March 24, 2017 – GOP Cancels Healthcare Vote

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
March 24, 2017
Volume 17
Number 12


Breaking News: House Republican leaders abruptly pulled a rewrite of the nation’s health-care system from consideration on Friday

MLMIC Insurance

Dear Colleagues:

This week, as Congress was feverishly debating whether to take up legislation that would change much of the Affordable Care Act (ACA), the MSSNY Executive Committee issued a statement highlighting both the positive and negative aspects of the proposed American Health Care Act (AHCA).

As a diverse group, our MSSNY members have a wide array of perspectives regarding whether they believe the ACA has been a success or a failure.  As a society that represents physicians of every region, of every specialty, and of every type of practice setting, extensive debate is to be expected.  The ACA was the most significant health care law enacted in our generation.  Regardless of our personal viewpoints on the ACA, most physicians would likely agree, that it is important that our policymakers address problems such as the narrow networks and use of high deductible plans that have clearly accelerated since the ACA went into effect.

In this regard, our statement acknowledged some of the positive aspects of the legislation before Congress, including ideas adopted at the MSSNY House of Delegates such as:

  • expanded use of Health Savings Accounts to provide health insurance coverage; and
  • preventing implementation of a tax on comprehensive health insurance coverage, also known as the “Cadillac Tax”, which would disincentivize employers from offering plans that limit patient cost-sharing.

At the same time, our statement expresses significant concerns regarding the impact that this bill may have for many of our patients who currently receive coverage through the “Essential Plan,” or expanded Medicaid.  The provisions of the AHCA under consideration  may cause patients to face  far greater out of pocket costs for plans that may not be as generous as what they are currently receiving under the ACA.  In fact, many patients may choose simply not to buy health insurance coverage at all.

That is a serious problem with this proposed legislation, which we hope can be addressed as Congress continues to debate how best to fix the ACA.  We also hope it is an opportunity to look at other issues that we believe impact upon health insurance costs, such as the excessive liability exposure faced by physicians, as well as the extraordinary market power held by the health insurance industry, not only in New York but also throughout much of our country.

For too long, debate over the ACA has been dominated by those who either want to completely eliminate it, or those who have been reluctant to change any aspect of it. In my opinion, neither side is correct.

It is my hope that the debate currently before Congress is the first step, not the last step, towards making necessary changes to improve the availability of affordable and comprehensive coverage options for our patients. For the benefit of our patients, let’s continue this conversation.

Please send your comments to comments@mssny.org




Final Stretch of NY Budget Negotiations
It comes down to just a few days.

Budget negotiations have entered their final stages as Governor Cuomo and legislative leaders iron out the details of a final State budget agreement. It is expected that “round the clock” talks will continue through the weekend and into early next week.  The final budget is due by April 1st. While the NYS Senate and NYS Assembly’s “one-House” budgets rejected several Executive Budget provisions that had been opposed by MSSNY, these provisions could still end up in the final enacted budget.

It is critical that you contact your legislators to ensure that they hold strong and to urge that they:

Critical items also under discussion in the final days of Budget negotiations include Workers Compensation reform, as well as proposals advanced by the Governor (and supported by MSSNY) that would directly regulate Pharmaceutical Benefit Managers, and regulate e-cigarettes under the “Clean Indoor Air” Act. To View a chart listing all of the Budget proposals in which MSSNY is engaging, please click here.   (Belmont)

Lacking Votes to Pass, ACA Repeal Bill Pulled From Consideration on House Floor
After a substantial floor debate on Friday afternoon, leaders of the US House of Representatives pulled from consideration the American  Health Care Act (AHCA), legislation to repeal and revise many aspects of the Affordable Care Act (ACA).  The bill was pulled from consideration when it appeared that there would not be enough votes for the bill to pass the House.

On Thursday, MSSNY President Dr. Malcolm Reid issued a statement developed by MSSNY’s Executive Committee shared with the New York Congressional delegation noting the need to fix the flaws of the ACA, and that the legislation had some beneficial provisions.  However, the statement also highlighted the concerns with provisions in the AHCA “that may cause New Yorkers who currently have low cost, ‘first dollar’ coverage to instead purchase coverage with high deductibles and other high cost sharing responsibilities.  Moreover, the statement noted our concerns regarding the “long-term impact of the AHCA on New York State’s Budget finances”.

As has been previously reported, several health care and patient advocacy organizations, including the AMA, AARP, the American Cancer Society, the Greater New York Hospital Association and the Healthcare Association of New York State (HANYS) had expressed strong concerns with the proposal.  Governor Cuomo also has issued several statements opposing the AHCA by highlighting the district by district financial impact on hospitals and nursing homes if the bill were to be enacted.

The proposal would have kept some of the popular provisions from the ACA, including required coverage for pre-existing conditions, prohibiting annual and lifetime limits, and requiring dependent coverage up to age 26.   It would also significantly expand the amount of funds that a person could direct to their Health Savings Account.

At the same time, the bill would have substantially revised ACA rules that facilitated various subsidized coverage programs for those who make up to 400% FPL ($94,000 for a family of 4).  While the expanded eligibility for Medicaid (up to 138% FPL) would be available through the end of 2019, starting in 2020 such expanded coverage would only be continued for those who had such coverage prior to the end of 2019.  The AHCA would also repeal the tax credits currently provided to help cover cost-sharing amounts for coverage for individuals who earn too much to qualify for Medicaid.

Instead, tax credits of $2,000-$4,500 (depending upon age) would be provided to enable the purchase of health insurance coverage.   Tax credits will be available in full to individuals earning less than $75,000 and households earning less than $150,000, but they will be capped for higher earners.  It appears as if the AHCA would have also completely eliminated funding for New York’s Essential Plan, which provides low-cost health insurance coverage with little cost-sharing responsibilities for over 600,000 New Yorkers who make between 138% and 200% of the FPL.

The bill would have repealed several other notable ACA provisions, including the requirement for all individuals to have health insurance coverage, the large employer coverage mandate, the provision to impose a “tanning” tax and a provision that limits the tax deductible treatment for health insurers of executive income that exceeds $500,000.

As of this writing, it is unclear how the legislation will be revised to garner majority support.  Please remain alert for further updates.        (AUSTER)


Increase in Cases of Hepatitis A among Men Who Have Sex with Men Reported in NYC
The New York City Health Department has noted an increase in hepatitis A cases among men who have sex with men (MSM) who did not report international travel.  There have been five cases of hepatitis A among unvaccinated MSM since January 1, 2017 and three of the five patients were hospitalized and all patients have recovered.   Since 1996, the Advisory Committee on Immunization Practices (ACIP) has recommended that all MSM receive two doses of hepatitis A vaccine; the second dose should be administered 6-12 months after the first dose.   The New York City Department of Health has issued Alert #6 and has sent a letter to all providers in the New York City region.   A copy of the letter can be found here.         (CLANCY)


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


SAVE THE DATE for Veterans’ Mental Health Training Initiative: CME Programs and Panel Discussions
The Medical Society of the State of New York, along with the New York State Psychiatric Association and the National Association of Social Workers will hold a two-day Veterans’ Mental Health Training Initiative: Addressing the Unspoken Needs of Veterans.

This two-day event will be held on Friday, May 5 (1-4:30 p.m.) and Saturday May 6 (8:30 a.m.-3 p.m.) at the Clarion Hotel and Conference Center, 3845 E Veterans Memorial Hwy, Ronkonkoma, NY.  Physicians are urged to reserve the dates for participation in this weekend.  Reservation links will be forthcoming for the entire conference.

The program will include three continuing medical education (CME) seminars on PTSD and TBI, Substance Use Disorders, and Suicide as well as panel discussions on the Dwyer Peer to Peer Program, Diversity among Veterans, and veteran-driven case studies.

Faculty for the CME programs includes Frank Dowling, MD, Thomas Madjeski, MD, and Adolph Meyer, MD. Physicians can register for all or part of the three CME programs. Just click on the program name listed below.

PTSD and TBI
Friday, May 5, 1:15 p.m.
Faculty Presenter: Thomas Madjeski, MD
The educational Objectives for the PTSD program are:

1)  Describe the symptoms of PTSD and TBI.

2)  Describe the treatment modalities of PTSD and TBI.

3)  Describe military culture & how to overcome unique barriers                 to treatment intrinsic to military culture

Suicide
Friday, May 5, 2:30 p.m.
Faculty Presenter: Frank Dowling, MD
The educational Objectives for the Suicide program are:

1)   Address the causes and warning signs of suicide and suicidal                  behavior among veterans.

2) Explore the best evidence-based diagnostic and treatment                       options available including psychotherapy and
pharmacotherapy.

3)  Identify barriers in military culture to identification and                             treatment and how to overcome them.

Substance Use Disorders
Saturday, 10:45 a.m.
Faculty Presenter: Adolph Meyer, MD
The educational objectives for the Substance Use Disorders program are:

1)  Explain substance use disorders (SUDs), symptoms, warning                   signs, comorbidities

2)  Explore treatment options for veterans including evidence-                      based practices in psychotherapy and pharmacotherapy

3)  Identify barriers to identification and treatment, including                        those unique to military culture, and how to overcome them

Veterans Matters is a CME series made possible through a grant from the New York State Office of Mental Health.

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 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.  (ELPERIN)


MSSNY to Hold CME Webinar on Concussion in Pediatric and Adult Population on April 19th; Registration Now Open
The Medical Society of the State of New York will hold a Continuing Medical Education (CME) webinar on the “Current Concepts in Concussion for Pediatric & Adult Patients” on Wednesday, April 19, 2017 at 1 p.m. for all physicians and other health care providers.  Registration for the webinar is now open HERE.

Faculty for the course will be John Anthony Pugh, MD, PhD, assistant professor of Neurology at Albany Medical Center (AMC), and Deborah Ilana Light, MD, primary care sports medicine and associate program director for the Sports Medicine Fellowship at Albany Medical Center.  Educational objectives are: 1) Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology; 2) Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol; 3) Describe methods for the primary and secondary prevention of concussion; 4) 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.  (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

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AG: Three Heart Monitor-Related Apps Are Not Medical Devices nor FDA Approved
Today, Attorney General Eric T. Schneiderman announced settlements with three popular health-related applications sold in Apple’s App Store and Google Play regarding misleading claims and irresponsible privacy practices. The settlement follows a year-long investigation of mobile health applications and requires the implicated companies and developers to amend deceptive statements about their apps and modify their privacy policies to better protect consumers, while also making clear that their apps are not medical devices and are not approved by the U.S Food and Drug Administration. The Attorney General today announces settlements with the following app developers:

  • Cardiio, an American company that sells Cardiio, an app downloaded hundreds of thousands of times that claims to measure heart rate. The developer had not tested its accuracy with users who had engaged in vigorous exercise, despite marketing the app for that purpose. The developer also misleadingly implied that the app was endorsed by MIT.
  • Runtastic, an Austria-based company that sells Runtastic, an app that purports to measure heart rate and cardiovascular performance under stress. Yet the developer failed to test its accuracy with users who had engaged in vigorous exercise, despite marketing the app for that purpose to the 1 million people who downloaded it.
  • Matis, an Israel-based company that sells My Baby’s Beat, an app downloaded hundreds of thousands of times, which Matis previously claimed could turn any smartphone into a fetal heart monitor, despite the fact that it has never been approved by the FDA. Although Matis exhorted consumers to use My Baby’s Beat rather than a fetal heart monitor or Doppler, it never conducted, for example, a comparison to a fetal heart monitor, Doppler, or any other device that had been scientifically proven to amplify the sound of a fetal heartbeat.

Additionally, the developers now post clear and prominent disclaimers informing consumers that the apps are not medical devices and are not approved by the FDA.


 MLMIC’s Risk Management Conference for Physicians on April 20 at HOD
In partnership with MSSNY and the 2017 MSSNY House of Delegates, Medical Liability Mutual Insurance Company (MLMIC) will be hosting its first House of Delegates Risk Management Conference on Thursday, April 20, 2017 at 9:30 a.m. at the Westchester Marriott in Tarrytown, NY.  Attendance at this complimentary educational event will enable physicians to earn AMA PRA Category 1 Credits™.

In this program, a renowned attorney from Fager Amsler Keller & Schoppmann, LLP, specializing in healthcare law will address recent legislative, regulatory and malpractice case law developments that impact the provision of healthcare.

The program will also feature risk management advice on electronic health records (EHRs) and their associated liability risks.  A highly regarded malpractice defense attorney and a physician expert and MLMIC Risk Management Consultant will discuss a number of topics, including the legal pitfalls of EHRs and the proper use of EHR features such as templates, the copy and paste function, and auto-population.  Recommendations will be provided to help improve medical and legal documentation and reduce potential liability exposures.

All NYS physicians are welcome to attend.  Pre-registration is required and space is limited. Register Today 


Multiple Physician Positions with DOHMH Office of School Health
Office of School Health is the largest program of the New York City Department of Health and Mental Hygiene (DOHMH). This bureau is responsible for managing the health issues and promoting the well-being of the over 1.3 million children and adolescents enrolled in New York City’s 1700 school buildings.

Positions with the Office of School Health (OSH) combine clinical skills and public health training. OSH focuses on child health, asthma prevention, obesity and nutrition, vision screening, dental care, mental health, reproductive health, and childhood disability. We collaborate with various city and community based agencies to provide social and academic services to address the needs of all New York City school children, especially those facing the most significant social, economic, and health challenges.

The Office of School Health is currently undergoing expansion. There is an immediate need for physicians with an expertise in pediatric, adolescent, or family medicine, with the capacity to utilize primary care skills set through a public health lens. OSH is also  interested in public health and preventive medicine graduates with programmatic, analytic, and social medicine skills.

The NYC DOHMH is reaching out to identify candidates for this recruitment. We are enlisting your help to nominate medical professionals who are committed to contributing their talents to improve health and academic outcomes in our schools. Please consider applying for these positions or passing these opportunities on to talented physicians among your own personal networks.

Attached are the American Academy of Pediatrics position statements on the role of the School Physician as well as the job description and recruitment flyers:

  • Adolescent School Health Physician, Family and Child Health/SH Reproductive/City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 277208
  • Field Doctor, Bureau of School Health/SH Medical (pre-K-8 Programs or High School) City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 265869
  • Supervising Medical Doctor, Bureau of School Health/SH Reproductive Health, City Medical Specialist, Level: 02/Part-time (35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ Job ID:  277026

Please list in your cover letter how you heard about this position (including name of the professional association, website, or individual who referred you). If you have questions, please contact Caroline Volel, MD, MPH at OSH@health.nyc.gov.


Weekly Charting Tip: Fair Market Value v. Commercial Reasonableness
In order to comply with three different federal laws, it is very important that you document the fair market value (FMV) and commercial reasonableness of the “arrangement” at issue. Fair Market Value is “the value in arm’s length transactions, consistent with the general market value”. In other words, if I were a stranger, and I wanted a similarly situated arrangement, what would it be worth? There are professional people who actually will prepare a FMV report for you. This is the safest way of doing it. What do rents go for in the same area for a similar amount of space? You can factor in closeness to public transportation, parking lots and the like. Commercial reasonableness encompasses both the series and payment for them. Is it reasonable to pay a neurologist say $300,000 for the 40 hours a week you are offering? That depends on the location and what is expected of the neurologist. Areas with many neurologists tend to offer less. Rural areas may offer more. Think supply and demand. If a deal is too good to be true, it probably is!

–Larry Kobak, Esq., LKobak@DrLaw.com

If you have any questions, please contact Kern Augustine, P.C. at 1-800-445-0954 or via email at info@DrLaw.com.


BECOME A LEADER IN HEALTH PROFESSION EDUCATION. ATTEND AN EVENT TO GET MORE INFORMATION ABOUT THIS DYNAMIC PROGRAM AT HOFSTRA UNIVERSITY
Hofstra University’s Master of Science in Health Professions Pedagogy and Leadership
is a program designed to prepare clinicians who provide care to patients with an expanded role as an educator for students, residents, externs and fellows and to advance in leadership roles in their field. The focus of the program is on advancing teaching, leadership and research skills applicable to established healthcare educational environments. All health professionals and administrators interested in teaching in their clinical fields of expertise, overseeing educational programs, or preparing for leadership roles can benefit from this program, which is offered in a hybrid, executive format.

Attend one of the following to learn more information about this dynamic MS program:

ONLINE WEBINAR
Tuesday, April 18, 2017 @ 5:30pm
Register

IN PERSON
Monday, April 24, 2017 @ 5:30pm
Center for Learning and Innovation (CLI)
1979 Marcus Avenue Suite #101
Lake Success, NY 11042
Register

In addition, you may contact Dr. Alice Fornari, Program Director, at Alice.Fornari@hofstra.edu for more information.


Pediatrics: Calls to Poison Control-60% re Kids Under Five; 30% Are Teenagers
A study published in Pediatrics  indicates that “from January 2000 until December 2015, about 188,000 calls were placed to poison control centers regarding pediatric and teenage exposure to opioids.” The data indicated “sixty percent of the children exposed to opioids were younger than 5, while teenagers accounted for 30 percent.”

A companion paper in Pediatrics  reports a strong link between prescribed opioids and their recreational use.” The study indicated that “teens who abused opioids were often prescribed the drugs at some point by a physician.”


Match Day Madness!
The Upstate Medical University Class of 2017 presents 2017 Matchin’, a parody of 24k Magic, in celebration of their Match Day! https://www.youtube.com/watch?v=sk6AyP4u2f0


CDC: Four Countries Added to Interim Travel Guidance
The CDC is working with other public health officials to monitor for ongoing spread of Zika virus‎. On March 10, 2017 CDC posted a Zika virus travel notice for Angola, Guinea-Bissau, Maldives and Solomon Islands. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika. For a full list of affected countries/regions, visit http://wwwnc.cdc.gov/travel/page/zika-travel-information.

To help pregnant women and others identify areas of Zika risk, CDC published a new interactive World Map of Areas with Zika Risk that allows people to search for location-specific Zika information and travel recommendations. CDC also published an interactive “Know Your Zika Risk” tool that offers tailored risk and prevention messages based on information provided by travelers.  In addition, CDC’s Zika testing recommendations for pregnant women have been aligned with these three risk categories, as depicted in a new map for healthcare providers to use for evaluating and caring for pregnant women possibly exposed to an area with Zika risk.

CDC update
From January 1, 2015 to March 15, 2017, there have been 5,139 Zika virus disease cases reported in the US. Of these cases:

  • 4,842 cases were in travelers returning from affected areas
  • 222 cases acquired through presumed local mosquito-borne transmission in Florida (N=216) and Texas (N=6)
  • 75 cases acquired through other routes, including sexual transmission (N=45), congenital infection (N=28), laboratory transmission (N=1), and person-to-person through an unknown route (N=1).

Meanwhile there were 1,534 pregnant women with any laboratory evidence of possible Zika virus infection in the US as of February 21, 2017.


Join Nassau County for Dinner and CME Program on “Frontiers in Cellular Therapy”
The Nassau Academy of Medicine and the Nassau County Medical Society Joint Membership Meeting will be held on TUESDAY, MARCH 28, 2017 at the WESTBURY MANOR, 1100 Jericho Turnpike, Westbury. Complimentary Dinner Meeting for NCMS / NAM Members. Non-members and their staff may attend at $25 per person. Seating is limited. REGISTRATION is at 6:30PM; dinner and meeting at 7:00PM.  PRE-REGISTER NOW – Send E-Mail Response To: NASSAUMED@GMAIL.COM The CME Program, “NEW FRONTIERS in CELLULAR THERAPY” will be presented by Patricia Shi, MD, MS, Medical Director, Therapeutic Apheresis and Cellular Therapy Collection Service, New York Blood Center

Educational Objective:  At the end of this CME activity, participants should be able to; distinguish between the various types of cellular therapies being investigated; understand the potential risks, benefits, and unknowns of such therapies and become familiarized with ethical concerns and questions raised by the advance of cellular therapy. 

Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of the Suffolk Academy of Medicine and the Nassau Academy of Medicine. The Suffolk Academy of Medicine is accredited by MSSNY to provide Continuing Medical Education for physicians. The Suffolk Academy of Medicine designates this live educational activity for a maximum of 1 AMA PRA Category 1 Credit. Physicians should claim



CLASSIFIEDS


Prime NYC Space for Rent
Prime Midtown Manhattan space two blocks away from Grand Central Station
next to Park Ave. 3100 RSF with nine windows in a professional building filled with MDs and DDSs. $59/RSF please inquire at wnyllc@aol.com



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities

Internist Needed Mon.-Fri. for Psychiatric Inpt in Queens
Internist needed for Full time general medical care of psychiatric inpatients.  Creedmoor Psychiatric Center is in Queens, and convenient to NYC, Nassau/Suffolk and near major transportation.  We are a small well organized Medical Department looking for another member.  Our physicians enjoy their work- life balance. Please contact: alan.diner@omh.ny.gov or call 718-264-4046

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.


Ophthalmologist Part Time
Ophthalmologist needed to work at multiple nursing homes in all 5 boros except Staten Island. Part time or full-time position available.  Generous salary and incentives.Ttech provided. Opportunity to perform surgery, but not required. Please email cv to privacyssw@gmail.com


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

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

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

March 17, 2017 UnitedHealthcare Council: Any Questions?

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
March 17, 2017
Volume 17
Number 11

MLMIC Insurance

Dear Colleagues:

UnitedHealthcare Physician Advocacy Council: Any Questions to Ask Them?

As part of the last legal settlement with United that was concluded in 2015, United agreed to the formation of a Committee referred to as the PAC – Physician’s Advisory Council.  MSSNY has FOUR physician members who are on the UHC PAC.  The Committee meets FOUR times a year with similarly named physicians from United.  One criteria for being on this group is that the physician must be participating with United.

We are meeting again on Tuesday, March 28 and need your input.

MSSNY is asking members if they have specific issues with United that we can address and advocate for on your behalf. If you have a concern, please send an email to Regina McNally, VP, Socio-Medical Economics.  Please state the subject as “UHC PAC Item,” and send your email to rmcnally@mssny.org  MSSNY email is not HIPAA-secure, so please do NOT include any PHI! The Committee addresses any issue of contention, either operational or administrative, in dealing with United.

While issues are discussed at length, the agreement stipulates that UHC is there to listen and report back to the UHC leadership on items discussed. Optimistically, the discussion should then lead to a resolution of the issues.

The spirit of the settlement agreement is that MSSNY could share subject matters at a high level to garner a better relationship with UHC. MSSNY Surveys indicate that most of our members participate with UnitedHealthcare; I am certain that many of you have had issues that are discussion worthy.

To ensure that the Council is successful, we need your participation.

