Charles Rothberg, MD
March 16, 2018
Next week is our Annual House of Delegates and I am leaving you in the capable hands of Dr. Tom Madejski. We came up the ranks together and we had brilliant mentors who taught us to follow— then lead. No one is better prepared to lead than Dr. Madejski.
My Three Pillars—Engagement, Disparity, Wellness
This year, membership was key to all of our pillars. The process was uncomfortable for some but it became apparent that we had to be more inclusive if we want to remain viable and true to our physician mission. We need the force of numbers behind our legislative platform if we want to succeed. We must encourage big step-recruiting – group practices, employees, hospital-based specialties, private practitioners who are newly affiliated with a health care system (sometimes through no effort of their own). We must engage physicians where and how they work.
Every physician needs MSSNY!
As to my Three Pillar platform of Wellness, Engagement and Disparity, we made meaningful inroads that will continue as areas of concentration.
Engagement: In addition to revitalizing the way we look at membership, our communications are updated and our social media presence has expanded mightily. We have improved our relations with other medical associations such as the AMA – as evidenced by collaboration on such matters as the Anthem 25 modifier issue. We have made an imprint on others, such as the coalition of state medical societies.
We have engaged the Health Department on education and disaster preparedness. We have fortified our relationships with MLMIC on so many physician programs. And we have collaborated with other provider stakeholders such as the hospital associations.
Big issues require partners. We continue to develop key relationships with New York and national media by delivering timely and decisive positions. We no longer try to be conciliatory when we should be militant.
Wellness: We progressed in studying our Physician Burnout issue under Dr. Michael Privitera’s Committee. Council approved a Peer Program and authorized us to seek the financial backing to start it. The Committee’s scientific papers will be presented at the House.
Disparity: We now have excellent representation on the AMA Committee for Disparity by Dr. Malcolm Reid and Dr. Erick Eiting.
Watch Out for the Big Players
I leave with one caveat! Adverse business practices by the mega-insurance companies is rearing its ugly head again. BCBS is instituting a policy of monitored anesthesia care by the surgeon (instead of the anesthesiologist) during common ophthalmological services (i.e. cataract extraction); Fidelis has instituted a policy requiring authorization for most of the common ultrasound procedures for OB/GYNS; another company is instituting a policy where they will not pay for a Level 4 or 5 ER visit unless the patient is admitted to the hospital. There are many other egregious activities by other plans. Anthem proposed to institute a 50% reimbursement reduction for an E & M visit performed on the same day as a procedure. With the help of the AMA and DFS, we were successful in having Anthem retreat on that proposal.
I don’t know if we have to initiate another class action lawsuit (as we did 18 years ago), but I do know as organized medicine we must speak loudly to the regulatory authorities and our legislature to curb the resurgence of these insurer directed adverse business practices that increase our burdens and decrease the quality of care.
We cannot do this alone. You need to speak to your colleagues, coworkers and any physician you know who is not a member and get them to JOIN US. The more voices, the more valid and powerful we become. If we fail, the insurers will WIN!
Not all stakeholders appreciate us. If they were more clever, they would leverage us as a resource. Good health and good healthcare is robust for us all – even business. Healthcare in NY would be a better system and a better product.
I thank our EVP Phil Schuh for his strong (amazing, actually) guidance and all MSSNY Division Vice-Presidents for their expertise. My predecessor Dr. Malcolm Reid “set the table for me” and I just had to “dig in.” Dr. Frank Dowling and Dr. Marie Basile are great friends, councilors AND counselors! Dr. Josh Cohen and Dr. Parag Mehta and the entire executive committee could not have been a more resourceful team. And this year’s MSSNY council was among the most thoughtful, deliberative and productive in memory. Thanks too to Past Board chair Drs. Scher and Ostuni, current chair Dr. Hamlin and the entire BOT for enabling and guiding our activities this year. And so many more on the MSSNY team.
What did I learn? We can always rely on the decency and humanity of doctors. We all seem to have innate curiosity; we are welcoming and we never seem to stop thinking and creating.
Thank you for letting me share the glory of being a physician!
Charles Rothberg, MD
Please send your comments to email@example.com
Assembly, Senate Advance Budget Proposals with April 1 Deadline In Sight
This week the Assembly and the Senate each advanced their respective “one-House” Budget proposals in reaction to the Governor’s proposed Budget. These proposals will set the stage for intense negotiations as the Governor and the Legislature seek to finalize a State Budget by April 1. In fact, the early arrival of Easter and Passover this year places additional incentive to reach Budget passage by Thursday, March 29.
