Successful Legislative Year Concludes – June 26, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R.Maldonado  
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Dear Colleagues:

This week has seen a significant share of federal and state legislative news.  The Supreme Court of the United States has ruled in King vs. Burwell by a vote of 6-3, that individuals in states that did not set up exchanges are eligible to receive tax subsidies.  Various folks have asked us to weigh in on the decision.  While enticing, dwelling on a discussion of the decision is purely a venting experience as it will contribute nothing other than creating greater divides.  Instead, we should accept closure on this matter and focus our energies on fixing the flaws of the ACA.  What good is a subsidized health plan that has a $6,000 deductible that encourages a patient to delay accessing care because of the out-of-pocket expense?

At the state level, we are pleased to announce that MSSNY has won two major victories—defeat of the mandated CME on pain management and change in commencement of the statute of limitations to the date of discovery.  We thank the many of you who took the time to contact their legislators to express their concerns with these bills. These are victories only in so much as we were able to stop governmentally proscribed redress of these issues.  We will NOT be able to walk away without addressing the core legitimate concerns raised by proponents of these now defunct pieces of legislation.  Instead, we will need to work with our specialty societies to devise an appropriate way to address the need for better medical education on pain management as well as responsible tort reform which includes not only redress for those harmed in the course of care but other reforms that will reduce our premium burden.

RED ALERT!!! Girding Our Loins this Summer

As we approach the 4th of July week, I draw on an archaic term to draw attention to a need to be prepared for the threat of danger.  This week, Rep. Devin Nunes, Chairman of the House Intelligence Committee stated that “the level of threat for a potential terrorist attack in the United States is at its highest.”  It has been 14 years since 9/11 and two years since the Boston bombing.  Within the past year, we dealt with an Ebola epidemic that reached our country and threatened our nation.  Presently, we face a new danger with avian flu and MERS.  MSSNY has a 50+ credit hour curriculum for Preparedness Planning which has been widely acclaimed.  It is critical that we voluntarily prepare to meet the needs of our patients PRIOR to the next potential crisis or terror event.  If we don’t volunteer, the next crisis will potentially bring a new mandate.  More importantly, it may bring casualties as a result of an unprepared medical community.  When was the last time you honed your preparedness skills and knowledge?   I would highly encourage you to use the CME link on the MSSNY website to access the curriculum. New users will need to register with an email and password. Why not use the curriculum as part of your summer reading?  It’s free to MSSNY members.  The knowledge you gain may save your family, friends, neighbors and community.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


MLMIC



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Dear MSSNY and Alliance Members: 

The 2015 legislative session conclude early this morning. Through your efforts guided by MSSNY leadership and the collective efforts of MSSNY staff, MSSNY has had a very successful legislative year. 

As part of the budget, we: (1) secured $127.4M in funding for the Excess Medical Liability program; (2) defeated accreditation and onerous new regulatory requirements for urgent care practices and practices which offer after-hour care; (3) defeated the retail clinic bill; (4) defeated proposals which would have imposed additional registration and reporting requirements on physician OBS practices; and (5) secured the elimination of fees physicians currently have to pay to initiate a Workers Compensation arbitration proceeding. 

As the session concluded, we have secured many more victories which demonstrate the tangible value of MSSNY to its physician members.  These victories are discussed in further detail below but can be quickly listed: we (1) defeated the date-of-discovery statute of limitationss; (2) defeated a CME mandate for pain management, addiction and end- of-life care; (3) defeated scope-of-practice expansion by the podiatrists, dentists, optometrists and many other non-physician practitioners; (4) participated in a coalition which secured passage of legislation requiring school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade; and (5) again defeated a last ditch effort by CVS Health to secure enactment of legislation to secure approval to establish corporate owned retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law. 

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

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

                                                                                  Your Lobby Team,
                                                                                  Liz, Moe, Pat, and Barb 

STATE SENATE LEAVES ALBANY WITHOUT PASSING UNSUSTAINABLE MALPRACTICE “DATE OF DISCOVERY” LEGISLATION
Despite a huge push from some media outlets and the trial lawyers, the State Legislature finished its 2015 session without enacting legislation to change the statute of limitations in medical liability actions.  We thank the very significant number of physicians who weighed in with their local legislators to highlight the serious adverse consequences to our health care system that would ensue if this legislation were to have been passed without any corresponding provisions to bring down New York’s already exorbitant medical liability insurance costs that for many are among the highest in the nation.  As previously reported, legislation (A.285, Weinstein) to change New York’s 2.5 year medical liability statute of limitation to a “date of discovery” rule had passed the Assembly two weeks ago.  Substantially similar legislation (S.911-A, Libous) advanced to the Senate floor on the last day of Session, but the Senate did not bring it up for a vote.  MLMIC estimates of similar legislation were that enactment of this legislation could trigger premium increases of 15%.

Conversations on this issue will continue however.  During a press conference with the Governor and Assembly Speaker discussing end of Session agreements, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that immediately following the conclusion of Session a series of roundtables with parties on both sides of this issue will be convened so that the issues can be addressed “sooner rather than later”.   This should present an opportunity for MSSNY and other allied hospital and health provider associations to raise issues with New York’s dysfunctional medical liability adjudication system with the goal of bringing down the cost of medical liability insurance.

MSSNY worked closely with many other provider associations also impacted by this legislation, including the Greater New York Hospital Association, Healthcare Association of NYS, the Health Care Facilities Association, other specialty medical societies, and the Lawsuit Reform Alliance of New York, in an effort to defeat this legislation.   There were print ads in several newspapers across New York State, and in the Legislative Gazette, as well as radio ads on several Albany stations, urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care.
(AUSTER, DEARS)


PHYSICIAN ACTION CREDITED WITH THE NYS ASSEMBLY TAKING NO ACTION ON CME MANDATE REQUIRMENT
The New York State Assembly did not vote on legislation requiring physicians to take three house of continuing medical education every two years.  Senate Bill 4348(Hannon) and Assembly Bill 355 (Rosenthal), would have required physicians to take three hours of continuing education on the following topics: I-STOP and drug enforcement administration 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.  The measure had passed in the NY Senate.  Thousands of physicians called or sent their legislators a letter through the Grassroots Action Center (GAC) about this legislation and urged its defeat.   MSSNY staff would like to thank all who weighed in on this issue.  Your grassroots advocacy made a real difference.  We also thank the many members of the Assembly who expressed their concern about this legislation, as well as the AMA Advocacy Resource Center staff who provided us with critically important information regarding the significant drop in opioid use in New York State compared to other states in recent years.
(CLANCY, DEARS)


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

The Senate bill passed the Senate and was placed on a Committee agenda in the Assembly where it failed to garner the necessary votes. Later in the week additional efforts were advanced to have the bill placed back on the Committee agenda. MSSNY working closely with the Nurses Association and other specialty medical societies succeeded in beating back this effort defeating the bill for the second time this year.

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

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


LEGISLATURE PASSES BILL TO BETTER ASSURE AVAILABILITY OF PAIN MEDICATIONS  THAT REDUCE RISK OF INAPPROPRIATE USE
The Senate and Assembly passed legislation (A.7427-A, Cusick/S.5170-A, Hannon) prior to the end of the Session to reduce barriers to patients receiving opioid medications containing abuse-dererrent technologies.  The legislation would (1) prohibit the substitution of an opioid analgesic drug product, brand or generic, with abuse-deterrent technologies with an opioid analgesic drug product lacking abuse-deterrent technologies without obtaining a new prescription from the prescriber and (2) ensure that abuse-deterrent opioid products are covered by health insurance plans in New York at least the same prescription coverage tier as non-abuse-deterrent opioid products and ensure that a patient is not required to take a non-abuse-deterrent opioid before an abuse-deterrent version.                                                                                             (AUSTER, CLANCY)

LEGISLATURE PASSES BILL TO REDUCE MEDICAID MANAGED CARE PRESCRIBING HASSLES
Legislation (A.7208, Gottfried/S.4893, Hannon) to reduce hassles experienced by physicians when prescribing certain medications for their patients insured through Medicaid Managed Care plans was passed by the Senate and Assembly towards the end of the Session.   MSSNY articulated its strong support for this legislation, and will urge the Governor to sign this legislation into law. 

For many years, New York State has held to the important principle that patients covered under the Medicaid “fee for service” program are entitled to receive the prescription medications that are recommended by their treating physician, and such decisions may not be overruled by Medicaid administrative staff.  After the Medicaid pharmacy benefit was included within Medicaid managed care, in 2012, the Legislature and Governor agreed to assure that these important “prescriber prevails” protections continued to be in effect for several classes of medications needed by patients affected with very serious health conditions, including medications in the anti-depressant, anti-retroviral,  anti-rejection, seizure, epilepsy, endocrine, hematologic, immunologic and atypical antipsychotic therapeutic classes. Since that time, many physicians have reported situations where health insurers forced them to wait an unreasonably long time to receive approval to assure their patients could receive a needed medication from one of these drug classes, despite the “prescriber prevails” protections.  This legislation would help to reduce these hassles, and assure that patients can receive needed medications more quickly.
 (AUSTER, DEARS)


AS SESSION ENDS MSSNY IS SUCCESSFUL IN PREVENTING PASSAGE OF SCOPE OF PRACTICE BILLS
The following are among many scope-of-practice bills that MSSNY defeated this year as the Legislative Session for 2015 concludes:

  1. 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains  in the Higher Education Committee in both the Senate and Assembly.
  2. 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand the scope of practice of podiatrists to diagnos, treat, operate or prescribe for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  3. 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers and call themselves naturopathic doctors. Despite claims that they cannot do invasive procedures, it would allow them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  4. 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  5. 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
  6. 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill remains in the Senate Higher Education Committee.  There is no same-as bill in the Assembly.

The outcome of all of these bills is a resounding victory for TEAM MSSNY and all of our physicians who reached out to their Legislators to oppose them.                                                                                                                            (ELLMAN, DEARS)


COLLABORATIVE DRUG THERAPY MANAGEMENT BILL PASSES BOTH HOUSE OF THE LEGISLATURE- ISSUES RAISED BY MSSNY ADDRESSED.

Legislation (A. 5805-A, McDonald/S. 4857-A, LaValle) which would extend the authorization of pharmacists to perform collaborative drug therapy management (CDTM) in certain settings passed during the final days of session and will soon be sent to the Governor for his consideration.  The final bill addressed many of the numerous issues raised by MSSNY with the initial version of this bill.

MSSNY was concerned that the bill removed protections which had been included when this demonstration program was first enacted which assured that the treating physician remained in control of the care provided to the patient. Specifically, the initial version of the bill would have allowed for the substitution of a drug which differed from that initially prescribed by the patient’s physician without authorization by the treating physician. The bill was modified to prohibit such substitutions or adjustments without authorization by the treating physician. Moreover, the initial version of the bill would have eliminated language which required the patient to consent to the collaborative drug therapy management. This protection was restored at the request of MSSNY. The initial version of the bill had inserted the term “prescribing” when ordering an adjustment or managing a drug regimen. MSSNY noted that “prescribing” remains outside of the pharmacist’ scope of practice and this term was removed from the bill. The original version of the bill would have extended to NPs and PAs the ability to collaborative with a pharmacist in collaborative drug therapy management. The extension of such collaborative authority was removed at MSSNY’s request. Lastly, MSSNY was concerned by the extension of CDTM to a nursing home or residential health care facility setting primarily because these settings are not well staffed by physicians. The final bill allowed for the extension of CDTM to other hospital settings including a nursing home but only if it has an on-site pharmacy staffed by a licensed pharmacist. The bill did not extend CDTM however to dental clinics, dental dispensaries, residential health care facilities and rehabilitation centers.