Please send your comments to comments@mssny.org




Senate And Assembly Advance One-House Budget Proposals; 3-Way Negotiations To Begin
This week, the New York State Assembly and Senate each released and passed their respective proposals to amend the Governor’s proposed State Budget for 2017-18.  The passage of these resolutions identifying key priorities sets the stage for 3-ways negotiations with the Executive to pass an agreed upon budget before the deadline of April  1, 2017.   To view a chart of key changes to the Executive Budget click here.  Some of the important provisions contained in these proposals of interest to physicians and their patients:

  • Both the Assembly and Senate rejected an Executive Budget proposal opposed by MSSNY that would require a physician to receive a “tax clearance” as a pre-condition of receiving Excess medical malpractice insurance coverage.  Both Houses accept the Executive’s recommendation, supported by MSSNY, to continue funding the program at historical levels.
  • Both the Assembly and Senate rejected an Executive Budget proposal opposed by MSSNY that would have  permitted pharmacists to enter into “comprehensive medication management protocols” with   nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or who have not met clinical goals of therapy.
  • Both the Assembly and Senate rejected the Executive Budget proposal opposed by MSSNY that would repeal “Prescriber prevails” protections in fee for service Medicaid and for several drug classes in Medicaid managed care.  Instead, the Assembly proposes to expand “prescriber prevails” across the entire Medicaid managed care program.
  • The Assembly rejected the Executive Budget proposal opposed by MSSNY to create a Regulatory Modernization Team.  The Senate included language to establish a workgroup but narrowed the scope, deleting the topic included in the Executive Budget proposal of revising “scope of practice” laws and deleting provisions that would give power to various agency commissioners to implement demonstration programs without the need for legislative approval.
  • The Assembly included an Executive Budget proposal supported by MSSNY to require the registration of PBMs and to disclose financial incentives to the State.  The Senate did not include this provision, instead requiring PBMs to disclose information to the health plans they contract with.
  • The Assembly included a proposal included an Executive Budget proposal supported by MSSNY to regulate vapor products under the “Clean Indoor Air” Act and to tax these products.  The Senate included language to regulate vapor products, but did not include the taxing provisions.
  • Both the Assembly and Senate included an Executive Budget proposal that would permit Medicaid to drop prescribers from the program who violate statutory opioid limits.  At MSSNY’s request, the Senate included language to assure that there first be a legal determination that the prescriber did in fact violate the opioid limit rather than giving Medicaid officials arbitrary authority to make this determination.
  • The Senate advanced a new proposal in its one-House to include information on physician profiles that detail each physician’s health plan participation information that DOH currently collects.   The information would be required to be included on the profile by DOH, not the physician, based on information maintained by DOH.  The proposal would also enable a physician to designate staff to complete and update the physician’s profile information.  The Assembly does not include a similar proposal.
  • The Senate proposed Workers’ Compensation reform, indicated it “will work to reduce the unsustainable cost increases for employers, while continuing to protect injured workers”. Suggested reforms include: updates to durational caps and schedule loss of use awards; ensuring prompt access to quality medical care and lost wage benefits; enhanced incentives for workplace safety programs; implementation of an efficient hearing process; and reducing frictional costs, streamline forms, improve independent medical examinations (IMEs), and require implementation of a prescription drug formulary.
    (DIVISION OF GOVERNMENTAL AFFAIRS)

House Budget Committee Votes to Advance ACA “Repeal and Replace” Bill
By a 19-17 vote, the US House of Representatives Budget Committee this week voted to advance the American Health Care Act (AHCA) to the House Rules Committee.  Three Republicans joined all 14 Democrats on the Committee in voting against the measure.  The lone New Yorker on the Committee, Rep. John Faso (R-Upper Hudson Valley) voted in support of the bill.

The AHCA would revise much of the Affordable Care Act (ACA) enacted in 2010.  As reported last week, several health care advocacy organizations, including the AMA, American Hospital Association (AHA), the Greater New York Hospital Association and the Healthcare Association of New York State (HANYS) have expressed strong concerns with the proposal.

The proposal would keep some of the popular provisions from the ACA, including required coverage for pre-existing conditions, prohibiting annual and lifetime limits, and requiring dependent coverage up to age 26.   It would also significantly expand the amount of funds that a person could direct to their Health Savings Account, and delay until 2025 implementation of the “Cadillac Tax” on comprehensive health insurance coverage.

At the same time, the bill would substantially revise ACA rules that facilitated various subsidized coverage programs for those who make up to 400% FPL ($94,000 for a family of 4).  While the expanded eligibility for Medicaid (up to 138% FPL) would be available through the end of 2019, starting in 2020 such expanded coverage would only be continued for those who had such coverage prior to the end of 2019.

The AHCA would also repeal the tax credits currently provided to help cover cost-sharing amounts for coverage for individuals who earn too much to qualify for Medicaid.  Instead, tax credits of $2,000-$4,500 (depending upon age) would be provided to enable the purchase of health insurance coverage.

Tax credits will be available in full to individuals earning less than $75,000 and households earning less than $150,000, but they will be capped for higher earners.  It appears as if the AHCA would also completely eliminate funding for New York’s Essential Plan, which provides low-cost health insurance coverage with little cost-sharing responsibilities for over 600,000 New Yorkers who make between 138% and 200% of the FPL.

The bill would repeal several other notable ACA provisions, including the requirement for all individuals to have health insurance coverage, the large employer coverage mandate, the provision to impose a “tanning” tax and a provision that limits the tax deductible treatment for health insurers of executive income that exceeds $500,000.

At this time, it still is not apparent whether there will be enough support for this legislation to pass the full US House as well as the US Senate, which could necessitate significant changes to this legislation.  Please remain alert for further updates.  (AUSTER)

 

CBO Predicts 24 Million to Lose Insurance Coverage as a Result of AHCA; Trump Administration Strongly Disagrees
This week, the Congressional Budget Office concluded that the AHCA under consideration by Congress would result in 14 million fewer people having health insurance coverage in 2018, and 24 million fewer people having health insurance coverage in 2026.  At the same time, it would produce an $880 billion reduction in Medicaid spending over the 2017-2026 period, and a $337 billion decrease in deficit spending over the same period.

Reacting to the CBO conclusion, AMA President Dr. Andrew Gurman issued a statement noting that While the Affordable Care Act was an imperfect law, it was a significant improvement on the status quo at the time, and the AMA believes we need continued progress to expand coverage for the uninsured. Unfortunately, the current proposal – as the CBO analysis shows – would result in the most vulnerable population losing their coverage… we hope the CBO estimates will motivate all Members of Congress to find a pathway to work together on significantly improving proposed health reform legislation so it is more focused on serving the very real needs of patients and improving the health of our nation.”

New HHS Secretary Dr. Tom Price issued a statement strongly objecting to the CBO conclusion:

“The CBO report’s coverage numbers defy logic…For there to be the reductions in coverage they project in just the first year, they assume five million Americans on Medicaid will drop off of health insurance for which they pay very little, and another nine million will stop participating in the individual and employer markets. These types of assumptions do not translate to the real world, and they do not accurately estimate the effects of this bill….Doctors and patients understand that, especially under current law, having coverage is not the same thing as having access to the care one wants or needs. Our approach will provide Americans with relief from the collapsing healthcare law, which never delivered on the benefits projected by the Congressional Budget Office in the first place.”  (AUSTER)


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


NYS DOH Releases Guidance On Mandated 3-Hour Course On Pain Management, Palliative Care And Addiction
The New York State Department of Health issued guidance on the required three (3) hours of course work or training in pain management, palliative care, and addiction that most New York prescribers with a DEA registration must complete.   The course work or training must be completed by July 1, 2017, and once every three years thereafter, pursuant to Public Health Law (PHL) §3309-a(3).

The course work or training must include the following eight (8) topics:

  • New York State and federal requirements for prescribing controlled substances;
  • Pain management;
  • Appropriate prescribing;
  • Managing acute pain;
  • Palliative medicine;
  • Prevention, screening and signs of addiction;
  • Responses to abuse and addiction; and
  • End of life care.

According to the letter, prescribers must complete course work or training in all eight topics. The topics may be covered by a single, comprehensive presentation or by multiple individual presentations for a total of at least three hours.  Depending on the presentations, it may take longer than three hours to complete all eight required topic areas.

The DOH letter lists the Medical Society of the State of New York as an accredited provider.  As reported previously, the Medical Society of the State of New York has developed three one-hour Continuing Medical Education (CME) webinars.  MSSNY will archive the webinars as an on-line program at MSSNY CME website.  This course work will be available from the CME website by the beginning of April.  Physicians and other prescribers will be able to view these webinars and obtain CME credit.  The online program will be available free of charge to MSSNY members; non-MSSNY members will pay a fee of $150 to view all three modules.

ATTESTATION
According to the information from DOH, prescribers must attest to their own completion of the course work or training.  For medical residents who prescribe under a facility’s DEA registration number, however, the facility must make such attestation.  For the initial attestation deadline of July 1, 2017, applicable course work or training completed from July 1, 2015, to July 1, 2017, is allowed.

For each and every subsequent attestation period, course work or training must be completed during the applicable attestation period.  Prescribers licensed on or after July 1, 2017, who have a DEA registration, as well as medical residents prescribing controlled substances under a facility DEA registration, shall complete the course work or training within one year of registration, and once within each three-year period thereafter.

DOCUMENTATION
Documentation of the completion of the course work or training must be maintained by the prescriber for a minimum of six (6) years from the date of the applicable attestation deadline for audit purposes. Documentation must include the course work or training provider name, course work or training name, location it occurred, date it occurred, and number of hours completed for each.

EXEMPTIONS
In certain limited circumstances, the Department may grant an exemption to the required course work or training to an individual prescriber who clearly demonstrates to the Department that there is no need to complete such training.

New York State Department of Health has indicated that that an attestation form to notify the Department of the satisfaction of the educational requirement, as well as FAQ’s and additional information, are coming soon.

A copy of the Department of Health letter can be found here.(CLANCY)

NYS DOH Adds Chronic Pain To List of Qualifying Conditions for Medical Marijuana And Permit PA’s To Certify Patients
Final regulations were adopted by the NYS Department of Health to add “chronic pain” to the list of conditions for patients to use medical marijuana.  Chronic pain is defined as “any severe debilitating pain that the practitioner determines degrades health and functional capability; where the patient has contraindications”.  Additionally, the regulations also allow physicians assistants to certify patients for the use of medical marijuana.

Authorization is dependent upon whether the supervising physician is already qualified to certify patients for medical marijuana. Physician assistants would have to complete the required coursework. Physician assistants who successfully complete the NYSDOH approved course and are in full compliance with other regulatory requirements must complete an authorization form with their supervising physicians, and mail this form along with the course completion certificate to the department. Once the information provided is validated, the department will send an email confirmation to the physician assistant containing a link that will authorize the physician assistant to register to certify patients.

In December, the Medical Society of the State of New York President Malcolm Reid, MD sent a letter to DOH Commissioner Howard Zucker that expressed concerns that the use of medical marijuana to treat chronic pain may be inconsistent with national treatment guidelines, and perhaps most importantly, could expose physicians’ to enhanced risk of federal prosecution especially with the change in the federal administration.   A copy of Dr. Reid’s letter can be found here(CLANCY)

New York Makes Large Jump in National Health Rankings
New York came in No. 12 in the country in health system performance, moving up from No. 20, according to the latest rankings from the Commonwealth Fund. New York and Washington made the biggest jumps in ranking, with New York moving into the top-performing group for the first time. New York saw gains on eight of 15 prevention and treatment measures, and it jumped from No. 10 to No. 6 in health care equity rankings, which took into account income and ethnicity. However, New York only improved on two of five measures in access and affordability. Notably, the share of adults who went without care because of cost over the course of a year dropped from 15% in 2013 to 12% in 2015.

The report released by the Commonwealth Fund compares health access and quality measures. The Commonwealth Fund is a private foundation that provides independent research on health care issues and making grants to improve health care practice and policy.  The report intentionally emphasized that states that expanded Medicaid access under the Affordable Care Act showed stronger progress than states that did not.                                           (BELMONT)

Senate Advances Legislation to Permit CV Techs to Administer Contrast Media
The New York State Senate Health Committee advanced legislation (S.3570, Valesky) this week to the Senate Higher Education Committee that would authorize Cardiovascular Technologists (CVTs) to administer contrast media during cardiovascular interventional procedures, under the “direct supervision” of a physician.

CVTs assist in technical procedures for cardiac catheterizations and interventions, but are not expressly permitted by statute in New York to administer contrast media.  MSSNY has heard from cardiologists in support of legislation to authorize CVTs to administer contrast media.   MSSNY and the NY Chapter of the American College of Physicians have requested an amendment to this legislation to require that the physician provide “personal supervision” of the CVT, which means they must be in the same room, instead of “direct supervision” which means that the physician must be in the same general area. Identical legislation (A.5963, Magee) has been introduced in the Assembly.
(AUSTER, BELMONT)

HCA Hosts Hospice and Palliative Care Forum
MSSNY recently participated in a meeting with representatives from the Home Care Association of New York State, the New York State Health Department, and hospitals state-wide to discuss the status of the State Palliative Care Education and Training Council. Vice-Chair of the State Council, Joan Dacher, PhD, RN, encourages the reformation of Social Work and RN training and education at the provider and professional school levels to include more concentrated training on long-term and palliative care.

In addition, representatives from Lourdes at Home/Hospice at Lourdes provided recommendations for encouraging the development of articulation agreements between hospitals and Homecare facilities to increase the number of homecare visits for patients with chronic illnesses.
(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 jbelmont@mssny.org

enews large


NYS: First Sepsis Report: Mortality Rates Have Declined
Mortality rates for sepsis have declined in recent years and more hospitals are on the hunt for the dangerous bacteria, according to New York State’s first sepsis report. The report is mandated by regulations that went into effect in late 2013. Read the report here.


2017 NRMP Main Residency Match the Largest Match on Record
Today the National Resident Matching Program® (NRMP®) announced the results of the 2017 Main Residency Match®, the largest in its history. A record-high 35,969 U.S. and international medical school students and graduates vied for 31,757 positions, the most ever offered in the Match. The number of available first-year (PGY-1) positions rose to 28,849, 989 more than last year.

Program Highlights
Results of the Main Residency Match are closely watched because they can be predictors of future changes in physician workforce supply.

Primary Care
In 2012, the NRMP implemented a policy requiring Match-participating programs to place all positions in the Match, spurring significant increases in the number of primary care positions offered. In the six years since implementation of the policy, Internal Medicine, Family Medicine, and Pediatrics have added a combined 2,900 positions, a 25.8 percent increase. Highlights from the 2017 Match include:

  • Internal Medicine programs offered 7,233 positions, 209 more than in 2016; 7,101 (98.2%) positions filled, and 3,245 (44.9%) filled with U.S. allopathic seniors.
  • Family Medicine programs offered 3,356 positions, 118 more than in 2016; 3,215 (95.8%) positions filled, and 1,513 (45.1%) filled with U.S. allopathic seniors. Since 2012, the number of U.S. allopathic seniors matching to Family Medicine has increased every year.
  • Pediatrics programs offered 2,738 positions, 49 more than in 2016; 2,693 (98.4%) filled, and 1,849 (67.5%) filled with U.S. allopathic seniors.

Other Highlights

  • Emergency Medicine offered 2,047 first-year positions, 152 more than in 2016, and filled all but six. The overall fill rate was 99.7 percent, and 78.2 percent were filled by U.S. seniors. Since 2012, the number of Emergency Medicine positions has increased by 379, or 23 percent.
  • Psychiatry offered 1,495 first-year positions, 111 more than in 2016, and filled all but four. The overall fill rate was 99.7 percent, and 61.7 percent were filled by U.S. seniors. Since 2012, the number of Psychiatry positions has increased 378, or 34 percent, and the number of positions filled by U.S. allopathic seniors has increased 307.
  • Specialties with more than thirty positions that achieved the highest percentages of positions filled by U.S. allopathic seniors, which is one measure of competitiveness, were Integrated Plastic Surgery (93.1% U.S. seniors), Orthopedic Surgery (91.9% U.S. seniors), and Otolaryngology (91.5% U.S. seniors).

Unmatched Applicants
Applicants who did not match to a residency position participated in the NRMP Match Week Supplemental Offer and Acceptance Program® (SOAP®) to attempt to obtain an unfilled position. This year, 1,177 of the 1,279 unfilled positions were offered during SOAP. SOAP results will be available in the full Match report published in May.


Upstate Association Sponsoring Tours for Medical Students
The Iroquois Healthcare Association (IHA) is sponsoring tours of Upstate NY for medical students and residents to `take a look’ and learn about practice opportunities in this area. Participants will learn about hospitals, medical staffs, communities and culture through visits to hospitals and ambulatory care settings.

The next all expenses paid tour is April 26-28th and will explore opportunities in the Finger Lakes Region. Click as follows for information on the program, a FAQ sheet, and a tour schedule.


MSSNYPAC – The Political Voice for New York’s Physicians
MSSNYPAC would like to thank the dedicated members of its leadership team, the MSSNYPAC Executive Committee  and the hundreds of physicians, residents, students and spouses for helping to raise over $10,000 for MSSNYPAC at this year’s Physician Advocacy Day!  If you were not able to attend in person but wish to support MSSNYPAC’s efforts to help elect physician-friendly candidates to office, consider making a contribution to MSSNYPAC.  Please join with your colleagues to help to assure that physicians have a meaningful seat at the table as health care policy is developed.


Join Nassau County for Dinner and CME Program on “Frontiers in Cellular Therapy”
The Nassau Academy of Medicine and the Nassau County Medical Society Joint Membership Meeting will be held on TUESDAY, MARCH 28, 2017 at the WESTBURY MANOR, 1100 Jericho Turnpike, Westbury. Complimentary Dinner Meeting for NCMS / NAM Members. Non-members and their staff may attend at $25 per person. Seating is limited. REGISTRATION is at 6:30PM; dinner and meeting at 7:00PM.  PRE-REGISTER NOW – Send E-Mail Response To: NASSAUMED@GMAIL.COM The CME Program, “NEW FRONTIERS in CELLULAR THERAPY” will be presented by Patricia Shi, MD, MS, Medical Director, Therapeutic Apheresis and Cellular Therapy Collection Service, New York Blood Center

Educational Objective:  At the end of this CME activity, participants should be able to; distinguish between the various types of cellular therapies being investigated; understand the potential risks, benefits, and unknowns of such therapies and become familiarized with ethical concerns and questions raised by the advance of cellular therapy. 

Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of the Suffolk Academy of Medicine and the Nassau Academy of Medicine. The Suffolk Academy of Medicine is accredited by MSSNY to provide Continuing Medical Education for physicians. The Suffolk Academy of Medicine designates this live educational activity for a maximum of 1 AMA PRA Category 1 Credit. Physicians should claim


CLASSIFIEDS


Prime NYC Space for Rent
Prime Midtown Manhattan space two blocks away from Grand Central Station
next to Park Ave. 3100 RSF with nine windows in a professional building filled with MDs and DDSs. $59/RSF please inquire at wnyllc@aol.com



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities

Internist Needed Mon.-Fri. for Psychiatric Inpt in Queens
Internist needed for Full time general medical care of psychiatric inpatients.  Creedmoor Psychiatric Center is in Queens, and convenient to NYC, Nassau/Suffolk and near major transportation.  We are a small well organized Medical Department looking for another member.  Our physicians enjoy their work- life balance. Please contact: alan.diner@omh.ny.gov or call 718-264-4046

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.


Ophthalmologist Part Time
Ophthalmologist needed to work at multiple nursing homes in all 5 boros except Staten Island. Part time or full-time position available.  Generous salary and incentives.Ttech provided. Opportunity to perform surgery, but not required. Please email cv to privacyssw@gmail.com


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

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

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

March 10, 2017 – Lobby Day – Another Home Run!

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
March 10, 2017
Volume 17
Number 10

MLMIC Insurance

Dear Colleagues:

This week, Moe Auster, Senior VP Government & Regulatory Affairs, wanted to thank everyone who participated in our Lobby Day.

Please send your comments to comments@mssny.org




Thank You For All Who Came to Physician Advocacy Day This Week
A big thank you to the over 250 physicians, residents, medical students and other physician advocates who took the time to come to Albany this week to participate in MSSNY’s Annual Physician Advocacy Day!  We also thank the American College of Obstetricians & Gynecologists – District II and the New York State Osteopathic Medical Society for participating and coordinating their annual Advocacy Days with MSSNY.

We appreciate the challenges you face in taking a day away from your practice or hospital to advocate for your profession and for your patients.  But your participation was absolutely essential to demonstrating to our legislative leaders the importance of ensuring physicians are able to continue to deliver the timely and quality care patients expect and deserve.  Moreover, it was important for legislators to hear the perspective of residents and students how the challenges of New York’s health care delivery system makes it difficult to considering practicing in New York State in the future.  As the Assembly and Senate will each be finalizing their respective “one-House” Budgets this week, having the opportunity to share with legislators our concerns with excessive liability exposure, and excessive health  insurer imposed prior authorization hassles is essential to ensuring that the State Budget does not incorporate provisions that will exacerbate these problems.

We also thank the several legislative and regulatory policy leaders who took the time away from State Budget negotiations to address the assembled physicians, share their vision for health care, and answer questions from the audience.  The speakers included Senate Majority Leader John Flanagan, Assembly Majority Leader Joseph Morelle, Senate Health Committee Chair Kemp Hannon, Senate Insurance Committee Chair James Seward, Assembly Health Committee Chair Richard Gottfried, Assembly Insurance Committee Chair Kevin Cahill, Deputy Financial Services Superintendent Troy Oechsner and Dr. Doug Fish, Medical Director for the New York State Department of Health.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Council Meeting in Albany on March 7
Moe Auster, Dr. Frank Dowling: Dr. Art Fougner; Dr. Thomas Madejski; Dr. Nicholas Kulbida; (Front) MSSNY President Elect Dr. Charles Rothberg; MSSNY President Malcolm Reid; Assembly Majority Leader Joseph D. Morelle; Dr. Christine Herde; Dr. Carla Eng; Dr. Paul Pipia

Legislation Introduced and Debated in Congress to Make Major Changes to the ACA
This week the US House of Representatives Leadership released the American Health Care Act, its proposal to change much of the Affordable Care Act (ACA) enacted in 2010.  Several health care advocacy organizations, including the AMA, expressed strong concerns with the proposal.

The proposal would keep some of the popular provisions from the ACA, including required coverage for pre-existing conditions, prohibiting annual and lifetime limits, requiring dependent coverage up to age 26, and required coverage of “Essential Health benefits”.  It would also expand the amount of funds that a person could direct to their Health Savings Account.

At the same time, the bill would substantially revise ACA rules that facilitated various subsidized coverage programs for those who make up to 400% FPL ($94,000 for a family of 4).  While the expanded eligibility for Medicaid (up to 138% FPL) would be available through the end of 2019, starting in 2020 such expanded coverage would only be continued for those who had such coverage prior to the end of 2019.

The AHCA would also repeal the tax credits currently provided to help cover cost-sharing amounts for coverage for individuals who earn too much to qualify for Medicaid.  Instead, tax credits of $2,000-$4,500 (depending upon age) would be provided to enable the purchase of health insurance coverage.   Tax credits will be available in full to individuals earning less than $75,000 and households earning less than $150,000, but they will be capped for higher earners.  It appears as if the AHCA would also completely eliminate funding for New York’s Essential Plan, which provides low-cost health insurance coverage with little cost-sharing responsibilities for over 600,000 New Yorkers who make between 138% and 200% of the FPL.

The bill would repeal several other notable ACA provisions, including the requirement for all individuals to have health insurance coverage, the large employer coverage mandate, the provision to impose a “tanning” tax and a provision that limits the tax deductible treatment for health insurers of executive income that exceeds $500,000.

The Healthcare Association of New York State (HANYS) issued a statement saying that the AHCA “would be disastrous for New York. It would threaten health coverage for millions of New Yorkers, create a fiscal crisis for the state, and burden hospitals and health systems with fewer resources and more uninsured or underinsured patients. The proposal would also destabilize insurance markets, driving up costs for all consumers.”

The Greater New York Hospital Association released an analysis in which it noted that “the proposed Medicaid changes would put a huge amount of pressure on state budgets and put many Americans at risk of losing health care coverage. In addition, the Medicaid DSH (Disproportionate Share Hospital) cuts will cost expansion states hundreds of millions in DSH dollars, adversely affecting safety net hospitals.”

The American Medical Association sent a letter to Congressional leaders and issued a statement noting several areas where the AHCA “fell short” of the health system reform objectives that had been adopted by the AMA, including concerns with:

  • Relating tax credits to age, rather than inversely related to income, which could result in more uninsured.
  • The proposed rollback of Medicaid expansions, which the AMA noted “have been highly successful in providing coverage for lower income individuals”.
  • Cutting funding for affiliates of the Planned Parenthood Federation of America, as “the AMA cannot support the precedent of restricting access to otherwise qualified providers of care for covered services”.

