing E-cigarettes in the same manner as tobacco cigarettes.

 Opposes:

  • Expanding scope of practice for certified nurse anesthetists (CRNAs).  Click here to send a letter to your legislator.
  • Authorizing health services offered by Big Box store owned retail clinics.  Click here to send a letter to your legislator.
  • Allowing nurse practitioners and pharmacists to provide comprehensive medication management to patients.  Click here to send a letter to your legislator.
  • “Community Paramedicine Collaborative” without a specific requirement to coordinate care delivery with treating providers.  Please click here to send a letter to your legislator.
  • Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.
  • Eliminating the Empire Clinical Research Investigator Program (ECRIP).
  • Consolidating 30 public health appropriations into four pools, and reduce overall spending by 20 percent.

As reported last week, there are also many other budget initiatives of interest to physicians that we continue to review.                                                                      (DIVISION OF GOVERNMENTAL AFFAIRS)





Governor Cuomo Issues Executive Order to Allow Pharmacists to Immunize Children Under 18 for Influenza
Governor Andrew Cuomo this week issued an executive order outlining several steps to respond to the latest flu epidemic including to allow pharmacists to immunize children under the age of 18.  The Executive Order, effective today, suspends the section of state education law that limits the authority of pharmacists to administer immunizing agents to anyone under age 18 to allow vaccines to be administered to anyone age two and up. Parents and guardians are also encouraged to call pharmacies ahead of their visit, to ensure they are ready to receive patients in this age group.   Parents and guardians with children between the ages of six months and 24 months are still encouraged to see their primary care provider for the vaccination.  This action by the governor has occurred in prior years when the influenza outbreak has been severe.  The Executive Order encompasses a disaster declaration by the Governor and the order will remain in effect until the disaster is over with.  Additionally, the Governor also took the following steps to combat the influenza outbreak:

  • Issuance of Department of Financial Services guidance to health insurers to ensure that prior authorization is not a barrier to the prescribing of antiviral medications within the first 48 hours of illness.
  • Direct engagement with all New York State county health commissioners to review the four key strategies of influenza control- vaccination, rapid antiviral treatment, isolation of sick individuals, and good hand hygiene-and promote local vaccination awareness efforts.
  • Ongoing communication with all New York State hospitals and nursing homes to review capacity management strategies and the actions available to expand capacity to handle patient surge.
  • Continued monitoring of hospital capacity through survey and direct outreach to hospital leadership.

A copy of the Executive Order can be found here.  (CLANCY)

Congress Passes Long-Term CHIP Extension and Delays Cadillac Tax
The short-term continuing Budget resolution agreed to by Congress and President Trump earlier this week importantly included 6 years of federal funding for the Children’s Health Insurance Program (CHIP) that provides coverage to nearly 9 million children across the country, including hundreds of thousands of children in New York State.  The Continuing resolution, which funds the federal government through February 8, also contains a 2-year delay on implementation of the “Cadillac Tax” on comprehensive health insurance coverage and the medical device tax.  MSSNY has adopted policy that calls for elimination of the “Cadillac Tax”, since it would disincentivize employers from offering generous health insurance policies to their employees.

Federal funding for the CHIP program had expired last fall, placing this program in jeopardy for many states, including New York.  Last week, MSSNY joined with several other patient and health care provider advocacy associations in a letter to New York’s Congressional delegation to work to continue funding for CHIP program as well as other key health subsidy programs, such as continued health insurance subsidies for lower and middle-income patients, as well as funding for community health centers and Disproportionate Share Hospitals.  Funding for these other programs will be discussed in the context of the next Continuing Budget Resolution.                                                        (AUSTER)                      

Legislation Introduced by Assembly Health Committee Chair to Reduce Prior Authorization Hassles Based on AMA Prior Authorization Principles
Legislation (A.9588, Gottfried) was introduced this week by Assembly Health Committee Chair Richard Gottfried to help reduce insurer-imposed administrative hassles consistent with the recently released document entitled Prior Authorization and Utilization Management Reform Principles.  These principles were developed by the American Medical Association, American Hospital Association, Medical Group Management Association, American Pharmacists Association, and Arthritis Foundation along with several other health and patient advocacy associations including MSSNY.    Assemblyman Gottfried’s legislation would enact into law several of the suggested reforms that were articulated in these Prior Authorization principles, including:

  • Requiring health plan utilization review criteria to be evidence-based and peer reviewed ;
  • Reducing the time frame for reviewing prior authorization requests from 3 business days to 48 hours (and to 24 hours for urgent situations)
  • Assuring that a prior authorization, once given, is enduring for the duration of the medication or treatment.
  • Prohibiting mid-year prescription formulary changes; and
  • Assuring that once a prior authorization is given, it cannot be withdrawn if eligibility is confirmed on the day of the service.

MSSNY together with NY Academy of Family Physicians & the NY chapter of The American College of Physicians advocated for the introduction of this legislation. Legislation to reduce prior authorization hassles is more important than ever.  For example, a recent study by Milliman noted that insurers’ use of burdensome prior authorization and step therapy requirements for many prescription medications nearly doubled between 2010 and 2015. And a recent Annals of Internal Medicine study reported that physicians spend two hours on administrative work for every hour with a patient.                                               (AUSTER)

A.G. Schneiderman Announces $1.15 Million Settlement with Aetna for Patient Privacy Breach
New York Attorney General Eric Schneiderman announced a settlement this week with Aetna to resolve alegations that Aetna revealed the HIV status of nearly 2,500 New York patients through a July 2017 mailing, according to the press release, in which the envelopes’ oversize transparent address window revealed text confirming the members’ HIV status.  According to the press release, as part of the settlement, Aetna will pay a $1.15 million civil penalty; develop and maintain enhanced operating procedures with regard to privacy protections of personal health information and personally identifiable information in mailings; and hire an independent consultant to monitor and report on the settlement’s injunctive provisions.

To read the press release, click here. 

To read the full settlement, click here.

According to the press release, Aetna has agreed to implement and maintain a series of enhanced privacy protections, including modifications to its Standard Operating Procedure for Print/Mailing Quality-Prevention of PHI/unwanted disclosure(s), and Use of Protected Health Information in Litigation – Best Practices Policy to provide enhanced safeguards to protect from negligent disclosure of personal health information and personally identifiable information through mailings.

“Through its own carelessness, Aetna blatantly violated its promise to safeguard members’ private health information,” stated Attorney General Schneiderman. “Health insurance companies handle personal health information on a daily basis and have a fundamental responsibility to be vigilant in protecting their members. We won’t hesitate to act to ensure that insurance companies live up to their responsibilities to the New Yorkers they serve.”   (AUSTER)

MSSNY Partners with AMA to Educate Physicians & Patients on Diabetes Prevention
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has created two free CME programs to educate New York State physicians on prediabetes prevention and the CDC’s National Diabetes Prevention program.

Live Webinar: Bending the Diabetes Curve
Tuesday, February 20th at 7:30am
Register for this webinar HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

House of Delegates Live Seminar: Bending the Diabetes Curve
Thursday, March 22nd, 2-3pm
Adams Mark Hotel, Buffalo, NY, Grand B
Pre-Register for this live seminar HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

* Must attend in person at the House of Delegates.

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

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

The Medical Society of the State of New York designates each of these live activities 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.

Additional information or assistance with registration may be obtained by contacting Carrie Harring at charring@mssny.org. (HARRING)

Medical Society of the State of New York Announces its January CME Webinar Schedule
The Medical Society of the State of New York is pleased to announce its January free Continuing Medical Education (CME) webinars.  Participation in the webinars will earn physicians one CME credit free of charge.  The January schedule is as follows: 

January 30th at 7:30amVeterans Matters:  PTSD & TBI in Veterans
Register for this webinar here.
Faculty: Emerald Lin, MD

Educational Objectives:

  • Identify signs and symptoms of PTSD & TBI
  • Examine evidence-based treatment modalities for PTSD & TBI
  • Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture

To view all of MSSNY’s scheduled programs, click here and select “Upcoming”.

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

The Medical Society of the State of New York designates each of these live activities 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.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.  (HOFFMAN, CLANCY)


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

pschuh@mssny.org   mauster@mssny.org  pclancy@mssny.org  

jbelmont@mssny.org charring@mssny.org

eNews

Bronx’s Essen Medical Buys Seven Urgent Care Centers in Queens, LI and Bronx
Essen Medical Associates, a large multispecialty practice based in the Bronx, said this week that it has acquired seven urgent-care centers in the Bronx, Queens and Long Island from Privia Medical Group. The price was not disclosed.