The bill extended the collaborative drug therapy demonstration with this parameter for three ore years.

MSSNY is grateful to the sponsors of the bill and the Chairs of the Higher Education Committees for their consideration of our concerns in constructing this on-going demonstration.                     
(DEARS, ELLMAN)
 


NYS LEGISLATURE APPROVES BILL TO ALLOW PHARMACISTS TO PROVIDE ADULT IMMUNIZATIONS; BILL WILL NOW GO TO GOVERNOR FOR CONSIDERATION
Pharmacists will expand the list of immunizations that they can provide to adults under legislation that passed the New York State Legislature.  A. 123B, Paulin/S. 4739A,Hannon would add Diphtheria, Tetanus and Pertussis (DPT) to the list of vaccines that can be administered by pharmacists. The bill now goes before Governor Andrew Cuomo for his consideration and action.    The bill would allow physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines.  The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script.  The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis.   Importantly, the bill requires the pharmacist to report the administration of the vaccine to the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry.   Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner.   The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide.  The bill also contains a three year sunset.   The Medical Society of the State of New York opposed this measure, because of its belief that this policy would further fracture the medical home.
(CLANCY, DEARS, ELLMAN) 


HOUSE PASSES IPAB REPEAL LEGISLATION
This week the US House of Representatives passed legislation (HR 1190) to repeal the Independent Payment Advisory Board (IPAB) by a vote of 244-154 (Roll call here).  Eleven Democrats, including New York Representative Sean Patrick Maloney, joined 233 Republicans in voting in favor of passage (including New York Representatives Chris Collins, Dan Donovan, Chris Gibson, Richard Hanna, John Katko, Peter King, Elise Stefanik and Lee Zeldin).  As H.R. 1190 was offset with funding from the ACA’s Public Health and Prevention Fund, several lawmakers commented that the number of Democrats voting for IPAB repeal would have increased had the bill been offset differently.

The IPAB is charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level that can only be overturned by a supermajority of Congress.  MSSNY recently signed on to a patient and provider advocacy letter in support of repeal of the IPAB.  The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decisionmaking responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”    
(AUSTER)


MSSNY JOINS OTHER STATE MEDICAL SOCIETIES TO URGE 2-YEAR ICD-10 TRANSITION PERIOD
MSSNY continued working with the medical associations of California, Florida and Texas, as well as with the AMA, in support of activities to assure a more fair transition to the ICD-10 coding set.  This week the CMA, FMA and TMA together with MSSNY wrote to the US Senate and House of Representatives leadership to urge a two-year ICD-10 “grace period” when physicians and other health care providers are required to use ICD-10 codes starting October 1, 2015.   MSSNY also joined a similar federation sign-on letter initiated by the AMA.   Moreover, MSSNY President Dr. Joseph Maldonado and Vice-President Dr. Charles Rothberg joined physician leaders and staff from the four state medical associations in a conference call meeting with CMS staff as a follow-up to a similar letter sent to Acting CMS Administrator Andy Slavitt last week.   While the “Big 4” letter to Congress notes that the groups’ first request is to pass legislation such as HR 2126 (Poe), to stop the implementation of ICD-10 altogether, it also urges that “for those physicians who have adopted ICD-10, we ask that the payers allow a dual coding system where physicians can bill using either ICD-9 or ICD-10… If these requests are not achievable, we strongly encourage you to pass legislation such as HR 2652, the Protecting Patients and Physicians Against Coding Act, by Congressman Gary Palmer (AL-06) and others, or simply join our call for CMS to implement a two-year ICD-10 grace period…We believe that two years of transition time, on-the-job learning by physicians — plus our continued ICD-10 educational activities — will result in a much less disastrous transition to this overwhelmingly complicated new coding system.”

Our group efforts have been noted in multiple media outlets, including here and here.
(AUSTER)


SENATE FAILS TO ACT ON INCLUING E-CIGARETTES UNDER CLEAN INDOOR AIR ACT
The NY Senate failed to act on in waning hours of the legislative session to prohibit e-cigarette use in all public places in accordance with the NYS Clean Indoor Air Act.  A.5595B/S.2202B sponsored by Assemblywoman Linda Rosenthal, and Senator Kemp Hannon, passed in the NY State Assembly.  In recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit.  Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions.  Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law.  The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure.   The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute.  MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air.    This will continue to be one of MSSNY’s public health legislative priorities.
(CLANCY, ELLMAN)

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

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

 

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Changes to the Medicare Opt-Out Law for Physicians and Practitioners
Prior to enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), physician/practitioner opt-out affidavits were only effective for two years. As a result of changes made by MACRA, valid opt-out affidavits signed on or after June 16, 2015, will automatically renew every two years. If physicians and practitioners that file affidavits effective on or after June 16, 2015 do not want their opt-out to automatically renew at the end of a two year opt-out period, they may cancel the renewal by notifying all Medicare Administrative Contractors with which they filed an affidavit in writing at least 30 days prior to the start of the next opt-out period. Valid opt-out affidavits signed before June 16, 2015, will expire two years after the effective date of the opt out. If physicians and practitioners that filed affidavits effective before June 16, 2015 want to extend their opt out, they must submit a renewal affidavit within 30 days after the current opt-out period expires to all Medicare Administrative Contractors with which they would have filed claims absent the opt-out.(Updated on 06/18/2015) 

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Please note: The application includes specific instructions for documentation requirements for each category, please check the instructions and form carefully for the documentation for the category for which you are applying. While supporting documentation must be provided for certain hardship exception categories, CMS does not require additional documentation for 2014 Edition certified EHR technology issues. You should, however, retain documentation for your own records. CMS will independently review each application and any supporting documentation.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22 ; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.


Need Guidance for ICD-10? Come to MSSNY Website!
Most physicians won’t need to know ALL the new ICD-10 CM diagnosis codes. However,

if you haven’t done so already, you should pick your top 10 or 20 ICD-9 Codes for your practice/specialty and “crosswalk” them to the new ICD-10 CM codes.

Please visit the following websites, for assistance:

www.roadto10.org

http://www.icd10data.com/Convert

http://www.icd10data.com/ICD10CM/Codes

http://www.icd10charts.com/

Reminder: Medicare Does Not Preauthorize Coverage for Items or Services
National Government Services has seen an increase in calls to their Provider Contact Center (PCC), asking if Medicare preauthorizes coverage for provided items and services. As a reminder, Medicare does not preauthorize coverage for items or services that will receive payment under Part A or Part B, except for custom wheelchairs.

Additional information is available in the MLN Matters article SE0916 Revised, “Medicare Parts A and B Coverage and Prior Authorization.” Refer to this MLN and update any applicable internal procedures and policies with this information and share with internal staff.
Related Content
SE0916 Revised: Medicare Parts A and B Coverage and Prior Authorization

NY Medicaid Management Information System (NYMMIS) Project Website

The New York State Department of Health and Xerox State Healthcare, LLC are working diligently on the design and development of the new Medicaid Management Information System, called NYMMIS.

NYMMIS has an interim website online that was created to serve as an ‘information billboard.’ It will be used as a main source for communicating information by providing updates and email bulletins regarding the implementation of the new system.  Updates will be provided on a regular basis in an effort to share relevant NYMMIS information that may potentially impact providers’ business processes. The interim website hosts a ListServ signup section.  Those who sign up to the ListServ are able to receive timely emails that contain any updates on the project that might affect them.

The interim NYMMIS website will have no impact on eMedNY nor will it be used for provider billing or other transactions. Please visit: www.interimnymmis.com

Skinny Jeans Have Their Down Side
A  report in the Journal of Neurology, Neurosurgery and Psychiatry, that tells of a case “of a 35-year-old woman who wound up lying prone on the pavement, unable to get up, after spending the day in skinny jeans while helping a relative move. By the time the doctors saw the patient, both her legs were so swollen below the knee that the medical team had to cut the jeans off her. She also had severe weakness in her feet and ankles and was not able to walk.”


Doctors without Borders Reception in Woodbury L.I.
On August 12 at 6:00pm at the Liquid Outdoor Lounge @ the Woodbury Country Club, 884 Jericho Turnpike, Woodbury NY 11797, Nikhil G. Jaiswal, age 13, is hosting a charity reception featuring hors d’oeuvres and raffles for Doctors without Borders. (Nikhil is the son of Arun Jaiswal, a member of Suffolk County Medical Society.) Tesla Motors will be showcasing their award-winning car, the Model S. All donations are tax deductible. If you would like to donate by check, please make it out to Doctors Without Borders and bring it to the event. To attend the event, the minimum donation is $75 per person. For more information contact Nikhil G. Jaiswal here.


Classifieds

Board Eligible Plastic Surgeon Seeks Full Time Position
Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.

Dr. Cohen

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

Legislature Not Going Home Yet – June 19, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R.Maldonado  
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Dear Colleagues:

It had been my hope that this week’s post would relay good news regarding our efforts in Albany.  Alas, the legislative session has gone into overtime and will be going into next week.  Thanks to all of you who have reached out to your Assemblyperson and Senator asking for their support of MSSNY’s position against the mandated pain management CME and extending the Statute of Limitations for filing a malpractice claim to run from the date of discovery.  Please keep an eye on your emails from MSSNY during the next five days as unexpected surprises may require us to issue an ALERT asking you to contact your state legislators once again.

At the federal level, we continue our joint efforts with other state and specialty societies in seeking assistance for physicians as we transition to ICD-10 on October 1, 2015. While MSSNY and many other physician associations strongly support and have advocated for postponing ICD-10, the efforts to delay its implementation or to completely bypass ICD-10 have been unsuccessful.  At this time, many of us in leadership at the state and specialty society level believe our efforts to assist physicians with the challenges of ICD-10 implementation should be directed towards establishing a grace period.  Such a grace period would allow for physicians to begin compliance with the requirement to use ICD-10. However, during said period, physicians would not be penalized for errors made in coding using the ICD-10 codes.   Data would be collected and physicians would be notified concerning errors in coding so that they can make appropriate changes in future coding.  However, payment for services would not be delayed because of errors.

This week, the four states with the largest numbers of physicians signed a joint letter to CMS’ Acting Administrator Mr. Andy Slavitt asking him to implement a two-year grace period.  This period is consistent with the recent vote of the House of Delegates of the AMA.  I would encourage you to review the attached letter and write to your Congressperson and our U.S. Senators asking for their support of this request.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


MLMIC



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LEGISLATIVE SESSION CONTINUES INTO NEXT WEEK- DEAL ON RENT CONTROL REMAINS ELUSIVE
A deal on rent control has not yet been reached. Late last evening the Senate and Assembly passed a five day extender of the rent control laws until Tuesday, June 23rd. The Senate then left town. The Assembly remained in Session on Friday. Physicians must remain vigilant on two issues discussed in greater detail in separate articles below: (1) the Date of Discovery state of limitations bill (A.285, Weinstein and similar proposal S.911A, Libous) which has passed the Assembly and (2) the CME mandate on pain management, addiction and end of life care which has passed the Senate and is on the floor of the Assembly. Over the weekend we urge physicians to continue their grassroots efforts by sending letters to their legislators urging defeat of each of these bills.