After extensive debate the bill was advanced from the Ways & Means Committee, and will be combined with the bill language that was advanced by the Energy & Commerce Committee this week.  At this time, it is unclear whether there are enough votes in the US House or Senate to enact this measure.  MSSNY will continue to monitor these developments, engage with New York’s Congressional delegation, and follow up with more details.
(AUSTER)

Assembly and Senate to Finalize One House Budget This Weekend; Keep Up Grassroots Activity
Details of the Senate and Assembly “one-house” budget proposals are expected to be released over the weekend or early next week.  It is expected that the Senate will leave out all tax and fee increases, including the proposed requirement that physicians receive a “tax clearance” as a pre-condition to receiving Excess Medical Malpractice Insurance coverage, a proposal opposed by MSSNY.  The Assembly has also shown some indications that they will reject the proposal as well. We will provide an update when more details become available.

Once each house has released its budget proposal, negotiations can begin between the two houses and the Executive to find agreement on a final budget.  MSSNY will continue to fight to have our concerns addressed in any final budget agreement but we will only be as successful as the participation of the MSSNY membership.  We encourage you to talk to your friends, family and colleagues to continue a strong grassroots effort to address all of the issues facing physicians.  Please continue to remain active and reach out to your legislators throughout the finalization of the budget. (Belmont) 

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, March 15, 2017 at 7:30 a.m. with Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

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 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.                                       
(Clancy, Hoffman)


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


First Webinar on Pain Management, Palliative Care and Addiction Completed; 2nd in Series on March 14th
The Medical Society of the State of New York held its first webinar on its Pain Management, Palliative Care and Addiction on Thursday, March 9th with over 1000 attendees and will hold the second webinar in the series on March 14th.   As has been previously reported, a 2016 law requires most physicians with DEA licenses to complete three hours of pain management education prior to July 1st of this year.

The first webinar, entitled “Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances” will be archived on the MSSNY CME site shortly.   This archived webinar will allow physicians to view the program at their leisure and receive CME credit.  The program will be free to MSSNY members and there will be a $50 charge for each archived webinar for non-members.  

The webinar is free to MSSNY member with a discount code; please check www.mssny.org website, under the Pain Management, Palliative Care and Addiction blue box on the opening page for information on how to obtain the code.  There is a fee of $50 for non-MSSNY members for each webinar.

Physicians may register for the live webinar on Tuesday below:

Tuesday, March 14, 2017—7:30-8:30am

Rational Opioid Prescribing for Chronic Pain Conditions

Faculty: Charles Argoff, MD & Patricia Bruckenthal, PhD, APRN-BS, FAAN

Educational Objectives:

Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation

Describe palliative medical care and end-of-life care

Register for this webinar here

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. (CLANCY)

CME Needs Assessment
The Continuing Medical Education (CME) Program of MSSNY strives to provide educational activities relevant to the practice of all recognized medical disciplines and include forums for public health, socio-economic, ethical, and legal issues related to the provision of quality healthcare.  In order to fulfill that goal, MSSNY’S office of CME is conducting a CME needs-assessment survey.  Physicians who have not already done so are encouraged to complete the survey here.  Questions about the survey or the MSSNY CME program may be directed to Miriam Hardin (mhardin@mssny.org or (518) 465-8085).       (HARDIN)

Register Now For Upcoming Veterans Matters CME Programs
The Medical Society of the State of New York encourages you to register for its upcoming Veterans Matters programs. These programs include CME presentations on PTSD and TBI in as well as Suicide in Returning Veterans.  Faculty for these programs is John McIntyre, MD and Frank Dowling, MD. Registration for all of these programs is open.  Just click on either of the presentation dates below.

Veterans’ Matters: PTSD and TBI

Webinar: Tuesday, April 4 at 8 a.m.

Faculty Presenter: John McIntyre, MD

The educational Objectives for the PTSD program are:

1) Describe the symptoms of PTSD and TBI.

2) Describe the treatment modalities of PTSD and TBI.

3) Describe military culture & how to overcome unique barriers to treatment intrinsic to military culture

Veterans’ Matters: Suicide
Live Seminar: Friday, April 28 at 8 a.m. at Brookhaven Memorial Hospital

Faculty Presenter: Frank Dowling, MD

The educational Objectives for the Suicide program are:

1) Address the causes and warning signs of suicide and suicidal behavior among veterans.

2) Explore the best evidence-based diagnostic and treatment options available including psychotherapy and pharmacotherapy.

3) Identify barriers in military culture to identification and treatment and how to overcome them.

Additional information or assistance with registration may be obtained by contacting Greg Elperin at gelperin@mssny.org.

Veterans Matters is a CME series made possible through a grant from the New York State Office of Mental Health.

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 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
(Elperin)

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

enews large

Physicians from Countries Affected by Immigration Order Serve Millions in NY
The Buffalo News (3/7) reports an analysis from the Immigrant Doctors Project found that roughly 75 doctors in the Buffalo-Niagara region from the six countries included in the most recent immigration ban “provide 100,000 to 150,000 appointments each year to patients.” On a national level, the project estimates that the six countries affected by the order have produced more than 7,000 physicians in the US who “see an estimated 14 million visits from patients each year.” The Association of American Medical Colleges criticized the executive order, stating, “We are deeply disappointed that the revised executive order and accompanying fact sheet do not explicitly recognize the importance of international medical graduates, physicians and medical researchers to the nation’s health security.”

PRI Reports $203 Million Loss in 2016 as Premiums Decline
Physicians Reciprocal Insurer reported a $203M underwriting loss (Politico, 3/7) in 2016. They now have a negative surplus of $354M as compared to an $83M loss in 2014, and $138M in 2015. Its premium revenue declined 24% in two years, from $384M to $293M. The Princeton Partnership, a firm that specializes in turnaround management, took over the day-to-day operations of PRI earlier this year.

119 Health Organizations Call for Task Force to End HepC in New York
A group of 119 health care organizations, including hospitals, advocacy groups and drug treatment centers have signed onto a statement renewing the call for Gov. Andrew Cuomo and the state legislature to create a task force to end the hepatitis C epidemic in New York. More than 100 organizations from across the state signed a letter to Gov. Andrew Cuomo and the leaders of the Legislature, calling for a commitment to eliminate hepatitis C, and, more specifically, an additional $10.8 million in this year’s budget to combat the virus. The statement comes one month after activists held a HepC elimination summit in Albany. An estimated 200,000 New Yorkers have chronic hepatitis C, with as many as half unaware they carry the virus, according to patient advocate VOCAL-NY. There were more than 16,000 reported new cases in 2014.

AG: $7.9M Settlement and Prison in Illegal Script Buy-Back/Laundering Scheme
AG Eric T. Schneiderman announced the sentencing of two pharmacy owners, a supervising pharmacist and ten corporations for defrauding several government-funded healthcare programs, including Medicaid and Medicare. An investigation revealed that on at least eight separate occasions between November 2013 and February 2014, the defendants paid patients hundreds of dollars in cash to forgo their prescription medications, the vast majority of which were to treat HIV. The defendants then submitted false claims to Medicare, Medicaid and Medicaid-managed care organizations and were reimbursed for distributing the medications, despite the fact that they were never dispensed to patients. Tarek Elsayed, 50, of Elmhurst Queens, the co-owner of 184th Street Pharmacy in the Bronx, was sentenced today in Bronx County Supreme Court by the Honorable Stephen Barrett to one to three years in state prison.

Previously, in August of 2016, Ahmed Hamed, 39, of Elmhurst, Queens, the second co-owner of 184th Street Pharmacy, was sentenced to two to six years in state prison. In October of 2016, Mohamed Hassan Ahmed, 38, of Bayside, the supervising pharmacist at 184th Street Pharmacy, was sentenced to one to three years in state prison and was required to surrender his license to practice pharmacy. Collectively, the three defendants stole over $10 million from government-funded health care programs.

In addition, the Attorney General’s Medicaid Fraud Control Unit (MFCU) reached a $4.1 million civil settlement agreement with defendant Elsayed and a $3.8 million civil settlement agreement with defendant Hamed. Defendant Hamed was also required to forfeit a Maserati and BMW he purchased with the proceeds from the scheme. Both vehicles have since been sold and proceeds from the sales returned to the state Medicaid program.

Between March 2013 and March 2014, Medicare, Medicaid and Medicaid-managed care organizations paid 184 St. Pharmacy over $10 million for medications 184 St. Pharmacy claimed to have dispensed to patients. MFCU’s investigation revealed however that the pharmacy ordered only $1 million in medications from legitimate pharmaceutical wholesalers. 

HHS: OIG Hotline Number Part of a Nationwide Phone Spoofing SCAM
The HHS Office of Inspector General (OIG) recently confirmed that the HHS OIG Hotline telephone number is being used as part of a telephone spoofing scam targeting individuals throughout the country. These scammers represent themselves as HHS OIG Hotline employees and can alter the appearance of the caller ID to make it seem as if the call is coming from the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477).

The perpetrator may use various tactics to obtain or verify the victim’s personal information, which can then be used to steal money from an individual’s bank account or for other fraudulent activity. HHS OIG takes this matter seriously. We are actively investigating this matter and intend to have the perpetrators prosecuted.

It is important to know that HHS OIG will not use the HHS OIG Hotline telephone number to make outgoing calls and individuals should not answer calls from 1-800-HHS-TIPS (1-800-447-8477). We encourage the public to remain vigilant, protect their personal information, and guard against providing personal information during calls that purport to be from the HHS OIG Hotline telephone number. We also remind the public that it is still safe to call into the HHS OIG Hotline to report fraud.  We particularly encourage those who believe they may have been a victim of the telephone spoofing scam to report that information to us through the HHS OIG Hotline 1-800-HHS-TIPS (1-800-447-8477) or spoof@oig.hhs.gov. Individuals may also file a complaint with the Federal Trade Commission 1-877-FTC-HELP (1-877-382-4357).

More information is available on the OIG Consumer Alerts webpage.

Percentage of “Inappropriate” PCIs Decreased in NY between 2010 And 2014
The New York State Insurance Fund is pleased to announce several enhancements to our online services for medical providers, improving your experience at nysif.com. We encourage you to register for an online account so you can take full advantage of the services we provide.

  • Direct Deposit
    Beginning March 1, medical providers will be able to sign up for direct deposit with simple online enrollment. Enjoy quicker access to funds, and avoid trips to the bank. Direct deposit payments are more secure, with no worry that your check may be lost or stolen. We’ll send you an email each time we deposit a payment into your account. Each direct deposit can contain payment for up to 25 separate bills. You can access information on each individual bill payment through your NYSIF online account.
  • Medical Provider Portal Search
    We have expanded search parameters in the medical provider portal to make it easier for providers to obtain the information needed to submit their bills for payment. Including complete information on your bill submission helps NYSIF process your bill more efficiently, resulting in faster payments to you.
  • Enhanced Online Privacy Protections
    NYSIF takes privacy seriously. NYSIF will be adding a second layer of protection to verify your identity. This additional step will help safeguard your login credentials and the confidential health information of your patients.

In addition, a third billing vendor has been added, which you can now use to submit your medical bills electronically. We urge you to take advantage of electronic bill submission by using any of our three vendors: iHCFA, ImageWork or IT Solutions of WNY. There is no cost to you to submit, and you’ll save on paper and postage.

NYSIF appreciates the important role health care providers play in the workers’ compensation system. We want to make doing business with NYSIF easier for you, and we expect these improvements will help accomplish that goal. Visit the Medical Provider section of nysif.com for more details. Link to ACH Med Provider User Guide:

JACC: Quality Improvement in Inappropriate Use of PCI in New York
Findings published online in the Journal of the American College of Cardiology http://bit.ly/2mtMEyI report that research indicated “quality improvement efforts in 2011-2012 took a solid bite out of inappropriate use of percutaneous coronary intervention (PCI)—at least in New York.” Investigators found that “in that state, inappropriate PCIs fell from 18.2% in 2010 to 10.6% in 2014, with a particularly sharp drop of 15.3% to 6.8% for the subgroup of Medicaid patients.”

Nasal Spray Approved to Treat Frequent Overnight Urination in Adults
The FDA has approved desmopressin acetate nasal spray (marketed as Noctiva) to treat adults who wake up at least twice nightly to urinate due to nocturnal polyuria.

The treatment is taken each night, about 30 minutes before bedtime. It increases water absorption through the kidneys, thereby decreasing urine production. Noctiva is approved only for those with nocturia caused by overproduction of urine. Accordingly, a 24-hour urine collection should be taken before treatment to confirm nocturnal polyuria.

Noctiva’s label includes a boxed warning about the risk for hyponatremia with treatment. Clinicians should check that patients’ serum sodium levels are normal before treatment, at 1 week and 1 month after treatment initiation, and periodically after that. The drug should not be used in those at high risk for severe hyponatremia — for example, patients with excessive fluid intake, those with conditions that can lead to fluid or electrolyte imbalances, and patients taking loop diuretics or glucocorticoids.

Additionally, Noctiva should not be used in those with symptomatic congestive heart failure or uncontrolled hypertension or in pregnant women. FDA news release

Physician Charged with Narcotics Distribution Resulting in Death
Avinoam Luzon, 32, a physician at Mercy Medical Center, allegedly provided Gabriel Tramiel, 32, with the fentanyl that took his life, according to US Attorney Preet Bharara.  Mr. Bharara said: “As a medical doctor and graduate student in public health, Avinoam Luzon was supposed to help the sick get healthy, but instead he allegedly helped fuel the nation’s most serious health crisis, the opioid abuse epidemic. As an alleged drug dealer with a medical degree, Luzon sold fentanyl to Gabriel Tramiel, a 32-year-old New Yorker, and it allegedly killed him.” Luzon, 32, of New York, New York, has been charged with one count of narcotics distribution resulting in the death of another, which carries a maximum sentence of life in prison, and a mandatory minimum sentence of 20 years in prison.

Cuomo: $1.4 Billion Plan to Fight Poor Health, Poverty in Central Brooklyn
The New York Times (3/9) reports Gov. Andrew Cuomo announced a $1.4 billion plan called Vital Brooklyn, which will target the persistence of poverty, violence, and poor health in central Brooklyn. Cuomo said his “holistic plan” will focus particularly on “health and wellness,” in a move the Times calls a “striking investment in one geographic location.” Other parts of the plan promote “healthy food, education and youth development, job creation, violence prevention, affordable housing and climate resiliency.”

The plan intends to add “$700 million for community health care clinics and programs, five acres of new recreation space, and programs to help young people stay out of trouble and learn job skills.” As Cuomo spoke, the Department of Health released a request for applications for the $700 million. The application can be found here.

CDC: 25% of US Adults Have Arthritis
Centers for Disease Control and Prevention Vital Signs report indicates that approximately 25% of US adults have arthritis. The report also indicated that “activity limitations from arthritis increased by 20 percent since 2002.”

Last Chance to Take Action! New and Improved NGSConnex Coming 3/6/2017!
NGSConnex is going through a transformation. On Monday, 3/6/2017 the new and improved NGSConnex provider portal launched. In order to make sure you are prepared follow these three simple steps.

Step 1: Verify you are using a supported browser to prevent interruption in use and for an optimal NGSConnex experience. (A supported browser is also required to access NGSMedicare.com.)

Step 2: Confirm the email address associated with your NGSConnex User Profile is current so that you can receive your MFA code and successfully log in.

Step 3: Familiarize yourself with the redesigned navigation for efficient use by reviewing the NGSConnex Navigation Crosswalk.

For detailed instructions on the new and improved NGSConnex and multi-factor authentication, visit the NGSConnex home page in the Provider Resources section of our website, NGSMedicare.com.

If you’re not already registered to use NGSConnex, you are missing out on an innovative and ever-evolving self-service tool; it’s free of charge and available 24/7 to all NGS providers. Sign up today at NGSConnex.com.

Council Notes-March 7, 2017 

  • Council reconsidered the MSSNY Physician Stress and Burnout Task Force Report, which was developed following a 2015 HOD resolution that directed MSSNY to “develop a series of programs, which may include CME credit, to assist physicians in early identification and management of stress.” In January 2017, Council approved four Task Force recommendations, but voted to table two recommendations. At Tuesday’s meeting, Council approved the following amendments by addition to the tabled recommendations:
  1. MSSNY membership distribution of burnout survey data coupled with a preliminary plan for interventions, beginning with distribution of survey results at House of Delegates and CME presentations during the annual meeting weekend.
  2. Development of a program to assist doctors when they need to reach out for help to sustain their wellness before it progresses to mental health or substance use disorder; charge MSSNY legal team and MSSNY staff to devise a solution which meets the needs of our members and maintains the legal and financial integrity of the MSSNY organization.
  • Valerie Grey, Executive Director of New York e-Health Collaborative (NYeC) presented a briefing on the Statewide Health Information Network of New York (SHIN-NY).
  • Douglas G. Fish, MD, Medical Director, Division of Program Development & Management for the New York State Department of Health presented on the Delivery System Reform Incentive Payment program (DSRIP).


CLASSIFIEDS



Prime NYC Space for Rent
Prime Midtown Manhattan space two blocks away from Grand Central Station
next to Park Ave. 3100 RSF with nine windows in a professional building filled with MDs and DDSs. $59/RSF please inquire at wnyllc@aol.com



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities

Internist Needed Mon.-Fri. for Psychiatric Inpt in Queens
Internist needed for Full time general medical care of psychiatric inpatients.  Creedmoor Psychiatric Center is in Queens, and convenient to NYC, Nassau/Suffolk and near major transportation.  We are a small well organized Medical Department looking for another member.  Our physicians enjoy their work- life balance. Please contact: alan.diner@omh.ny.gov or call 718-264-4046

Ophthalmologist Part Time
Ophthalmologist needed to work at multiple nursing homes in all 5 boros except Staten Island. Part time or full-time position available.  Generous salary and incentives.Ttech provided. Opportunity to perform surgery, but not required. Please email cv to privacyssw@gmail.com



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

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

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

March 3, 2017- DC Welcomes MSSNY

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
March 3, 2017
Volume 17
Number 9

Commissioner’s Grand Rounds

MLMIC Insurance

Dear Colleagues:

New York Physician Leaders Head To Nation’s Capital  

Several MSSNY physician leaders travelled to Washington DC to join their colleagues from across the country to meet with their Representatives and Senators fighting for needed improvements in health care delivery, and in opposition to proposals that would jeopardize health care access and coverage for their patients.  The Hill visits were in conjunction with the AMA’s Annual National Advocacy Conference.

Specifically, these physicians urged the enactment of legislation to ease some of the burdens associated with the new Medicare Merit-Based Incentive Payment System (MIPS), and for carefully considered reforms to the Affordable Care Act (ACA) that improve, rather than reduce, coverage options for our patients.  While physicians expressed strong concerns regarding the high deductible plans and narrow networks that have accelerated since the adoption of the ACA, they also noted the new opportunity for affordable health insurance options that have been provided to hundreds of thousands of New Yorkers that could be lost if ACA reforms are not carefully crafted.

The physicians represent every part of New York State and work in small practices, large practices, hospital medical staffs, and academia.  They included: MSSNY President-elect Dr. Charles Rothberg; Past-MSSNY President Dr. Robert Hughes; Past MSSNY President Dr. Robert Goldberg; Speaker of the MSSNY House of Delegates Dr. Kira Geraci; Past-Speaker of the MSSNY House of Delegates Dr. Jerome Cohen; Erie County Medical Society President-Elect Dr. Willie Underwood; Kings County President-Elect Dr. Hilary Fairbrother; Dr. Jack Mcintyre; Dr. Steve Lee, and MSSNY staff.

Meetings were held with key members of New York’s Congressional delegation who will play a large role in developing and analyzing proposals that restructure the ACA, including US Senate Minority Leader Charles Schumer, Senator Kirsten Gillibrand, and Representatives Yvette Clarke, Chris Collins, Joseph Crowley, Eliot Engel, Brian Higgins, Tom Reed, Paul Tonko and Lee Zeldin.  MSSNY physician representatives, in conjunction with other state medical societies, met with other key top policymakers including Representative Dr. Michael Burgess (R-TX) and Ways & Means Committee Chair Kevin Brady (R-TX).

These physicians are to be commended for the extensive time they took away from their practices to advocate on behalf of their colleagues and their patients.

National Advocacy Conference attendees MSSNY Senior VP Legislative & Regulatory Affairs Moe Auster; MSSNY EVP Phil Schuh; Past-Speaker of the MSSNY House of Delegates Dr. Jerome Cohen; Past MSSNY President Dr. Robert Goldberg; Past MSSNY President Dr. Robert Hughes; Rep Chris Collins (R-NY 27th District); Dr. Jack McIntyre; Dr. Steve Lee; and Speaker of the MSSNY House of Delegates Dr. Kira Geraci.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org




Last Call! MSSNY Lobby Day (MARCH 8) is Quickly Approaching! Register Now!
MSSNY’s “Physician Advocacy Day” will be held this Wednesday, March 8th in the Lewis Swyer Theatre in the Egg, located at the Empire State Plaza, Albany NY.

If you have not already, please Register Here.  Please join your colleagues from across the state to urge needed reform to our health care system, and for our profession and our patients.

Take advantage of this opportunity to express your support and voice your concerns to a full slate of legislators and key policymakers including:

  • Assembly Majority Leader, Joe Morelle
  • Senate Majority Leader, John Flanagan
  • Senate Health Chair, Kemp Hannon; Assembly Health Chair, Richard Gottfried: Senate Insurance Chair, James Seward; Assembly Insurance Chair, Kevin Cahill; and
  • Troy Oechsner, Deputy Superintendent for eaHealthHealth, Department of Financial Services

Come meet with your legislators to urge that they:

  • REJECT burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the Governor’s proposed State Budget;
  • REJECT inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners;
  • REJECT changes to increase burdensome physician prior authorization requirements contained in the proposed State Budget;
  • SUPPORT legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
  • SUPPORT legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up costs; and
  • REJECT legislation that would impose costly and time consuming mandates on physician delivery of patient care.

A brief luncheon to which members of each house are invited to speak with their constituents will follow the morning program. County medical societies will also be scheduling appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org or call 518-465-8050.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Budget Update
After a brief recess where legislators heard feedback from constituents in their districts, the legislature returned to Albany on Tuesday.  The Senate and Assembly released their joint revenue forecast this week.  Both houses project that there will be more revenue than Governor Cuomo’s budget has estimated.  The Senate estimated $354 million in additional revenue beyond Cuomo’s 2017-18 budget.  The Assembly forecast estimates having an additional $1 billion more than what Governor Cuomo expects.  This is an important first step in budget negotiations.  Each house is then expected to release its one-house budget proposal in the next few weeks and the final budget agreement is due by April 1.  Budget negotiations will now begin to heat up and we must continue to apply pressure on the legislature to ensure that our voices are heard.

As these negotiations ensue, please take action as noted below:

  • We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  Send a letter to your legislators here.
  • Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or who have not met clinical goals of therapy. While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  Send a letter to your legislators here.
  • “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.  To send a letter to your legislators, click here.
  • The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic.  To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.
  • The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including “modernizing” Certificate of Need laws, and changing scopes of practice for non-physicians. Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval.Over a dozen specialty societies have joined MSSNY in a letter to the entire Legislature to urge that this proposal be removed from the budget, or remove the provision that enables these demonstration programs.
  • Giving overbroad discretion to state officials to drop physicians and other prescribers from the Medicaid program based upon the “inappropriate prescribing of opioids”.
    (BELMONT)

US House Committees to Begin Consideration of ACA Repeal Legislation Next Week
The US House of Representatives has outlined a three-week time frame for developing and passing legislation to repeal and replace large portions of the Affordable Care Act, according to numerous media reports.   Next week, the House Ways& Means and Energy & Commerce Committees will begin “marking up” legislation.  The following week, the House Budget Committee would move to combine the bills into a “reconciliation” package eligible for expedited Senate debate, with votes on the House floor expected the week after that.