Privia, a national practice that has more than 500 locations across the country, approached Essen about the acquisition, said (MSSNY Member) Dr. Sumir Sahgal, Essen’s founder and chief medical officer.”We were planning to expand in Queens and Long Island, and this came at the right time,” Sahgal said.

Although Essen’s brick-and-mortar presence is concentrated in the Bronx, it offers house calls, nursing-home care and additional services in other boroughs. Essen, which pursues value-based payments through the Balance Accountable Care Organization, is not seeking to build new urgent-care centers for their own sake, Sahgal </a?said. “We are hoping that we will be able to bring these urgent-care patients back to primary care for prevention,” he said. (Crain’s Health Pulse Jan. 26).

YPS/RFS/MSS Annual Meeting Next Saturday in Westbury; All Invited
The joint YPS/RFS/MSS Annual Meetings will take place on Saturday, February 3, 2018 at the Courtyard Marriott, 1800 Privado Road,  Westbury. Lectures will include an interactive dialogue/discussion on Physician Burnout and a presentation, Your Medical Records: An Asset or Liability? Your Employment Contract: Protecting Yourself Before You Sign…Or At Least Know What’s In It.”* Webinar available. MSS RSVP to mreyes@mssny.org. RFS and YPS RSVP sbennett@mssny.org. Meet with your colleagues, discuss policy, and participate in leadership elections.

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

MSSNY designates this live activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

South Nassau Joins Mount Sinai Health System
South Nassau Communities Hospital will become the flagship hospital on Long Island for the Mount Sinai Health System under an affiliation agreement announced today by the Boards of Trustees of the two institutions. Final state regulatory review is underway and approvals are expected in the coming months.

If the affiliation is approved, South Nassau will join Mount Sinai’s $7 billion health system, which includes the Icahn School of Medicine at Mount Sinai. Mount Sinai Health System is encompasses seven hospitals (eight with the addition of South Nassau) in New York, 300 ambulatory practices and other community locations, and more than 6,500 physicians.   

South Nassau’s current Board of Directors will retain local governance over the day-to-day operations of the 455-bed hospital. The South Nassau Board will be joined by two new members from Mount Sinai’s Board, and two members of South Nassau’s Board will also join the Mount Sinai Board.

Mount Sinai will infuse a total of $120 million in capital contributions to South Nassau’s five-year master facility plan, which will help expand surgical facilities, intensive care units, and South Nassau’s emergency department. For more information, click here.

The ABC’s of Legislative and Political Action

Always Be Communicating; Always Be Contributing; Always Be Champions

We can’t keep fighting with one arm tied behind our back. We need all the tools and a multifaceted approach to make a difference against other special interest that continues to try to undermine the delivery of quality health care.  We need resources and activists like you to so that we will be a united force with which to be reckoned. 

Always Be Communicating

  • One of the keys to successful activism is educating other physicians and your colleagues on the importance of MSSNYPAC.
  • Please make it a point to be in Albany on Wednesday March 7, 2018, for MSSNY’s Annual Physician Advocacy Day. It is essential for legislators to know what they do in Albany will have impact on our patients, and their constituents, back home.
  • Nothing resonates more to an elected official than personal stories and issues facing their constituents.  Regular face to face meetings with elected officials is still the ideal way to communicate with your legislators.

To register for lobby day, click here.

Always Be Contributing

MSSNYPAC continues to be outspent nearly 5-1 by the trial lawyers and almost 3-1 by the dentists. MSSNYPAC provides the resources for physicians to have a voice in Albany and in your community.  Your support and participation in MSSNYPAC strengthens MSSNY’s clout in the legislative process.

Please consider:

  • Increasing your PAC contributions
  • Joining MSSNYPAC

To contribute to MSSNYPAC, please click here.

Always Be Champions 

Please consider:

  • Holding regional fundraisers / events
  • Reaching out and educating colleagues
  • Recruiting other physicians to MSSNYPAC and getting at least 5 other colleagues to join

To Join the PAL Network, please click here.




Education

NEJM: Barriers/Benefits of Using Generic Medications for HIV Treating/Prevention
Weill Cornell Medicine researchers, in collaboration with SUNY Albany, published a perspective piece in the New England Journal of Medicine on current barriers and economic benefits of using generic medication for treating and preventing HIV in the United States. Read more here.

Practice Management

Coding Tip of the Week
By Jacqueline Thelian, CPC, CPC-I, CHCA, CPMA Medco Consultants, Inc.

No Therapy Cap Exceptions for 2018
Beginning January 1, 2018, the cap on physical therapy services has a slight increase to $2,010.00.  That’s the good news.

The bad news, the “exception process” which would allow the continuation of PT services up to $3,700.00 with the use of the “KX” modifier (Requirements specified in the medical policy have been met) is no longer applicable.

Additionally, the manual review process for claims that would exceed the $3,700.00 is also no longer a valid option.

The Final Rule that put the end to the exception process states, “Without a therapy cap exceptions process, the statutory limitation requires that beneficiaries become financially liable for 100% of expenses they incur for services that exceed the therapy caps.” The rule goes on to state, “the therapy caps will be applicable without any further medical review, and any use of the “KX” modifier on claims for these services by providers of outpatient therapy will have no effect.” In short, without the renewal of the exception process:

  • CMS will deny reimbursement of any claims that exceed the current therapy cap of $2,010.00
  • Medicare beneficiaries will be responsible for claims over the cap amount of $2,010.00
  • The KX modifier for Physical Therapy claims will have no impact on the claims

So, what can you? Providers can issue Advanced Beneficiary Notices (ABNs). The ABN is a notice of non-coverage which advises the Medicare beneficiaries of non-coverage and their financial responsibility for therapy over the cap. Click on the link below to brush up on how to complete the ABN.  

Source:

If you have a coding or compliance question you would like to have answered please send your question to MSSNY at eskelly@mssny.org, and complete the subject line with Tip of the Week.

Medicare / Medicaid / HHS / CMS

Small Percentage of Clinicians See Medicare Pay Increases for Patient Care
Modern Healthcare (1/22) http://bit.ly/2GjY7bH reports that only 20,000 of the 1.1 million clinicians who billed Medicare in 2016 will receive a pay bump of 6.6 percent to 19.9 percent under the program’s “pay-for-performance” model based on quality metrics in patient care. CMS said in its notice that “the overwhelming majority of clinicians received neutral payment adjustments.” While some 300,000 clinicians failed to submit data, the CMS decided not to penalize those groups in order “to smooth the transition to the Merit-based Incentive Payment System, which replaces the modifier program going forward.” 

CMS Will Be Sending New Medicare Cards in April
In April 2018, CMS l begin mailing new Medicare cards with new Medicare Numbers. Take a look:


 

Classified

RENTAL/LEASING SPACE


Medical Office Space Available – Levittown, NY
Prime location in a busy medical building at 2920 Hempstead Turnpike in Levittown, New York. 4,000 sq. ft. available on the first floor and 6,000 sq.ft. available on the lower level. Spaces can be rented together or divided. 64 parking spots, including handicap on premises.

FIRST FLOOR SPACE:

  •  Large waiting area
  • 10 examination rooms
  • Spacious reception area with large file storage area
  • 2 bathrooms
  • Separate consult rooms
  • X-Ray ready room
  • Handicap accessible
  • Elevator to all floors
  • Security Cameras
  • Close to public transportation and major highways

LOWER LEVEL SPACE:

    • Divided into 2 usable spaces; can be made into one
    • Private billing office space
    • 4 Bathrooms
    • 8 examination rooms
    • 3 consult rooms
    • 1 Kitchenette on one side of the space
  • 1 large kitchen and dining area on the other side of the space
  • Tenant to design open spaces to your liking

CONTACT:  Kathleen 631.833.4949 or kgunsberger@gmail.com


Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com


For Rent or Share (Half days or Full) – Union Turnpike, Queens
A brand new state of the art, beautifully appointed medical building has availability for turnkey share or rent on a busy artery of Queens.  Smartly located in the area bounded by the LIE to the north, Grand Central Parkway to the south, Clearview Expressway to the West and the Cross Island to the East, this office is easily accessible by car with ample parking available at all times of the day.  The building is located on the Q46 bus line with a stop only steps away.  Easy access to all major Queens and western Nassau county hospitals.  There is already in-house patient traffic so this is a great opportunity to build a satellite practice or to start a practice with potential cross-referral benefits.  Very reasonably priced starter options available. Please email queensmedicalhealth@gmail.com or call (917) 860-8307.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying To Sell New or Used Medical Equipment?
Clineeds, the new online platformed designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES


NYC Office of School Health PT and FT Positions for MDs and DOs
The New York City Office of School Health has both part-time and full-time job openings in the five boroughs for board certified/board eligible Physicians (MD, DO) specializing in Pediatrics, Adolescent Medicine, and Family Medicine with an emphasis on the school-aged population (K through 12) and/or Reproductive Health.