Link to Date of Discovery Statute of Limitations Letter in Opposition.

Link to CME Mandate Letter in Opposition. 


PHYSICIANS MUST CONTINUE TO CONTACT THEIR SENATORS TO OPPOSE HUGE MEDICAL LIABILITY EXPANSION LEGISLATION
With the Legislature continuing its Session beyond its scheduled end date, all physicians must continue to contact their Senators to urge that they oppose legislation (S.911-A, Libous) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.   Last week, the bill was passed by the New York State Assembly by a 120-25 vote (roll call here).

MLMIC’s estimate based upon similar legislation is that could single bill could increase physician liability premiums by an untenable 15%!    While many other states do have some exceptions to their statutes of limitation for “discovery” of alleged negligent acts, the vast majority of these states also place strict limitations on non-economic damages.  As New York physicians continue to pay liability premiums that are among the very highest in the country and face dwindling payments from Medicare and commercial insurers, any changes to permit more lawsuits must be considered only as part of a comprehensive package that seeks to bring down these exorbitant costs.

MSSNY is working with many other provider associations also impacted by this legislation, including hospitals, nursing homes, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.  This past week, there were print ads in several newspapers across New York State, and radio ads on several Albany stations, urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care.    To view the print ad, click here.
(AUSTER, DEARS)


NYS SENATE PASSES CME MANDATE BILL; BILL STILL ON ASSEMBLY DEBATE LIST —URGENT ACTION IS NEEDED TO OPPOSE THIS LEGISLATION
Legislation requiring physicians to take three house of continuing medical education on pain management, palliative care, addiction and ISTOP, has passed the NY Senate and is on the Assembly debate list and could be voted on at any time.   Physicians are urged to contact their assembly members and urge them to reject this legislation.  Physicians are urged to send a letter urging defeat of this measure.  Or they can call their member at the generic Assembly phone number (518)455-4100 and ask to speak with him/her.

Senate Bill 4348(Hannon) and Assembly Bill 355 (Rosenthal), would require physicians to take three hours of continuing education on the following topics: I-STOP and drug enforcement administration 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.  When speaking to their Assembly members, physician can speak about how the mandate to check the Prescription Monitoring Program (PMP) has change behavior.   Notably, New York State now ranks 50th in overall utilization of opioids and has shown a -12.4% reduction in the filling of hydrocodone prescriptions between 2013 when the ISTOP law was first implemented and 2014.  This comparison data is from IMS, Inc. Plymouth Meeting PA, — a company that provides information, services and technology for the healthcare industry.  It is the largest vendor of U.S. physician prescribing data in the nation.  It was provided to MSSNY from the American Medical Association.   Nationwide, there are 13 states that require physicians and other prescribers to complete either a one-time course or a course every two to four years in pain management and opioid prescribing.   All of these states ranked higher than New York State (50th) in overall utilization of opioids (annual prescriptions per capita 2014 Opioid Products).    New York State was 46th in the growth in opioid utilization by state (per change in filled prescription 2014 vs 2013)—only two states with CME had a greater reduction in the growth of opioid utilization.  New York State also ranked 45th in growth on hydrocodone utilization by state (NY saw a reduction of -12.4% in filled prescriptions between 2014 vs. 2013)—again only two states that require CME had greater reduction—Rhode Island ( a state that requires CME) had a -12.9% reduction in filled prescriptions.  According to IMS Health, Inc., NY is ranked 49 in overall utilization of Controlled Substances II and 41 in growth in Controlled Substance II utilization.  Overall utilization of Controlled Substance III, New York State is ranked 27th, however, growth in Controlled Substance III was reduced by -5.8% and the state is ranked 50th in growth of utilization with all CME states above New York.

This data shows strong evidence that prescribing practices by physicians have changed within the last two years due to the implementation of ISTOP in August 2013 that required physicians to check the Prescription Monitoring Program (PMP) prior to issuing a prescription for any controlled substances.   There has been strong physician compliance with the law and in many respect; it has been successful in achieving its goals to significantly reduce doctor shopping and reduce drug diversion.   According to the New York State Department of Health and the policy paper by Brandeis University: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States—  since the implementation of ISTOP drug diversion in New York State has been reduced by 75%. MSSNY believes that the implementation of the I-STOP law and the statutory requirement for all prescribers to check the PMP prior to issuing a Controlled Substances II, III, IV prescription has already changed prescribing practices within New York State in a relatively short period of time.   It would appear from the data noted above the PMP has changed behavior more significantly than would  continuing medical education coursework and training  in the area of  pain management and opioid use as noted by the data by the IMS Health, Inc.  MSSNY also believes that the implementation of the E-prescribing requirement for controlled substances and non-controlled substances in New York State, will also significantly impact prescriber’s behavior and the exercise of their clinical judgment in the use of controlled substances.
(CLANCY, DEARS)


NYS ASSEMBLY PASSES BILL TO INCLUDE E-CIGARETTES UNDER CLEAN INDOOR AIR ACT; ACTION IS NEED IN NYS SENATE

The NY State Assembly passed legislature to prohibit e-cigarette use in all public places in accordance with the NYS Clean Indoor Air Act.  The measure is pending in the NY State Senate.  A. 5595B/Senate Bill 2202B sponsored by Assemblywoman Linda Rosenthal, and Senator Kemp Hannon and must see action in the Senate before it can become law.   Physicians are urged to contact their senators in support of this measure by sending a letter.

Patients can also send a letter through MSSNY Grassroots Action Center.

In 2003, New York updated its Clean Indoor Air Act by prohibiting the use of tobacco products in all workplaces. The purpose was to protect workers from the dangers of secondhand smoke and to provide clean indoor air for the overwhelming majority of New Yorkers who do not smoke.  Due to this law and other important steps that New York has taken, the state have seen major reductions in smoking rates.  However in recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit.  Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions.  Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law.  The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure.   The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute.  MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air.
(CLANCY, ELLMAN)


LEGISLATURE PASSES BILL TO REDUCE MEDICAID MANAGED CARE PRESCRIBING HASSLES
Legislation (A.7208, Gottfried/S.4893, Hannon) to reduce hassles experienced by physicians when prescribing certain medications for their patients insured through Medicaid Managed Care plans passed the Senate and Assembly this week.   MSSNY articulated its strong support for this legislation, along with many other patient advocacy organizations, and will urge the Governor to sign this legislation into law. 

For many years, New York State has held to the important principle that patients covered under the Medicaid “fee for service” program are entitled to receive the prescription medications that are recommended by their treating physician, and such decisions may not be overruled by Medicaid administrative staff.  After the Medicaid pharmacy benefit was included within Medicaid managed care, in 2012, the Legislature and Governor agreed to assure that these important “prescriber prevails” protections continued to be in effect for several classes of medications needed by patients affected with very serious health conditions, including medications in the anti-depressant, anti-retroviral, anti-rejection, seizure, epilepsy, endocrine, hematologic, immunologic and atypical antipsychotic therapeutic classes. Since that time, many physicians have reported situations where health insurers forced them to wait an unreasonably long time to receive approval to assure their patients could receive a needed medication from one of these drug classes, despite the “prescriber prevails” protections.  This legislation would help to reduce these hassles, and assure that patients can receive needed medications more quickly.
(AUSTER, DEARS) 


SCHOOL BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION PASSES NYS LEGISLATURE; WILL NOW GO TO GOVERNOR
A.791C/S. 4324A, sponsored by Assemblywoman Aileen Gunther and Senator Kemp Hannon, has passed the NYS Legislature.   The bill will now go to Governor Andrew Cuomo for his consideration.   The bill will require school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade.  The Medical Society of the State of New York is part of a coalition of organizations supporting this legislation.  This bill is consistent with the Advisory Committee on Immunization Practices.   Organizations in support of the measure included the GMHC, the American Academy of Pediatrics NYS Chapter, District II, Latino Commission on AIDS, Kimberly Coffey Foundation, March of Dimes, Meningitis Angels, National Meningitis Association, the Nurse Practitioner Association New York State, New York State Academy of Family Physicians, and the New York Chapter of the American College of Physicians.
(CLANCY)


CVS HEALTH MAKES ADDITIONAL EFFORT AT THE END OF SESSION FOR AUTHORITY TO ESTABLISH RETAIL CLINICS- MASSNY WORKING WITH NURSES ASSOCIATION AGAINST THIS EFFORT
CVS HEALTH which operates CVS Pharmacies, a pharmacy benefit manager, mail order and specialty pharmacies, and retail-based health clinic subsidiary, MinuteClinic, made another effort during the waning days of the legislative session to secure passage of legislation (S. 5458, Hannon and a similar bill A. 1411, Paulin) to secure approval to establish retail clinics statewide without establishment of public need as is normally required under the certificate of need provisions of current law.

The Senate bill passed the Senate earlier this week. MSSNY working closely with the Nurses Association and other medical specialties sought to defeat the Assembly proposal when considered by the Assembly Codes Committee earlier this week. The bill was defeated in Committee. Later in the week, however, additional efforts were advanced to have the bill placed back on the Committee agenda. Again, MSSNY and Nurses Association lobbyists worked together to assure that the bill remained in Committee.

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

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

MSSNY will remain vigilant against any further efforts to advance this measure before the end of session.
(DEARS, AUSTER)


COLLABORATIVE DRUG THERAPY MANAGEMENT BILL PASSES BOTH HOUSE OF THE LEGISLATURE- ISSUES RAISED BY MSSNY ADDRESSED.
Legislation (A. 5805-A, McDonald/S. 4857-A, LaValle) has passed both houses of the Legislature which would extend the authorization of pharmacists to perform collaborative drug therapy management (CDTM) in certain settings.  The final bill addressed many of the numerous issues raised by MSSNY with the initial version of this bill.

MSSNY was concerned that the bill removed protections which had been included when this demonstration program was first enacted which assured that the treating physician remained in control of the care provided to the patient. Specifically, the initial version of the bill would have allowed for the substitution of a drug which differed from that initially prescribed by the patient’s physician without authorization by the treating physician. The bill was modified to prohibit such substitutions or adjustments without authorization by the treating physician. Moreover, the initial version of the bill would have eliminated language which required the patient to consent to the collaborative drug therapy management. This protection was restored at the request of MSSNY. The initial version of the bill had inserted the term “prescribing” when ordering an adjustment or managing a drug regimen. MSSNY noted that “prescribing” remains outside of the pharmacist’ scope of practice and this term was removed from the bill. The original version of the bill would have extended to NPs and PAs the ability to collaborative with a pharmacist in collaborative drug therapy management. The extension of such collaborative authority was removed at MSSNY’s request. Lastly, MSSNY was concerned by the extension of CDTM to a nursing home or residential health care facility setting primarily because these settings are not well staffed by physicians. The final bill allowed for the extension of CDTM to other hospital settings including a nursing home but only if it has an on-site pharmacy staffed by a licensed pharmacist. The bill did not extend CDTM however to dental clinics, dental dispensaries, residential health care facilities and rehabilitation centers.

The bill extended the collaborative drug therapy demonstration with this parameter for three more years.