While many concepts have been highlighted such as expanded use of health savings accounts, providing states more flexibility to spend Medicaid funds, expanded use of tax credits to purchase health insurance coverage and permitting sales of health insurance coverage across state lines,  no legislative text has been publicly released as of yet.

As such, there is little ability to assess at this time how such proposals will impact upon the millions of New Yorkers who have obtained coverage through the several new coverage expansion mechanisms established through the ACA, as well as the impact on the New York State Budget.  There are also questions regarding whether the significant health policy divisions within the House and Senate Republican conferences can be reconciled in such a way that a majority vote can be achieved in both houses.  With details on this enormously important issue still fluid, please remain alert for further updates.
(AUSTER)

Starting next Thursday, March 9,  MSSNY is Offering a 3 Hour CME Program on Pain Management.  NYS Requires Every Prescriber to take this 3 Hour Course By July 1, 2017
The Medical Society of the State of New York announces a series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers holding a DEA license to complete three hours of coursework no later than July 1st, 2017.   These webinars are being offered FREE OF CHARGE to MSSNY members with a discount code.  The discount code has been provided to MSSNY members.  Non-MSSNY members will be charged $150 for the series.

The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services in the development of this program.   Following the webinars, the course will be offered on-line on the MSSNY CME site.   The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series.

The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Webinars will be held on:

Thursday, March 9, 2017—7:30-8:30am

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Trishia Allen, Esq.

Educational Objectives:

Understand New York State and Federal Requirements for Prescribing Controlled Substances

Discuss Guidelines for Chronic Pain

Register for this webinar here 

Tuesday, March 14, 2017—7:30-8:30am

Rational Opioid Prescribing for Chronic Pain Conditions

Faculty: Charles Argoff, MD & Patricia Bruckenthal, PhD, APRN-BS, FAAN

Educational Objectives:

Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation

Describe palliative medical care and end-of-life care

Register for this webinar here 

Tuesday, March 21, 2017—7:30-8:30am

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Charles Morgan, MD & Frank Dowling, MD

Educational Objectives:

Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral.

Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed.

Describe Strategies for Treating Pain in Patients with Substance Use Disorders.

Register for this webinar here 

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.

Additional information or assistance with registration may be obtained by contacting Pat Clancy at pclancy@mssny.org
(CLANCY)

AMA Expresses “Alarm” Regarding Possible Revival of Anthem-Cigna Merger with New Administration
The American Medical Association (AMA) wrote to Acting US Assistant Attorney General Brent Snyder this week to express its “alarm” regarding recent statements by Anthem, made in a Delaware Court, asserting that the company expects to close its merger transaction with CIGNA through “resolution with a new DOJ”.

MSSNY has shared the AMA letter with New York’s Attorney General Eric Schneiderman to urge that the New York AG continue to oppose the merger.  Connecticut AG George Jepsen issued a statement Wednesday indicating that his office would continue to oppose the merger.

As has been previously reported, on February 8, 2017, Judge Amy Berman Jackson issued a ruling blocking the proposed Anthem-Cigna merger from moving forward. The merger had been challenged by several patient advocacy and physician advocacy organizations including the AMA and MSSNY, as well as the Department of Justice and 11 state attorney generals because of the very significant market impact the mergers would have had in various regions across the country, and in New York. Last fall, MSSNY President Dr. Malcolm Reid and AMA representatives testified at a New York Department of Financial Services (DFS) hearing to express strong concerns with the proposed merger.

The AMA letter this week expresses great concern with the possibility that, despite the recent strong ruling, the merger could be revived because of a new Administration.  In particular, the letter referenced a statement by an Anthem attorney that “the company believes that its prospects for a timely closing are enhanced by a supportive Vice President Mike Pence.”  The letter goes on to state that it is “implausible that the U.S. Department of Justice (DOJ), eleven states, and the District of Columbia—that have diligently and successfully prosecuted this antitrust merger case—could now be swayed to allow this merger to close pursuant to politically-driven settlement negotiations as Anthem has suggested. To do so would cause irreparable harm to the integrity of the federal courts to adjudicate anticompetitive behavior in a fair and impartial manner, leaving consumers at risk.  We strongly believe that political influence should play no role in the enforcement of the antitrust laws and urge you to vigorously defend Judge Jackson’s ruling”.

Please remain alert for further updates on this issue.  To read the letter, click here.
(AUSTER)


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


Governor Cuomo Announces Action To Expand Cutting-Edge Breast Cancer Screening Options For Women
Governor Andrew Cuomo announced this week that health insurers are required under New York Insurance Law to provide medically necessary coverage for 3-D mammograms (tomosynthesis) without co-pays, coinsurance, or deductibles.   To read the press release, click here.  The Medical Society supported this initiative.

“We are undertaking the most aggressive action in the nation to expand access to breast cancer screenings, because early detection is the best possible treatment,” Governor Cuomo said“By expanding access to cutting-edge, life-saving breast cancer screening options, like 3D mammograms, we are taking our efforts to protect our mothers, sisters and daughters another step further. We will continue working to further remove barriers to breast cancer detection and treatment to create a stronger, healthier New York for all.”

The press release notes that that the action was part of continuing series of actions by the Governor to support women’s health and reproductive rights, including increasing access to breast cancer screenings and health insurance coverage that went into effect January 1, 2017; ensuring that all medically necessary abortion services are covered by health insurance policies without cost sharing; and ensuring that all women are covered by health insurance policies for contraceptives in amounts up to twelve month’s supply at a time without cost-sharing.
(AUSTER, CLANCY)

DFS Fines Oxford Health $1 Million For New York Insurance Law Violations
New York State Department of Financial Services Superintendent Maria Vullo announced this week that Oxford Health Plan has been fined $1 million by the Department of Financial Services (DFS) for improper payments to an unlicensed producer and for failing to respond to consumer grievances within required timeframes in violation of New York State Insurance Law. 

The press release noted that the violations were discovered through a “market conduct” examination by DFS looking at claims between 2009 and 2013.  Among the violations found were that Oxford failed to timely acknowledge insureds’ grievances and failed to send initial adverse determination notices as well as adverse appeal determination letters to insureds as mandated by New York Insurance Law.  Specifically, the press release noted that, in almost 1/3 of the cases sampled, Oxford failed to acknowledge consumer grievances within the required 15-day time frame; it also did not resolve grievance cases regarding referrals or benefit coverage within 30 days; and, in 44% of additional cases sampled, the company failed to issue initial adverse determination letters or adverse determination letters following an appeal within the 30 days mandated by law.  You can read the consent order here.                    (AUSTER) 

FDA Notice to Physicians
The FDA issued a notice to health professionals on the risks of buying drugs from unlicensed sources.  It reminded physicians that purchasing drugs from unlicensed sources (foreign or domestic) puts patients at risk of consuming drugs that may be unapproved, counterfeit, contaminated, or ineffective.  It also noted that medical practices should be aware that importing medications from foreign sources other than those authorized by the FDA is in violation of the Federal Food Drug and Cosmetic Act.

The FDA stated, “While the U.S. health care supply chain is one of the most secure and sophisticated in the world, there is a growing network of rogue wholesale drug distributors selling potentially unsafe drugs in the U.S. market.”   Since 2012, FDA has notified nearly 3,500 physicians that their drug purchasing practices may be illegal. DOJ has successfully prosecuted more than 95 corporations and individuals, including physicians, for criminal charges related to selling unapproved drug products, or receiving and administering unapproved drug products to patients. These criminal convictions have resulted in jail time and fines of millions of dollars.  The full notice may be viewed here.

In order to protect patients from unsafe or ineffective drugs, FDA advises health care providers to know the source for prescription drugs.  Additional information may be found on the FDA’s website.(BELMONT)    

NYS Department of Health Issues Blanket Waivers for Certain E-prescribing Requirements
The NYS Department of Health Commissioner of Health Howard Zucker, MD, JD issued a blanket waiver for certain electronic prescribing requirement.   The waiver replaces and supersedes the Commissioner March 26, 2017 waiver letter.  This letter has been sent to all practitioners and pharmacists in NYS.  The new waiver letter can be found here.

The following exceptional circumstances from the requirement of electronic prescribing include:

  1. any practitioner prescribing a controlled or non-controlled substance, containing two (2) or more products, which is compounded by a pharmacist;
  2. any practitioner prescribing a controlled or non-controlled substance to be compounded for the direct administration to a patient by parenteral, intravenous, intramuscular, subcutaneous or intraspinal infusion;
  3. any practitioner prescribing a controlled or non-controlled substance that contains long or complicated directions;
  4. any practitioner prescribing a controlled or non-controlled substance that requires a prescription to contain certain elements required by the federal Food and Drug Administration (FDA) that are not able to be accomplished with electronic prescribing;
  5. any practitioner prescribing a controlled or non-controlled substance under approved protocols for expedited partner therapy, collaborative drug management or comprehensive medication management, or in response to a public health emergency that would allow a non-patient specific prescription;
  6. any practitioner prescribing an opioid antagonist that would allow a non-patient specific prescription;
  7. any practitioner prescribing a controlled or non-controlled substance under a research protocol;
  8. a pharmacist dispensing controlled and non-controlled substance compounded prescriptions, prescriptions containing long or complicated directions, and prescriptions containing certain elements required by the FDA or any other governmental agency that are not able to be accomplished with electronic prescribing;
  9. a pharmacist dispensing prescriptions issued under a research protocol, or under approved protocols for expedited partner therapy, or for collaborative drug management or comprehensive medication management; and
  10. a pharmacist dispensing non-patient specific prescriptions, including opioid antagonists, or prescriptions issued in response to a declared public health emergency.

The letter also noted that waivers would be continued for the following situations in nursing homes and residential facilities:

  1. a practitioner prescribing a controlled or non-controlled substance either through an Official New York State Prescription form or an oral prescription communicated to a pharmacist serving as a vendor of pharmaceutical services, by an agent who is a health care practitioner, for patients in nursing homes and residential health care facilities as defined by PHL § 2801; and
  1. a pharmacist serving as a vendor of pharmaceutical services dispensing a controlled or non-controlled substance through an Official New York State Prescription form or an oral prescription communicated by an agent who is a

health care practitioner, for patients in nursing homes and residential health care facilities as defined by PHL § 2801.

The waiver is effective from March 26, 2017 until March 25, 2018.   For further information, please go to the DOH website here.           
(CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, March 15, 2017 at 7:30 a.m. with Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are:  1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

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 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.
(Clancy, Hoffman)


Commissioner’s Grand Rounds to be held on March 21, 2017 on “Baby Boomer Health”
NYS Department of Health Commissioner, Howard A. Zucker, MD, JD will host “Baby Boomer Health” on Tuesday, March 21 2017 at 7:30-9 a.m. at SUNY Upstate, Medical Alumni Auditorium, Weiskotten Hall, 766 Irving Avenue, Syracuse NY, 13210.   The intent of the program is to inform physicians and other providers of often undiagnosed conditions in baby boomers.

The presenter will be:  David Bernstein, MD, FAASLD, FACG, AGAF, FACP, Chief of Hepatology and Director, Sandra Atlas Bass Center for Liver Diseases, Northwell Health, Professor of Medicine, Hofstra-Northwell School of Medicine; Bob Morrow, MD Associate Clinical Professor-Department of Family and Social Medicine, Associate Director of Interventional CME-Center for CME Albert Einstein College of Medicine’ Sophia McIntyre, MD, MPH, MBA, FAAFP, CPE, Chief of Clinical Quality and Physician Leadership Development, Hudson River HealthCare, Inc..   The grand rounds program is free and advance registration is required for the live session and webinar.  A copy of the flyer and the link to register can be found here.

There will be CME credits awarded.  The Medical Society of the State of New York has partnered with the DOH to provide this program.                                                                                                                        (CLANCY)

CME Needs Assessment
The Continuing Medical Education (CME) Program of MSSNY strives to provide educational activities relevant to the practice of all recognized medical disciplines and include forums for public health, socio-economic, ethical, and legal issues related to the provision of quality healthcare.  In order to fulfill that goal, MSSNY’S office of CME is conducting a CME needs-assessment survey.  Physicians are encouraged to complete the survey here:

https://www.surveymonkey.com/r/MSSNYCME1

Questions about the survey or the MSSNY CME program may be directed to Miriam Hardin (mhardin@mssny.org or (518) 465-8085).                                                                                                                     (HARDIN) 

Register Now for Upcoming Veterans Matters CME Webinars
The Medical Society of the State of New York encourages you to register for its upcoming Veterans Matters webinars. These programs include CME presentations on PTSD and TBI in Returning Veterans.  Faculty for these programs is John McIntyre, MD. Registration for all of these programs is open.  Just click on either of the presentation dates below. 

Veterans’ Matters: PTSD and TBI

Friday, March 10 at 8 am

Tuesday, April 4 at 8 am

Faculty Presenter: John McIntyre, MD

The educational Objectives for the PTSD program are:

1) Describe the symptoms of PTSD and TBI.

2) Describe the treatment modalities of PTSD and TBI.

3) Describe military culture & how to overcome unique barriers to treatment intrinsic to military culture

Additional information or assistance with registration may be obtained by contacting Greg Elperin at gelperin@mssny.org.

Veterans Matters is a CME series made possible through a grant from the New York State Office of Mental Health.

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 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.
(ELPERIN)

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

enews large

AMA/Over 100 Societies Send Letter to CMS to Defer Mandatory EHR until 2019
On February 27, the AMA sent a letter to CMS and Office of the National Coodinator for Health Information (ONC), requesting a deferment from implementing certified electronic health record technology (CEHRT) until such technology is widely available and no sooner that January 2019. The letter cites that the CEHRT should remain voluntary because:

  • Mandating 2015 Edition CEHRT by 2018 jeopardizes success in the QPP and MY
  • A rush to certify products will result in broad hardship exemptions
  • Hasty deployment of CEHRT is counterproductive and threatens patient safety
  • 2015 Edition CEHRT should incorporate improvements to HER certification

The letter was delivered yesterday.  Over 100 state, national and specialty societies signed the letter, including MSSNY.

Albany Considers Compensation to Live Organ Donors For Expenses
Crain’s New York Business (2/23) reports the Living Donor Support Act “could make New York the first state in the country to directly compensate living organ donors…for lost wages, child care and other expenses.” The bill “has broad support from lawmakers” and has already unanimously passed the Senate Health Committee. Many state lawmakers and health care groups are rallying behind the cause because of some dire statistics.

New York ranks 50th in the United States for organ donation registration, according to LiveOn NY, the metropolitan region’s federally designated organ-procurement organization. While most organs are donated after a person’s death, increasing living donations is one way to address the acute shortage, advocates say.|

The proposed legislation would cost the state about $3 million per year, and donors would receive on average about $4,400 each, according to Waitlist Zero.

·        About 10,000 New Yorkers are awaiting an organ transplant, and about every 18 hours, a New Yorker dies waiting for a heart, lung, kidney or pancreas.
·        New York State is ranked last in the nation for the share of people registered as organ donors—just 28% versus a national average of about 50%, according to the latest data from LiveOnNY.
·        More than 8,000 await kidneys; over 1,300 need livers; and more than 300 need hearts.
·        Others also need pancreas (more than 100), lungs (over 50) and intestine (around 10).

·        Every 2½ hours, a person’s name is added to the New York State organ transplant waiting list.

Some Doctors Worried about Prosecution if They Prescribe Opioids
The Buffalo News http://buffalonews.com/2017/02/27/physicians-raise-alarm-criminalizing-efforts-treat-patients-pain/ carried a story about doctors who do prescribe painkillers are very worried about prosecution. Patients with chronic conditions complain that they cannot find a physician to help them. Six physicians in Erie and Niagara counties have been criminally prosecuted for illegally prescribing opioids in recent years. “We certainly have no problem with physicians being prosecuted if they have committed a true crime, said MSSNY Vice President Dr. Thomas Madejski.  “But to criminalize physicians in the practice of medicine is really a step in the wrong direction.”


 SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details



SUNY Albany Researchers Develop Cheaper, More Efficient Test for Ebola
The Albany Times Union http://bit.ly/2mf4KVn (2/28) reports Mehmet Yigit, a SUNY Albany assistant chemistry professor, has developed a method of detecting the Ebola virus by sampling patient urine or saliva. His “cheaper and more efficient” methods “could prove crucial for combating Ebola” as well as for detecting the Zika virus. The article points out that samples of the Zika virus “are largely inaccessible for researchers not funded by the National Institutes of Health.”

WHO Lists 12 Bacteria that Pose Greatest Threat to Human Health
The World Health Organization has listed 12 families of bacteria that “pose the greatest threat to human health” because of resistance to antibiotics. The group hopes the list will guide research into and development of new treatments.

These three carbapenem-resistant bacteria earned highest priority (critical) based on their threat to patients in hospitals, those in nursing homes, and those reliant on ventilators and blood catheters:

  • Acinetobacter baumannii
  • Pseudomonas aeruginosa
  • Extended-spectrum beta-lactamase-producingEnterobacteriaceae

The second priority tier (high) includes:

  • Enterococcus faeciumresistant to vancomycin
  • Staphylococcus aureusresistant to methicillin and vancomycin
  • Helicobacter pyloriresistant to clarithromycin
  • Campylobacterspecies resistant to fluoroquinolone
  • Salmonellaeresistant to fluoroquinolone
  • Neisseria gonorrhoeaeresistant to cephalosporin and fluoroquinolone

The third priority group (medium) includes:

  • Streptococcus pneumoniaenot susceptible to penicillin
  • Haemophilus influenzaeresistant to ampicillin
  • Shigellaspecies resistant to fluoroquinolone

WHO news release

JAMA Pediatrics: Parents Notice Errors/Reactions Not Documented in Records
JAMA Pediatrics published a study that found parents of hospitalized children noticed “medical errors and bad reactions to treatment that aren’t documented in their children’s hospital records.” The study found overall error rates were “nearly 16 percent higher with family reporting than without, “while overall rates of adverse events were nearly 10 percent higher with family reporting.” The report states “family-reported error rates were five-fold higher than hospital incident rates, and adverse event rates reported by families were nearly three-fold higher.”

Study: Colon and Colorectal Cancers Increases in Millennials and Gen X Adults
Research published in the Journal of the National Cancer Institute https://academic.oup.com/jnci/article/3053481/Colorectal indicates “colon and rectal cancers have increased dramatically and steadily in millennials and Generation X adults in the United States over the past four decades.” Investigators found that “rates of rectal cancer are increasing by about 3 percent a year in 20- and 30-somethings, and by 2 percent a year among the 40- to 54-year-old age group.” Meanwhile, “colon cancer rates are rising by smaller amounts in those age groups.”

Rebecca Siegel, who led the study, “suggested one explanation might be a complex interaction involving the same factors that have contributed to the obesity epidemic — changes in diet, a sedentary lifestyle, excess weight and low fiber consumption.”


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Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities

Ophthalmologist Part Time
Ophthalmologist needed to work at multiple nursing homes in all 5 boros except Staten Island. Part time or full-time position available.  Generous salary and incentives.Ttech provided. Opportunity to perform surgery, but not required. Please email cv to privacyssw@gmail.com



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

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

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

Council – March 7, 2017

AGENDA
Council Meeting
Tuesday, March 7, 2017 at 1:00 p.m.
Renaissance Albany Hotel
144 State Street
Albany, NY  12205
518-992-2500

A.Call to Order and Roll Call

B.Approval of the Council Minutes of January 19, 2017

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

      1. President’s Report
        a.  Action Item – Request to Reconsider MSSNY Physician Stress  &  Burnout Task  Force Report – To be presented by Maria A. Basile, MD, MBA
      2. Board of Trustees Report  – Dr. Leah McCormack will present the report (handout)
      3. Secretary’s ReportDr. Fougner will present the report
      4. MLMIC Update  – Mr. Fager will present a verbal report (via phone)
      5.  AMA Delegation Update -Dr. John Kennedy will present a verbal report
      6.  MSSNYPAC Report – Dr. Joseph Sellers will present the report
      7. Commissioners  (Action Items)
        (No reports submitted)
      8. Councilors (All Action Items from County Societies and District Branches)
        (No reports submitted)

D. Reports of Officers (Informational)

  1.   Office of the President – Malcolm D. Reid, MD, MPP –  Meetings Attended:
    • Meeting w/ Mike Borden, NYS Podiatric Association
    • 3rd & 4th District Retreat @ Mirror Lake Inn
    • MLMIC Executive Committee
    • YPS, RFS & Student meeting
    • Retirement Party for Stu Friedman
    • Black/Hispanic Dinner Caucus
    • Mitchell Wealth Care Annual Dinner
  2.      Office of the President Elect – Charles Rothberg, MD
  3.      Office of the Vice President – Thomas J. Madejski, MD
  4.      Office of the Treasurer – Joseph R. Sellers, MD, Financial
    Statement for the  period 1/1/16 – 12/31/16
  5.  Office of the Speaker  –  Kira A. Geraci-Ciradullo, MD, MPH

E. Reports of Councilors (Informational)
1.    Kings/Richmond Report  Parag H. Mehta, MD
2.    Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
3.    Nassau County Report – Paul A. Pipia, MD
                      (No written report submitted)

4.    Queens County Report – Saulius J. Skeivys, MD
 5.   Suffolk County Report – Maria A. Basile, MD, MBA 
6.    Third District Branch Report – Brian P. Murray, MD
7.    Fourth District Branch Report – John J. Kennedy, MD
                       (No written report submitted)
8.    Fifth District Branch Report –Howard H. Huang, MD
9.    Sixth District Branch Report – Robert A. Hesson, MD
10. Seventh District Branch Report – Mark J. Adams, MD
11. Eighth District Branch Report –
Edward Kelly Bartels, MD
(No written report submitted)
   
12. Ninth District Branch Report – Thomas T. Lee, MD
13. Medical Student Section Report
  Christina Kratschmer 
14. Organized Medical Staff Section Report –
   Richard A. Ritter, MD  (No written report submitted)
             15. Resident & Fellow Section Report
  Robert A. Viviano, DO (No written report submitted)
16. Young Physician Section Report – L. Carlos Zapata, MD
  (No written report submitted)
                     

F. Presentations

      1.  SHIN-NY Presentation – Presented by Valerie Grey, Executive Director  New York e-Health Collaborative (NYeC)
      1.  DSRIP Presentation – Presented by Douglas G. Fish, MD, Medical Director,  Division of Program Development & Management New York State Department of Health

G. Commissioners (Committee Informational Reports/Minutes)

      1. Commissioner of Communications,
        Joshua M. Cohen, MD, MPH
        a. Report from the Division of Communications
      1.  Commissioner of Science & Public Health,
        Frank G. Dowling, MD
        a.  Long Term Care Subcommittee Minutes, January 11, 2017
        b. Quality Improvement & Patient Safety Minutes, January 11, 2017
      1. Commissioner of Governmental Relations,
        Gregory Pinto, MD
        a. MSSNY-HCA Task Force Minutes, January 13, 2017
        b. MSSNY-HCA Task Force Minutes, February 24, 2017
        c. Report from the Division of Governmental Affairs

HReport of the Executive Vice President, Philip Schuh, CPA, MS
      1. Membership Dues Revenue Schedule
2. Group/Institution Membership Revenue Schedule

I. Report of the General Counsel,
    Donald Moy, Esq. & David Vozza, Esq.
    1. Report of the General Counsel (verbal report)

J. Report of the Alliance, Barbara Ellman, Co-President
    1. Alliance Report

K.  Other Information/Announcements

  1.      Federation Health Reform Notes
  2.      National Restaurant Association (NRA) vs. DOH
    Sodium Warning Rule
  3.       CEHRT Sign On Letter

L.  Adjournment

 

February 24, 2017 – FREE In-Office TRAINING for PQRS!