New York City School Health Physicians have flexible schedules (Minimum 20hrs/week to Maximum 35hrs/week).  Physicians working 20 or more hours per week receive comprehensive health insurance and other employment benefits.  Duties involve a balance of clinical work in New York City schools, administrative tasks, and public health assignments.  Work days are generally 9am to 5pm with no evening or weekend calls.  Physicians have the option to work or be furloughed during holidays and summers when schools are not in session. For more information, please send email inquiries to osh@health.nyc.gov. To apply directly online and for job descriptions, please upload your resume and cover letter to https://a127-jobs.nyc.gov. For the Field Doctor positions, School Health Physician (K – 8), enter Job ID 319959

For the CATCH Reproductive School Health Physician (High School) positions, enter Job ID 297081
For the Supervising School Health Physician Positions, enter Job ID 307390


Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next generation of primary care. If the fusion of health care and technology inspires you, please apply here.


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


 

MSSNY eNews January 19, 2018 – Be There if You Care!

 

Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE

Charles Rothberg, MD
January 19, 2018
Volume 18
Number 3


Come to State Legislation Day! Let your voice be heard!

Please send your comments to comments@mssny.org




Capital Update

MSSNY’s Lobby Day (3/7) will be here before You Know it! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reduce excessive health insurer prior authorization hassles that needlessly            delay patient care
  • Reduce the high cost of medical liability insurance
  • Preserve choice of physician for our patients
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for our medical students and residents to become New        York’s future health care leaders

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Physicians should contact their County Medical Societies which will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.  (HARRING)

Governor Cuomo Releases $168 Billion Budget Proposal; Contains Positive Proposals for New York Healthcare System, But Also Several Items of Concern
This week Governor Cuomo released his proposed $168.2 Billion Budget for the 2018-19 Fiscal Year.  The Budget proposal seeks to close a $4.4 billion Budget gap, including through $1 billion in “revenue raisers”.  Based upon an initial staff review of the thousands of page of Budget language and supporting documents, among the key proposals of interest/concern to physicians:

Some positive items include:

  • Extending the Excess Medical Malpractice Insurance Program, providing additional liability coverage for over 20,000 physicians, for another year at the historical level of $127,400,000.
  • Continuing funding for MSSNY’s Committee for Physicians Health program at historical funding level of $990,000 (Legislation is needed to extend the program beyond March 30).
  • Re-appropriation of $150,000 for MSSNY’s Veterans’ Mental Health Initiative
  • Reducing interest rate on all court judgments, both against public and private defendants, from 9% to market rate (which is currently less than 2%)

Some items of potentially significant concern include:

  • Expanding the use of Nurse-Anesthetists
  • Permitting corporate-owned clinics in pharmacies and grocery stores, provided they have a collaboration with a hospital, physician practice, ACO or PPS
  • Permitting collaborative drug therapy arrangements between pharmacists and nurse practitioners
  • Requiring prescribers to have a detailed opioid treatment plan for their Medicaid patients who have been on an opioid for more than 3 months or past the time or normal tissue healing.
  • Increasing prior authorization demands on physicians by eliminating “prescriber prevails” protections for prescriptions for patients insured by Medicaid.

Items of Interest and Further Review

  • Establish a “Healthcare shortfall fund” to pay for continued health insurance coverage program (Essential Plan, CHIP, etc.) to be funded by health insurer conversion dollars (such as the Centene purchase of Fidelis).
  • Establish a 10 cent per milliliter tax on vapor products
  • Establish an opioid surcharge on pharmaceutical manufacturers of 2 cents per milligram of active opioid ingredient on prescription drugs
  • 14% surcharge on health insurers for underwriting gains from health insurance policies
  • Medicaid coverage for telehealth services initiated in a patient’s home
  • Board for Medicine would include physician experts in women’s health and disparities
  • Conduct a study regarding the potential legalization of marijuana in New York
  • Prohibiting the suspension of professional licenses for those who fall behind in student loan payments;
  • Grant powers to the State Budget director to create a “Medicaid Savings Allocation Plan” to establish cuts to health programs to account for shortfalls in federal funding

Of further note, the Budget proposal did not contain provisions from previous years’ Budget proposals that MSSNY opposed, such as removing the ability of county medical societies to review applications of physicians to participate in Workers Compensation, and required accreditation of urgent care practices.

MSSNY staff review of the Budget proposal is ongoing, and we will be testifying at the Joint Assembly-Senate Health Budget hearing on Monday, February 12.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Please Urge Governor Cuomo to Support Comprehensive, Not One-Sided, Medical Malpractice Legislation
Action by Governor Cuomo on legislation (S.6800/A.8516) to significantly expand the medical malpractice statute of limitations, passed by the State Legislature last June, is required by the end of January.   While thousands of physicians and others have contacted the Governor to express their great concerns with this legislation, physicians are urged to continue to contact the Governor to request that he pursue comprehensive legislation that addresses the many deficiencies of New York’s malpractice adjudication system instead of signing this one-sided bill into law.

You can send a letter to the Governor here and/or call 518-474-8390.

Given that there are ongoing discussions with the State Legislature regarding the ultimate disposition of S.6800, physicians are also urged to contact their local senators and assembly members to: 

  • share their concerns about the impact of this legislation to access to patient care in their communities, and
  • urge them to work towards the enactment of comprehensive medical liability reform. New York overwhelmingly has the highest medical liability costs in the country and was recently designated by WalletHub as the worst state in the country to be a physician.

A letter can be sent from here.
(DIVISION OF GOVERNMENTAL AFFAIRS)

AMA, Medical Groups, Hospitals and Health Insurers Announce Shared Prior Authorization Principles
This week the AMA, the Medical Group Management Association and associations representing pharmacists, hospitals, and health insurance companies announced a “Consensus Statement” to improve prior authorization processes for patients’ medical treatments.  The effort is an outgrowth of efforts by the AMA together with several state and specialty medical societies, including MSSNY, to develop principles to reduce excessive prior authorizations imposed by health insurers that often unduly delay patient care delivery.

To read the full Consensus Statement, click here. Other groups signing on included the America’s Health Insurance Plans (AHIP), the Blue Cross Blue Shield Association, American Hospital Association, and American Pharmacists Association.

The group press release noted that “Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive. Streamlining approval processes will enhance patient access to timely, appropriate care and minimize potential disruptions. Enhanced transparency and communication also play critical roles in improving prior authorization processes, which underscores the importance of this new effort.”

The statement reflects that the organizations will work together to:

  • Reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider.
  • Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them.
  • Improve channels of communications between health insurance providers, health care professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes.
  • Protect continuity of carefor patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirement; and
  • Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

While this is an important step toward reducing unnecessary and lengthy PA processes, it should be noted that there are not yet specific examples of treatments or processes that have been identified as going to be revised as a result of these principles.  Discussions between the groups will continue.                                                                         (AUSTER)

MSSNY Urges Congressional Delegation to Fund CHIP and Other Key Health Insurance Programs
MSSNY joined with several other patient and health care provider advocacy associations in a letter to New York’s Congressional delegation this week to urge continued funding for the Child Health Insurance Program (CHIP) and health insurance subsidies, as Congress was debating a short-term continuing resolution to fund the government after the current Resolution expires on January 19.  On Thursday night, the US House of Representatives passed a continuing resolution to fund the government until mid-February that also contained a 6-year stream of funding for the CHIP program, but it was doubtful that it was going to also pass the US Senate because of other outstanding issues.

As part of the group press release, MSSNY President Dr. Charles Rothberg stated “Failing to continue funding for these important programs threatens access to care for over a million New Yorkers, including countless children, who depend upon these programs to have coverage for the care they need.  There is no credible reason for why funding for these programs should be controversial.  We urge Congress and the President to work together to come to an agreement ASAP to assure funding for these essential programs are continued.”

Please remain alert for further updates. (AUSTER)

New York State Workers’ Compensation Board Issues Draft Regulations to Establish Drug Formulary
The enacted 2017-18 budget required the New York State Workers’ Compensation Board to establish a drug formulary by the end of the year to include  a tiered list of high-quality, cost-effective medications that are pre-approved to be  prescribed  and  dispensed,  as well as additional non-preferred drugs that can be prescribed with prior approval.