Assembly One-House Budget
The Assembly Budget proposal deleted nearly all of the initiatives contained in the Governor’s Budget proposal that were opposed by MSSNY. Among the proposals rejected by the Assembly:
- Independent practice authority for CRNAs
- Authorization for corporate-owned retail clinics
- Authorization for patient drug management protocols between Nurse Practitioners and pharmacists
- Steep Cuts to the Patient-Centered Medical Home program
- Authorizations for EMTs to provide non-emergency care in patient homes without any express coordination requirement with that patient’s treating physician
- Elimination of “Prescriber prevails” protections for Medicaid prescriptions
- Significant expansion of the DOH’s Commissioner’s power to investigate physician misconduct, including provisions that would have a) greatly reduced the time to respond to document requests and b) expanded the power to search and seize records and equipment. However, it included a provision to permit the Commissioner to summarily suspend a physician who is both been charged with a felony crime and believed to be an imminent danger to the public as determined by the Commissioner.
The Assembly Budget proposal also included aspects of the Governor’s proposal supported by MSSNY including maintaining the historical funding level for the Excess Medical Malpractice Insurance Program, and taxing e-cigarettes in the same manner as tobacco cigarettes.
Click here to read MSSNY President Dr. Charles Rothberg’s comments on the Assembly Budget proposal.
Senate One-House Budget
The Senate one-House Budget proposal also rejected a number of Executive Budget proposals opposed by MSSNY including:
- Independent practice authority for CRNAs
- Steep Cuts to the Patient-Centered Medical Home program
- Elimination of “Prescriber prevails” protections for Medicaid prescriptions
- Significant expansion of the DOH Commissioner’s power to investigate physician misconduct
- Authorization for patient drug management protocols between Nurse Practitioners and pharmacists.
The Senate Budget proposal also contains important adds, including a new $150,000 appropriation for MSSNY’s Veterans Mental Health Initiative, and a continuation of MSSNY’s Committee for Physicians Health for an additional 5-year period, including an extension of the programs goals to address physician burnout. The Senate Budget proposal also maintained the historical funding level for the Excess Medical Malpractice Insurance Program.
However, the Senate included language opposed by MSSNY to permit corporate-owned retail clinics, though its proposal has significant differences from the Governor’s proposal.
Moreover, the Senate Budget proposal contained a comprehensive proposal to address opioid abuse, which contains a number of important public health improvement initiatives but also several items of concern to place new restrictions on opioid prescribing (see attached article).
Click here to read MSSNY President Dr. Charles Rothberg’s comments on the Senate Budget proposal. (DIVISION OF GOVERNMENTAL AFFAIRS)
March Madness Also Begins in Albany
As both the New York State Assembly and Senate have released their “one-House” Budget proposals this week in reaction to the Governor’s proposed Budget, it sets the stage for round the clock negotiations as the Governor, Assembly and Senate seek to finalize a Budget by April 1, just two weeks away.
This is the time when physicians must be engaged in extensive grassroots communications with their legislators. In this regard, physicians are urged to continue to contact their legislators, and make phone calls, Facebook and Twitter updates, e-mail blasts and other forms of activism on the following issues that will be on the table in the next 2 weeks:
- 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 mall. Sponsors could include a business corporation. 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 Overbroad Prescribing Restrictions (see related article)
While the Senate Budget proposal contains a number of important initiatives to respond to the heroin and opioid abuse epidemic, it also contains a number of proposals to place new restrictions on the clinical decision making authority of physicians to prescribe medications that may be needed by their patients to alleviate pain. To urge your legislator to oppose overbroad prescribing restrictions, 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.
- Oppose 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.
- Oppose Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, forcing physicians to go through even more burdensome prior authorization requirements
- Oppose Overbroad Authority to Investigate Alleged Physician Misconduct that would authorize the Commissioner of Health to obtain a warrant that would allow DOH to search and seize documents, computers and electronic devices where relevant, as well as shorten from 30 to 10 days the time allowed to respond to the Commissioner’s request for relevant information.
(DIVISION OF GOVERNMENTAL AFFAIRS)
Physicians Urged to Contact Legislators on the Senate’s Proposal to Further Limit Opioid Prescribing
There is a comprehensive proposal in the Senate one-House Budget to address the heroin and opioid abuse epidemic in New York. While there are important initiatives contained within this proposal including removal of barriers to patients receiving needed treatment and an expanded drug “take back” program, the Medical Society is concerned that this proposal may also have the effect of discouraging physicians from addressing their patients’ legitimate pain needs.
It would further limit the prescribing of an opioid medication from 7 to 3 days for an initial prescription for acute pain, require parental consent for the prescribing of an opioid to a minor and would also require a detailed written treatment plan for coverage by Medicaid and commercial payors when opioids are used for longer than 30 days.