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
February 24, 2017
Volume 17
Number 8

MLMIC Insurance

Dear Colleagues:

On February 17, CMS awarded approximately $20 million to 11 organizations for the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 clinicians or fewer. These local, experienced, community-based organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas, including rural areas, health professional shortage areas, and medically underserved areas.

The training and education resources will be available immediately, and will be provided at no cost to eligible clinicians and practices. CMS also launched a new telephone helpline for clinicians seeking assistance with the Quality Payment Program at 866-288-8292 or qpp@cms.hhs.gov. For more information, visit the Quality Payment Program website. IPRO, with whom we have partnered with on several projects in the past, is one of the 11 recipient organizations. Questions can be sent to IPRO at email address: NY-QPP@atlanticquality.org  or you can call IPRO at 1-866-333-4702.

We will keep you apprised of exactly how this will roll out and really assist physicians who, to date, have not gotten on board with Quality Payment Program.

National Advocacy Conference in DC

Next week is the AMA’s National Advocacy Conference in Washington. Due to a prior commitment, I cannot attend, but we have excellent representation from our MSSNY leadership that includes President Elect Dr. Charles Rothberg, Past Presidents Dr. Robert Goldberg and Dr. Robert Hughes, and Speaker Dr. Kira Geraci, as well as Executive Vice President of Government and Regulatory Affairs Moe Auster and our Executive Vice President Phil Schuh.

We will be meeting with our Senators Schumer and Gillibrand to outline our issues and identify how they can directly help MSSNY. At the actual conference we will be discuss medicine’s “big issues,” including prescription drug pricing, which has been a consistent concern for patients and their physicians. This problem has caught the bipartisan attention of Congress. The panel will discuss the rising costs and projected growth in spending on pharmaceuticals, the impact they have on patient access and adherence to medically necessary prescription drugs and suggested solutions. The AMA’s health care reform objectives highlight key elements that will guide continuing discussions with Congress and the Trump Administration.

Among these objectives are ensuring that low/moderate income patients are able to secure affordable and adequate coverage and ensuing that Medicaid, CHIP and other safety net programs are adequately funded. This week, Governor Cuomo warned that an ACA repeal could cost the state $3.7 billion in funding and throw 2.7 million New Yorkers off the healthcare rolls. Clearly, the potentially devastating impact this would have on health care delivery in New York State will certainly be raised by our leadership.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org



MSSNY Lobby Day (3/8) is Quickly Approaching! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8th in the Lewis Swyer Theatre in the Egg, located at the Empire State Plaza, Albany NY.  The program begins at 8 AM. If you have not already, please register here:. Joint hundreds of your colleagues from across the State who are coming to Albany on this day to meet with their local Senators and Assembly members, as well as hearing from New York’s top health care policymakers including:

  • Senate Majority Leader John Flanagan;
  • Assembly Majority Leader Joseph Morelle;
  • Senate Health Committee Chair, Kemp Hannon; Assembly Health Committee Chair, Richard Gottfried: Senate Insurance Committee Chair, James Seward; Assembly Insurance Committee Chair, Kevin Cahill;
  • Jason Helgerson, NYS Medicaid Director;
  • Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services

Come meet with your legislators to urge that they:

  • REJECT burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the Governor’s proposed State Budget;
  • REJECT inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners;
  • REJECT changes to increase burdensome physician prior authorization requirements contained in the proposed State Budget;
  • SUPPORT legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
  • SUPPORT legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up costs; and
  • REJECT legislation that would impose costly and time consuming mandates on physician delivery of patient care.

A brief informal luncheon to which members of each House are invited to speak with their constituents will follow the morning program. In addition to registering here please contact your local county Medical Societies who will be scheduling appointments for physicians to meet with their elected representatives. If you have any questions/comments, please contact Carrie Harring at charring@mssny.org or call 518-465-8085.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Please Contact Your Legislators To Express Concerns With Several State Budget Proposals
The month of March brings with it an intensification of negotiations between the Assembly, Senate and Governor to meet the April 1 State Budget deadline. As these negotiations ensue, physicians are urged to continue to contact their elected officials regarding a number of State Budget proposals listed below.   While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  For example:

  • We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  Send a letter to your legislators here.
  • Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or who have not met clinical goals of therapy. While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  Send a letter to your legislators here.
  • “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements. To send a letter to your legislators, click here.
  • The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.
  • The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including “modernizing” Certificate of Need laws, and changing scopes of practice for non-physicians. Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval. Over a dozen specialty societies have joined MSSNY in a letter to the entire Legislature to urge that this proposal be removed from the budget, or remove the provision that enables these demonstration programs.
  • Giving overbroad discretion to state officials to drop physicians and other prescribers from the Medicaid program based upon the “inappropriate prescribing of opioids”. (DIVISION OF GOVERNMENTAL AFFAIRS)

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


MSSNY OFFERS 3 Hour CME Program on Pain Management, Palliative Care and Addiction; NYS Requires Every Prescriber to Take 3 Hour Course By July 1, 2017
The Medical Society of the State of New York announces a series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers holding a DEA license to complete three hours of coursework no later than July 1st, 2017.   These webinars are being offered FREE OF CHARGE to MSSNY members with a discount code.  The discount code has been provided to MSSNY members.  Non-MSSNY members will be charged $150 for the series.  The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services in the development of this program.   Following the webinars, the course will be offered on-line on the MSSNY CME site.

The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series. The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Webinars will be held on:

Thursday, March 9, 2017—7:30-8:30am

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Trishia Allen, Esq.

Educational Objectives:

Understand New York State and Federal Requirements for Prescribing Controlled Substances

Discuss Guidelines for Chronic Pain. Register for this webinar here

Tuesday, March 14, 2017—7:30-8:30am

Rational Opioid Prescribing for Chronic Pain Conditions

Faculty: Charles Argoff, MD & Patricia Bruckenthal, PhD, APRN-BS, FAAN

Educational Objectives:

Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation. Describe palliative medical care and end-of-life care. Register for this webinar here

Tuesday, March 21, 2017—7:30-8:30am

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Charles Morgan, MD & Frank Dowling, MD

Educational Objectives:

Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral. Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed.Describe Strategies for Treating Pain in Patients with Substance Use Disorders.Register for this webinar here

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.

Additional information or assistance with registration may be obtained by contacting Pat Clancy at pclancy@mssny.org.
(CLANCY)

New York Physician Leaders to Head to Nation’s Capital Next Week
Several MSSNY physician leaders from across New York State will travel to Washington DC next week to join thousands of physicians across the country meeting with their Representatives and Senators fighting for needed improvements in health care delivery, and in opposition to proposals that would jeopardize health care access and coverage for their patients. The Hill visits are in conjunction with the AMA’s Annual National Advocacy Conference.

Specifically, physicians will be urging the enactment of legislation to ease some of the burdens associated with the new Medicare Merit-Based Incentive Payment System (MIPS), and to reduce hassles associated with Medicare audits initiated by Recovery Audit Contractors.

MSSNY will also be advocating for carefully considered reforms to the Affordable Care Act (ACA). Last month, MSSNY President Dr. Malcolm Reid wrote to New York’s entire Congressional delegation to express concern with efforts to repeal funding for coverage expansions authorized under the ACA without simultaneously specifying how it will be replaced.

Dr. Reid’s letter acknowledged the many concerns physicians have expressed with the impact of the ACA, but also noted that “the ACA has provided the opportunity for hundreds of thousands of New Yorkers to obtain affordable health insurance coverage that previously was not available to them” and that “elimination of the funding currently provided to New York State through these programs could drive a huge hole in our State Budget, and prompt untenable cuts affecting millions of more New Yorkers.”    Therefore, he urged “that any legislation that threatens the availability of affordable health insurance options for our patients simultaneously specifies how these currently available coverage options will be replaced with improved coverage options”.
(AUSTER)

DFS Announces Comprehensive Investigation Into Insurer Contraceptive Coverage Compliance
Superintendent Maria Vullo announced this week that the New York State Department of Financial Services (DFS) is conducting a comprehensive investigation of health insurer compliance with contraceptive coverage requirements under New York Insurance Law, following an undercover sting of 15 insurers.  The press release, noted a report that describes how DFS discovered that certain New York health insurers are providing consumers with incorrect information about contraceptive coverage.

The press release notes that, in its undercover sting, DFS identified 11 New York health insurers that had provided consumers with incorrect information about contraceptive coverage.  Some health insurers were incorrectly telling callers that the consumer must pay for contraceptive drugs and devices, when both New York law and the ACA mandate such coverage.  In addition, several health insurers incorrectly stated that a particular contraceptive drug or device is not covered, or that co-payments are required when they are not. The press release further noted that, as part of this comprehensive investigation, DFS will take several steps to correct any violations they find, including:

  • Taking all necessary action to ensure that all health insurers in New York cover the full range of FDA-approved contraceptive delivery methods at no cost-sharing;
  • Requesting a corrective action plan and related relief from health insurers found to have failed to provide accurate or complete information;
  • Requesting information and documentation from health insurers regarding their coverage and reimbursement of contraceptive drugs and devices under health insurance policies.  Specifically, DFS will be requesting information about contraceptive claims submitted and whether the claims were appropriately paid, with no cost-sharing imposed.  DFS will also be requesting information about complaints and appeals involving contraceptive coverage.
    (AUSTER, CLANCY)

AG Settles Case with Oxford for Improper Denial of Infusion Services
New York Attorney General Eric Schneiderman announced an agreement with Oxford Health Plan this week requiring Oxford to provide refunds to hundreds of small group plan members in New York State for improperly denying coverage of infusion services, including necessary supplies and nurse visits, since November 2015.  According to the press release, the investigation began after an Oxford enrollee complained to the Attorney General’s Health Care Bureau Helpline that she began to receive bills from a provider of infusion supplies, when the infusion supplies had been previously covered by her plan.  As a result of the AG’s inquiry, Oxford acknowledged that hundreds of other members’ infusion services claims were also improperly denied as well as claims for nurse home healthcare visits for the administration of infusion medication.

Specifically, Oxford identified a total of 2,587 claims that were improperly denied, totaling nearly $500,000.   The agreement requires Oxford to mail letters to members notifying that they may have paid too much for infusion services, and setting forth the steps to secure a full refund; Re-examine all infusion claims from October 1, 2015; and pay $35,000 to New York State.
(AUSTER)

Register Now For Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, March 15, 2017 at 7:30 a.m. with Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise. 2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 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 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.                                                                                                                           (Clancy, Hoffman)

Register Now For Upcoming Veterans Matters CME Webinars
The Medical Society of the State of New York encourages you to register for its upcoming Veterans Matters webinars. These programs include CME presentations on PTSD and TBI, as well as Substance Use Disorders. Faculty for these programs are Frank Dowling, MD and John McIntyre, MD. Registration for all of these programs is open.  Just click on any of the presentation dates below.

Substance Use Disorders (SUDs): Friday, March 3 at 7:30 a.m.

Faculty Presenter: Frank Dowling, MD

The educational Objectives for the SUDs program are:

1) Explain substance use disorders (SUDs), symptoms, warning signs, comorbidities.

2) Explore treatment options for veterans including evidence-based practices in psychotherapy and pharmacotherapy.

3) Identify barriers to identification and treatment, including those unique to military culture, and how to overcome them.

PTSD and TBI: Friday, March 10 at 8 a.m.

Faculty Presenter: John McIntyre, MD

The educational Objectives for the PTSD program are:

1) Describe the symptoms of PTSD and TBI.

2) Describe the treatment modalities of PTSD and TBI.

3) Describe military culture & how to overcome unique barriers to treatment intrinsic to military culture

Additional information or assistance with registration may be obtained by contacting Greg Elperin at gelperin@mssny.org.

Veterans Matters is a CME series made possible through a grant from the New York State Office of Mental Health. 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 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.             
(Elperin)

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

enews large

For Your Patients: MY DRUG IS NOT COVERED. NOW WHAT?
With the rising cost of healthcare today, families are in need of assistance.  The New York Rx Card can help with those prescription costs and is a free program available to all New York residents.  No eligibility requirements or forms to fill out, simply take the card into the pharmacy to receive savings of up to 75% on prescription medications for the whole family.  New York Rx Card is a proud supporter of Children’s Miracle Network. A donation will be made to your local CMN hospital each time a prescription is processed through the New York Rx Card.  Go to www.newyorkrxcard.com and print your free card today. 

January 2018: New Paid Family Leave Regulations in New York
On February 22, Governor Andrew M. Cuomo announced that the state has filed regulations for the implementation of New York’s paid family leave program, the most comprehensive paid family leave program in the nation. The new regulations provide guidance to employers, insurance carriers and employees about their rights and responsibilities under the law. New York’s Paid Family Leave Law will provide for 12 weeks of paid leave when fully phased-in for employees who seek to take care for a new child, a close relative with a serious health condition or relieve the pressures created when a family member is called to active military service.

The Governor launched a new helpline (844) 337-6303 and a new website to answer questions and provide New Yorkers with more information about the new program. The state also issued a Request for Information to solicit information from potential vendors and develop a leave plan for state employees. The new policy will be phased in over a four-year period, beginning on January 1, 2018.

Beginning January 1, 2018, the state’s paid family leave program will provide employees with wage replacement during time away from their job in order to bond with a child, care for a close relative with a serious health condition, or to help relieve family pressures when someone is called to active military service. Employees are also entitled to be reinstated to their job when their leave ends, as well as the continuation of their health insurance. The regulations filed today provide regulatory guidance to employers, insurance carriers, and employees to clarify their rights and responsibilities under the program so that they can plan accordingly when the new law goes into effect.

The regulations also address eligibility, coverage, the phase-in schedule of the new program, and more information on how employees, employers, and insurance carriers will interact to pay out benefits. The full Workers Compensation Board regulations are available here. DFS regulations for insurance companies are available hereEligibility: To be eligible for paid family leave, employees must have been employed full-time for 26 weeks or part-time for 175 days by a covered employer, at the time they apply for benefits.

The proposed paid family leave regulations are subject to a 45-day notice and public comment period following the publication in the New York State register before its final issuance.   New York’s Paid Family Leave website, found at www.ny.gov/paidfamilyleave, has also been updated to reflect information based on the draft regulations. Information on the site will be regularly updated. The public is also encouraged to call the Paid Family Leave helpline at (844) 337-6303 with any questions.

To be eligible, employees must present certification from a health care provider treating the family member.
For adoption and foster care of child, documentation is also required. Coverage: The program is included under an employer’s disability policy that all private employers must carry, and will be fully funded by employees through payroll deductions—beginning in July 2017. The program is mandatory for all private employers, and public employers may opt-in to the program.

 SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details


United Accused of Overcharging Medicare through Medicare Advantage Program
UnitedHealth Group, one of the nation’s largest health insurers, is accused in a scheme that allowed its subsidiaries and other insurers to improperly overcharge Medicare by “hundreds of millions — and likely billions — of dollars,” according to a lawsuit made public at the Justice Department’s request. The accusations center on Medicare Advantage, a program through which people 65 or older agree to join private health maintenance organizations, or HMOs, whose costs the government reimburses.

The program was created in 2003 after UnitedHealth and other insurers said that managed care could help contain the overall cost of Medicare. Instead of slowing Medicare costs, UnitedHealth may have improperly added excess costs in the billions of dollars over more than a decade, according to the lawsuit, which was unsealed in Federal District Court in Los Angeles.

A spokesman for UnitedHealth disputed that assertion, saying it was based on faulty interpretations of Medicare rules.

GOP Aims to Push HSAs to Consumers to Lower Healthcare Costs
The AP http://apne.ws/2mfijET reports the Federal government may begin pushing consumers to help reduce healthcare costs. While the fate of the Affordable Care Act remains uncertain, “Republicans indicated last week that they will encourage wider use of insurance that comes with a health savings account aimed at pushing patients to save and shop for care.” They are convinced that when consumers’ “money is on the line – and not the insurance company’s” – they will shop around for the best value and do their “part to curb national health care spending.”

CMS Streamlines ICD-10 Resources
To streamline your access to resources, CMS has merged all up-to-date content from our Road to 10 website to our main ICD-10 site, cms.gov/ICD10.

We are now phasing out the Road to 10 site, with an anticipated completion date of April 3.

Please be sure to update all your bookmarks and links for Roadto10.org to point to cms.gov/ICD10.

After the successful transition to ICD-10, we noted that:

  • Visits to the Road to 10 website dropped sharply
  • Most users were opting to visit cms.gov, not Road to 10, for ICD-10 information

CMS has made cms.gov/ICD10 your one-stop site for official CMS ICD-10 resources.

MSSNYPAC – The Political Voice for New York’s Physicians
Significant victories have been hard won by physicians.  Numerous administrative simplifications have been achieved.  E-prescriptions will soon be permitted to be transferred from pharmacy to pharmacy! Reporting to the DOH is no longer necessary when you have to write a paper prescription!  Health insurer step therapy medication protocols can be more readily overridden!

Health insurer credentialing times have been shortened!  These and the many other victories the physician community achieves are possible when physicians work collectively on the three important fronts of advocacy – Lobbying, Grassroots and Political.  If any one area lacks, all areas are weakened.  Like joining MSSNY, or sending letters or making calls in support of important measures, Your support of MSSNYPAC is essential to our collective advocacy successes.  Help pave the way for more victories!
Join or increase your support and participation today at www.mssnypac.org/contribute

REMINDER: THERE IS A MARCH 17 DEADLINE FOR MEANINGFUL USE EHR ATTESTATION AND THE DEADLINE FOR PQRS HAS BEEN EXTENDED UNTIL MARCH 21, 2017.

CDC Report: Season’s Flu Vaccine Has Been 48% Effective So Far
According to a report from the Centers for Disease Control and Prevention, the flu vaccine has been 48% effective so far this season.

Weekly Charting Tip: What is the cause of the vast majority of social media poor reviews? Poor patient service; NOT poor patient care. Return phone calls and attempt to realistically appoint your patients. If the physician is delayed due to an emergency, immediately explain this to the people waiting. Perhaps, proactively call the later patients that will be affected by the delay; like some airlines are now doing.

If you have any questions, please contact Kern Augustine, P.C. at 1-800-445-0954 or via email at info@DrLaw.com.


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Member firm “The MD TAXES Network” CPAs Specializing in Healthcare Professionals


Modern/High End Office (Upper East Side)
Large and Modern office to share.  Located on the ground floor.  2+ treatment/exam rooms, large waiting room, private office, storage.  Price is negotiable for 1-3 day/week.  Call Dr. Austin 5189284819 or email ian@caneandaustin.com No broker fee.  Craig Austin, M.D. 120 East 64th Street, NYC 10065



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities


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

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

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

February 17, 2017 – Overreaching Prosecution re Opioids?

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
February 17, 2017
Volume 17
Number 7

MLMIC Insurance

Dear Colleagues:

Several physician leaders of the Erie County Medical Society and MSSNY met with the Buffalo News editorial board this week to express concerns about the impact to patient care as a result of statements made by various prosecutorial agencies regarding their intention to prosecute more physicians for inappropriate prescribing of opioids. The participants included: MSSNY Vice President Dr. Thomas Madejski, Erie County Medical Society President Dr. Timothy Gabryel, former MSSNY House of Delegates Speaker (and former AMA President) Dr. Nancy Nielsen and Medical Society of Erie County Executive Director Christine Nadolny.

The physicians emphasized the extensive efforts of the medical community to respond to the opioid abuse crisis. They also recognized the appropriateness of criminal prosecution in certain instances where prescribers are intentionally writing prescriptions for diversion purposes.  However, they also emphasized that it is wrong to prosecute physicians for medical decision-making, as such efforts could intimidate physicians into greatly limiting their prescriptions for necessary medications, which in turn would greatly narrow treatment options for patients.

It is yet another reason for physicians to come to Albany for MSSNY’s Physician Advocacy Day on March 8 to make sure their legislators are aware of the possible narrowing of treatment options for patients due to potentially overly aggressive efforts to prosecute.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org



MSSNY Lobby Day Scheduled for March 8TH – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.

Physicians are urged to come to Albany to participate in MSSNY’s lobby day to give firsthand accounts on the current needs in health care, lobby for the positive provisions included in the proposed state budget and stop several proposals that could have an adverse impact on physician care delivery.

If you plan to attend, please register here.

The morning program will begin at 8 AM, after which physicians will have the opportunity to have meetings with their local Senators and Assemblymembers.   A full slate of legislators and key policymakers have been confirmed to participate in the morning program including:

  • NYS Senate Majority Leader John Flanagan;
  • Jason Helgerson, NYS Medicaid Director;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and top health care staff at DFS have been invited.

A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.   In addition to registering here please contact your county medical societies, as they will be scheduling appointments for physicians to meet with their local Assemblymembers and Senators.
(DIVISION OF GOVERNMENTAL AFFAIRS)                                                      

MSSNY Testifies at Health Budget Hearing
Division of Governmental Affairs’ Senior Vice President / Chief Legislative Counsel Moe Auster testified at a joint public hearing on the health care budget this week.

MSSNY stressed the need for lawmakers to reduce burdensome prior authorization hassles and not increase already overwhelming overhead costs borne by physicians.  In this regard, the testimony included support for the continued funding for the Excess Medical Liability Insurance program while stressing our opposition to the proposed tax clearance obligation as a condition for Excess coverage which could serve as an impediment to timely issuance of the Excess policy.

MSSNY also expressed support for budget proposals that call for the regulation and taxation of E-cigarettes in the same manner as tobacco cigarettes, and the registration and regulation of Pharmaceutical Benefit Manager (PBMs).

MSSNY outlined concerns with a proposal that would allow pharmacists to enter into “comprehensive medication management protocols” with nurse practitioners to manage, adjust and change the medications of certain patients. While similar collaborative drug therapy programs exist in the hospital environment, only physicians are currently permitted to enter into these protocols.

Additionally, MSSNY expressed concerns regarding the Health Care Regulation Modernization team proposal that would be empowered to review and propose fundamental restructuring of statutes, policies and regulations including certificate of need rules and clinician scope of practice laws.  Of greatest concern, the proposal appears to allow various state agencies the ability to implement “demonstration programs” to test and evaluate procedures and processes for organizing, financing and delivering health care services that are not permissible under current statute or regulation.

MSSNY also urged that outstanding Health Republic claims be paid in full.  DFS Superintendent Maria Vullo gave a presentation at the hearing regarding her extensive efforts to oversee the liquidation of HR including the possible initiation of litigation to collect “Risk Corridor” payments as other states have done.

To read MSSNY’s full testimony, please click here.                                           (DIVISION OF GOVERNMENTAL AFFAIRS STAFF) 

MSSNY OFFERS 3 Hour CME Program on Pain Management, Palliative Care and Addiction; NYS Requires Every Prescriber to Take 3 Hour Course By July 1, 2017
The Medical Society of the State of New York announces a series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers holding a DEA license to complete three hours of coursework no later than July 1st, 2017.   These webinars are being offered FREE OF CHARGE to MSSNY members with a discount code.  The discount code has been provided to MSSNY members.  Non-MSSNY members will be charged $150 for the series.

The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services in the development of this program.   Following the webinars, the course will be offered on-line on the MSSNY CME site.   The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series.

The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Webinars will be held on:

Thursday, March 9, 2017—7:30-8:30am

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Trishia Allen, Esq.