On December 27th, the Workers’ Compensation Board announced draft regulations and initiated a 60-day comment period.  Please click here to read the board’s recommendations for its preferred drug list.  Please click here to review the regulations that set forth how physicians can request a non-formulary drug for their patient.  The formulary is proposed to begin  July 1.

MSSNY is continuing to review the proposal and will provide comments.  In particular, MSSNY will argue to assure that pre-authorization hassles be minimized.  Any physicians interesting in submitting comments and requests to add/delete pharmaceuticals to the preferred list of the prescription drug formulary must submit their comments on or before February 26, 2018. To submit comments, click here.                                                      (BELMONT)

The Physician Advocacy Liaison Network
MSSNY has created the Physician Advocacy Liaison (PAL) Network to expand the ways by which physicians are involved in the legislative and political process.

We must make certain that our elected officials remain committed to championing the issues that matter most to MSSNY members and their patients.  There has never been a greater need for physicians to become active.  With so many changes occurring in our health care system, and other opposition interests seeking to marginalize the physician’s role as leader of the health care team, we must make up for it with an overwhelming presence in grassroots activity that will make it impossible for legislators to ignore.

PAL responsibilities include:

  • Educating other members on issues facing physicians, such as at local county medical society or medical staff meetings.
  • Working as appropriate with your county medical society, be available to meet with your members of the legislature at least twice a year.
  • Being responsible for calling or writing letters to members of the legislature on issues that impact physicians.
  • Attend training programs in regard to legislative issues.
  • Enlisting other member to support our action plans and mobilize them to action.
  • Joining and recruiting others to join MSSNYPAC.

We will provide a budget overview to the PAL on Wednesday, January 24th Click here to sign up and be a PAL!                                                                              (BELMONT)

Seasonal Influenza has Hit New York State Early and Hard
New York State saw its first pediatric death from influenza on January 11th.  During the week ending January 6th, there were 3,942 laboratory confirmed cases of influenza, a 37% increase over the previous week.  And there were 1,258 patients hospitalized with laboratory confirmed influenza, a 40% increase over the previous week.  Additionally, 61 counties reported influenza cases during that week.

MSSNY offers several CME courses and podcasts that will help to keep you informed and better prepared to manage this year’s flu season.  Go to https://cme.mssny.org and check out our Medical Matters courses: The Many Faces of Flu, When is the Flu not the Flu, and The Importance of Herd Immunity to learn more about preparing for, diagnosing and treating influenza.

MSSNY also has a podcast available for patients to learn more about the importance of adult vaccines here or you can go to here for all of MSSNY’s podcasts.                           (Clancy, Hoffman)

Medical Society of the State of New York Announces its January CME Webinar Schedule
The Medical Society of the State of New York is pleased to announce its January free Continuing Medical Education (CME) webinars.  Participation in the webinars will earn physicians one CME credit free of charge.   The January schedule is as follows: 

January 17th at 7:30am – Medical Matters:  Mental Health and Disasters Overview

Register for this webinar here.
Faculty: Craig Katz, MD

Educational Objectives:

  • Explore the psychological impact of mass trauma.
  • Provide physicians with a strong background on both the psychological                  symptoms and syndromes specific to mass trauma.
  • Prepare physicians to conduct acute assessments and interventions.

January 22nd at 7:30amCurrent Concepts in Concussion for Pediatric and Adult Patients

Register for this webinar here.
Faculty: Deborah Light, MD

Educational Objectives:

  • Identify signs and symptoms indicative of concussion as well as red flags that        indicate alternate or more severe pathology;
  • Outline an appropriate management plan for a patient presenting with                  concussion including a return to “normal life” protocol;
  • Describe methods for the primary and secondary prevention of concussion;
  • Identify patients who would benefit from referral to a concussion specialist

January 30th at 7:30amVeterans Matters:  PTSD & TBI in Veterans

Register for this webinar here.
Faculty: Emerald Lin, MD

Educational Objectives:

  • Identify signs and symptoms of PTSD & TBI
  • Examine evidence-based treatment modalities for PTSD & TBI
  • Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture

To view all of MSSNY’s scheduled programs, click here and select “Upcoming”.

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

The Medical Society of the State of New York designates each of these live activities 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.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.                                                                    (HOFFMAN)


For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
pschuh@mssny.org   mauster@mssny.org  pclancy@mssny.org  

jbelmont@mssny.org charring@mssny.org


eNews

National Anthem Policy to Cut Physician Fees
MSSNY recently met with and wrote to representatives of the NYS Department of Financial Services (DFS) to express the physician community’s strong concerns with a national policy being rolled out by the state subsidiaries of Anthem BlueCross BlueShield (for NYS, it is only Empire Blue Cross Blue Shield at this time) that will, as of March 1, drastically reduce payment to physicians who use CPT Modifier 25 when billing to indicate that the physician performed “a significant, separately identifiable service performed on the same day as another procedure or service.”  MSSNY has expressed great concerns that the new policy will have the result of inconveniencing patients who see physicians in both primary and specialty care settings. In some cases, patients may have to be treated over the course of multiple visits, instead of on the same day. This will increase patients’ out-of-pocket costs i.e. copayments, coinsurance, etc.)

Following Anthem’s announcement of its intent to cut payment for these “same day distinct service” claims by 50% in early December, physician outrage over this change prompted the AMA House of Delegates to adopt a policy calling for  the AMA to “aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.”  MSSNY strongly supported and advocated for this policy.

Following this policy adoption, the AMA met with Anthem to discuss the physician community’s great concern with this enormously unfair policy change. Following this meeting in late December, Anthem announced that it would reduce the size of its planned payment cut for such services from 50% to 25% and pushed back the implementation to March 1, 2018.  This change was announced to New York physicians in an e-mail dated January 10, 2018.  While marginally helpful, it will still produce an enormous cut and still not fully address our concerns regarding same-day distinct services being treated differently.   Moreover, the January 10 notice may not satisfy New York statutory provisions that require 90 days advance notice of adverse reimbursement changes.

Click here to read MSSNY’ letter that was sent to DFS outlining MSSNY’s concerns with egregious attempt to cut payments.

We will keep you apprised of any updates.
(AUSTER/MCNALLY) 

Council Notes-January 18, 2018

    • Council discussed concerns over the proposed CVS takeover of Aetna. Specifically, they addressed the adverse implications for patients if this merger goes forward. The leadership is concerned with burdensome and excessive prior authorization barriers for prescription medications. There are also concerns with potential advancement of “minute-clinics” and patients being treated by non-physicians. The Council is wary of CVS’s ultimate intent. Following the discussion, Council approved the following resolution:
      MSSNY, along with other state medical society allies, will communicate our opposition to the Aetna/CVS merger to appropriate federal agencies. MSSNY will then communicate that information to the AMA, seeking that they take similar action in opposition to the merger.
    • On behalf of MSSNY General Counsel Garfunkel Wild, Don Moy, Esq., addressed the question concerning whether a physician can consult the Prescription Monitoring Program Registry (PMP) to access the controlled substance history of a potential patient for the purpose of deciding whether to accept or decline the individual as a patient. Following an explanation regarding what a practitioner must attest to after accessing the PMP, Garfunkel Wild’s conclusion is as follows: “It appears that accessing the PMP to learn the controlled substances history of a potential patient, not for the purpose of diagnosis or treatment, but for the purpose of deciding whether to accept or decline the individual as a patient is not an authorized purpose of the PMP, and could be determined by the DOH to violate Public Health Law 3343-a and 3371. We are aware of no case in which a physician had been charged with a violation of this law.”
    • Kate Kirley, MD, MS, Director of Chronic Disease Prevention at the AMA, presented Diabetes Prevention: Clinical and Payment Considerations. As part of ongoing work to reduce the incidence of type 2 diabetes nationwide, the AMA has launched a multi-state effort to reach more of the estimated 84 million Americans who unknowingly live with prediabetes.  MSSNY has partnered with the AMA to launch this proactive initiative to educate New York State physicians on how to initiate clinical practice change and prevent diabetes in patient population. If your practice is interested in implementing the program, please contact Pat Clancy: pclancy@mssny.org or Carrie Harring: charring@mssny.org.
    • Speaker Kira Geraci-Ciardullo, MD, announced details regarding MSSNY’s 2018 House of Delegates in Buffalo, which include the following:
    • NYS Health Commissioner Howard Zucker, MD, JD will open the House at 8 am on Friday morning, March 23.
    • Andrew Gurman, AMA Immediate Past President, will address the House at 8am on Saturday, March 24.
    • Elections for AMA Delegates will be held at 7 am on Sunday, March 25.

  • Resolutions due to MSSNY at 5pm on February 9.