The Medial Society is concerned that the “law of unintended consequences” could follow with further restricting what was already an arbitrary 7-day limitation on patients’ ability to receive necessary medications, such as a situation where a patient has surgery and is unable to easily return to the physician’s office or hospital if additional pain medications are necessary. These concerns are even more magnified by reducing this 7-day limitation to three days, when many patients post-surgical pain will not have not yet abated. Requiring parental consent for a minor to receive an opioid could also impact on patients’ ability to receive necessary medications. This could also set a precedent for requiring parental consent for minors for certain procedures where our laws do not require receiving such consent. The provision to require a written treatment plan when use of opioids will be longer than 30 days significantly differs from the CDC Guidelines for the treatment of chronic pain which recommends a written treatment plan for use more than 90 days or past the time of normal tissue healing. Physicians are encouraged to send a letter to their legislators. (CLANCY)
Register NOW for MSSNY House of Delegates Live CME Seminars on Thursday March 22nd and Friday March 23rd
The Medical Society of the State of New York will conduct three live seminars at its House of Delegates meeting on March 22nd and 23rd. The programs are opened to all physicians in the western New York area and will be held at the Adam’s Mark Hotel, 120 Church Street, Buffalo, NY 14202. Pre-registration is strongly suggested. The following programs will be offered:
Medical Matters: Disaster Medicine: Every Physician’s Second Specialty
Thursday, March 22nd, 1:00-2:00pm
Faculty: Lorraine Giordano, MD, FACEP, FAADM
* Must attend in person at the House of Delegates.
- Identify core preparedness competencies every physician should know
- Explore essential elements of preparedness plans for staff, patients, and family
- Describe available courses, resources and organizations to obtain disaster preparedness education and training
Bending the Diabetes Curve
Thursday, March 22nd, 2:00-3:00pm
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD
* Must attend in person at the House of Delegates.
- 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
Current Concepts in Concussion for Pediatric and Adult Patients
Friday, March 23rd, 1:00-2:00pm
Faculty: Deborah Light, MD & John Pugh, MD, PhD
* Must attend in person at the House of Delegates.
- 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 (HOFFMAN)
Tickborne Diseases: An update on trends, diagnostics, and emerging infections to be presented at the MSSNY House of Delegates on March 22nd
The New York State’s Department of Health Commissioner’s Grand Rounds session titled “Tickborne Diseases” will be presented as a live seminar at the MSSNY House of Delegates on Thursday, March 22, 2018 from 3-4:30 p.m. at the Adam’s Mark Hotel, 120 Church Street, Buffalo, NY 14202. The purpose of this presentation is to describe the epidemiology of tickborne diseases in NYS, review diagnostic approaches to tickborne diseases, and provide an update on emerging tickborne infections.
Host for the afternoon session will be NYS Health Commissioner Howard A Zucker, MD, JD. Faculty will include C. Ben Beard, MS, PhD, Deputy Director Division of Vector-Borne Diseases. Centers for Disease Control and Prevention; Philip Molloy, MD, Rheumatologist, Nantucket Cottage Hospital, Medical Director for Tickborne Diseases, Imugen Inc.; Michael Ryan, PhD, Director, Division of Laboratory Quality Certification, Wadsworth Center, New York State Department of Health; P. Bryon Backenson, MS, Deputy Director, Bureau of Communicable Disease Control, New York State Department of Health, Assistant Professor, Department of Epidemiology and Biostatistics, University at Albany School of Public Health.
The Grand Rounds session is offered free to all health care providers and advance registration is required. For additional information and to register for this event please see the flyer here.
Continuing Medical Education Credits will be issued by The School of Public Health, University at Albany which is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians. The School of Public Health, University at Albany designates this live activity for a maximum of 1.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (CLANCY)
DOH To Host Buprenorphine Training in Syracuse
The NYSDOH AIDS Institute and Onondaga County Health Department are hosting a Free Buprenorphine Waiver Eligibility Training for Clinical Providers on Saturday, April 21st, 2018 from 8:00AM to 1:00PM at the SUNY Upstate Medical University, 762 Irving Ave, Setnor Hall, Room 3509-3510, Syracuse, NY 13210.
Trainers for the event are:
Ross Sullivan, MD, SUNY Upstate Medical/Upstate University Hospital, Syracuse, NY
Laura Martin, DO, ACR Health & MyCare Syracuse Family Practice, Syracuse, NY
Please Note: CME Credits will be made available. This is the first half of the minimum required 8 hours of training, and the second half must be completed online after attendance to the live training. Currently NPs & PAs are required to take an additional 16 hours of online training which is available on the PCSS-MAT website (Part 2).