MSSNY is grateful to the sponsors of the bill and the Chairs of the Higher Education Committees for their consideration of our concerns in constructing this on-going demonstration.     
(DEARS, ELLMAN)


NYS LEGISLATURE APPROVES BILL TO ALLOW PHARMACISTS TO PROVIDE ADULT IMMUNIZATIONS; BILL WILL NOW GO TO GOVERNOR FOR CONSIDERATION
Pharmacists will expand the list of immunizations that they can provide to adults under legislation that has passed the New York State Legislature.  A. 123B/S. 4739A, sponsored by Assemblywoman Amy Paulin and Senator Kemp Hannon, would add Diphtheria, Tetanus and Pertussis (DPT) to the list of vaccines that can be administered by pharmacists. The bill now goes before Governor Andrew Cuomo for his consideration and action.    The bill would allow physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines.  The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script.  The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis.   Importantly, the bill requires the pharmacist to report the administration of the vaccine to the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry.   Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner.   The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide.  The bill also contains a three year sunset.   The Medical Society of the State of New York opposed this measure, because of its belief that this policy would further fracture the medical home.      (CLANCY, DEARS, ELLMAN)


AS SESSION WINDS DOWN SCOPE OF PRACTICE BILLS STATUS UNCHANGED WITH TWO EXCEPTIONS
The following are among many scope-of-practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  1. 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains in the Higher Education Committee in both the Senate and Assembly.
  2. 719-A (Pretlow)/ S.4600-A (Libous) – a bill that would expand on a bill enacted in 2012, and would allow podiatrists to diagnose, treat, operate or prescribe for cutaneous conditions of the ankle up to the level of the knee. It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and also would allow them to basically train themselves.  This bill is in the Higher Education Committee in the Senate and Assembly.
  3. 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, call themselves naturopathic doctors, claims that they cannot do invasive procedures, yet allows them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  4. 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  5. 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
  6. 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill is in the Senate Higher Education Committee.  There is no same-as bill in the Assembly.

The bills that have passed both Houses were vigorously negotiated by MSSNY to make them more acceptable to medicine.  
(ELLMAN, DEARS)


BILL REQUIRING EDUCATION OF ATHLETES REGARDING SUDDEN CARDIAC ARREST PASSES NYS ASSEMBLY; PENDING IN SENATE RULES COMMITTEE
Assembly Bill 8107/Senate Bill 5984, sponsored by Assemblymember Michael Cusick and Senator Andrew Lanza, has passed the NYS Assembly.  Its companion measure is pending in the Senate Rules Committee.   The legislation would require that the New York State Department of Health to develop an educational brochure on preventing sudden cardiac arrest among student athletes.  Under the bill’s provisions, the NYS Commissioner of Health shall provide educational materials for students and their parents and guardians regarding sudden cardiac arrest.  The Medical Society of the State of New York supports this measure and worked with the sponsors to help develop this legislation. The bill also calls for this material to be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart Association. The brochure would include an explanation of sudden cardiac arrest, a description of early warning signs, and an overview of options that are privately available for screening. The State of New Jersey currently has a program where brochures are sent home to parents and guardians. This legislation would establish a similar program by developing brochures that could be given to parents as well as pediatricians to distribute.

Sudden cardiac death is the result of an unexpected failure of proper heart function, usually (about 60% of the time) during or immediately after exercise without trauma. Since the heart stops pumping adequately, the athlete quickly collapses, loses consciousness, and ultimately dies unless normal heart rhythm is restored using an automated external defibrillator (AED). About 100 such deaths are reported in the United States per year. According to the American College of Cardiology, the chance of sudden death occurring to any individual high school athlete is about one in 200,000 per year. Sudden cardiac death is more common: in males than in females; in football and basketball than in other sports; and in African-Americans than in other races and ethnic groups. It remains important that athletes, parents, coaches and the health care community are educated about the issue of sudden cardiac arrest and the importance of recognizing the early warning signs and be provided with information about available screening options.   Additionally, it is important that all school officials and coaches are trained in the use of AEDs and having them available on the athletic field.
(CLANCY, AUSTER)


HEALTHCARE PROFESSIONAL TRANSPARENCY ACT HITS SNAGS DURING LAST WEEK OF SESSION- COMMITTEE CHAIRS AND SPONSORS COMMIT TO WORKING TO RESOLVE ISSUES DURING THE OFF SESSION
Throughout the Session MSSNY has worked closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, in pursuing legislation (S.4651-C, Griffo/A.7129-D, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public. Specifically, the bill would require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional.  In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information.  Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.  Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship.  Importantly, this measure would have also required health care practitioners to wear an identification name tag during all patient encounters that includes the type of license held by the practitioner.

While the bill advanced to the floor of the Senate and was placed on an Assembly Committee agenda, changes were proposed to the Assembly bill which could not be embraced. Of concern is the issue of whether practitioners should be subject to professional misconduct in all instances where they fail to wear the identification badges. The Chair of the Assembly Higher Education Committee and the sponsors of the legislation have agreed to work with the physician community to address these concerns.
 (DEARS, ELLMAN) 


US HOUSE TO CONSIDER IPAB REPEAL LEGISLATION NEXT WEEK
Legislation is expected to be voted on next week by the U.S. House of Representatives to repeal the Independent Payment Advisory Board (HR 1190, Roe) enacted as part of the ACA.   Among the 235 co-sponsors of the IPAB repeal legislation are New York Congressional delegation members Chris Collins, Peter King, Sean Patrick Maloney, Chris Gibson, Tom Reed, Elise Stefanik, Richard Hanna and John Katko.  Physicians are urged to contact their Respective member of the US House of Representatives in support of this legislation.  To find contact information for your respective House member, please go to MSSNY’s Physician Action Center here.

The IPAB is charged with making recommendations to cut Medicare expenditures if spending growth reaches an arbitrary level that can only be overturned by a supermajority of Congress.  MSSNY recently signed on to a patient and provider advocacy letter  in support of repeal of the IPAB.  The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decision making responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”
(AUSTER)           


MSSNY JOINS OTHER STATE MEDICAL SOCIETIES TO URGE 2-YEAR ICD-10 TRANSITION PERIOD
MSSNY joined the medical associations of California, Florida and Texas in writing to CMS Acting Director Andy Slavitt to urge a two-year ICD-10 “grace period” when physicians and other health care providers are required to use ICD-10 codes starting October 1, 2015.   At its recent meeting, physician delegates to the AMA House of Delegates overwhelmingly called upon the AMA to seek such 2-year “grace period”.  The letter notes that “the Oct. 1 mandatory implementation of the ICD-10-CM coding system is a looming disaster. The results of the recent end-to-end tests give us little confidence that the nation’s physicians, electronic health records, claims clearinghouses, commercial insurance companies, and government agencies will be ready when we “throw the switch” to ICD-10.”

Specifically, the letter asks that CMS implement the following steps with regard to ICD-10 implementation:

  • A two-year period during which physicians will not be penalized for errors, mistakes, and/or malfunctions of the system;
  • A two-year period in which physicians will not be subject to RAC audits related to ICD-10 coding mistakes;
  • A two-year period during which physician payments will not be reduced or withheld based on ICD-10 coding mistakes; and
  • Advanced payments in the event that claims are delayed.
    (AUSTER)


CME WEBINARS ON PTSD AND TBI IN RETURNING VETERANS

MSSNY will be offering two CME webinars on the topic of “PTSD and TBI In Returning Veterans:  Identification and Treatment.”

June 24, 2015, 7:00 – 8:00 AM

Faculty:  Frank Dowling, MD

Registration:

June 30, 2015, 6:00 – 7:00 PM

Faculty:  Joshua Cohen, MD

Registration:

Course Objectives:

  • Explain the two most common disorders facing returning veterans today, their prevalence, risks, costs, and comorbidities.
  • Identify common symptoms and causes of PTSD and Traumatic Brain Injury (TBI), especially those that affect returning veterans most.
  • Outline proven treatment options in psychotherapy and pharmacotherapy, from concept to implementation.
  • Outline the process of recovery and post-traumatic growth.
  • Discuss barriers to treatment, including those unique to military culture, and how to overcome them.

The sessions are sponsored by MSSNY through a grant offered by the NYS Office of Mental Hygiene.

Program flyer can be accessed here:

For more information, contact Greg Elperin at gelperin@mssny.org or (518) 465-8085.

(DEARS, ELPERIN, HARDIN) 


FINAL “ADVOCACY MATTERS” SESSION ON SHIN-NY PATIENT LOOK-UP
The final “Advocacy Matters” CME webinar on the topic “SHIN-NY Statewide Patient Record Look-Up,” co-sponsored by MSSNY in conjunction with the New York Chapter of the American College of Physicians (NYACP) and the New York eHealth Collaborative (NYeC), will be held on June 24, 2015, from 6-7 PM.  The faculty will include David Whitlinger, CEO of NYeC, Inez Sieben, NYeC COO,   Lisa Halperin Fleischer, NYeC CMO, and Paul Wilder, NYeC CIO.

Course objectives:

  • Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
  • Give Healthcare Providers Information on how they will be able to access and share patient records through the SHIN-NY
  • Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access.

Registration link is below:

June 24, 2015 (6-7 PM):   Register here

Flyer is available here:

Information sheet on the Data Exchange Incentive Program is available here:

For more information, contact Miriam Hardin at mhardin@mssny.org  or (518) 465-8085.                                                                                                          (DEARS, HARDIN)

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

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

 

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Council Notes from June 18 Meeting

  • Dr. Thomas Madejski was elected to the AMA’s Council on Medical Service at the June AMA Meeting in Chicago.
  • Dr. John Kennedy has been named Chair of the AMA Delegation with Dr. Charles Rothberg as Vice-Chair.
  • Dr. Sellers presented the MSSNYPAC report, which included information about the possibility of procuring data to enrich the PAC database.  The data would be used as a tool for increased contributions. MSSNYPAC has a mobile donate site at www.mssny.org/mobile and active Facebook and Twitter accounts.
  • The Medical, Educational, and Scientific Foundation of New York (MESF) reported the following:
    • MESF has completed The Essentials of Leadership: What They Didn’t Teach You in Medical School program, which was presented by Rick Popovic to 13 county medical societies and other organizations. The total attendee count was nearly 400.
    • As a follow-up to the basic Leadership Training Program, MESF has responded to an RFP from the Physicians Foundation and has submitted an application for funding for additional leadership training programs. The grant application is for $150,000 for a two year program.
    • MESF has held discussions with Johns Hopkins in Baltimore for the development of a series of two year online programs on various Internal Medicine topics. The approach will permit efficient use of Johns Hopkins faculty time while taking advantage of readily available medical writers in India.


NY Workers Comp Business Re-Engineering Project (BPR) Roadshow Series
The BPR team has scheduled its next series of roadshows. The roadshow sessions will provide an update on current BPR initiatives and talk about what is planned for Phase 2. Here is the agenda: Programmatic Updates; Medical Authorization Portal; Payor Compliance; and BPR Phase 2: New Initiatives to Come

The full schedule is listed below.