Leaders Collaborate to Streamline Prior Authorization to Improve Timely Access
(Washington DC January 17) Physicians, pharmacists, medical groups, hospitals, and health insurance providers are working together to improve prior authorization processes for patients’ medical treatments, also known as pre-approval. This will help patients have access to safe, timely, and affordable care, while reducing administrative burdens for both health care professionals, hospitals and health insurance providers.

If a treatment or prescription requires prior authorization, it must be approved by a health insurance provider beforehand… Prior authorization approvals can be burdensome for health care professionals, hospitals, health insurance providers, and patients because the processes vary and can be repetitive. Streamlining approval processes will enhance patient access to timely, appropriate care and minimize potential disruptions. Enhanced transparency and communication also play critical roles in improving prior authorization processes, which underscores the importance of this new effort.

As the first step in this collaboration, the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA) have announced a Consensus Statement outlining their shared commitment to industry-wide improvements to prior authorization processes and patient-centered care.

According to the Consensus Statement, these health care leaders will work together to:

  • Reduce the number of health care professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with the health insurance provider
  • Regularly review the services and medications that require prior authorization and eliminate requirements for therapies that no longer warrant them.
  • Improve channels of communications between health insurance providers, health care professionals, and patients to minimize care delays and ensure clarity on prior authorization requirements, rationale, and changes.
  • Protect continuity of carefor patients who are on an ongoing, active treatment or a stable treatment regimen when there are changes in coverage, health insurance providers or prior authorization requirements.
  • Accelerate industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

This group of health care leaders is committed to ongoing collaboration to improve the prior authorization process for health care professionals, health insurance providers, and, most importantly, patients. As experience is gained, these processes will be further refined to maximize efficiency and minimize care disruption for patients.


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew.
KEEP MSSNY STRONG!


Workers Compensation Re-Registration
As of December 18, 2017, the total number of listed authorized physicians was 24,894. The WCB has updated their WC directory of authorized providers as of Friday January 19, 2018.  As of this date, 10,356 out of the 24,894 authorized have registered.  The WCB is continuing to work with a number of physicians that have reported issues and these physicians will be added as their registration process is completed.

Report Recommends Lowering Threshold for Drunk Driving
To combat drunk driving, a panel from the National Academies of Sciences, Engineering, and Medicine is recommending that states lower the threshold for what is considered alcohol-impaired driving from 0.08% to 0.05% blood alcohol concentration.

The panel found that a person’s ability to operate a vehicle begins to deteriorate before BAC reaches 0.08%. 

IV Bag Shortage Caused By Hurricane Maria A “Crisis” During Flu Season
Hurricane Maria’s devastating impact continues to be felt, including in a national shortage of IV bags. USA Today (1/14) reported that hospital pharmacy departments “have devised ways to reserve the 25-to-100 milliliter saline bags for use in patients whose condition requires them and adopt viable substitute procedures when possible.” For example, hospitals “have been using oral medications when they can, stopping IV bags once a patient no longer requires them and looking to Canadian suppliers to help fill the gap.” Other hospitals use different sizes of bags when possible or replacing saline for dextrose.

Calling All “Tweeters”!
Are you willing to be a MSSNY Twitter Ambassador? Make a commitment to regularly liking and retweeting from @mssnytweet?  Please consider helping us to expand our reach so that the issues of importance to New York State physicians are heard far and wide!  We are hoping to form a group of MSSNY members who will commit to doing this on a regular basis. If interested, please contact Roseann Raia at rraia@mssny.org.

FOR YOUR PATIENTS: App to Quit Smoking
The NYCDOMHH has a new app to help patients quit smoking. The HelpMeQuit app can track and celebrate progress, offer tips on how to outlast cravings, and connect your patient with other quitters for support.

Easy Access to MSSNY Publications
Doctors, did you know your staff can have access to Enews and the News of New York? If you have internet in your office, a staff member can go to www.mssny.org. Go to the far right and click on “Publications.” Just click and you’re in! For back issues, click “archives.”

Statue of Surgeon Who Practiced on Slaves Is Being Reviewed for Removal
A 14-foot-tall statue of Dr. J. Marion Sims that stands in Central Park, near Fifth Avenue at 103rd Street, is being moved out of Manhattan after fierce controversy over the South Carolina doctor. Dr. Sims was long hailed as a pioneer in gynecology, but he practiced surgical procedures on women who were enslaved, had not given consent, and were not given anesthesia. A New York City commission has now recommended that the bronze monument be moved from Central Park to Dr. Sims’s grave in Brooklyn.


CMS/HHS/MEDICARE / MEDICAID

HHS Forming Conscience and Religious Freedom Division for Medical Professionals
HHS said it will form a Conscience and Religious Freedom Division within its Office for Civil Rights (OCR). HHS said it is seeking to “more vigorously and effectively enforce existing laws” regarding medical professionals’ right to claim that certain procedures would violate their personal and religious beliefs.

Appearing on the HHS website today is a page detailing the type of procedures that would come under the new office’s authority, such as abortion, sterilization, physician-assisted death, and related training and research activities.

CMS Approves First Medicaid Work Requirements
CMS last week approved a Kentucky Medicaid waiver that allows the state to implement work requirements for its Medicaid program. The move marks the first time CMS has ever allowed a state to tie Medicaid eligibility to work requirements, and the agency in the approval letter signaled it would approve similar waivers for other states


CLASSIFIED

RENTAL/LEASING SPACE


Medical Office Space Available – Levittown, NY
Prime location in a busy medical building at 2920 Hempstead Turnpike in Levittown, New York. 4,000 sq. ft. available on the first floor and 6,000 sq.ft. available on the lower level. Spaces can be rented together or divided. 64 parking spots, including handicap on premises.

FIRST FLOOR SPACE:

  •  Large waiting area
  • 10 examination rooms
  • Spacious reception area with large file storage area
  • 2 bathrooms
  • Separate consult rooms
  • X-Ray ready room
  • Handicap accessible
  • Elevator to all floors
  • Security Cameras
  • Close to public transportation and major highways

LOWER LEVEL SPACE:

    • Divided into 2 usable spaces; can be made into one
    • Private billing office space
    • 4 Bathrooms
    • 8 examination rooms
    • 3 consult rooms
    • 1 Kitchenette on one side of the space

  • 1 large kitchen and dining area on the other side of the space
  • Tenant to design open spaces to your liking

CONTACT:  Kathleen 631.833.4949 or kgunsberger@gmail.com



Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com


For Rent or Share (Half days or Full) – Union Turnpike, Queens
A brand new state of the art, beautifully appointed medical building has availability for turnkey share or rent on a busy artery of Queens.  Smartly located in the area bounded by the LIE to the north, Grand Central Parkway to the south, Clearview Expressway to the West and the Cross Island to the East, this office is easily accessible by car with ample parking available at all times of the day.  The building is located on the Q46 bus line with a stop only steps away.  Easy access to all major Queens and western Nassau county hospitals.  There is already in-house patient traffic so this is a great opportunity to build a satellite practice or to start a practice with potential cross-referral benefits.  Very reasonably priced starter options available. Please email queensmedicalhealth@gmail.com or call (917) 860-8307.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying To Sell New or Used Medical Equipment?
Clineeds, the new online platformed designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


Upper East Side Plastic Surgery Office Available for Rent or Share
Beautifully equipped Plastic Surgery office available for part-time share along with Quad A-certified OR available for rent. Located in a lovely carriage house on the Upper East Side in close proximity to Lenox Hill Hospital and MEETH and conveniently located near all NYC mass transit. 1 exam room/OR and Recovery room along with large administrative space. Free WIFI. Available for </>full or half-days. Suits Plastic/Cosmetic Surgeons/ DERM/ ENT/or other Medical MDs. Please contact Kim at Kim@madisonps.com (212) 628-7600. 

PHYSICIAN OPPORTUNITIES


Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next </a?generation of primary care. If the fusion of health care and technology inspires you, please apply here.

 


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


 

Charles Rothberg M.D. Re: Executive Budget Proposal


MSSNY Seal


Medical Society of the State of New York

865 Merrick Ave. Westbury, NY 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

For Immediate Release

 

Statement by Charles Rothberg, MD, President of the Medical Society of the State of New York (MSSNY), Regarding the Executive Budget Proposal

“While MSSNY is continuing to review all of the legislative proposals contained in the Executive Budget, New York’s physicians appreciate the continued efforts of Governor Cuomo to assure the availability of affordable health insurance options for New Yorkers despite efforts by some at the federal level to drastically reduce funding for these programs.   The enormous Budget deficit this State faces presents a significant challenge.  While we have concerns with some provisions of the proposed Budget that could make it more difficult for patients to receive needed physician care, we will continue to work proactively with the Governor and Legislature to meet these challenges so as to protect and preserve our world class health care system.”