Educational Objectives:

Understand New York State and Federal Requirements for Prescribing Controlled Substances

Discuss Guidelines for Chronic Pain

Register for this webinar here 

Tuesday, March 14, 2017—7:30-8:30am

Rational Opioid Prescribing for Chronic Pain Conditions

Faculty: Charles Argoff, MD & Patricia Bruckenthal, PhD, APRN-BS, FAAN

Educational Objectives:

Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation

Describe palliative medical care and end-of-life care

Register for this webinar here 

Tuesday, March 21, 2017—7:30-8:30am

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Charles Morgan, MD & Frank Dowling, MD

Educational Objectives:

Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral.

Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed.

Describe Strategies for Treating Pain in Patients with Substance Use Disorders.

Register for this webinar here 

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.

Additional information or assistance with registration may be obtained by contacting Pat Clancy at pclancy@mssny.org
(CLANCY)


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


Physician Uproar Over Kinney Drugs’ New Strep and Flu Testing Program
This week MSSNY alerted state Department of Health and State Education Department officials to the concerns raised by several physicians regarding a new program from Kinney Drug Stores in 10 Onondaga County locations to conduct “rapid tests” of customers for strep and influenza and facilitate telemedicine treatment for these customers if these initial tests are positive.  These physicians’ concerns were extensively documented on a local Syracuse television station this week.

Several physicians have been in contact with Kinney officials directly questioning whether Kinney has legal authority to do this, as well as whether this could adversely impact patient health because of the possibility of “false positives” and “false negatives”.  These initial conversations have resulted in Kinney increasing from 13 to 18 the minimum age of customers who could be rapid tested for strep and flu.  Kinney representatives have noted that its actions are legal because these sites have been approved by New York State to perform rapid strep and flu tests under the supervision of a physician medical director as these are “CLIA waived tests”.

MSSNY staff has also been in touch with Kinney representatives, and will be facilitating dialogue between local county medical society physician leaders and Kinney representatives to discuss how best to assure patients’ health.
(AUSTER, CLANCY)

Details on Federal Health Care Changes Start to Emerge
House Republicans have released an outline of how they would repeal and replace the Affordable Care Act.  Their plan would include giving states the power to design their own plans, increasing the amount individuals can put in their Health Savings Accounts and allows individuals and families to spend money from their HSA on “over-the-counter” health care items.  Their plan also includes a monthly portable tax credit that can be used to buy a health insurance plan that would be based on age. Of greatest significance to New York State, it would phase out the Medicaid eligibility expansion contained in the ACA.

The Centers for Medicare & Medicaid Services (CMS) also issued a proposed rule this week that would make the following changes, with the goal of helping to stabilize the individual and small group market.

  • Expand Pre-Enrollment verification of eligibility
  • Allowing an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year’s plan with the same issuer.
  • Provide greater flexibility to insurers to offer varying coverage options.
  • Give states the authority to assess issuer network adequacy.
  • Shorten the upcoming annual open enrollment period for the individual market.
    (Belmont)

Aetna-Humana Calls off Its Merger and Cigna Sues to End Merger with Anthem
While Aetna and Humana announced that they were ending their proposed merger this week, a federal judge temporarily blocked Cigna from immediately terminating its proposed merger agreement with Anthem, after Cigna earlier this week sued Anthem seeking to end the agreement.  These actions follow recent rulings blocking these proposed mergers from moving forward.  These proposed mergers had been challenged by several patient advocacy and physician advocacy organizations including the American Medical Association and MSSNY because of the very significant market impact the mergers would have had in various regions across the country, and in New York.  Last fall, MSSNY President Dr. Malcolm Reid and AMA representatives testified at a New York Department of Financial Services (DFS) hearing to express strong concerns with the proposed merger of Anthem and Cigna.                        (AUSTER)

DOH Provides Information on New Breast Cancer Screening and Diagnostic Imaging
In July 2016, Governor Andrew M. Cuomo signed legislation to help more women get breast cancer screening and diagnostic imaging. The legislation prohibits insurers in New York from requiring cost-sharing for women who get these services. A copy of the letter that the New York Department of Financial Services sent to insurers about the new requirements can be found here.

No cost-sharing means that women who have health insurance policies covered by this law do not have to pay any out-of-pocket costs for breast cancer screening and diagnostic imaging. This means that insurers cannot apply the services against annual deductibles and also cannot charge patients a co-payment or coinsurance.  Important note: no cost-sharing applies only when services are delivered by a provider in your health plan’s network. Services may not be covered at all if delivered by a provider outside of your health plan’s network. The law removes cost-sharing for mammograms, including:

a single, baseline mammogram for women 35 to 39 years old, yearly mammograms for women 40 years of age or older, and mammograms for women at any age who are at an increased risk of breast cancer because they have a prior history of breast cancer, or they have a first degree relative (e.g., parent, sibling, child) with breast cancer. The law also removes cost-sharing for women in need of imaging tests other than standard mammograms – such as diagnostic mammograms, breast ultrasounds, and breast magnetic resonance imaging (MRI) for the detection of breast cancer.  Additional information can be found here.  (CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, March 15, 2017 at 7:30 a.m. with Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

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 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.  (CLANCY, 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

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MSSNYPAC – The Political Voice for New York’s Physicians
Supporting MSSNYPAC with a financial contribution is an important investment in the preservation of our noble profession.   You can help to strengthen the physician’s political voice to help direct the shape of healthcare policy.  Physicians face opposition on many fronts.  Therefore, we need to be prepared with a well-funded MSSNYPAC to support the candidates who truly understand the concerns of physicians trying to assure their patients receive the best possible care.  In light of what’s at stake, isn’t it time you lent your voice to our efforts?  Join or increase your support and participation today at www.mssnypac.org/contribute

MLMIC Shares Anticipated Timeline for Berkshire Hathaway Transaction

Dear MSSNY Member:

As you know, in July of 2016, your endorsed carrier MLMIC announced its intention to be acquired by Berkshire Hathaway. We’re pleased to advise you that the transaction is on track and progressing forward in accordance with the measures and actions required under New York Insurance Law Section 7307 (NYIL §7307), designed to protect “the interests of the policyholders and the public.” We are, however, disappointed that the process is taking slightly longer than anticipated.  As you know, we anticipated a culmination of the process in the third quarter of 2017. We are now hopeful that the process will be completed by year end 2017.  As such, policyholders can expect several major milestones to occur between now and the expected close of the transaction.  The estimated timeline for these milestones is currently as follows:

  1. In accordance with NYIL §7307, MLMIC is being examined by the NYS Department of Financial Services (DFS) to assess the financial condition of the Company. That examination is expected to be completed during the second quarter of 2017.
  2. In accordance with NYIL §7307, the DFS will also conduct an independent valuation of the Company to assess the fairness of the cash consideration to be paid by Berkshire to owners of eligible MLMIC policies from July 14, 2013 through July 14, 2016. This valuation is expected to be completed during the third quarter of 2017.
  3. In accordance with NYIL §7307, once the examination and independent valuation are done, MLMIC’s Board will request permission from the Superintendent to submit a Plan of Conversion for approval by DFS. MLMIC will then prepare and disseminate detailed information regarding the Plan of Conversion to all of those who are eligible to vote (i.e. those who were policyholders on July 14, 2016) on this transaction.  The Superintendent will then hold a public hearing regarding the Plan of Conversion.  Following this hearing, the Superintendent will review the Plan of Conversion, and if approved, will authorize MLMIC to conduct a vote.
  4. In accordance with NYIL §7307, we expect to hold a vote of those eligible to vote on this transaction during the fourth quarter of 2017. If two-thirds or more of those voting elect to proceed with the transaction, the transaction will close and Berkshire will authorize distribution of payments shortly thereafter.

As we progress forward and achieve these milestones, we will provide an update via MSSNY E-News, and on MLMIC’s blog and the “Frequently Asked Questions” webpage. If you have any questions about the transaction, please call 1-888-998-7871.

Thank you for your continued support as we complete this exciting transaction that will deliver a significant financial benefit to those who owned an eligible policy from July 14, 2013 through July 14, 2016 and will enable us to continue to serve our policyholders with high quality liability insurance for many years to come.

Robert A. Menotti, M.D.
President, MLMIC


SAVE THE DATE

Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details



New York Investigating Three Cases of Leptospirosis in Bronx Neighborhood
The New York Times (2/14) reported that the NYC Department of Health and Mental Hygiene “is investigating three recent cases” of the rare disease leptospirosis “that have occurred in the Grand Concourse neighborhood of the Bronx.” Leptospirosis “infections commonly occur through exposure to rat urine,” and the city has “taken ‘immediate measures’ to reduce the rat population in the area and” educate residents about the disease.


FOR YOUR PATIENTS: MY DRUG IS NOT COVERED. NOW WHAT?

With the rising cost of healthcare today, families are in need of assistance.  The New York Rx Card can help with those prescription costs and is a free program available to all New York residents.  No eligibility requirements or forms to fill out, simply take the card into the pharmacy to receive savings of up to 75% on prescription medications for the whole family.  New York Rx Card is a proud supporter of Children’s Miracle Network.  A donation will be made to your local CMN hospital each time a prescription is processed through the New York Rx Card.  Go to www.newyorkrxcard.com and print your free card today.

Travel Ban Creates Uncertainty for Upcoming Match Day
The Chicago Tribune (2/11) reported that the “continuing uncertainty surrounding” President Trump’s travel ban “has international medical school graduates and teaching hospitals on edge.” According to the national Resident Matching Program, “about 14 percent of residents who matched through the main matching program – more than 3,700 people – were non-U.S. citizens who graduated from medical schools outside the U.S.” The article points out that the American Medical Association “has asked the Trump administration for guidance on Trump’s order to ensure it doesn’t keep out qualified med school grads or leave hospitals with unfilled training spots.”

AMA President Andrew W. Gurman said, “International medical graduates have been a resource to provide medical care to areas that don’t otherwise have access to physicians. With the current uncertainty about those physicians’ immigration status, we don’t know whether or not these areas are going to receive care.”

Over 65: Taking At Least Three Psychiatric Meds More Than Doubled in Nine Years
“The number of retirement-age Americans taking at least three psychiatric” medications “more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers” found after analyzing “data from annual government surveys of office-based” physicians. In particular, investigators “focused on office visits by people 65 or older that resulted in the prescribing of at least three of a list of psychiatric, sleep and pain medications.” The findings were published online Feb. 13 in a research letter in JAMA Internal Medicine.

Two Upstate New York Medical Groups to Merge
The Schenectady Daily Gazette (2/9) reports that Community Care Physicians and CapitalCare Medical Group are planning to merge. When combined, the two “will offer urgent care, primary care and care in 30 specialties at more than 50 locations across the Capital Region.” The article reports that additional details will be released Friday “when Dr. Shirish Parikh, CEO of Community Care, and Joan Regan Hayner, CEO of Capital Care, make a formal announcement of the plans at a news conference.”

Pediatrics: Drunk Driving Contributes To More than One in Four Crashes among Young
Research suggests that drunk driving “contributes to more than one in four motor vehicle fatalities for children, teens and young adults [in the United States] – and nearly half of these deaths happen at night or on weekends.” Researchers “analyzed crashes that occurred from 2000 to 2013 and involved at least one driver with a blood alcohol level of at least 0.08 percent, the legal limit in most states.” People killed in motor vehicle crash fatalities involving alcohol were “predominantly male (73 percent) and most were at least 18 years old.” The findings were published in the journal Pediatrics.


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PCAOB-Registered, Peer-Reviewed
Member firm “The MD TAXES Network” CPAs Specializing in Healthcare Professionals


Modern/High End Office (Upper East Side)
Large and Modern office to share.  Located on the ground floor.  2+ treatment/exam rooms, large waiting room, private office, storage.  Price is negotiable for 1-3 day/week.  Call Dr. Austin 5189284819 or email ian@caneandaustin.com No broker fee.  Craig Austin, M.D. 120 East 64th Street, NYC 10065



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities


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

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

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

February 10, 2017 – Victory! Aetna-Humana Merger Nixed!

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
February 10, 2017
Volume 17
Number 6

mssny_enews_dividend

Dear Colleagues:

As you may be aware, some of our physicians in the Central New York and Adirondack area have received letters from the Medicaid Fraud Control Unit (MFCU) of the NYS Attorney General’s Office.

These letters are the result of investigations conducted by MFCU concerning billing agents (and the providers that utilize their services). Our physicians are being asked to refund money based on MFCU’s decision of fraudulent billing stemming from contracts that are perceived to be allowing fee splitting.

MFCU points out that billing services that charge medical professionals a percentage of costs for claims submitted is in violations of Medicaid rules. MFCU also mentions that this form of billing is in violation of NYS Education Law. MSSNY is advising our member physicians to review their billing vendor service contracts. If your contract appears to allow this type of percentage billing, it is urged that you share these two documents with your billing service:

It is important that you seek to amend the fees you pay your biller for Medicaid claim submissions to either payment based on time or a flat fee for claims submitted.

Again, these letters are coming from MFCU and are not generated by NYSDOH, OMIG, NYS Education Department or OPMC. From our understanding, this recovery activity will impact fee for service and Medicaid fee for service and managed care.

If you have questions, please call Regina McNally at 488-6100 ext. 339.

Anthem Cigna Merger Blocked

Wednesday’s decision to block the mega-merger between insurance giants Anthem and Cigna is an important development for patients and their physicians. While many regions of New York State and across the country continue to be dominated by a few large insurers, this proposed merger would have made this problem even worse. Indeed, many patient and physician advocacy organizations raised concerns regarding the potential impact of this merger proposal on patient care, including MSSNY and the American Medical Association during a public hearing (where I testified) held by the New York Department of Financial Services (DFS) last September. We thank New York DFS Superintendent Maria Vullo for publicly articulating the huge market impact of this proposed merger had it been permitted to go forward, and New York Attorney General Eric Schneiderman for joining the US Department of Justice’s action to block the merger.

The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds.

As expected, the day after the decision, Anthem Inc. appealed the federal judge’s decision to block its acquisition of Cigna, but the future of the deal was unclear amid discord between the two partners.

Apparently, it’s not over yet.

As a personal endnote, my family and I would like to sincerely thank everyone for the outpouring of sympathy regarding the death of my mother last Sunday.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org




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


Please Contact Your Legislators to Express Concerns with Several State Budget Proposals
Physicians are urged to continue to contact their elected officials regarding a number of State Budget proposals listed below.   While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made.  For example:

  • We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  To send a letter to your legislators, click here.
  • Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  To send a letter to the Legislature, click here.
  • “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.  To send a letter to your legislators, click here.
  • The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.
  • The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including “modernizing” Certificate of Need laws, and changing scopes of practice for non-physicians. Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval.
  • Giving overbroad discretion to state officials to drop physicians and other prescribers from the Medicaid program based upon the “inappropriate prescribing of opioids.

MSSNY will be testifying at a Joint Legislative Hearing this Thursday to examine concerns with the proposed Health Budget.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Court Ruling Blocks Anthem-Cigna Merger from Moving Forward
A US Federal court issued a ruling this week blocking the proposed merger between health insurance giants Anthem and Cigna.  The proposed merger had been challenged by several patient advocacy and physician advocacy organizations including the American Medical Association and MSSNY because of the very significant market impact the merger would have had in various regions across the country, including in Long Island and New York City.  Last fall, MSSNY President Dr. Malcolm Reid testified at a New York Department of Financial Services (DFS) hearing to express strong concerns with the proposed merger.

The judge found that the merger would have substantially lessened competition for the sale of health insurance to national employers resulting in higher prices and diminished prospects for innovation. In a historic, stunning affirmation of the position urged by the AMA and consequently adopted by the government, Judge Jackson concluded that an enhanced ability to coerce physicians to accept lower reimbursement is not a merger efficiency defense.  She determined that it would not benefit consumers and “would erode the relationship between insurers and providers” and “reduce the collaboration” that is essential to innovation in payment and delivery.

In response to the court’s ruling, Dr. Reid gave the following statement.

Yesterday’s decision to block the mega-merger between insurance giants Anthem and Cigna is an important development for patients and their physicians.  While many regions of New York State and across the country continue to be dominated by a few large insurers, this proposed merger would have made this problem even worse.  Indeed, many patient and physician advocacy organizations raised concerns regarding the potential impact of this merger proposal on patient care, including the Medical Society of the State of NY (MSSNY) and the American Medical Association (AMA) during a public hearing held by the New York Department of Financial Services (DFS) last September.

We thank New York DFS Superintendent Maria Vullo for publicly articulating the huge market impact of this proposed merger had it been permitted to go forward, and New York Attorney General Eric Schneiderman for joining the US Department of Justice’s action to block the merger.

Anthem Has announced that it will appeal the decision.                              (AUSTER)

Several Health Insurance Reform Initiatives Advanced to Assembly Floor
Several bills supported by MSSNY to address inappropriate health insurer practices were favorably reported from various Assembly committees to the Assembly floor this week:

  • Legislation (A.2704, Lavine) to assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company is non-renewed, similar to protections provided when a physician is terminated from network participation;
  • Legislation (A.2539, Gottfried) to prohibit a health insurer from denying care unless it is reviewed by a physician in the same or similar specialty, and licensed in New York State.
  • Legislation (A.2389, Gottfried) to require health insurers to use uniform credentialing forms for reviewing applications to participate in a health insurer’s network; and
  • Legislation (A.2370, Gottfried) to prohibit health insurers from imposing certain requirements on their participating providers, including prohibiting referrals to out of network physicians, and “Most Favored nation” clauses                                                                         (AUSTER)

Physicians Action Needed  March 8th
MSSNY’s Annual Physician’s Advocacy Day – physician’s Urged to Attend and Wear Your White Lab Coats
Join MSSNY and your colleagues to lobby your elected leaders at this year’s annual “Physician’s Advocacy Day” on March 8th! Encourage your Senators and Assembly members to support legislation that is crucial to your practice and oppose the bills that place restrictions and add unreasonable burdens.  This year’s event will be held at the Lewis Swyer Theater at The Egg in Albany from 8am to 12noon, ending with a catered lunch and the opportunity to speak more directly with your legislators.  If you are interested in attending, please register here  or contact Carrie Harring at charring@mssny.org.

The morning program will begin at 8 AM, after which physicians will have the opportunity to have meetings with their local Senators and Assemblymembers.   A full slate of legislators and key policymakers have been confirmed to participate in the morning program including: NYS Senate Majority Leader John Flanagan;Jason Helgerson, NYS Medicaid Director;Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and top health care staff at DFS have been invited. A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.

County medical societies will be scheduling appointments for physicians to meet with their elected representatives. Come meet with your legislators to urge that they:

  • Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
  • Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into “medication management protocols” with nurse practitioners;
  • Reject changes to increase physician prior authorization requirements contained in the proposed State Budget;
  • Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
  • Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
  • Reject legislation that would impose costly and time consuming mandates on physician practices.

Do not leave it to the “other guy”.  Please plan to come to Albany to advocate on behalf of your profession, your community and your patients!
(DIVISION OF GOVERNMENTAL AFFAIRS)

Dr. Tom Price Confirmed as HHS Secretary
By a 52-47 vote, the US Senate this week confirmed Dr. Tom Price to become the next Secretary of the US Department of Health and Human Services (HHS).  Dr. Price, an orthopedic surgeon from Georgia, was a Congressman and a Georgia delegate to the AMA House of Delegates.

Dr. Price was the long time sponsor of the Medicare Patient Empowerment Act, legislation supported by many organizations that would enable seniors to have partial coverage to receive care from a physician who does not participate in Medicare program.  He has also opposed various Medicare bundled payment demonstration programs, such as for joint replacement and cardiac surgery, that have been implemented by CMS in several regions across the country. (AUSTER)                                                                                                                                      

Assembly Health Committee Advances Retail Clinic Legislation to Codes Committee
Assembly Bill 958, sponsored by Assemblywoman Amy Paulin, passed out of the Assembly Health Committee to the Codes Committee.   This legislation would authorize the establishment of clinics in corporate-owned retail stores.   MSSNY believes that by permitting this practice, NYS will infringe upon the independence of medical decision-making and the integrity of the doctor-patient relationship.

Furthermore, many are concerned that corporately owned and operated retail clinics will open the floodgates to conflicts of interest  as retail clinics could directly profit from the very prescriptions that are written there , and treatments they recommend—all under the very same roof.   Voting against this measure was: Assembly members Kevin Cahill, Aileen Gunther, Ellen Jaffe, Thomas Abinanti and Edward Ra. The measure now goes to the Assembly Codes Committee for its consideration. To send a letter in opposition, click here.
(CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.

The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from an active shooter/bombing event in the healthcare setting.  2) Identify means by which members of the healthcare team can address  stress before,  during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

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 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.  (CLANCY, HOFFMAN)

Assemblyman Schimminger Introduces Proposals Strongly Supported by MSSNY
Assemblyman Schimminger introduced two bills strongly supported by MSSNY. 

  • 5648 – The “medical liability reform act” would implement a number of important reforms to the medical liability adjudication system to reduce the exorbitant and rapidly rising cost of medical liability insurance.  This bill would require an attorney for a plaintiff in a medical, dental or podiatric malpractice case to include with the certificate of merit, an affidavit from a physician stating that there is a reasonable basis for such malpractice action.  The failure to file would result in the dismissal of the suit. The bill also limits noneconomic damages in such causes of action to $250,000 has been adopted by several other states.  Additionally, the bill requires enhanced and comprehensive disclosure of expert witnesses to be used by any party in medical, dental and podiatric malpractice cases.
  • 4914 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 alleviate some of burdensome costs & time demands associated with Maintenance of Certificate (MOC) requirements.
    (BELMONT)

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

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BMJ: IMGs Seem to Perform At Least as Well as U.S.-Trained Physicians
Hospitalized patients in the U.S. who are treated by attending physicians who received their medical training abroad fair just as well — and in some cases better — than those treated by domestically trained physicians, suggests a study in The BMJ.

The authors examined data on 1.2 million Medicare beneficiaries who were admitted from 2011 to 2014 and treated by 44,000 general internists. Roughly 44% of the internists were international medical graduates.

After multivariable adjustment, patients of international medical graduates had significantly lower 30-day mortality rates than those of U.S. graduates (11.2% vs. 11.6%). The mortality differences were similar across numerous clinical conditions. However, international graduates had higher costs of care ($1145 vs. $1098). Readmission rates were similar between the groups.

The authors write: “Taken together, our findings should reassure policymakers and the public that our current approach to licensing international medical graduates in the US is sufficiently rigorous to ensure high quality care.” The BMJ article

Weekly Charting Tip:

Remember when you were bad in 2nd grade and your teacher told you it was going on your permanent report card? Well, your National Practitioner Data Bank profile is that permanent report card for health care professionals. Most any malpractice settlement or judgment, hospital privilege loss, being terminated by a managed care company, being disciplined by your state board; all of these and more can be found in your NPDB profile. Request a copy via going on line to the NPDB and initiate a “self-query.” It is only a few dollars. Don’t you want to know what every inquiring entity knows about you? You also want to make sure it is accurate. While patients and plaintiff attorneys cannot access this, a hospital where you applied for privileges, a medical group doing a due diligence prior to hiring you or a managed care company, can certainly access it. Also be warned that if you settle a case, your state board will have access to this information if they want to investigate the matter. Forewarned is forearmed!  – Larry Kobak, Esq., Kern Augustine

Governor Announces $20 Million Fund to Expand/Upgrade Healthcare Facilities
The AP (2/3) reports New York Gov. Andrew Cuomo announced the creation of the Community Health Care Revolving Fund, which aims to “help community health organizations that might not be able to expand otherwise.” The state has set aside almost $20 million for the fund in order “to assist local health care providers looking to expand or upgrade their facilities.” The money will be awarded in the form of low-cost loans.