District Office
Brooklyn 111 Livingston Street
19th Floor, Room 1917
Brooklyn, NY 11201
6/23/15 12:00 pm
4:00 pm
Manhattan 215 West 125th Street
Room 509-511
New York, NY 10027
6/24/15 12:00 pm
4:00 pm
White Plains 75 South Broadway
White Plains, NY 10601
6/30/15 12:00 pm
Queens 168-46 91st Avenue
3rd Floor, Room 325
Jamaica, NY 11432
7/1/15 12:00 pm
4:00 pm
Hauppauge 220 East Rabro Drive
Board Room 116-H
Hauppauge, NY 11788
7/2/15 12:00 pm
4:00 pm
Buffalo Ellicott Square Building
295 Main Street
Suite 400, Room 438
Buffalo, NY 14203
7/7/15 12:00 pm
4:00 pm
Rochester 130 Main Street West
Basement Conference Room
Rochester, NY 14614
7/8/15 12:00 pm
4:00 pm

These sessions offer an opportunity for stakeholders to learn about what is happening on the BPR project directly from the BPR team leaders. They also have become an important means of direct communication with their stakeholders. The team looks forward to addressing questions and exchanging ideas. Please email bpr@wcb.ny.gov with any questions.


Many Seniors Treated in ED after Car Crash on Pain Meds Six Months Later
Many seniors injured in motor vehicle crashes remain in pain for months afterwards, negatively affecting their quality of life and ability to live independently, according to a study published in Annals of Emergency Medicine available here.

The study looked at patients aged 65 and older who visited one of eight emergency departments after a motor vehicle crash between June 2011 and 2014 and were discharged home after evaluation. More than half of the patients were still taking some type of pain reliever after six months and about 10% had become daily users of opioid pain relievers, the study found. Of patients with persistent moderate to severe pain, 73% had experienced a decline in their physical function and 23% had experienced a change in living situation to obtain additional help. “The types of injuries that younger people recover from relatively quickly seem to put many seniors into a negative spiral of pain and disability,” said lead author Timothy Platts-Mills, M.D. “Older adults are an important subgroup of individuals injured by motor vehicle crashes and their numbers are expected to double over the next two decades.”


OPRA Prescription Reminders for Unlicensed/Foreign Residents and Interns
In December 2013, New York State (NYS) Medicaid issued a Special Edition (Vol.29, No.13) of the Medicaid Update to provide enrollment requirements and guidance for all Ordering, Prescribing, Referring, and Attending (OPRA) servicing/billing providers.

The purpose of this article is to provide a reminder regarding OPRA prescription requirements for unlicensed residents, interns and foreign physicians in training.

  • NYS Medicaid recognizes prescriptions written by providers legally authorized to prescribe per NYS Education Law Article 131 Section 6526 and 10NYCRR 80.75(e). This includes unlicensed residents, interns and foreign physicians in training programs, under the supervision of a NY State Medicaid enrolled physician.
  • In accordance with NYS Education Law, NYS Medicaid does NOT require the name and signature of the supervising physician to be included on the prescription. However, in order to enable billing by the dispensing pharmacy, prescriptions written by unlicensed residents must include the NPI of the supervising/ attending physician who is enrolled in Medicaid (see last bullet point below regarding billing requirements).
  • NYS Medicaid only enrolls licensed providers. As a result, unlicensed residents, interns or foreign physicians in training programs are not eligible for enrollment as NYS Medicaid providers.
  • Effective January 2014, NYS Fee-For-Service (FFS) Medicaid implemented claims editing that enforced the OPRA requirement for healthcare professionals, practice managers, facility administrators, and servicing/billing providers. Therefore, pharmacy claims for services ordered by unlicensed residents, interns and foreign physicians in training programs reject when initially submitted for payment. The following two (2) options continue to be available to pharmacies, to enable payment:
    1. Resubmit the claim, using the National Provider Identifier (NPI) of the enrolled NYS Medicaid provider (the intern or resident’s supervising physician).
    2. In the event the NPI number of the supervising physician cannot be obtained – or – the pharmacy’s billing system is limited to submitting only one prescriber NPI number then use the urgent/emergency override option (outlined below).


Ask the HPV Experts: CDC Experts Answer Your Questions
The questions and answers in this edition of IAC Express, all related to human papillomavirus (HPV) vaccination, first appeared in the May 2015 issue of Needle Tips.
The questions are answered by experts, medical officer Andrew T. Kroger, MD, MPH; and nurse educator Donna L. Weaver, RN, MN. Both are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC).


Narcotic Addicts Can Sue Doctors and Pharmacies for “Enabling” Them
In a 3-2 decision, the Supreme Court of West Virginia ruled that narcotic addicts may sue pharmacies and physicians for facilitating their addictions. A suit was brought on behalf of 29 pain center patients who had been treated with narcotics for various injuries and became addicted. One article quoted the Chief Justice’s explanation: “A plaintiff’s wrongful or immoral conduct does not prohibit them from seeking damages as the result of the actions of others.”

The court recognized that most of the plaintiffs “admitted their abuse of controlled substances occurred before they sought help “at the pain clinic. In a dissenting opinion, one justice wrote that the decision “requires hardworking West Virginians to immerse themselves in the sordid details of the parties’ enterprise in an attempt to determine who is the least culpable—a drug addict or his dealer.”

In response to the ruling, the West Virginia Medical Association issued a statement: “It may cause some physicians to curb or stop treating pain altogether for fear of retribution should treatment lead to patient addiction and/or criminal behavior. It may create additional barriers for patients seeking treatment for legitimate chronic pain due to reduced access to physicians. It would allow criminals to potentially profit for their wrongful conduct by taking doctors and pharmacists to court.”

A post on the American Pharmacists Association website explained that pharmacists were included in the ruling “because they were aware of the ‘pill mill’ activities of the medical providers. The plaintiffs said these pharmacies refilled the controlled substances too early, refilled them for excessive periods of time, filled contraindicated controlled substances, and filled ‘synergistic’ controlled substances.”



Classifieds

Board Eligible Plastic Surgeon Seeks Full Time Position

Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.

Dr. Cohen

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

Reform Needed Before Date of Discovery Change – June 12, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R.Maldonado
 

 


Dear Colleagues:

This week, the NYS Assembly passed “Lavern’s Law,” legislation that extends the statute of limitations (SOL) on medical malpractice cases. If passed, the SOL begins to run from the date of discovery of the alleged harm rather than from the date of “injury” as is currently the law.  It remains to be seen if next week, the Senate takes up the bill in the remaining days of the current legislative session.  On the surface, it seems impossible to raise any valid ethical arguments against the right of an injured patient to be legitimately compensated for harm caused.  It seems logical that a wronged patient should be able to file a lawsuit within a period of time that commences the running of the statute of limitation from the time they became aware of the injury.  Is it really fair that the timeline for seeking redress begins from the time of injury when one is not aware that injury has occurred?  This is the argument raised by those advancing Lavern’s Law.  Raising any objection or any argument against this framing or analysis seems repugnant and places those advancing a different view in a seemingly untenable position.  And yet, I argue that we must advance a different view to afford ALL New Yorkers the justice they deserve.

Consequences of Lavern’s Law

The framing of justice for injured parties must be placed in a wider framework that includes consideration for all parties in a claim concerning injury as well as the consequences to society at large in regards to access to healthcare.  First, one needs to ask the question why are there two time standards concerning the SOL for the Lavern case?  The time frame for filing a lawsuit alleging harm in the case of municipal hospitals such as in the Lavern case is 15 months.  However, in most other cases, the SOL runs 2 ½ years.  Shouldn’t the standards be the same?  Second, should any consideration be given to the consequences on premium rates and ability to retain physicians in NYS if the SOL is amended?  Are the residents of the State of New York benefitted by a law that may drive physicians to insurance companies in precarious financial positions or may not even be chartered in New York, thus making recovery for damages more difficult for legitimately injured parties?  Will New Yorkers benefit from a seemingly just law that drives more Obstetricians and Neurosurgeons out of this state? Third, Lavern’s Law fails to grant justice to defendants where a statute of limitations is drawn out longer possibly blurring the memories of both the plaintiff and defendant.  What can an injured party recall about a conversation with a physician nine years after a patient-doctor encounter?  What can a physician recall about his/her cognitive thinking on a finding in question where the standard of care has changed over that period of time?

Big Picture Required for Real Solutions

On the surface, Lavern’s Law seems just.  And yet, on further analysis, one realizes it is a disservice to ALL New Yorkers.  Concerns for injured parties who are unaware of injury and later cannot obtain justice within the current legal framework deserve justice.  However, solutions for how justice should prevail MUST be carried out within a more comprehensive discussion on tort reform.  Other states that have addressed justice for the concerns in Lavern’s Law have done addressed other “big picture” concerns such as caps on non-economic damages.  It’s time New York did the same:  REFORM OUR TORT SYSTEM!

Please have your medical staff and family weigh in on this issue affecting  ALL NEW YORKERS by using our grassroots advocacy website.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President
Please send your comments to comments@mssny.org


MLMIC



Capital_Update_Banner

ASSEMBLY PASSES DISASTROUS LIABILITY EXPANSION BILL; PHYSICIANS MUST CONTACT THEIR SENATORS TO OPPOSE NOW!

All physicians must continue to contact their senators immediately to urge that they oppose legislation (S.911, Libous) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.  This week the bill was passed by the New York State Assembly by a 120-25 vote (roll call here).

MLMIC’s estimate based upon similar legislation is that this could single bill could increase physician liability premiums by an untenable 15%!    As New York physicians continue to pay liability premiums that are among the very highest in the country and face reduced payments from Medicare and commercial insurers, as well as rapidly increasing overhead costs to remain in practice, no liability increases can be tolerated.

MSSNY is working with many other provider associations also impacted by this legislation, including HANYS, GNYHA, nursing homes associations, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.  As reported in today’s Crains’ Health Pulse, ads will be running in several newspapers across New York State urging that the Legislature address the issue of medical liability comprehensively, and reject “stand-alone” legislation that would harm patient access to needed care.   For example, the ad notes that while many other states have adopted “date of discovery” exceptions to their statutes of limitations, the vast majority of these states have also enacted limitations on non-economic damages.  To view the ad, click here.                                               (DIVISION OF GOVERNMENTAL AFFAIRS)

NYS SENATE PASSES CME MANDATE BILL; BILL ON DEBATE LIST IN THE ASSEMBLY—URGENT ACTION IS NEEDED TO OPPOSE THIS LEGISLATION

The New York State Senate on Tuesday, June 9, 2015 passed Senate Bill 4348 (Hannon), which would require physicians to take three hours of continuing education on pain management, palliative care, and addiction.  Its companion measure, Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, is on the Assembly Debate list and can be voted at any time.  While several legislators have urged that this bill be defeated, we need more given the significant recent media attention to this issue.  Physicians are urged to send a letter urging defeat of this measure.

Additionally, the Governor has submitted to the NYS Legislature, language in his heroin legislative package that would require a four hour course work in pain management and addiction as part of registration renewal for all prescribers in New York State.   This language also provides an exemption from the requirement to anyone who requests the exemption and can clearly demonstrate that there would be no need for him/her to complete such course work because of the nature of his/her practice or can demonstrate that he/she has completed course work deemed by the department or the professional’s certifying or accrediting body to be equivalent to the course work approved by the department.

Assembly Bill 355/Senate Bill 4348 would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration 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.