# # #

Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

 

Media Contact:
Roseann Raia
Medical Society of the State of New York
516.488.6100 x 302
rraia@mssny.org

 

 

 

 

January 12, 2018 – Fair Health Should Be Fair


Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE

Charles Rothberg, MD
January 12, 2018
Volume 18
Number 2

MLMIC Insurance for Physicians


Dear Colleagues: 

We received concerns from a few specialties regarding fee data published by Fair Health in the fall of 2017.

Neurosurgeons, orthopedic and hand surgeons noticed a significant and unexpected decrease in fees relating to some of their most common procedures. The Fair Health database is a reference used in adjudicating out of network insurance payments to physicians.

Subsequently, MSSNY leadership and staff held a conference call with representatives of Fair Health. MSSNY expressed grave concern with regard to the fact that Fair Health should be fair. Their data should be objective and not manipulated. Fair Health identified that their research unveiled significant outliers in several of the surgical specialty fees and after analysis, they tweaked the data that resulted in the significant reductions.

During the course of our teleconference, Fair Health agreed that many of our points of concern were valid and agreed to rerun the fee data. After the re-publication, many of the fees have been corrected.  However, some of our specialists have concerns that remain.  We will ask Fair Health to address them as soon as possible.

We will keep you posted.

I have observed that Fair Health continues to be sensitive and sympathetic to the concerns raised by our physicians.

Once more, MSSNY, in concert with its physician members, was instrumental in seeking correction that would have harmed reimbursement for all physicians.

Sincerely,

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org



Governor Cuomo to Release Proposed Budget Tuesday
This Tuesday, January 16th at 1 PM, Governor Cuomo will give a presentation to release his FY 2018-19 proposed State Budget.  The Governor’s proposed Budget, certain to run into the thousands of pages, will seek to close an anticipated deficit of over $4 billion, as well as address uncertainty regarding continued federal funding for key New York health programs such as Child Health Insurance, the Essential plan, Community Health Centers, and Disproportionate Share (DSH) payments for hospitals. Please look for a summary of highlights following an initial MSSNY staff review of the Budget proposal.  (AUSTER)

MSSNY’s Lobby Day (3/7) will be here before You Know it! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reduce excessive health insurer prior authorization hassles that needlessly delay patient care
  • Reduce the high cost of medical liability insurance
  • Preserve choice of physician for our patients
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for our medical students and residents to become New York’s future health care leaders

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Please contact your county Medical Society to coordinate scheduling appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org (HARRING)

Please Urge Governor Cuomo to Support Comprehensive, Not One-Sided, Medical Malpractice Legislation
Legislation (S.6800/A.8516) to significantly expand the medical malpractice statute of limitations was the ONLY bill that passed the State Senate and Assembly in 2017 that has NOT yet been acted upon by the Governor!  Based upon a quirk in our State Constitution, with the bill delivered on December 29, Gov. Cuomo has until the end of January to consider the legislation.  

All physicians are urged to contact the Gov. to urge him to veto this legislation. You can send a letter to the Governor here and/or call 518-474-8390.

Urge him to work to develop comprehensive legislation that addresses the many deficiencies of New York’s malpractice adjudication system.   NY overwhelmingly has the highest medical liability costs in the country and was recently designated by WalletHub as the worst state in the country to be a physician.  The bill would significantly expand the time to bring a medical malpractice lawsuit, in circumstances based upon an “alleged negligent failure to diagnose a malignant tumor or cancer.” 

This week a letter was sent to Governor Cuomo from Dr. Michael Pisacaino, President of the Bronx County Medical Society.

that describes the negative consequences to the Bronx health care delivery system if this bill were to be signed into law without enacting needed reforms to bring down our costs.  The letter was also shared with Assembly Speaker Carl Heastie, whose district is in the Bronx.  

Given that there will be ongoing discussions with the Legislature regarding the ultimate disposition of S.6800, physicians are urged to contact their local senators and assembly members to: 

  • Share their concerns about the impact of this legislation to access to patient          care in their communities, and
  • Urge them to work towards the enactment of comprehensive medical liability        reform.

A letter can be sent from here.
(DIVISION OF GOVERNMENTAL AFFAIRS)

NYS Council on Women and Girls Issues Status Report
Governor Andrew Cuomo Council on Women and Girls issued a 2018 report this week.   Members of Governor Cuomo’s administration crisscrossed the state to hear the concerns of New York women on issues such as the gender wage gap, sexual harassment in the workplace, and lack of educational programs to encourage interest in computer science and engineering. In the healthcare arena the report identifies areas that need to be addressed:

  • Passage of the Contraceptive Coverage Act: The use, accessibility and availability contraception to all women and in 2018 the Governor will advance legislation to codify access to contraception, including emergency contraception in NYS.
  • Codify Roe v Wade Into State Law and Constitution: The governor will again call for legislation that will ensure the right of women to abortion and will also eliminate the criminal component of this act by placing it under the public health law rather than the penal law.
  • Improve Access To IVF and Fertility Preservation Services
  • Launch Multi-Agency Effort to Combat Maternal Depression
  • Partnering with ACOG, establish the Maternal Mortality Review Board to Save Lives
  • Add physician experts in women’s health and health disparities to the state board of medicine


The entire report can be found here. (CLANCY)

Senator DeFrancisco Introduces Legislation to Prohibit Hospitals, Health Plans from Requiring Board Certification
Senate Deputy Majority Leader John DeFrancisco (R-Syracuse) this week introduced legislation (S.7537) supported by MSSNY that would prohibit a hospital from requiring board certification as a condition of having staff privileges, and prohibit a health insurance company from requiring board certification as a condition of being a participating physician in such plan. The legislation is designed to provide physicians with some ability to push back against the extraordinary time and cost demands associated with completing Maintenance of Certification (MOC) requirements imposed by some specialty boards.

In December, MSSNY President-elect Dr. Thomas Madejski along with several other state medical society representatives participated in a meeting with the American Board of Medical Specialties to discuss how best to collaboratively address what many physicians believe are excessive MOC time and cost requirements that go far beyond what is relevant to physicians’ actual practice.  Click here to read Dr. Madejski’s follow-up letter to ABMS.

The Senate legislation is substantially similar to legislation also supported by MSSNY (A.4914) introduced by Assemblymember Robin Schimminger (D-Kenmore).             (AUSTER)

New York State Workers’ Compensation Board Issues Draft Regulations to Establish Drug Formulary
The enacted 2017-18 budget required the New York State Workers’ Compensation Board to establish a drug formulary by the end of the year to include  a tiered list of high-quality, cost-effective medications that are pre-approved to be  prescribed  and  dispensed,  as well as additional non-preferred drugs that can be prescribed with prior approval.

On December 27th, the Workers’ Compensation Board announced draft regulations and initiated a 60-day comment period.  Please click here to read the board’s recommendations for its preferred drug list.  Please click here to review the regulations that set forth how physicians can request a non-formulary drug for their patient. The formulary is proposed to begin  July 1.

MSSNY is continuing to review the proposal and will provide comments.  In particular, MSSNY will argue to assure that pre-authorization hassles be minimized.  Any physicians interesting in submitting comments and requests to add/delete pharmaceuticals to the preferred list of the prescription drug formulary must submit their comments on or before February 26, 2018.

To submit comments, click here.                                                                                    (BELMONT)

Want to Learn More About New York’s New Prescription Step Therapy Override Law?
Please click here to view a webinar discussing New York’s new law that gives physicians a stronger ability to override a health insurer’s step therapy protocol when seeking to assure their patients can receive coverage for necessary prescription medications.    Among the faculty for the program are MSSNY President-elect Dr. Thomas Madejski and MSSNY Senior Vice President Moe Auster    The webinar, sponsored by the National Psoriasis Foundation, will provide physicians with 0.5 hours of CME credit.

As of January 1, the new law is applicable to all NY-regulated health insurance plans, including Medicaid Managed Care plans.  MSSNY has created a template for physicians and their support staff to use in requesting a step therapy protocol override, available here.

Enforcement is the key to assuring that the law is working as intended.  Therefore, please let us know if you or your staff experience instances where health insurers are not following the law.  Moreover, you can file a complaint with </athe State here.(AUSTER)

US Department of Labor Proposes Rules to Expand Use of Cross-State Association Health Plans
The US Department of Labor (DOL) has formally proposed rules that would “broaden the ability of small businesses and sole proprietors to have more freedom to band together” to establish Association Health plans (AHPs).  It follows up a October 2017 Presidential Executive Order which directed the DOL to consider proposing regulations or revising guidance to expand access to health coverage by allowing more employers to form AHPs.