Upcoming NYSDOH Spring/Summer Waiver Trainings (contact DOH for more info):
April 28th – Schenectady County
May 5th – Columbia County
June 2nd – Sullivan County
June 23rd – Dutchess County
Dates TBD – Westchester County, Broome County, Long Island
For more information about the Clinical Education Initiative and their opioid resources, please visit https://ceitraining.org/resources/opioid. For more information about NYSDOH buprenorphine related trainings, mentoring, coaching, technical assistance and more, please contact us at firstname.lastname@example.org or 1-800-692-8528. (CLANCY)
For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
Physician Advocacy Institute Study: 42% of Physicians Are Employed by Hospitals
On March 14, the Physicians Advocacy Institute (PAI), of which MSSNY is a charter member and a member of the Board of Directors, released a report that updates a previously-released study conducted by Avalere Health that examined the continued growth in hospital acquisitions of physician practices and the trend toward physician employment. The new study adds an additional year of data to the earlier study, which reviewed the period from mid-2012 to mid-2015.
Avalere researchers found that by mid-2016, hospitals acquired an additional 5,000 medical practices, and physician employment grew 11% from a year prior. By 2016, 42% of physicians were employed, as compared to just one in four in 2012. In a regional analysis, researchers found growth in hospital acquisitions of medical practices in every region of the country, ranging from 83% to 205% over the four-year period. PAI is studying these trends as part of an ongoing research collaboration with Avalere Health in order to better understand how physician employment and consolidation in the health care system affects the practice of medicine and impacts spending by payers and patients.
Invitation to MSSNYPAC Network Reception
Charles Rothberg, MD and the MSSNYPAC Executive Committee cordially invite you to attend the MSSNYPAC & Physician Advocacy Liasion Network Reception.
When: Friday, March 23, 2018 at 3:30-5pm
Where: Adam’s Mark Hotel Buffalo Grand Ballroom E
Admission: FREE Open Bar * Lite Fare * Business Attire
We ask all attendees to bring a colleague to the reception (physician, resident or medical student).
Join us for a candid discussion with physicians from around the state about the PAL Network we are building, collective political action and state-wide grassroots activities. We will explore the relationship of advocacy to patient care and how engaging with policymakers to assure patients continue to receive the care they expect and deserve is a vital aspect of the practice of medicine.
To learn more visit www.mssnypac.org/PAL
View the invitation here. RSVP to email@example.com or send a text to 914-933-7722
Residency Match Is Largest Ever Per National Resident Matching Program (NRMP)
NRMP announced today that the 2018 Main Residency Match is the largest yet, with a record 37,103 US and international applicants listing program choices for 33,167 positions. The number of first-year (PGY-1) positions increased by 1383 from last year and now stands at 30,232.Of those 30,232 positions, nearly half (14,695) were in primary care: family medicine; internal medicine; internal medicine–pediatrics; internal medicine–primary; and pediatrics. Within the primary care slots, 14,333 (97.5%) were filled, and 7104 (48.3%) were filled by US allopathic seniors. Since 2014, the number of primary care positions has grown by 1713, or 13.2%. The following is the breakdown of primary care highlights from 2018.
NYT Prints Letter to Editor from MSSNY Past President Robert Goldberg
To the Editor:
“The Price They Pay” (Science Times, March 6) puts a face on “Why Your Pharmacist Can’t Tell You That $20 Prescription Could Cost Only $8” (news article, Feb. 25).
Anyone watching the effort by CVS to buy Aetna should be alarmed by the prospect of a future filled with medication denials and cost shifts to the sickest in our midst.
Imagine the power and conflict in having Aetna determine the tier of a drug and letting CVS bill at least a third of the list price to the patient to save Aetna money.
Worse, a person examined by a nurse in a CVS walk-in clinic may be prescribed a drug that might have a cheaper alternative. Unbeknown to the patient, the pharmacist is prohibited from revealing that.
New York State prevents doctors from owning a pharmacy, to avoid a scenario of having their patients exit through it as through a museum gift shop. The cost of drugs, the proposed merger and the gag orders translate to staggering human suffering.
REGISTER NOW for MLMIC’s Free Risk Management Conference in Buffalo
When: March 22, 2018 at 9:30am
Where: Adams Mark Hotel – Buffalo, NY
MLMIC is pleased to invite you to attend its Risk Management Conference on Thursday, March 22, 2018, at the Adams Mark Hotel in Buffalo, New York (The morning of the MSSNY House of Delegates). The program will run from 9:30 a.m. to 12:30 p.m. During this year’s event, which qualifies physicians for CME credit, experts will examine current risk management issues facing all specialties.