New York legislators have already taken aggressive and far-reaching actions to reduce the inappropriate prescribing of diverting of pain medications and the action taken has worked.   In particular, New York State now ranks 50th in overall utilization of opioids and has shown a -12.4% reduction in the filling of hydrocodone prescriptions between 2013 when the ISTOP law was first implemented and 2014.  This comparison data is from IMS, Inc. Plymouth Meeting PA, — a company that provides information, services and technology for the healthcare industry.  It is the largest vendor of U.S. physician prescribing data in the nation.  It was provided to MSSNY from the American Medical Association.   Nationwide, there are 13 states that require physicians and other prescribers to complete either a one-time course or a course every two to four years in pain management and opioid prescribing.   All of these states ranked higher than New York State (50th) in overall utilization of opioids (annual prescriptions per capita 2014 Opioid Products).    New York State was 46th in the growth in opioid utilization by state (per change in filled prescription 2014 vs 2013)—only two states with CME had a greater reduction in the growth of opioid utilization.  New York State also ranked 45th in growth on hydrocodone utilization by state (NY saw a reduction of -12.4% in filled prescriptions between 2014 vs. 2013)—again only two states that require CME had greater reduction—Rhode Island ( a state that requires CME) had a -12.9% reduction in filled prescriptions.  According to IMS Health, Inc., NY is ranked 49 in overall utilization of Controlled Substances II and 41 in growth in Controlled Substance II utilization.  Overall utilization of Controlled Substance III, New York State is ranked 27th, however, growth in Controlled Substance III was reduced by -5.8% and the state is ranked 50th in growth of utilization with all CME states above New York.

This data shows strong evidence that prescribing practices by physicians have changed within the last two years due to the implementation of ISTOP in August 2013 that required physicians to check the Prescription Monitoring Program (PMP) prior to issuing a prescription for any controlled substances.   There has been strong physician compliance with the law and in many respect; it has been successful in achieving its goals to significantly reduce doctor shopping and reduce drug diversion.   According to the New York State Department of Health and the policy paper by Brandeis University: Mandating PDMP Participation by Medical Providers: Current Status and Experience in Selected States—  since the implementation of ISTOP drug diversion in New York State has been reduced by 75%. MSSNY believes that the implementation of the I-STOP law and the statutory requirement for all prescribers to check the PMP prior to issuing a Controlled Substances II, III, IV prescription has already changed prescribing practices within New York State in a relatively short period of time.   It would appear from the data noted above the PMP has changed behavior more significantly than would  continuing medical education coursework and training  in the area of  pain management and opioid use as noted by the data by the IMS Health, Inc.  MSSNY also believes that the implementation of the E-prescribing requirement for controlled substances and non-controlled substances in New York State, will also significantly impact prescriber’s behavior and the exercise of their clinical judgment in the use of controlled substances.          (CLANCY, DEARS)

HEALTHCARE PROFESSIONAL TRANSPARENCY BILL ON SENATE FLOOR

PLEASE CONTACT YOUR ELECTED REPRESENTATIVES.

MSSNY, working closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, is aggressively pursuing legislation (S.4651-C, Griffo/A.7129-C, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public.  Importantly, this bill will require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional.  In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information.  Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.  Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship.  Importantly, this measure would also require health care practitioners to wear an identification name tag during patient encounters that includes the type of license held by the practitioner.  The bill would also require the health care practitioner outside of a general hospital to display a document in his or her office that clearly identifies the type of license that the practitioner holds.

Physicians are encouraged to contact their elected representatives in both houses of the Legislature to ask that the bill be passed this year.
(DEARS, ELLMAN) 

LEGISLATION EXPANDS LIST OF IMMUNIZATIONS THAT PHARMACISTS CAN ADMINISTER TO ADULTS

Legislation that would expand the list of immunizations that pharmacists can provide to adults appears headed for passage in the New York State Legislature.  A. 123B/S. 4739A, sponsored by Assemblywoman Amy Paulin and Senator Kemp Hannon, would add Diphtheria, Tetanus and Pertussis to the list of vaccines that can be administered by pharmacists.   The bill also allows physicians and nurse practitioners to authorize non-patient specific scripts for pharmacists to administer any of these vaccines.  The law currently allows pharmacists to administer influenza and pneumococcal vaccines to adults through a non-patient specific script and to administer the acute herpes zoster and meningococcal vaccines to adults under a patient specific script.  The bill also authorizes the pharmacists to administer emergency treatment for anaphylaxis.   Importantly, the bill  requires the pharmacist to report  the administration of the vaccine to  the physician and/or primary health care practitioner, by electronic transmission or facsimile and, to the extent practicable, to make himself or herself available to the discuss the outcome of such immunization, including any adverse reactions with the attending physician and/or to report the administration of the vaccine to the statewide or NY city wide registry.   Under the bill’s provisions, the pharmacist is also required to inform the patient of the total cost of the immunization, including whether insurance coverage is available, and if the vaccine is not covered, the pharmacists must also inform the patient of the possibility that the immunization may be covered when administered by a primary care physician or a nurse practitioner.   The bill stipulates that the administration of a vaccine must occur in a privacy area to ensure the patient’s privacy and that the adult immunization schedule by the Advisory Committee for Immunizations Practices must be clearly posted for patients to read. The bill also authorizes that the commissioner of health can declare an outbreak or the threat of an outbreak; that he/she may issue a non-patient specific regimen applicable statewide.  The bill also contains a three year sunset.   The New York City Department of Health has made passage of this bill a priority; pharmacists and the pharmaceutical industry is also lobbying in support of the bill’s passage.   The Medical Society of the State of New York remains opposed as it believes that this policy would further fracture the concept of the “medical home”.   The bill is pending in the Higher Education Committee of both houses, but it is expected to be placed on the agenda and moved to the floor for passage next week.
(CLANCY, DEARS, ELLMAN)

HEALTH GROUPS URGE PASSAGE OF BILL TO INCLUDE E-CIGARETTES UNDER CLEAN INDOOR AIR ACT

Senate Bill 2202B/A. 5595B, sponsored by Senator Kemp Hannon and Assemblywoman Linda Rosenthal, is pending in the New York State Legislature.   The bill would prohibit e-cigarette use in all public places in accordance to the NYS Clean Indoor Air Act.  The bill is on Senate floor and is in the Assembly Codes Committee.  Physicians are urged to contact their legislators in support of this measure.   In 2003, New York updated its Clean Indoor Air Act by prohibiting the use of tobacco products in all workplaces. The purpose was to protect workers from the dangers of secondhand smoke and to provide clean indoor air for the overwhelming majority of New Yorkers who do not smoke.  Due to this law and other important steps that New York has taken, the state have seen major reductions in smoking rates.  However in recent years, there has been the proliferation of electronic cigarettes which threaten to reverse the progress New York has made preventing children from starting this deadly habit and helping smokers to quit.  Through unregulated marketing and widespread use in public areas, electronic cigarettes are re-normalizing “smoking” to kids while exposing workers and patrons to secondhand emissions.  Use of e-cigarettes in indoor public places also makes it very difficult to enforce the existing clean indoor air law.  The Medical Society of the State of New York has joined with other health organizations calling for passage of this measure.   The measure is supported by: American Cancer Society Cancer Action Network, American Heart Association/ American Stroke Association, American Lung Association in New York, Americans For Nonsmokers’ Rights, Campaign for Tobacco-Free Kids, County Health Officials of New York (NYSACHO), Health Plan Association, League of Women Voters of New York State, New York Chapter American College of Physicians, Services Inc., New York State Academy of Family Physicians, New York State Public Health Association, Roswell Park Cancer Institute.  MSSNY has significant House of Delegates policy calling for inclusion of e-cigarettes under the Clean Indoor Air Act.                                                             (CLANCY, ELLMAN) 

SCHOOL BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION PENDING IN ASSEMBLY CODES COMMITTEE AND ON SENATE FLOOR

Assembly Bill 791C, sponsored by Assemblywoman Aileen Gunther, is pending in the Assembly Codes Committee and its companion measure, Senate Bill 4324A, sponsored by and Senator Kemp Hannon,  is on the floor of the Senate for a vote.   This bill would require school-based immunizations against the meningococcal disease for every person entering seventh grade and 12th grade. The Medical Society of the State of New York has been part of a coalition of organizations supporting this legislation and is urging physicians and their patients to advocate in legislation. Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill.  MSSNY has also developed a patient-support letter that patients can use to urge support of this legislation.

This bill is consistent with the Advisory Committee on Immunization Practices.  Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis.  The bacteria are spread through the exchange of nose and throat droplets, coughing, sneezing or kissing.  Young people, between the ages of 10-25 years of age, are most at risk for this disease.   If not treated quickly, it can lead to death within hours or lead to permanent damage to the brain and other parts of the body.  Organizations in support of this measure include GMHC, the American Academy of Pediatrics NYS Chapter, District II, Latino Commission on AIDS, Kimberly Coffey Foundation, March of Dimes, Meningitis Angels, National Meningitis Association, the Nurse Practitioner Association New York State, New York State Academy of Family Physicians, and the New York Chapter of the American College of Physicians.                            (CLANCY)

CDC ISSUES ADVISORY ON MERS-CoV; PHYSICIANS ENCOURAGED TO TAKE MSSNY’S FREE CME PROGRAM ON CORONAVIRUS

The Centers for Disease Control and Prevention (CDC) continues to work with the World Health Organization (WHO) and other partners to closely monitor Middle East Respiratory Syndrome Coronavirus (MERS-CoV) globally, including the cases of MERS-CoV infection recently reported by China and the Republic of Korea. The CDC has issued an advisory to provide updated guidance to state health departments and healthcare providers in the evaluation of patients for MERS-CoV infection, which have been revised in light of the current situation in the Republic of Korea.

The Medical Society of the State of New York has a free online program on “Coronavirus” on its website http://cme.mssny.org/.   New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the various courses.  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 Credit.    Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Healthcare providers and public health officials should maintain awareness of the need to consider MERS-CoV infection in ill persons who have recently traveled from countries in or near the Arabian Peninsula or in the Republic of Korea as outlined in the guidance. Since May 2015, the Republic of Korea has been investigating an outbreak of MERS.  It is the largest known outbreak of MERS outside the Arabian Peninsula.  Middle East Respiratory Syndrome (MERS) is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV).  MERS affects the respiratory system (lungs and breathing tubes).  Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died.   The CDC is “sounding the alarm for American doctors now,” as more than 1,200 people have been infected around the world and the death toll is “approaching 500.”   Further information on MSSNY CME online programs may be obtained by contacting Pat Clancy at pclancy@mssny.org.
(CLANCY)

SCOPE-OF-PRACTICE BILLS STATUS AT END OF SESSION

The following are among many scope-of-practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  1. 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains  in the Higher Education Committee in both the Senate and Assembly.
  2. 5805 (McDonald)/ S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states. It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol.  The bill includes nursing homes in the definition of facility.  This bill is in the Higher Education Committee in the Senate and Assembly.
  3. 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand on a bill enacted in 2012, and would  allow podiatrists to care for up to the knee.  This would include diagnosing, treating, operating or prescribing for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves. This bill is in the Higher Education Committee in the Senate and Assembly.
  4. 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, and call themselves naturopathic doctors.  While they  claim the bill would not permit them to perform invasive procedures, it would allow them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  5. 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  6. 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.
  7. 5824 (Lanza) – a bill that would provide for the certification of psychologists to prescribe drugs. This bill is in the Senate Higher Education Committee.  There is no same-as bill in the Assembly.      (ELLMAN)

WORKERS COMPENSATION BOARD TO HOST REGIONAL FORUMS ON PROGRAMMATIC INIATIVES

The New York Workers Compensation Board (WCB) will be hosting regional programs across New York State to update physicians, their staff and other WC stakeholders regarding the status of its Business Process Re-Engineering (BPR) to improve  the WC program in New York State.  The programs will be held in each District Office beginning next Tuesday in Albany and running through the first week of July.  The discussion will include updates on the Board’s proposal to establish a Medical Authorization Portal and assure greater payor compliance.  The release by the WCB also notes that the program will discussing upcoming initiatives.  The schedule is listed below.  Physicians and/or their staff are encouraged to attend. 