Click here to read the full press release.

Specifically, the proposed rule would broaden the criteria under ERISA for determining when employers may join together in an employer group or association that is treated as the ‘employer’ sponsor of a single multiple-employer ‘employee welfare benefit plan’ and ‘group health plan.   The proposed rule applies only to employer-sponsored health insurance. According to the DOL press release, the rule would:

  • Allow employers to form a Small Business Health Plan on the basis of geography or industry. A plan could serve employers in a state, city, county, or a multi-state metro area, or it could serve all the businesses in a particular industry nationwide;
  • Allow sole proprietors to join Small Business Health Plans, clearing a path to access health insurance for the millions of uninsured Americans who are sole proprietors or the family of sole proprietors

After the Presidential Executive Order was released, consistent with policy adopted at the 2017 MSSNY House of Delegates, MSSNY President Dr. Charles Rothberg issued a statement expressing concerns with the possibility that the expanded use of AHPs could remove oversight of health insurance plans away from state governments, resulting in “more consumers purchasing plans with even more exorbitant out of pocket costs, fewer choices of physicians and a reduction in the ability of patients and physicians to enforce provisions of a health insurance contract”.   MSSNY working together with the AMA and medical </asocieties across the country are analyzing the DOL proposed regulation and will follow up with appropriate comments. (AUSTER)

CMS Announces New Voluntary Bundled Payment Model
The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) announced this week the launch of a new voluntary bundled payment model – the “Bundled Payments for Care Improvement Advanced” (BPCI Advanced model).

Please click here for more information.

The new BCPI Advanced model focuses on 32 different clinical episodes, including major joint replacement of the lower extremity (inpatient) and percutaneous coronary intervention (inpatient or outpatient). CMS notes that the BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM) under the MACRA’s Quality Payment Program.  As such, BCPI Advanced model participants will bear financial risk, have payments under the model tied to quality performance, and are required to use Certified Electronic Health Record Technology. The new CMMI model would allow participants to earn additional payments if “all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.”

The Model Performance Period for BPCI Advanced starts on October 1, 2018 and runs through December 31, 2023. The model will include a formal, independent evaluation process to assess the quality of care and changes in spending under the model.  Applications for participate must be submitted by March 12, 2018.  CMMI will also host an Open Forum on the model on Tuesday, January 30th from 12pm-1pm.
(AUSTER

MSSNY and AMA Working Together to Educate Physicians on Prediabetes and the Prevent Diabetes STAT Toolkit
Diabetes affects more than 25 percent of Americans aged 65 or older, and its pervasiveness is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue.

As part of ongoing work to reduce the incidence of type 2 diabetes nationwide, the American Medical Association (AMA) has commenced a multi-state effort to reach more of the estimated 84 million Americans who unknowingly live with prediabetes.  MSSNY has proudly partnered with the AMA to launch this proactive initiative to educate New York State physicians on how to initiate clinical practice change and prevent diabetes in patient population.

The AMA and Center for Disease Control (CDC) have collaborated to create a comprehensive toolkit that can be utilized by both physicians and patients. The Prevent Diabetes STAT Toolkit incorporates resources to assist with engaging and educating healthcare teams and patients, as well as resources to help healthcare providers seamlessly incorporate screening, testing, and referral systems within their practice. The toolkit enables patients to leave the office with concrete information for later reference. For physicians, the toolkit provides references such as letter/email templates for practices to conduct efficient follow-ups and patient referrals, among other valuable information. To view or download the complete Prevent Diabetes STAT Toolkit, click here.

Please contact Carrie Harring at charring@mssny.org for more information and to express your interest in developing a partnership.                                                  (HARRING)

MSSNY Partners with AMA To Educate New York’s Physicians and Patients on Diabetes Prevention;  Physicians  Encouraged to Take Survey
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York.  MSSNY has developed a short survey to sample physician’s knowledge of the National Diabetes Prevention Program (DPP) and the Prevent Diabetes STAT program. The survey also serves as a platform to physicians to express what specific boundaries they have experienced or anticipate experiencing regarding the implementation of the DPP and/or Prevent Diabetes STAT. Participation in this survey is essential to the development of various educational components that will benefit both the physician and patient communities. Click here to take the survey.

By educating physicians and connecting more patients to evidence-based lifestyle change programs, this diabetes initiative will help bridge the gap between clinical care settings and communities to reduce the incidence of type 2 diabetes. “Improving the quality of prediabetes and diabetes care in medical practices is crucial to the health of New York State’s patient population,” said MSSNY’s President Dr. Charles Rothberg. “Over 700,000 New Yorkers have this disease, yet almost a third are unware.  Educating both physicians and patients about lifestyle changes and diabetes management is a priority, and MSSNY is proud to be partnered with the AMA in an effort to make these necessary changes.”                                                                                                          (HARRING, CLANCY) 

Bill to Prohibit Children From Using Tanning Booths Advances in the Legislature
Senate Bill 5585 A, sponsored by Senator Phil Boyle, has been placed on the Senate Health Committee agenda for next week and would prohibit children under the age of 18 from using tanning facilities.  The bill also removes  the procedures in granting 17 to 18 year olds access to tanning booths and exempts licensed physicians who use or prescribe a phototherapy device with respect to a patient of any age. Current law prohibits children under 16 years of age from using tanning facilities.  Identical legislation (A.7218, Jaffee) is on the Assembly calendar.  The American Cancer Society has noted that the highest risk for skin cancer lies is from the use of indoor tanning facilities.  Moreover, the World Health Organization categorizes tanning devices as its highest cancer risk. It has been found, that using tanning booths before the age of 35 increases the risk of melanoma by 59%, squamous cell carcinoma by 67% a name=”sea”>and basal cell carcinoma by 29%.  The Medical Society of the State of New York strongly supports this measure.  (CLANCY)      

Seasonal Influenza has Hit New York State Early and Hard
New York State saw its first pediatric death from influenza on January 11th.  During the week ending January 6th, there were 3,942 laboratory confirmed cases of influenza, a 37% increase over the previous week.  And there were 1,258 patients hospitalized with laboratory confirmed influenza, a 40% increase over the previous week.  Additionally, 61 counties reported influenza cases during that week.

MSSNY offers several CME courses and podcasts that will help to keep you informed and better prepared to manage this year’s flu season.  Go to https://cme.mssny.org and check out our Medical Matters courses: The Many Faces of Flu, When is the Flu not the Flu, and The Importance of Herd Immunity to learn more about preparing for, diagnosing and treating influenza.

MSSNY also has a podcast available for patients to learn more about the importance of adult vaccines here or you can go to

http://www.buzzsprout.com/51522 for all of MSSNY’s podcasts.                            (CLANCY, HOFFMAN)

Medical Society of the State of New York Announces its January CME Webinar Schedule
The Medical Society of the State of New York is pleased to announce its January free Continuing Medical Education (CME) webinars.  Participation in the webinars will earn physicians one CME credit free of charge.   The January schedule is as follows: 

January 17th at 7:30am – Medical Matters:  Mental Health and Disasters Overview

Register for this webinar here.
Faculty: Craig Katz, MD

Educational Objectives:

  • Explore the psychological impact of mass trauma.
  • Provide physicians with a strong background on both the psychological                  symptoms and syndromes specific to mass trauma.
  • Prepare physicians to conduct acute assessments and interventions.

January 22nd at 7:30amCurrent Concepts in Concussion for Pediatric and Adult Patients

Register for this webinar here.
Faculty: Deborah Light, MD

Educational Objectives:

  • Identify signs and symptoms indicative of concussion as well as red flags that        indicate alternate or more severe pathology;
  • Outline an appropriate management plan for a patient presenting with                  concussion including a return to “normal life” protocol;
  • Describe methods for the primary and secondary prevention of concussion;
  • Identify patients who would benefit from referral to a concussion specialist

January 30th at 7:30amVeterans Matters:  PTSD & TBI in Veterans

Register for this webinar here.
Faculty: Emerald Lin, MD

Educational Objectives:

  • Identify signs and symptoms of PTSD & TBI
  • Examine evidence-based treatment modalities for PTSD & TBI
  • Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture

To view all of MSSNY’s scheduled programs, click here and select “Upcoming”.

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

The Medical Society of the State of New York designates each of these live activities 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.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.                                                                    (HOFFMAN)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
pschuh@mssny.org   mauster@mssny.org  pclancy@mssny.org  

jbelmont@mssny.org charring@mssny.org



enews large


MSSNY Takes Aim at Insurers
From Crain’s NY, 1/2/18:

This year the Medical Society of the State of New York wants the Legislature to take up a number of issues that have made it increasingly difficult to practice as an independent physician in the state.