Topics will include:
- Effective Coordination of Care: The Role of the Hospitalist
- The Physician-Patient Relationship: A Closer Look
- 2018 Healthcare Law Review
Attendance at this complimentary educational event will enable physicians to earn a maximum of 3.0 AMA PRA Category 1 Credits™
Click on the link below to register at www.mlmic.com/2018risk; or REGISTER BY E-MAIL
Forward this e-mail with your full name to firstname.lastname@example.org
To REGISTER BY FAX: Print and Fax this e-mail with your full name to 212-300-9406
MLMIC is accredited by the Medical Society of the State of New York to sponsor continuing medical education for physicians. MLMIC designates this live activity for a maximum of 3.0 AMA PRA Category 1 CME Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the program.
9:00-9:30 a.m. Registration and Continental Breakfast
9:30-10:30 a.m. Effective Coordination of Care: The Role of the Hospitalist
John Krisa, MD
Hospitalist and Physician Advisor for Acute Care Troy
St. Peter’s Health Partners
10:30-11:30 a.m. The Physician-Patient Relationship: A Closer Look
Carol S. Doty, Esq. – Partner
Jonathan D. Rubin, Esq. – Senior Partner
Kaufman Borgeest & Ryan, LLP
11:30-12:30 p.m 2018 Healthcare Law Review
Nancy May-Skinner, Esq.
Fager Amsler Keller & Schoppmann, LLP
The Legal Pitfalls of HIT Technology: Mitigating the Risks on Sat., April 28
Join the Medical Society of the County of Kings for an informative program entitled “The Legal Pitfalls of EHR Technology: Mitigating the Risks. The program is supported by both MSSNY and Medical Liability Insurance Company (MLMIC).
Topics will include the legal pitfalls of Cut and Paste, Copy Forward, Metadata, Burnout, Privacy and Security and will be presented by physicians and attorneys who are national experts in the field. There is no charge for NY physicians, NPs, PAs and invited guests. Breakfast and lunch will be provided.
When: Saturday, April 28, 2018, 8:30am-3pm
Where: Brooklyn Borough Hall, 209 Joralemon Street, Brooklyn, NY 11201
Click here for the flyer. Or contact Liz Harrison, Executive Director of the Medical Society of the County of Kings at liz@MSCK.org or 718.745.5800.
“Wave of Mergers” Leaves Long Island With Only One Independent Hospital Left
Newsday (NY) (3/15) reports there is only one independent hospital left on Long Island following “a wave of mergers.” Hospitals have merged “with larger health systems” for many reasons including access to services, funding, and increased negotiating power.
Higher Prices, Not Higher Use
The United States spends nearly twice as much on health care as 10 other wealthy nations, according to a study published on March 13 in JAMA. The study suggests that the United States does not spend more because U.S. residents use more services, but because U.S. residents pay more for procedures and treatments.
Gun Violence: APHA Offers Free Access to Gun Violence and Public Health
The American Public Health Association is offering free access to its archive of peer-reviewed, published research on gun violence and public health. “With the Centers for Disease Control and Prevention functionally barred from conducting meaningful research on firearm violence by Congress, the public health community is stepping up to fill the knowledge gap,” said Dr. Alfredo Morabia, editor-in-chief of AJPH, in a statement.
|MIPS, NGS, CMS|
MIPS Filing Deadline
By now, you should know that the deadline for filing MIPS claims data is MARCH 31. MSSNY has been working with The Physicians’ Advocacy Institute (PAI). PAI’s MACRA resource center is here.
For those of you who need help in submitting your 2017 MIPS data, we suggest that you call the MACRA Help Group at IPRO IPRO; 518-320-3508. Or complete details and the latest information, visit the CMS QPP website here. For questions, contact the QPP Service Center by phone at (866) 288-8292 or by email at QPP@cms.hhs.gov.
Revised: Important Notice Re Handwriting on Claims Submitted to Medicare
On Monday, 7/10/2017, NGS began returning paper claims submitted with handwriting on the face of the claim that is not a signature field, (i.e., Items 12, 13, or 31). A notice will be attached to the front of the returned claim and a new claim will need to be submitted.
NGS has been rolling out the return of handwritten paper claims on a state/locality basis and by June 2018, all handwritten paper claims with handwriting other than in the signature field will be returned to the provider.
NGS has published an informative article titled, “Revised: Important Notice Regarding Handwriting on Claims Submitted to Medicare.” Please click on the link to review the schedule of implementation dates and nonpaper claim submission alternatives we offer.
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