District Office Address Date Times
Menands/Albany 100 BroadwayCR 518A & 518BMenands, NY 12241 6/16/15 12:00 pm4:00 pm
Syracuse 935 James StreetSyracuse, NY 13203 6/17/15 12:00 pm4:00 pm
Binghamton State Office Building44 Hawley Street, 18th FloorWarren Anderson Community RoomBinghamton, NY 13901 6/18/15 12:00 pm4:00 pm
Brooklyn 111 Livingston Street19th Floor, Room 1917Brooklyn, NY 11201 6/23/15 12:00 pm4:00 pm
Manhattan 215 West 125th StreetRoom 509-511New York, NY 10027 6/24/15 12:00 pm4:00 pm
White Plains 75 South BroadwayWhite Plains, NY 10601 6/30/15 12:00 pm
Queens 168-46 91st Avenue3rd Floor, Room 325Jamaica, NY 11432 7/1/15 12:00 pm4:00 pm
Hauppauge 220 East Rabro DriveBoard Room 116-HHauppauge, NY 11788 7/2/15 12:00 pm4:00 pm
Buffalo Ellicott Square Building295 Main StreetSuite 400, Room 438Buffalo, NY 14203 7/7/15 12:00 pm4:00 pm
Rochester 130 Main Street WestBasement Conference RoomRochester, NY 14614 7/8/15 12:00 pm4:00 pm

 (AUSTER)

PHYSICIANS, HOSPITALS AND NURSING HOMES JOINTLY ADVOCATE TO PREVENT FURTHER EXTENSION OF MEDICARE SEQUESTRATION CUTS

MSSNY joined with the Healthcare Association of New York State (HANYS), the Greater New York Hospital Association (GNYHA) and other provider associations in urging the New York House Congressional delegation to reject a Medicare sequestration cut extension (in 2024) included in the Trade Act of 2015 that was passed by the US Senate.  To read the letter, click here.  As of this writing, it appeared as if the US House of Representatives would remove the sequestration extension provision in a separate piece of legislation also to be passed by both Houses.  The letter notes that: “Extending Medicare sequestration reductions to pay for non-Medicare programs reinforces a dangerous precedent set last year of syphoning funds from the Medicare Trust Fund for non-Medicare purposes.  Such action will most certainly undermine the strength of the Trust Fund and the ability of hospitals, health systems, physicians, home care providers, nursing homes, and other providers to deliver the care our communities need and deserve.”  Earlier this year, the American Medical Association joined the American Hospital Association in a similar letter to Congress expressing concern with extending Medicare sequestration to pay for non-health care programs.
(AUSTER, DEARS) 

ADDITIONAL “ADVOCACY MATTERS” SESSIONS ON SHIN-NY PATIENT LOOK-UP

The June 9, 2015 “Advocacy Matters” CME webinar was on the topic “SHIN-NY Statewide Patient Record Look-Up.” There will be three more sessions offered on the same topic, co-sponsored by MSSNY in conjunction with the New York Chapter of the American College of Physicians (NYACP) and the New York eHealth Collaborative (NYeC).  The faculty will include David Whitlinger, CEO of NYeC, Inez Sieben, NYeC COO,   Lisa Halperin Fleischer, NYeC CMO, and Paul Wilder, NYeC CIO.

Course objectives:

  • Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
  • Give Healthcare Providers information on how they will be able to access and share patient records through the SHIN-NY
  • Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access.

Dates, times, and registration links are as follows:

June 16, 2015 (8-9 AM):   Register Here

June 18, 2015 (6-7 PM):   Register Here

June 24, 2015 (6-7 PM):   Register Here

For more information on the June 16 or June 18 program, contact Karen Tucker at ktucker@nyacp.org   or (518) 427-0366.  For more information on the June 24 program, contact Miriam Hardin at mhardin@mssny.org  or (518) 465-8085.

Program flyer is available here.
(DEARS, HARDIN) 

pschuh@mssny.org ldears@mssny.org     mauster@mssny.or
pclancy@mssny.org bellman@mssny.org  

enews_738px

New York County Medical Society Honors Anthony A. Clemendor, MD
At its annual meeting on June 2, New York County Medical Society President Joshua M. Cohen, MD, MPH presented the Society’s Nicholas Romayne, MD Lifetime Achievement Award to Anthony A. Clemendor, MD.

“Dr. Clemendor has worked tirelessly on behalf of physicians and patients throughout his career,” said Dr. Cohen. “He embodies the finest attributes represented by this award and its namesake, Dr. Romayne.”

The award is named for Dr. Nicholas Romayne, who in addition to serving as the Society’s first president in 1806, was also a founder of the New York College of Physicians and Surgeons.  It was said of Dr. Romayne that “he was unwearied in toil and of mighty energy, dexterous in legislative bodies, and at one period of his career was vested with almost all the honors the medical profession can bestow.”   In recognition of the caliber of physician this award honors, this year the Society presents it to a physician of equally impressive stature.

A graduate of the Howard University College of Medicine, Dr. Clemendor is board certified in obstetrics and gynecology. He is Clinical Professor of Obstetrics and Gynecology at New York Medical College, where he served as a dean for 23 years.

As a member of both New York County Medical Society and the Medical Society of the State of New York, Dr. Clemendor has served in a number of capacities: he chaired the MSSNY Task Force to Eliminate Ethnic and Racial Disparities in Health Care, and served on the AMA Commission to End Disparities in Health Care.  He served on the New York State Board for Professional Medical Conduct; as treasurer of the Empire State Medical Scientific and Educational Foundation; and on the New York State Council on Graduate Medical Education. In addition, he served on the Executive Committee of the Medical Society of the State for New York as Treasurer and as Councilor representing Manhattan and the Bronx.

Dr. Clemendor is a fellow of the New York Academy of Medicine. He continues to serve as vice chair of the Society’s delegation to the Medical Society of the State of New York. 

New York State Smoking Levels Reach “Historic Lows”

Smoking levels in New York State have reached a “historic low.” According to data released Monday by the state, smoking among high school students has dropped 42% over the past four years, with the rate now at 7.2%. Similarly, the adult smoking rate of 14.5% is below the national average of 17.8%. The statewide drop comes “even as smoking has been on the rise in the city after years of decline,” reaching 16% in 2013 after achieving a low of 14% in 2010. Experts cited New York’s “nation-high tobacco taxes as a reason,” alongside anti-smoking ads, laws and programs. Gov. Cuomo said, “With the lowest smoking rate in recorded history, it’s clear that New York State is becoming healthier than ever.”

Harlan Juster, director of the state’s Bureau of Tobacco Control, stated that the data is part of an annual survey that will be released in a full report later this year. He said the state has been collecting data on smoking since 1985, “when smoking rates were 31 percent among adults.” The data shows that 17.1% of men versus 12.1% of women smoke. Furthermore, “blacks have the highest percentage of smokers: 16.1 percent, compared with 15.1 percent of whites and 14.1 percent of Hispanics.” 

Study: Stroke Ages Patients by 7.9 Years

A study conducted by researchers at the University of Michigan and published in Stroke, based on data from over “4,900 black and white Americans aged 65 and older who underwent tests of memory and thinking speed between 1998 and 2012,” found that a stroke had the effect on the test results equivalent to aging 7.9 years. The effect of the stroke was “similar” for black and white patients.

AMA Delegates Ask CMS to Wave ICD-10 Penalties for Two Years

Physicians at the 2015 AMA Annual Meeting passed policy requesting that CMS wave penalties for errors, mistakes or malfunctions in the system for two years directly following implementation. The policy stipulates that CMS should not withhold physician payments based on coding mistakes, “providing for a true transition, where physicians and their offices can work with ICD-10.” With less than four months to go before the deadline for implementing the ICD-10 code set, physicians agreed to seek a two-year grace period for physicians to avoid financial penalties to facilitate a smoother transition that would allow physicians to continue providing quality care to their patients without undue disruption.

Related policy pushes the AMA to advocate for physician voices to be part of the group that manages the International Classification of Diseases (ICD). Currently, the four cooperating parties that manage ICD code sets are the Centers for Disease Control National Centers for Health Statistics, CMS, the American Hospital Association and the American Health Information Management Association. A physician group is necessary in these conversations because none of the current groups “represent providers who have licensed authority to define, diagnose, describe and document patient conditions and treatments.”

The new policy also directs the AMA to seek data on how ICD-10 implementation has affected patients and changed physician practice patterns, such as physician retirement or moving to all-cash practices.

CMS has acknowledged that the transition to ICD-10 will have an impact on physician payment processes. The agency estimates that “in the early stages of implementation, denial rates will rise by 100-200 percent,” according to a 2013 report from the Healthcare Financial Management Association.

A 2014 AMA study (log in) conducted by Nachisom Advisors on the cost of implementing ICD-10 estimated that a small practice could see payment disruptions ranging from $22,579 to $100,349 during the first year of ICD-10 implementation. The study also estimates that a small practice could incur a 5 percent drop in revenue because of productivity loss during and after the change.

While the AMA continues to urge regulators to ease the burden of ICD-10 implementation on physicians, physicians should act now to make sure your practice is prepared.

Parents’ Age May Play Role in Children’s Autism Risk
A study found increased autism rates among children born to teen moms and among kids whose parents have large gaps between their ages. The research, published in Molecular Psychiatry, indicated that “autism rates were 66 percent higher among children born to dads over 50 years old, as compared to dads in their 20s.” Meanwhile, “autism rates were 15 percent higher when moms had children in their 40s and 18 percent higher for children of teen moms, when compared to those born to women in their 20s.”

The risk also went up even more if the parents’ ages differed by at least 10 years. The researchers found that “the age gap risk showed up especially among fathers between 35 and 44 with a partner more than 10 years younger, and among mothers in their 30s with a partner at least 10 years younger.” The investigators came to these conclusions after looking at nearly “31,000 children with autism to nearly 6 million without autism in five countries.” These findings were reported online June 9 in the journal Molecular Psychiatry. The study authors compared almost 31,000 children with autism to nearly 6 million without autism in five countries. Those countries included Australia, Denmark, Israel, Norway and Sweden.

The CDC estimates that one in 68 children has an autism spectrum disorder.

Physician Burnout Scores at 40%–10% Higher than General Population

Physician burnout is largely attributed to the increasing administrative burden of modern medicine, according to a study from the AMA and RAND Corporation, a nonprofit, nonpartisan research organization that helps improve policy and decision-making.

The initiative, called AMA STEPS Forward, is comprised of interactive, online “physician-developed strategies for confronting common challenges in busy medical practices and devoting more time to caring for patients.”

“Research shows that rates of overall burnout among U.S. physicians approach 40 percent, more than 10 percentage points higher than the general population, which is why the AMA is taking a hands-on approach to meeting their day-to-day concerns through a new online practice transformation series called AMA STEPS Forward,” said James L. Madara, MD, AMA Executive Vice President and CEO, in a press release.