“Our goal is to help turn around our recent designation as the worst state in the country to be a doctor,” said Moe Auster, senior vice president for legislative and regulatory affairs, referring to rankings published by the website WalletHub.

MSSNY’s top priority is to renew its push for a bill (A.4472/S.3663) allowing independent physicians to form groups to negotiate payment rates with insurers. The organization said this is necessary given actions from insurers, such as EmblemHealth, to cut certain independent doctors out of their networks in favor of larger groups.

It differs from the concept of an independent practice association in that doctors wouldn’t have to be financially or clinically integrated, Auster said. A similar bill was approved by the Senate and Assembly health committees but didn’t make it to a full vote by either chamber.

MSSNY is also advocating for a bill that would give doctors access to an appeal hearing if an insurer doesn’t renew their contract and another that would require health plans to offer a product that covers out-of-network care.

The group will oppose several bills that could increase medical liability costs after suffering a loss last year, when the Legislature passed Lavern’s Law, which pertains only to malpractice cases brought by cancer patients. Gov. Andrew Cuomo has not yet signed the measure, which starts the clock on the statute of limitations at the date of discovery of a medical error, not the date the error occurred. The bill was delivered to the governor on Dec. 29. (Crains)


Don’t ignore what may be our last chance to defeat this detrimental piece of legislation. It takes less than a minute! 

MSSNY Members Only: Unpaid Claims? We Can Help!
In 2016, MSSNY’s Ombudsman Program was successful in recovering $89,815.79 for physicians who had reached a stalemate regarding unpaid claims. From January to June of 2017, the program recovered $121,441.68 for our members who availed themselves of the Ombudsman service. Since then, we recouped an additional $187,447.50.  So, for calendar year 2017, we recovered a total of $308,889.18 for our MSSNY members.

If you are a member in good standing, this service is available to you for FREE! For further information, call 516-488-6100 ext. 334 or 332. 

New York City to Build a New $400 Million Public-Health Laboratory
The Wall Street Journal (1/9) reports that New York City plans to spend $400 million for a new public-health laboratory with greater capacity to handle an emergency, such as Zika or Ebola, after deciding against a renovation of its current facility. The Journal stated that the current facility tests more than 200,000 clinical and environmental samples every year.


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew.
KEEP MSSNY STRONG!


How to Make the Physician-Hospital Relationship a Win-Win for All
SAVE THE DATE for this interactive panel discussion with audience participation, which will kick off the Organized Medical Staff Section annual meeting on Thursday, March 22, 2018, 3:00 – 4:00 pm, at the Adam’s Mark Hotel, Buffalo NY. Two medical staff presidents and two hospital administrators will discuss how to make relationships work in the hospital for everybody’s benefit, and will answer audience questions. Moderator will be Andrew Blustein, JD, an attorney with MSSNY’s General Counsel firm, Garfunkel Wild.

Listen and voice your opinion on what it’s like to work with each other, the highs and the lows, and how to communicate and promote dialogue. RSVP sbennett@mssny.org.


LOBBY DAY IS ON WEDNESDAY,

MARCH 7-MEET YOUR LEGISLATORS!

CALL YOUR COUNTY EXEC FOR INFO

MEDICARE / MEDICAID

CMS Launches New Data Submission System for Clinicians in QPP
On Tuesday, January 2, CMS launched a new data submission system for clinicians participating in the Quality Payment Program. Clinicians can now submit all of their 2017 Merit-based Incentive Payment System (MIPS) data through one platform on the qpp.cms.gov website. Data can be submitted and updated any time from January 2, 2018 to March 31, 2018, with the exception of CMS Web Interface users who will have a different timeframe to report quality data from January 22, 2018 to March 16, 2018. Clinicians are encouraged to log-in early to familiarize themselves with the system. 

How to Login to the Quality Payment Program Data Submission System

To login and submit data, clinicians will use their Enterprise Identity Management (EIDM) credentials.

  • The EIDM account provides CMS customers with a single user identification they can use to access many CMS systems.
  • The system will connect each user with their practice Taxpayer Identification Number (TIN). Once connected, clinicians will be able to report data for the practice as a group, or for individual clinicians within the practice.
  • To learn about how to create an EIDM account, see this user guide.

Real-Time Scoring

As data is entered, clinicians will see real-time initial scoring within the MIPS performance categories. Data is automatically saved and clinician records are updated in real time. This means a clinician can begin a submission, leave without completing it, and then finish it at a later time without losing the information. 

Payment Adjustment Calculations

Payment adjustments will be calculated based on the last submission or submission update that occurs before the submission period closes on March 31, 2018. 

Determining Eligibility

There are two eligibility look-up tools available to confirm a clinician�s status in the Quality Payment Program. Clinicians who may be included in MIPS should check their National Provider Identifier (NPI) in the MIPS Participation Status Tool, which will be updated with the most recent eligibility data, to confirm whether they are required to submit data under MIPS for 2017. For clinicians who know they are in an MIPS APM or Advanced APM, CMS is working to improve the Qualifying APM Participant (QP) Look-up Tool to include eligibility information for Advanced APM and MIPS APM participants. We anticipate sharing this updated tool in January 2018.

CMS Claims New York Owes Them $20 million
New York did not follow federal funding requirements for money it used to set up the New York State of Health marketplace and should refund the Centers for Medicare and Medicaid Services more than $20 million, a federal audit found.

The audit, by the Department of Health and Human Services’ Office of the Inspector General, found that New York’s insurance marketplace improperly allocated costs related to its contract with Maximus, which operated the marketplace’s customer service center from June 2012 to March 2015. It reviewed $39.8 million in contract costs that the state attributed to the establishment grants it was given to set up the marketplace.

The report said New York erred in part because it did not have written policies that outlined how to properly allocate costs and did not establish a basis for the amount of profit Maximus would be able to keep at the beginning of the contract.

CDC To Discuss Preparations for Possible Nuclear War
The Centers for Disease Control and Prevention will give a presentation on Jan. 16 called “Public Health Response to a Nuclear Detonation” with the aim of preparing those who “would be responsible for overseeing the emergency response to a nuclear attack.” Bert Kelly, a spokesman for the CDC, said the agency started planning the event last April, and that the workshop “is part of CDC’s longstanding and routine work, similar to work it does to prepare for other possible health emergencies, with the goal of ensuring the public health community is prepared for all types of health threats.”

The workshop will include sessions titled “Preparing for the Unthinkable,” “Roadmap to Radiation Preparedness,” and “Public Health Resources to Meet Critical Components of Preparedness,” according to the agency’s website about the workshop. https://www.cdc.gov/cdcgrandrounds/archives/2018/January2018.htm


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RENTAL/LEASING SPACE


For Rent or Share (Half days or Full) – Union Turnpike, Queens
A brand new state of the art, beautifully appointed medical building has availability for turnkey share or rent on a busy artery of Queens.  Smartly located in the area bounded by the LIE to the north, Grand Central Parkway to the south, Clearview Expressway to the West and the Cross Island to the East, this office is easily accessible by car with ample parking available at all times of the day.  The building is located on the Q46 bus line with a stop only steps away.  Easy access to all major Queens and western Nassau county hospitals.  There is already in-house patient traffic so this is a great opportunity to build a satellite practice or to start a practice with potential cross-referral benefits.  Very reasonably priced starter options available. Please email queensmedicalhealth@gmail.com or call (917) 860-8307.


Space Available in North Bronx
● Medical Office for Rent
● Located on the Grand Concourse (walking distance from all major transportation)
● 2 Examination Rooms
● Large Waiting Area
● Private Doctor’s Office
● Fully equipped with new furniture
Contact info: jp@bronxheart.com // 718-584-0797


Upper East Side Plastic Surgery Office Available for Rent or Share
Beautifully equipped Plastic Surgery office available for part-time share along with Quad A-certified OR available for rent. Located in a lovely carriage house on the Upper East Side in close proximity to Lenox Hill Hospital and MEETH and conveniently located near all NYC mass transit. 1 exam room/OR and Recovery room along with large administrative space. Free WIFI. Available for </>full or half-days. Suits Plastic/Cosmetic Surgeons/ DERM/ ENT/or other Medical MDs. Please contact Kim at Kim@madisonps.com (212) 628-7600.

Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying To Sell New or Used Medical Equipment?
Clineeds, the new online platformed designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES


Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next </a?generation of primary care. If the fusion of health care and technology inspires you, please apply here.


 


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


 

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