CDC: 40,000,000 Have Some Hearing Loss Due To Noise Outside Workplace
In a Feb. 7, 2017, media briefing with Anne Schuchat, MD, acting director, U.S. Centers for Disease Control and Prevention regarding the Feb. 7, 2017, Morbidity and Mortality Weekly Report, “40,000,000 American adults have lost some hearing because of noise, and half of them suffered the damage outside the workplace, from everyday exposure to leaf blowers, sirens, rock concerts and other loud sounds.” Researchers found that “24 percent of adults had ‘audiometric notches’ – a deterioration in the softest sound a person can hear – in one or both ears.” The data “came from 3,583 people who had undergone hearing tests and reported the results in the 2011-2012 National Health and Nutrition Examination Survey.
The report is available at http://bit.ly/2kAsqlQ

Jan 28 NYSDOH Report: Four Deaths This Influenza Season
The NYS Department of Health (NYSDOH) reports in their Influenza Surveillance Report for the week ending January 28, 2017 that  influenza activity level was categorized as geographically widespread:

  • This is the sixth consecutive week that widespread activity has been reported.
  •  There were 5,235 laboratory-confirmed influenza reports, a 20% increase over last week. Of the 1,873 specimens submitted to NYS WHO/NREVSS laboratories, 406 (21.68%) were positive for influenza.
  • Of the 66 specimens tested at Wadsworth Center, 41 were positive for influenza. 31 were influenza A (H3), 2 were influenza A (Not Subtyped), 4 were influenza B (Yamagata) and 4 were influenza B (Victoria).
  • Reports of percent of patient visits for influenza-like illness (ILI3 ) from ILINet providers was 9.19%, which is above the regional baseline of 3.00%.
  • The number of patients hospitalized with laboratory-confirmed influenza was 961, a 4% increase over last week.

There was one influenza-associated pediatric death reported this week. There have been four influenza-associated deaths this season. https://www.health.ny.gov/diseases/communicable/influenza/surveillance/2016-2017/flu_report_current_week.pdf


SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details


NY State of Health Report on Number of Insured by County
Nearly one-quarter of New York City residents have purchased health insurance on New York State of Health, the exchange created by the Affordable Care Act. See the county results here.


Obese People May Be Less Likely To Receive Hospice Care, Research Suggests
Research suggests that obese people are less likely receive hospice care “and more likely to die at home.” The study authors “tracked the experiences of almost 5,700 Medicare beneficiaries who died between 1998 and 2012.” The investigators “looked at weight levels and whether or not someone died in hospice care.” Overall, about “35 percent of those in the study received hospice care, but just 23 percent of the severely obese did. In addition, the severely obese spent four fewer days in hospice care than those with a BMI of 20.” The findings were published online Feb. 6 in Annals of Internal Medicine.

Attest to 2016 EHR Incentive Requirements by March 13 to Avoid Pay Adjustment
The Centers for Medicare & Medicaid Services (CMS) has extended the attestation deadline for providers participating in the Medicare EHR Incentive Program to Monday, March 13, 2017, at 11:59 p.m. PT.

Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by March 13, 2017 to avoid a 2018 payment adjustment.  If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.

Attestation Resources

For More Information
For questions about the Registration and Attestation System, contact the EHR Information Center at 1-888-734-6433 (press option 1). The EHR Information Center is open Monday through Friday from 6:30 a.m. to 5:30 p.m. ET, except federal holidays


CLASSIFIEDS


TAXES • ACCOUNTING
Expert Certified Public Accountants firm
Tax, Accounting, Advisory Services
Specialty practice to medical & dental groups, professionals & organizations since 2004 • Highest quality work and client service • Competitive fees Susan Li, CPA, MBA
YSL & Associates LLC
(212) 232-0122
PCAOB-Registered, Peer-Reviewed
Member firm “The MD TAXES Network” CPAs Specializing in Healthcare Professionals


Modern/High End Office (Upper East Side)
Large and Modern office to share.  Located on the ground floor.  2+ treatment/exam rooms, large waiting room, private office, storage.  Price is negotiable for 1-3 day/week.  Call Dr. Austin 5189284819 or email ian@caneandaustin.com No broker fee.  Craig Austin, M.D. 120 East 64th Street, NYC 10065



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities


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

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

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

February 3, 2017 – DSRIP Not Trickling Funds Down to Doctors

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
February 3, 2017
Volume 17
Number 5

mssny_enews_dividend

Dear Colleagues:

The Delivery System Reform Incentive Payment program, better known as DSRIP, was designed to overhaul Medicaid. NY State released its NYS DSRIP Mid-Point Assessment Final Reports for all 25 PPSs (Performing Provider Systems) throughout the state on January 3, 2017. The reports are extensive.  In case you want to take a look at it, click here.

At our January 19 Council Meeting, a summary of the report was given to the Councilors. The bad news is that DSRIP is not trickling down to physicians as we had anticipated. In the reports, you need to review the DSRIP fund’s flow charts. See them here.

What is quite telling is that the funds are not flowing to physicians. We see that the larger entities are taking their slice of the pie and keeping it for themselves.

On our brief review of the fund flow charts, we see the following:

  • Advocate Community Providers, Inc. has the highest percentage of funds to physicians – 40.8% to PCPs and 6.1% to non-PCPs.
  • Sisters of Charity Hospital of Buffalo, New York is next with 15.53% to PCPs and 1.20% to non-PCPs.
  • Next is Alliance for Better Health Care, LLC at 9.3% to PCPs and appears to have no non-PCPs.
  • Montefiore is next at 6.26% for PCPs and 1.4% to non-PCPs.

Regrettably, the remaining PPSs shared less with the participating physicians.

Based on a statement of the OMIG and the DOH, DSRIP funds are distributed among the participating providers to incentivize providers to reach DSRIP performance goals.

I strongly advise all physicians who are participating in Performing Provider Systems (PPSs) to speak to the administrator of their PPS and question when they will receive their fair share.

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

Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org



Please Contact Your Legislators to Express Concerns with Several State Budget Proposals
Physicians are urged to contact their elected officials regarding a number of State Budget proposals listed below.   While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made.  For example,

  • We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  To send a letter to your legislators, click here.
  • Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  To send a letter to the Legislature, click here.
  • “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.  To send a letter to your legislators, click here.
  • The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here. 
  • The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including: “Modernizing the Certificate of Need laws, and changing scope of practice for non-physician.” Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval. 

Other Items of Note in the State Budget

  • Funding for MSSNY’s Committee for Physicians Health would be continued at past levels;
  • Re-appropriating $300,000 for MSSNY’s Veterans Health Care Initiative.
  • E-cigarettes would be taxed in the same manner as tobacco cigarettes.
  • Requiring the registration and regulation of Pharmaceutical Benefit Manager (PBMs)
  • Making the “inappropriate prescribing of opioids” an unacceptable provider practice in the Medicaid program, giving the state discretion to remove a physician or other prescriber from the program.
  • Reducing prescription drug costs by making drug companies pay a surcharge when costs exceed a certain benchmark to be determined by a Drug Utilization Review Board within the NYS Department of Health;
  • Requiring the testing of public water systems every three years for contaminants.

MSSNY will testify at the state Senate and Assembly public hearing on February 16, 2017 on the proposed NYS health budget.  (DIVISION OF GOVERNMENTAL AFFAIRS)

MSSNY Lobby Day Just a Few Weeks Away – March 8th – Physicians Urged to Attend and Wear Your White Lab Coats
Please make your plans now to to come to Albany Wednesday March 8 for MSSNY’s “Physician Advocacy Day”, which will be held at the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany.  Please register here.

The morning program will begin at 8 AM.   A full slate of legislators and key policymakers have been invited and/or confirmed to participate including:

  • Jason Helgerson, NYS Medicaid Director;
  • Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.

A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.   County medical societies will be scheduling appointments for physicians to meet with their elected representatives.

Come meet with your legislators to urge that they:

  • Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
  • Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners;
  • Reject changes to increase physician prior authorization requirements contained in the proposed State Budget;
  • Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
  • Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
  • Reject legislation that would impose costly and time consuming mandates on physician practices.

Do not leave it to the “other guy”.  Please plan to come to Albany to advocate on behalf of your profession, your community and your patients!                     
(DIVISION OF GOVERNMENTAL AFFAIRS)

Medical Liability Bills Re-Introduced
Legislation, A.3339 and S.4080,  have been re-introduced that would substantially lengthen the statute of limitations for medical malpractice actions and lead to enormous increases in the cost of liability insurance for physicians and hospitals.  If enacted, this bill could increase liability premiums by 15% at a time when no premium increases can be tolerated.

MSSNY continues to oppose expansion of liability provisions that would have drastic consequences on York’s health care system.  MSSNY will continue to push for comprehensive liability reform to preserve access to care for patients, not one-sided proposals that would further reduce access.

As we go into Super Bowl weekend, it is a good reminder that little can be done sitting on the sidelines.  Physicians are urged to contact their legislators by writing letters, making phone calls and meeting with their elected officials.  Physicians can send a letter from here.     (BELMONT)


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


Collective Negotiation Bill Introduced
One of MSSNY’s priority pieces of legislation was re-introduced this week.  Legislation, A.4472, Gottfried and S.3663, Hannon, would allow physicians to communicate with each other and jointly negotiate with health maintenance organizations (HMOs).  The bill divides the matters subject to being collectively negotiated into two major areas.

The first issue area involves non‐fee related matters such as utilization review, coverage provisions, benefits and exclusions definition of medical necessity, risk transfer, referral provisions, burdensome pre‐authorization procedures, limited drug formularies and access where necessary to out‐of‐network specialists.

The second issue area which can be negotiated involves fee‐related matters. These can be negotiated, however, only if the health care plan has substantial market share in the service area in which the physicians are practicing.  Strikes are expressly prohibited.

As many health insurers continue to expand their market share, shrink networks and impose more and more administrative burdens that interfere with patient care delivery, enactment of this legislation is essential to preserving the ability of a physician to advocate to assure their patients can get the care they need.   (Belmont) 

Assembly Health Committee Advances Legislation to Protect Physician Due Process Rights with Health Insurers
Legislation, A2704, Lavine, to assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company is non-renewed was favorably reported from the Assembly Health Committee to the Codes Committee this week.   MSSNY strongly supports this legislation.

The legislation is designed to protect existing patient-physician treatment relationships from being severed due to arbitrary health plan decisions to shrink their networks.  For example, in late 2015, hundreds of physicians were unfairly dropped from the networks of one large NYC-based insurer, allegedly because of these physicians’ failure to transition to value-based payments. Moreover, a recent MSSNY survey showed that more than 25% of the respondents indicated that they had been dropped from an insurer’s network in recent years.  Identical legislation (S.3943, Hannon) has been introduced in the New York State Senate.
(AUSTER)

Assembly Health Committee Agenda Next Week: Physicians Urged to Oppose Corporate-Owned Retail Clinic Bill
There are several bills of note on the Assembly Health Committee agenda next week, some supported by MSSNY, and some we oppose.  These include:

  • Legislation (A.958, Paulin) strongly opposed by MSSNY which would authorize the establishment of clinics in corporate-owned retail stores. To send a letter in opposition, click here:
  • Legislation (A.2539, Gottfried) strongly supported by MSSNY that would prohibit a health insurer from denying care unless it is reviewed by a physician in the same or similar specialty, and licensed in New York State; and
  • Legislation (A.2703, Gottfried) strongly supported by MSSNY that would clarify that the statutory liability protections offered for physician participants in MSSNY’s Committee for Physicians’ Health (CPH) program extend to the organization who sponsors the program as well as its employees.
    (AUSTER)

MSSNY Fights for Funding to Attract and Retain Physicians in NYS
MSSNY paired up with other health care advocates as part of the Workforce Advisory Group Lobby Day in hopes of gaining support in their efforts to address the shortage of primary physicians in underserved regions in New York State.

Among the notable issues was the request of legislative support for additional funding for Doctors Across New York (DANY).  DANY is a state funded program that was launched in 2008 to train and place physicians in areas of New York State where that specialty is most needed.  After seeing success in recruitment and retention rates in the previous cycles, the Workforce Advisory Group asked for an additional investment of $2 million dollars to award 50 more physicians.  The group also advocated for the expansion of the Take a Look Program – which introduces medical students and residents practicing in NYC to Upstate New York and the opportunities available in medicine.
(Harring, Belmont)

Blue Cross/Blue Shield of WNY Announces Reducing Prior Authorization Burdens for Many Services
As reported in the Buffalo News and on radio station WBFO, Blue Cross/Blue Shield of Western New York will be dropping prior authorization http://(http://buffalonews.com/2017/02/01/insurer-policy-shift-drops-preapproval-requirement-many-services/requirements for over 200 medical services.  To review the list of services that will no longer require prior authorization, click here.

These articles note that the action by BCBSWNY followed a report issued last week by the AMA noting the overwhelming burden to physician practices of prior authorization requirements, and the recommendation of several principles that health insurers should follow to reduce these burdens.     MSSNY was one of a handful of state medical societies to work with the AMA in developing these principles.  It also follows strong and sustained advocacy by leaders of the Erie County Medical Society to BCBSWNY and other regional health insurers regarding the need to reduce the administrative burdens that are interfering with patient care delivery.  Review of the list of services is ongoing, and suggestions may be made to expand this list of services not requiring PA.
(AUSTER)

NY State of Department  of Health Announces More Than 3.6 Million New Yorkers Secure Health Coverage
The NY State Department of Health reported this week that it saw a sharp influx of enrollees bringing the total number of people who receive coverage through New York’s Exchange to over 3.6 million – a 29% increase since the end of Open Enrollment in 2016.  While most continue to be enrolled in Medicaid, 1.2 million are enrolled in non-Medicaid plans.  242,880 are enrolled in a non-qualified health plan, with almost 60% of new enrollees entitled to federal tax credits to reduce the cost of monthly premiums.  The “Essential Plan”, which covers individuals with income between 138-200% FPL, saw a 75% upsurge in enrollment, bringing the total number receiving coverage to almost 670,000 New Yorkers.    In addition, 299,214 children are enrolled in Child Health Plus.
(HARRING, AUSTER)

MIPS Educational Webinar Program Available from MSSNY MACRA Webpage
Over 120 physicians and/or their staff participated in a January 26 webinar hosted by MSSNY to learn about key aspects of the new Medicare Merit Based Incentive Payment System (MIPS) that went into effect on January 1, 2017.  The MIPS program was enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and will have a significant impact on physician care delivery and billing for Medicare.  MSSNY thanks Frank Winter, Partnership Manager for the New York Regional Office for CMS, for taking the time to present important information about this new program for physicians and their staffs, and answering their questions.

To listen to a re-broadcast of this one-hour program, please go to the “MACRA” section of the MSSNY website or click here:  (Members only).
(AUSTER)

DOH Commissioner Medical Grand Rounds to be Held on Feb. 8th
The third session of the 2016-2017 Commissioner’s Medical Grand Rounds series will be held on February 8, 2017 from 6-8 p.m.   The session, “Technology Changes Our Connection: Physician and Patient Communication” will take place in Manhattan at the Borough of Manhattan Community College. The flyer for this session is here.

The session will also be streamed as a live webcast for those unable to attend in-person and will also be offered on our webpage as an archived webinar afterwards. Participants are eligible for CME credits whether they view in-person, via the live webcast, or the archived webcast.   The session will be hosted by NYS DOH Commissioner Howard Zucker, MD.  Presenters are: Richard M Frankel, PhD; Professor of Medicine and Geriatrics, Indiana University School of Medicine Senior Scientist, VA HSR&D Center for Health Information and Communication and Joseph C Kvedar, MD, Vice President, Connected Health, Partners HealthCare Associate Professor, Dermatology, Harvard Medical School.(CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.

The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from an active shooter/bombing event in the healthcare setting.  2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

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 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.                               (CLANCY, 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

enews large

AMA to Homeland Security: Concern re IMGs Who Have Visas to Train/Practice in US
The American Medical Association entered the immigration debate Wednesday with a letter to the U.S. Department of Homeland Security asking the agency to clarify how the Trump Administration’s executive order applies to health workers trained abroad, to those seeking to train in the U.S. and to patients needing care. MSSNY has the same concerns as the AMA as we have a higher percentage of IMGs in New York than other states. The Association of American Medical Colleges said 260 medical students from the seven countries are applying to residency programs in the United States.

It is “vitally important” that this process not impede patients’ access to timely treatment or restrict doctors and international medical graduates “who have been granted visas to train, practice, or attend medical conferences” in the U.S., ” the AMA’s chief executive officer, Dr. James L. Madara, wrote in a letter to Homeland Security Secretary John F. Kelly.

Dr. Madara noted that the order could block entry to foreign medical graduates who have applied for or who have been granted visas to come to the U.S. to train and provide care in poor and underserved communities to “some of our most vulnerable patients,” many of whom live in rural and low-income areas. “One of every four physicians practicing in the United States is an [international medical graduate],” he said, noting that they meet the same stringent licensing requirements as US graduates, but they are more likely to practice in underserved and poor communities, and to fill training positions in primary care and other specialties that face significant workforce shortages.

The letter requests rapid action, because the order places into limbo foreign medical school graduates whose residency assignments will be decided next month. He also expressed concerns about how the order might affect medical school applicants granted temporary work permits under an Obama Administration program that allows certain undocumented immigrants who entered the U.S. as minors to remain for at least two years.

Erie County Suing Pharmaceuticals for Promoting Opioids to Doctors/Patients
Erie County Executive Mark Poloncarz is suing several pharmaceutical companies alleging that the companies misled doctors and patients into thinking that their highly addictive medications were safe. The lawsuit, filed in State Supreme Court, names 11 major companies- including Purdue, Hanssen, and Endo. Read the Buffalo News story here.

MSSNY Members ONLY: Free Service to Resolve Your Insurance Problems
The Division of Socio-Medical Economics (SME) is responsible for addressing health insurance-related issues and developments affecting the physician community. SME is here to help you and your staff with problems relating to insurance reimbursement for care you render to your patients. We receive thousands of calls each year regarding Medicare, Medicaid, Workers’ Comp (WC), No-Fault Auto (NFA), managed care, traditional indemnity plans, etc. Sometimes we help our members by explaining insurer requirements, diagnosis and procedure coding questions, Medicare/Medicaid Crossover issues, National Provider Identifier (NPI) matters, WC/NFA questions, private-pay arrangements, etc.  This is a FREE SERVICE for MEMBERS ONLY.

In other cases, we may argue with a health plan on behalf of our members for policy clarification or proper payment of a bill or claim. In 2016, our Ombudsman Program recovered $89,815.79 for our members

Please contact the SME staff if you have questions or problems with which you think we can help at 516-488-6100 ext. 334.

Regina McNally, Vice-President


SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details


MSSNYPAC – The Political Voice for New York’s
PhysiciansFace-to-face relationship-building with those who will be deciding policies which impact our ability to provide care to our patients is of great importance to all physicians.  MSSNYPAC provides opportunities for physicians to support and encounter physician-friendly candidates.  Every individual physician, resident, medical student and Alliance member is essential to strengthen these relationships. Join or increase your support and participation today at www.mssnypac.org/contribute

Open Payments System Is Now Available
The Open Payments system is now available, enabling physicians and teaching hospitals to register. Physicians and teaching hospitals must register first in order to review any payments and other transfers of value attributed to them. If physicians and teaching hospitals registered last year, they do not need to register again.

If it has been over 180 days since a physician or teaching hospital has logged onto the Enterprise Identity Management System (EIDM), the account has been deactivated for security purposes. If an account must be reactivated, physicians and teaching hospitals can contact the Help Desk. Beginning today, the Help Desk has extended hours from 7:30 a.m. – 6:30 p.m. (EST).

The review and dispute period is targeted to start in April 2017, following the close of data submission (the Program Year 2016 data submission window begins on February 1, 2017 and ends on March 31, 2017).

You can learn more about the Open Payments system enhancements by viewing the Open Payments Overview and Enhancements presentation. Additional updated resources are located here.

Questions—Contact Live Help Desk
For more information about Open Payments, please visit the Open Payments website. If you have any questions, you can submit an email to the Help Desk at openpayments@cms.hhs.gov..

Live Help Desk support is available by calling 1-855-326-8366, Monday through Friday, from 7:30 a.m. to 6:30 p.m. (EST), excluding Federal holidays.

Please be aware that other critical deadlines for the House of Delegates meeting remain ahead of us.

Resolutions Have Two DeadlinesFebruary 17 and March 17!
We tried this last year and it worked well.  Please try to submit any resolutions that are ready by FEBRUARY 17.  This gives staff adequate time to review and contact you or the author with questions or clarifications.

The final deadline for receipt of resolutions is MARCH 17 at 5 PM.  This deadline was selected so that any issues which might arise as a result of Physician Advocacy Day participation can still be addressed.  Anything received after Friday March 17th will be considered LATE and referred to the House Committee on Rules, Credentials and Order of Business.  That committee meets on Thursday April 20, 2017 at 2 PM and the author of that late resolution must be present to discuss the reasons for the lateness of the resolution.

Resolutions must be submitted as word documents (each resolution as a separate document) with the proper formatting, necessary research and policy citations noted.  Resolution titles should be succinct and reflect the broad topic of the resolution.  Guidelines for constructing resolutions and proper formatting are installed on the MSSNY website.  Please research your resolutions to establish whether there is already existing policy on your topic.  The Policy and Position Statements are on the MSSNY website and have been updated through the January Council meeting.

Join us for ARTMED INSIGHT’s February Workshop at the MET Museum! 

THE ART OF SEEING: ART IN CLINICAL PRACTICE 

Expanding Point of View and Creative Thinking Skills
February 17, 2017, from 6 to 8.30 pm and February 18, 2017 from 5 to 7.30 pm

Boost your perceptual and communication skills and strengthen your clinical practice! 

Open to all physicians, physician assistants, psychiatrists, residents, nurses, medicals students, and healthcare professionals across disciplines. 

Expanding Point of View: February 17 from 6 to 8.30 pm

Participants explore art works in order to uncover their perceptual habits and move beyond them. Multiplying perspectives, participants learn how to access new data and ways of seeing. Issues of bias and context are also considered and their relevance to medical practice and patient communication explored.

Enhancing Creative Thinking Skills: February 18 from 5 to 7.30 pm

In part 2 of this workshop, participants investigate art works and develop perceptual tools to “reframe” their looking. This serves to stimulate participants’ creativity and capacity for creative problem solving. Challenges regarding ambiguity and premature closure are also examined and explored.      

Cost: $285 (includes 1/17/17 and 1/18/17 + museum entrance fee) $185 for students

Art experience is welcome but not necessary–Location: The MET Museum in NYC.

Space is limited to insure interactivity! For more information check out our website www.artmedinsight.org and to register go here.


CLASSIFIEDS


TAXES • ACCOUNTING
Expert Certified Public Accountants firm
Tax, Accounting, Advisory Services
Specialty practice to medical & dental groups, professionals & organizations since 2004 • Highest quality work and client service • Competitive fees Susan Li, CPA, MBA
YSL & Associates LLC
(212) 232-0122
PCAOB-Registered, Peer-Reviewed
Member firm “The MD TAXES Network” CPAs Specializing in Healthcare Professionals


Modern/High End Office (Upper East Side)
Large and Modern office to share.  Located on the ground floor.  2+ treatment/exam rooms, large waiting room, private office, storage.  Price is negotiable for 1-3 day/week.  Call Dr. Austin 5189284819 or email ian@caneandaustin.com No broker fee.  Craig Austin, M.D. 120 East 64th Street, NYC 10065



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities


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

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

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

January 27, 2017 – Victory! Aetna-Humana Merger Nixed!

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
January 27, 2017
Volume 17
Number 4

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Dear Colleagues:

This week, in a landmark win for organized medicine and the nation’s patients, federal judge John D. Bates blocked the proposed Aetna-Humana merger. The judge found that the merger would have substantially lessened competition in Medicare Advantage and commercial health insurance markets. This is a comprehensive, fact-based ruling that acknowledges that meaningful action was needed to preserve competition and protect high-quality medical care from unprecedented market power that Aetna would acquire from the merger deal. The decision is a historic, stunning affirmation of the position urged by the American Medical Association (AMA) and the 17-state medical association antitrust coalition members of which MSSNY is an active member. The court’s ruling sets a notable legal precedent by recognizing Medicare Advantage as a separate and distinct market that does not compete with traditional Medicare.

MSSNY was vigorously opposed to this merger and joined with stakeholders, various patient coalitions, and the National Association of Attorneys General. The coalition presented physician surveys that gauged physician concerns about the merger and presented the compelling survey results to DOJ and state regulators; testified in or submitted memoranda in state insurance department hearings and/or attorney general investigations, and secured outside experts to demonstrate how the merger would harm patients and physicians.

We want to take this opportunity to thank our physicians and, all of our coalition partners for helping to achieve this historic victory on behalf of our physician members and their patients. Our collective work on these mergers is, without a doubt, a model for future advocacy success.

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

Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org



Please Contact Your Legislators to Express Concerns in Proposed State Budget
As noted last week, Governor Cuomo released his proposed $152.3 billion spending plan for the 2017-18 Fiscal Year.   While the proposed Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made.  For example,

  • We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  To send a letter to your legislators, click here.
  • Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  To send a letter to the Legislature, click here.
  • “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.  To send a letter to your legislators, click here.
  • The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic.  To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.

Other Items of Note in the State Budget

  • Funding for MSSNY’s Committee for Physicians Health would be continued at past levels;
  • Re-appropriating $300,000 for MSSNY’s Veterans Health Care Initiative.
  • E-cigarettes would be taxed in the same manner as tobacco cigarettes.
  • Requiring the registration and regulation of Pharmaceutical Benefit Manager (PBMs)
  • Creating a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including: modernizing Certificate of Need laws; “creating more flexible rules on licensing and scope of practice for clinicians and caregivers” and “increasing flexibility of state agency regulations governing the delivery of and reimbursement for telehealth programs;
  • Making the “inappropriate prescribing of opioids” an unacceptable provider practice in the Medicaid program, giving the State discretion to remove a physician or other prescriber from the program.
  • Reducing prescription drug costs by making drug companies pay a surcharge when costs exceed a certain benchmark to be determined by a Drug Utilization Review Board within the NYS Department of Health;
  • Requiring the testing of public water systems every 3 years for contaminants

The state Senate and Assembly have scheduled a February 16 public hearing to receive comments regarding concerns with the proposed Health Budget, at which MSSNY will testify.
(DIVISION OF GOVERNMENTAL AFFAIRS)

MSSNY LOBBY DAY SCHEDULED FOR MARCH 8TH – PHYSICIANS URGED TO ATTEND AND WEAR YOUR WHITE LAB COATS
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.  Please register here  if you plan to attend.

A full slate of legislators and key policymakers have been invited to dialogue with Advocacy Day participants including:

  • Jason Helgerson, NYS Medicaid Director;
  • Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program.   County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Come meet with your legislators to urge that they:

  • Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
  • Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners
  • Reject changes to increase burdensome physician prior authorization requirements contained in the proposed State Budget;
  • Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
  • Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
  • Reject legislation that would impose costly and time consuming mandates on physician delivery of patient care

Please come to Albany to make your legislators aware of these challenges!                   (GOVERNMENTAL AFFAIRS STAFF)


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


ACA Discussions Continue in Washington
This week, several Senators proposed different pieces of legislation to repeal and replace pieces of the Affordable Care Act (ACA).

Under the Cassidy-Collins bill, called the Patient Freedom Act, states could enroll people who would otherwise be uninsured in health plans providing basic coverage and would allow consumers to buy additional coverage.  States could stay with the ACA, or they could receive a similar amount of federal money, which consumers could use to pay for medical care and health insurance.  The bill would eliminate the individual coverage mandate and the requirements for larger employers to offer coverage to full-time employees, but allow some protections to remain in place. Parents would still be allowed to keep children on their insurance until the age of 26, and insurers could not impose annual or lifetime limits on benefits.

Additionally, Senator Rand Paul announced the “Obamacare Replacement Act” which would eliminate several provisions of the ACA, including the individual mandate and minimum standards for care. It would also provide a two-year window for people with preexisting conditions to sign up for care.  It also allows insurers to sell plans in multiple states and a $5,000 tax credit that people can put toward a health savings account.

As reported previously, MSSNY has written to New York’s Congressional delegation to urge that the funding mechanism for ACA health insurance coverage programs not be repealed unless such proposals also specify how the current available coverage options will be repealed with improved coverage options that will increase the availability of comprehensive health insurance coverage.             (Belmont)

Governor Cuomo Announces Regulatory Action to Preserve Women Access to Reproductive Health Care
Governor Andrew M. Cuomo announced this week a series of New York State actions to protect access to women’s reproductive rights in New York State.  The Governor announced that New York State will take regulatory action to provide that contraceptive drugs and devices are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles regardless of the future of the Affordable Care Act.

He also proposed that contraceptives are available in amounts exceeding one month’s supply at a time; and all medically necessary abortion services are covered by commercial health insurance policies without co-pays, coinsurance, or deductibles. The announcement coincided with the Women’s Marches in Washington D.C., across New York State and across the country, as well as the 44th anniversary of the landmark United States Supreme Court ruling in Roe v. Wade.  Further information can be obtained HERE and HERE.

The Governor’s action followed action by the New York State Assembly. The Assembly passed the Reproductive Health Act, (A.1748), sponsored by Assemblymember Deborah Glick,  which amended the public health law and placed the abortion procedure in the public health law rather than the penal law.   Additionally, the Assembly also passed A. 1378, the Comprehensive Contraception Coverage Act (CCCA), sponsored by Assemblymember Kevin Cahill.  This measure would require New York State insurers to cover all FAD approved contraceptive methods without out-of-pocket costs, and would ease the multiple barriers experienced by women in obtaining contraceptives and from using them effectively and consistently.                                                                          (CLANCY)

Advocates for Aid in Dying Legislation Hold Press Conference
This week, advocates for “aid in dying” legislation, along with members of the New York State Legislature, held a press conference to push for legislation that would allow a terminally ill patient in New York State to request and use medication to aid in dying.   Advocates from Compassion and Choices joined with Assembly members Amy Paulin and Richard Gottfried and Senator Diane Savino, sponsors of the bill A. 2383/S3151, at the January 23 press conference.  Susan Rahn, who has Stage IV breast cancer, spoke about advocating for the right to “die with dignity.”  The legislation is currently in the Assembly Health Committees.  A similar measure S. 2045 has also been introduced by Senator John Bonacic and is in the Senate Health Committee.

MSSNY position on Physician Assisted Suicide and Euthanasia 95.989 states: Patients, with terminal illness, uncommonly approach their physicians for assistance in dying including assisted suicide and euthanasia. Their motivations are most often concerns of loss of autonomy, concerns of loss of dignity, and physical symptoms which are refractory and distressing. Despite shifts in favor of physician-assisted suicide as evidenced by its legality in an increasing number of states, physician-assisted suicide and euthanasia have not been part of the normative practice of modern medicine. 

Compelling arguments have not been made for medicine to change its footing and to incorporate the active shortening of life into the norms of medical practice. Although relief of suffering has always been a fundamental duty in medical practice, relief of suffering through shortening of life has not.  Moreover, the social and societal implications of such a fundamental change cannot be fully contemplated. MSSNY supports all appropriate efforts to promote patient autonomy, promote patient dignity, and to relieve suffering associated with severe and advanced diseases.  Physicians should not perform euthanasia or participate in assisted suicide.”            (HARRING, CLANCY)

NYS Assembly Codes Committee Approves Expedited Partner Therapy Bill
The New York State Assembly Codes and Health committees approved legislative (A.313, Bichotte) supported by MSSNY, which would allow expedited partner therapy for sexually transmitted infections that the Centers for Disease Control and Prevention (CDC) recommend for the sexual partner or partners of someone having been diagnosed with the disease. Currently, the CDC has recommended the use of EPT for Chlamydia Trachomatis and in November 2012 also recommended EPT in cases of gonorrhea.

In 2005, the New York State passed a law to allow health care providers to provide EPT for Chlamydia infection.  This law was made permanent, along with immunity protections for prescribers as part of the 2013-14 NYS budget process.   This bill will expand the current law to include other sexually transmitted infections that the CDC recommends for expedited partner therapy. EPT helps physicians and other health care providers decrease rates of sexually transmitted infections. While expedited partner therapy in no way replaces a face to face interaction with a health care provider, it can help patients who otherwise would not reach out for treatment.

The CDC has found through randomized controlled tests that EPT has the potential for the same success that it has shown with Chlamydia with other sexually transmitted infections (STIs).  EPT can be highly effective in decreasing infection rates with other STIs that can be cured by taking antibiotics by mouth, such as gonorrhea.  The bill is expected to go to the Assembly floor for a vote and its companion measure, S. 2545, sponsored by Senator Kemp Hannon, is in the Senate Health Committee.                                      (CLANCY) 

AG Schneiderman Announces Settlement with Cigna to Resolve Mental Health Coverage Investigation
New York Attorney General Eric Schneiderman announced a settlement with Cigna this week to require the health insurer to eliminate a written ban on coverage for claims for neuropsychological testing of psychiatric conditions and autism spectrum disorder.

According to the press release the AG’s Health Care Bureau launched an investigation into Cigna’s administration of mental health benefits following a complaint about its written policy for neuropsychological testing. The policy said that “Cigna does not cover neuropsychological testing” for psychiatric conditions and autism spectrum disorder “because such testing is considered educational in nature and/or not medically necessary.”

Under the terms of the settlement, the company agrees to comply with Timothy’s Law, which requires New York group health plans provide “broad-based coverage for the diagnosis and treatment of mental, nervous or emotional disorders or ailments … at least equal to the coverage provided for other health conditions.”   The settlement also requires Cigna to revise its policies, pay autism claims previously rejected, and pay a penalty of $50,000.  Cigna also clarified its policy regarding concussion and mild cognitive impairment.                                                                            (AUSTER)

MSSNY, AMA and Others Release Principles Urging Reduction in Prior Authorization Burdens
Noting that 75% of surveyed physicians described prior authorization burdens as “high or extremely high”, the American Medical Association released a document this week calling on health insurers and benefit managers to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.  The document, entitled “Prior Authorization and Utilization Management Principles” lists 21 principles where prior authorization hassles could be reduced.  MSSNY was one of a handful of state medical societies to assist I the development of the principles.

While some of the principles that are already imposed on health insurers under New York law, many other principles listed, if implemented, would help reduce some of the PA burdens faced by New York physicians and their staff.  These suggested reforms include:

  • Utilization review entities should offer an appeals system for their utilization management programs that allows a prescribing/ordering provider direct access, such as a toll-free number, to a provider of the same training and specialty/subspecialty for discussion of medical necessity issues;
  • A drug or medical service that is removed from a plan’s formulary or is subject to new coverage restrictions after the beneficiary enrollment period has ended should be covered without restrictions for the duration of the benefit year;
  • Eligibility and all other medical policy coverage determinations should be performed as part of the prior authorization process.
  • If a utilization review entity requires prior authorization for non-urgent care, the entity should make a determination and notify the provider within 48 hours of obtaining all necessary information. For urgent care, the determination should be made within 24 hours of obtaining all necessary information.   (AUSTER)

CMS Again Institutes Audits to Check Physician & Home Care Compliance with Medicare Face to Face Requirements
All physicians should be aware that CMS is again instructing its Medicare Administrative Contractors (MACs), including National Government Services (NGS) covering New York, to conduct Home Health “Probe-and-Educate” medical review audits relating to claims submitted by home health agencies (HHAs) for Medicare home health services including the face-to-face (F2F) requirement.

As many physicians know, the F2F provision requires a certifying physician to document that he or she, or a non-physician practitioner (NP or PA) working with the physician, has seen the patient, as a condition of eligibility for Medicare home health services.  Many home care agencies and physicians have noted that the CMS regulations implementing this provision have created unnecessary and overly burdensome documentation requirements that are delaying or denying coverage for needed home care services.  MSSNY has been working the Home Care Association of New York State (HCA) on efforts to eliminate or reduce the hassles in Medicare and Medicaid associated with this requirement.  Dr. Evelyn Dooley-Seidman chairs a MSSNY-HCA working group that also has the participation of Suffolk County geriatrician Dr. Jay Slotkin.

Specifically, CMS is directing MACs to sample five claims for pre-payment review from each HHA within their jurisdictions.  Based on the results of these reviews, MACs will conduct provider-specific educational outreach. CMS will instruct MACs to deny each non-compliant claim and to outline the reasons for denial in a letter to the HHA, which will be sent at the conclusion of the probe review portion of the process. CMS will also instruct the MACs to offer individualized phone calls/education to all providers with errors in their claim sample. During such calls, the MAC will discuss the reasons for denials, provide pertinent education and reference materials, and answer questions.  For those providers that are identified as having moderate or major concerns (two to five denials out of five), the MACs will repeat the probe-and-educate process for dates of services occurring after education has been provided.

The “probe and educate” initiative, in turn, will likely result in increased efforts to assure physicians are providing the necessary certification.  It is another example of the burdensome paperwork hassles associated with complying with the F2F requirement for physicians and home care agencies. As such, MSSNY will continue to work with HCA to convince New York’s Congressional Delegation to work towards repeal or substantial modification of this rule.  Moreover, we are hopeful that the new Trump Administration Executive Order to reduce regulatory burdens on health care providers and patients will provide a new opportunity to revisit this rule.  With the requirement also slated to go into effect for Medicaid patients as of July 1, 2017, MSSNY is also working with HCA to advocate to the NYS Department of Health to reduce the burdens associated with complying with this rule.                           (AUSTER)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1)  Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event.  2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2) Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

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 1.0 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.                                               (Clancy, Hoffman)

Activism Matters
The New York Times published an article highlighting the importance of activists to call and meet with legislators. Several lawmakers and staff indicated the value that a large volume of calls on an issue can have on legislator’s positions.  Even if you don’t speak directly to the lawmaker, staff members often pass the message along in one form or another.  From our firsthand experience, lawmakers have always expressed the importance that phone calls and meetings with their constituents can have on their position.

How can I help?
Your participation in the legislative and political process remains critical.  We need to make sure our elected officials know where we stand when their positions helps or hurts you.  MSSNY’s input is valued by many of our elected officials.  Throughout our website, MSSNY provides various resources to make sure you have the tools to fight back when harmful proposals are introduced.

Proposals are constantly introduced that directly affect you and your family.  As many know, physician activism is essential to making a difference in Albany.  MSSNY needs resources and activist like you to so that we will be a united force to be reckoned with.   Every MSSNY member has an opportunity to get involved in one form or another.  Becoming a member of MSSNY allows you to receive the latest information on legislative and budgetary proposals that impact you.

MSSNY is an important avenue to make sure our collective voices are heard.  Every physician should be a part of MSSNY and MSSNYPAC in order to be able to continue our efforts.  And please avail yourself of our resources that make it easier for you to contact your elected officials.                                                                  (BELMONT)

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

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Council Notes: January 19, 2017

  • Council approved the Board of Trustees report, which included the pricing policy for the opioid training modules that MSSNY has developed in accordance with the regulations set by the Bureau of Narcotics. The course will be free to MSSNY members. The cost for Non-Members will be $150 for the 3 Module course. However, this $150 will be applied towards deferring the cost of MSSNY membership dues in the event that non-members decide to join MSSNY.
  • Michael R. Privitera, MD, presented a report of MSSNY’s Physician Burnout Task Force. In 2015, the MSSNY House of Delegates passed resolution 2015-200, titled “Physician Health Programs and Membership Recruitment” to develop a series of programs to assist physicians in early identification and management of stress. Council approved the following recommendations from the Task Force:
  1. Development of CME programs on physician stress and burnout, as well as the peer support model and recruitment of a cadre of doctors to do such CME presentations and presentations to leaders and other stakeholders.
  2. Seeking grants or other funding to support CME, burnout study and program activities in an enduring way.
  3. Continued collaboration with other organizations on burnout reduction and wellness efforts.
  4. Seek grants or other funding to help develop a peer support model to all county societies, hospitals and hospital systems and practices in an ongoing way.
  • Council approved the following mission and vision statements from MSSNY’s Committee to Eliminate Health Care Disparities:
    Mission Statement:
    The mission of the Committee to Eliminate Healthcare Disparities is to increase awareness of how factors such as race, ethnicity, culture and religious beliefs, sexual orientation, gender and gender identity contribute to both health and healthcare disparities.

Vision Statement:
The vision of the Committee to Eliminate Health Care Disparities is a New York State healthcare system that bridges gaps and identifies potential bias in order to provide the highest quality care to all people throughout the state with respect for their race, ethnicity, culture and religious beliefs; sexual orientation, gender and gender identity.

  • Speaker Dr. Kira Geraci-Ciardullo announced that Health Commissioner Howard Zucker, MD, JD, will address the 211th House of Delegates on Friday morning, April 21.
  • Don Moy, Esq. spoke briefly about the Overtime Pay Final Rule that was effective on December 31, 2016. Click here for more information.


MSSNYPAC – The Political Voice for New York’s Physicians
Advocating for our profession is both a duty and an honor and physicians are a force for change in New York State healthcare. Our patients deserve excellent care and we strive to provide that in our practices and in policy formation. Participation in MSSNYPAC is an important step in helping to elect physician-friendly candidates, and MSSNYPAC’s President’s Circle and Chairman’s Club help to develop the strong relationships that are necessary for effective political action.  It is essential that physicians not only have a seat at the discussion table but speak with a strong united voice. Join or increase your support and participation today at www.mssnypac.org/contribute. 

AARP Medicare Complete Is Not AARP Medicare Mosaic
For physicians who participate in a Medicare “Advantage” plan called AARP Medicare Complete, there is another plan called AARP Medicare Complete – Mosaic.

They are not the same and if a physician participates in AARP Medicare Complete, he/she does not necessarily participate in the Mosaic product.

When a patient calls for an appointment and says they have AARP Medicare Complete, the practice’s office staff should confirm if the patient is enrolled in the AARP Medicare Complete or the Mosaic product. UHC’s Mosaic plan is a limited language network for patients who speak Chinese, Korean, or Spanish.

The practice will only be paid for services from their contracted plan.

                                    From Regina McNally, VP of MSSNY Socio-Med Division

Nonmedical Vaccine Exemptions on the Rise in NY, Other States, CDC Data Show
STAT (1/20l7) reported that nonmedical vaccine exemptions are on the rise in some states, even as they decline nationally, according to data from the Centers for Disease Control and Prevention. The number of children not being vaccinated for nonmedical reasons in 11 states – Connecticut, Florida, Iowa, Kentucky, Maryland, New York, North Carolina, North Dakota, Ohio, Oklahoma, and Virginia –”is higher than at any point in the past five years.”

Deadline for Abstract submission Is Tuesday, Jan. 31 for Poster Symposium

Resident/Fellow/Medical Student

The Annual Poster Symposium will be held on:

Friday, April 21, 2017
Westchester Marriott
Tarrytown, New York
2 pm – 4:30 pm

In the words of past participants, the MSSNY symposium is an “excellent networking opportunity,” a place to “meet fellow residents and attendings” and “learn from other presentations” that they “would highly recommend.” 

Click here for detailed guidelines.

Check out last year’s Abstract Book here.

We welcome the participation of your residents and fellows. Participants must be MSSNY members, and membership is free for first-time resident members. Join online.


SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details


Health Care Coalition Calls for Prior Authorization Reform
Releases new principles to improve timely access to care and reduce administrative burdens

CHICAGO – Responding to unreasonable hurdles for patients seeking care, a coalition including the American Medical Association (AMA) and 16 other health care organizations this week urged health plans, benefit managers and others to reform prior authorization requirements imposed on medical tests, procedures, devices and drugs.

The coalition, which represents hospitals, medical groups, patients, pharmacists and physicians, says that requiring pre-approval by insurers before patients can get certain drugs or treatments can delay or interrupt medical services, divert significant resources from patient care and complicate medical decisions.

Given the potential barriers that prior authorization can pose to patient-centered care, the coalition is urging an industry-wide reassessment of these programs to align with a newly created set of 21 principles. Prior authorization programs could be improved by applying the principles’ common-sense concepts grouped in five broad categories:

  • Clinical validity,
  • Continuity of care,
  • Transparency and fairness,
  • Timely access and administrative efficiency, and
  • Alternatives and exemptions.

The data entry and administrative tasks associated with prior authorization reduce time available for patients. According to a new AMA survey, every week a medical practice completes an average of 37 prior authorization requirements per physician, which takes a physician and their staff an average of 16 hours, or the equivalent of two business days, to process.

The AMA survey illustrates that physician concerns with the undue burdens of preauthorizing medical care have reached a critical level. Highlights from the AMA survey include:

  • Seventy-five percent of surveyed physicians described prior authorization burdens as high or extremely high.
  • More than a third of surveyed physicians reported having staff who work exclusively on prior authorization.
  • Nearly 60 percent of surveyed physicians reported that their practices wait, on average, at least 1 business day for prior authorization decisions—and  more than 25 percent of physicians said they wait 3 business days or longer.
  • Nearly 90 percent of surveyed physicians reported that prior authorization sometimes, often, or always delays access to care.

The AMA and other coalition organizations welcome the opportunity to work collaboratively with health plans and others to create a partnership that lays the foundation for a more efficient prior authorization process. In addition to the AMA, the coalition includes the: American Academy of Child and Adolescent Psychiatry, American Academy of Dermatology, American Academy of Family Physicians, American College of Cardiology, American College of Rheumatology, American Hospital Association, American Pharmacists Association, American Society of Clinical Oncology, Arthritis Foundation, Colorado Medical Society, Medical Group Management Association, Medical Society of the State of New York, Minnesota Medical Association, North Carolina Medical Society, Ohio State Medical Association and Washington State Medical Association.

CMS: New Participants Join Several CMS Alternative Payment Models
CMS announced over 359,000 clinicians are confirmed to participate in four of CMS’s Alternative Payment Models (APMs) in 2017. Clinicians who participate in APMs are paid for the quality of care they give to their patients. APMs are an important part of the Administration’s effort to build a system that delivers better care and one in which clinicians work together to have a full understanding of patients’ needs. APMs also strive to ensure that patients are in the center of their care, and that Medicare pays for what works and spends taxpayer money more wisely resulting in a healthier country.

“By listening to physicians and engaging them as partners, CMS has been able to develop innovative payment reforms that bring physicians back to the core practice of medicine – caring for the patient,” said Acting Administrator Andy Slavitt. “By reducing regulatory burden and paying for quality, CMS is offering solutions that improve the quality of services our beneficiaries receive and reduce costs, to help ensure the Medicare program is sustainable for generations to come.”

The Medicare Shared Savings Program (Shared Savings Program), Next Generation Accountable Care Organization (ACO) Model, Comprehensive End-Stage Renal Disease (ESRD) Care Model (CEC) and Comprehensive Primary Care Plus (CPC+) Model all apply the concept of paying for quality and effectiveness of care given to patients in different health care settings.


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917-939-0019

Upper East Side Medical Office for Sale
Suitable for a solo practice or shared multi- specialist group. Large unit, about 1100 Sq Ft, located on the ground floor of a cooperative building with own entrance to office, 2 or 3 equipped exam rooms with exam tables and work station areas, front waiting room with reception area with storage unit of shelves for medical charts, a consultation office, 1 and a half bathrooms and kitchenette. Lots of shelves throughout exam rooms, 2 EKGs, one PC computer that comes equipped with a PFT machine and operating software, an operating X-ray machine suitable for chest X-rays with film processor. No brokers, call office manager, Diana Peron @ 212-861-9012


Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
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Physician Opportunities


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

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

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