Many physicians say factors such as bureaucratic obstacles, administrative rules and paperwork have negatively impacted their job satisfaction—taking time away from patients and affecting their ability to provide high-quality, the report found. The initiative provides strategies to help physicians refocus their practices so they and their staff can “thrive in the evolving health care environment by working smarter, not harder.”

There are currently 16 modules available at www.STEPSforward.org. They focus on practice efficiency and patient care, patient health, physician health and technology and innovation. More than 25 modules are expected to be available by the end of the year, according the AMA. The modules can be used to earn continuing medical education credit.

New AMA Policy Aims to Reduce Risk of Concussion in Youth Sports

With growing concerns about the negative health effects of sports-related concussions in recent years, the American Medical Association (AMA) voted today to adopt policies aimed at reducing the risk of concussions in young athletes.

The AMA’s newly adopted policy supports requiring youth athletes who are suspected of having sustained a concussion to be removed immediately from the activity and allowed only to return with a physician’s written consent. The new policy also encourages the adoption of evidence-based, age-specific guidelines for physicians, other health care professionals and athletic organizations to use in evaluating and managing concussion in all athletes as well as the development and evaluation of effective risk reduction measures to prevent or reduce sports-related injuries and concussions.

According to the Centers for Disease Control and Prevention, between 1.6 million and 3.8 million sports- and recreation-related traumatic brain injuries, including concussions and other head injuries, occur in the U.S. every year. A recent study shows that 59 percent of middle school female soccer players reported playing with concussion symptoms, with less than half having been evaluated by a physician or other qualified health professional. A study of high school athletes with concussions also found that 15 percent returned to play prematurely, and nearly 16 percent of football players who sustained a concussion that resulted in loss-of-consciousness returned to play in less than one day.

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22 ; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception.

Apply by July 1
As a reminder, the application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered.

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based

Transitioning to ICD-10-CM
This webinar will provide Part B providers with an overview of ICD-10-CM and will assist you with planning for the mandated ICD-10-CM transition. This session will include testing opportunities and transition stages that will help you prepare your office for the upcoming implementation.
As per the CMS IOM Publication 100-09, Chapter 6, Section 30.1.1, National Government Services cannot make determinations about the proper use of codes for the provider. Questions related to ICD-9-CM and ICD-10-CM are handled by the American Hospital Association’s Coding Clinic. Details about this resource are available at http://www.ahacentraloffice.org.

Date: Tuesday, 6/16/2015
Time: 12:00-1:30 p.m.

Register for session


Classifieds

Board Eligible Plastic Surgeon Seeks Full Time Position
Brookdale University Hospital Attending Emeritus is resuming practice after retirement. 20 years private practice experience in cosmetic, reconstructive and hand surgery. Plastic Surgery Board Eligible. Seeks full time position with NYS group; flexible salary, will relocate. 6 month on the job preceptorship required to activate NY Medical license. Please email fredricjcohenmd@aol.com.

Dr. Cohen

Council Meeting – June 18, 2015

AGENDA
Council Meeting
June 18, 2015 at 9:00 a.m.
Long Island Marriott
101 James Doolittle Blvd.
Uniondale, NY 11553

A. Call to Order and Roll Call

B. Approval of the Council Minutes of May 3, 2015

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

1. President’s Report:
a. Approval of the 2015 HOD Resolutions referred to Council

2. Secretary’s Report – Nominations for Life Membership & Dues Remissions

3. Board of Trustees Report – Dr. Latreille will present the report (handout at Council)

4. MSSNYPAC Report – Dr. Sellers will present the report (handout at Council)

5. MLMIC Update – Mr. Don Fager will present a verbal report

6. AMA Delegation Update – Dr. Kennedy will present a verbal update

7. MESF Update – Dr. Kleinman will present the report

8. Commissioners (All Action Items )
    No action items submitted

9. Councilors (All Action Items from County Societies and District Branches)
    No action items submitted

D. Reports of Officers (Informational)
1. Office of the President – Meetings attended:
April 21   Albany meeting with Phil, Liz & Bill Muldrow
April 28   SHIP Meeting. Albany
April 29   DSRIP Meeting, Syracuse, NY
May 1- 3  MSSNY HOD
May 5      10th Annual Regional Healthcare Recognition & Luncheon
May 5      MLMIC Cocktail Party
May 6     MLMIC Audit Meeting & Annual Meeting
May 6     Annual Meeting of Erie County
May 11   University Club Dinner – Specialty Coalition Lobby Day, Albany
May 12   Specialty Coalition Lobby Day
May 13   Trial Lawyers Meeting
May 15   Workers’ Comp Board Teleconference
May 18   SHIP Meeting
May 18   Meeting with Dr. Frankel
May 19   Meetings with Drs. Sana Bloch & David Jakubowicz in the Bronx
May 19   Annual Meeting – Broome County Medical Society
May 26  Annual Meeting – Albany County
May 28  News Conference to Support Legislation (A.2834/S.3419)
May 29  Suffolk County Medical Society Annual Meeting
May 30  NYS Podiatric Annual Meeting
June 2   NYMGMA Annual Meeting
June 3   MLMIC Executive Meeting
June 3   Otsego Annual Meeting
June 5-9   AMA
June 10    Columbia Memorial Hosp. Meeting
June 11    Interview with Jonathan LaMantia of Crains NY Business
June 14   NYS Neurological Society Annual Meeting
June 15   Breakfast Fundraiser – MSSNY Albany Office
June 16   Massena Memorial Hosp. Meeting

2. Office of the President-Elect – Malcolm D. Reid, MD

3. Office of the Vice President – Charles Rothberg, MD

4. Office of the Treasurer –Thomas Madejski, MD (Financial Statement for the period 1/1/15 to 5/31/15)

5. Office of the Secretary – Arthur C. Fougner, MD

6. Office of the Speaker – Kira A. Geraci-Ciradullo, MD

E. Reports of Councilors (Informational)

1. Kings & Richmond Report – Parag Mehta, MD
2. Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
3. Nassau County Report – Paul A. Pipia, MD
4. Queens County Report – Saulius J. Skeivys, MD
5. Suffolk County Report – Frank G. Dowling, MD
6. Third District Branch Report – Harold M. Sokol, MD
7. Fourth District Branch Report – John J. Kennedy, MD
8. Fifth District Branch Report –Howard H. Huang, MD
9. Sixth District Branch Report – Robert A.Hesson, MD
10. Seventh District Branch Report – Mark J. Adams, MD
11. Eighth District Branch Report – Edward Kelly Bartels, MD
12. Ninth District Branch Report – Thomas T. Lee, MD
13. Medical Student Section Report – Charles A. Kenworthy
14. Resident and Fellow Section Report – Robert A. Viviano, DO
15. Young Physician Section Report – L. Carlos Zapata, MD

F. Commissioners (All Committee & Sub-Committee Informational Reports/Minutes)

1. Commissioner of Public Health & Education, Frank G. Dowling, MD
a. Addiction & Psychiatric Medicine Committee Minutes, April 17, 2015
b. Eliminate Health Care Disparities Committee Minutes, May 15, 2015
c. Infectious Diseases Committee Minutes, April 16, 2015
d. Preventive Medicine & Family Health Committee Minutes, May 14, 2015
e. Quality Improvement Committee Minutes, January 21, 2015
f. Quality Improvement Committee Minutes, May 20, 2015

2. Commissioner of Communications, Joshua M. Cohen, MD
a. Report of the Communications Division

G. Report of the Executive Vice President
1. Membership Dues Revenue Schedule

H. Report of the General Counsel
1. Request for Amicus Brief (handout at Council)

I. Report of the Alliance
1. Alliance Report – To be presented by Joan Cincotta

J. Other Information/Announcements
1. Letter of Appreciation to Regina McNally from Dr. Alpert

K. Adjournment

Act Now: Date of Discovery – June 5, 2015

drmaldonado PRESIDENT’S MESSAGE

Dr. Joseph R.Maldonado, President

Dear Colleagues:

We are nearing the end of the 2015 legislative session.  This session has seen recurring as well as new legislative efforts to change the practice of medicine in the State of New York.  This has occurred under new leadership in both the Assembly and Senate.  Last week, we saw the Assembly support a single payer effort in the State of New York.  This week, we have seen a strong push to have Date of Discovery Statute of Limitations and CME Mandate legislation voted on in the state legislature.  When examined in a vacuum, both of these issues appear to garner sympathy.  After all, who wouldn’t want their physician to have an up-to-date understanding of the pharmaceutical management of pain?  And yet, these issues cannot be considered purely in their ideological vacuum state.  Other considerations must be weighed into this discussion.

For example, what is the financial and workforce cost of enacting the Date of Discovery legislation?  What is the purpose of mandating CME on everything from I-STOP and drug enforcement administration 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? Any one of these subjects could be the focus of a three hour course. Simple solutions complicate already complicated issues.  Our solutions for complex problems must take into consideration a nuanced understanding of the etiology and nature of the problem.  It must consider the potential consequences of the solution.  The trial attorneys argue that the change in the statute of limitations concerning date of discovery affects a very small number of potential plaintiffs.  If so, why are the medical liability insurers concluding that this measure threatens to raise malpractice premium rates by at least 15%?  Why must we worsen the work environment for all physicians in a state that ranks lowest in WalletHub’s recent survey?  Why must we mandate all physicians to take a three -hour course every two years? Does a three-hour course even suffice for the physician who does pain management for a living?  Shouldn’t the professional specialty societies be the better judges of what is appropriate for their specialty society members?

Let’s take a moment this weekend to contact our state legislators.  Sign on to the letter we have drafted or draft your own expressing a reasoned, evidence based argument for a pragmatic approach to these problems.  Urge them not to support the current bills. Instead, urge them to study these issues more thoroughly and draft legislation that does justice for all New Yorkers

Physicians opposed to mandatory prescribing CME are urged to send a letter urging defeat of this measure.  Or physicians may call 518-455-4100 and ask for their assembly member office.

To defeat Day of Discovery, please click here.

Its companion measure, Senate Bill 4348 is also on the Senate floor and can be acted on at any time.  Physicians are urged to send the above letter or call the NYS Senate at 518-455-2800 and ask for their senator’s office.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC 

MSSNY President

Please send your comments to comments@mssny.org


MLMIC


Capital_Update_Banner 

PHYSICIAN ACTION URGED TO DEFEAT DISASTROUS LIABILITY EXPANSION BILL
All physicians must contact their legislators to urge that they oppose legislation (A.285, Weinstein/S.911, Libous) that would drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

Physicians are also urged to call their assemblymembers and senators.   Talking points are available here.

This week the bill was reported from the Assembly Codes Committee to the Assembly Rules Committee, where it could be reported to full Assembly and voted on as soon as Monday.   As many New York physicians continue to pay liability premiums that are among the very highest in the country and face reduced payments from Medicare and commercial insurers, as well as rapidly increasing overhead costs to remain in practice, no liability increases can be tolerated.  MSSNY is working with many other provider associations also impacted by this legislation, including hospitals, nursing homes, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.                                    (DIVISION OF GOVERNMENTAL AFFAIRS)

NYS SENATE TO VOTE ON MONDAY FOR THE CME MANDATE BILL; BILL ON DEBATE LIST IN THE ASSEMBLY—URGENT ACTION IS NEEDED TO OPPOSE THIS LEGISLATION
On Monday afternoon, June 8, the New York State Senate is expected to vote upon Senate Bill 4348 (Hannon), which would require physicians to take three hours of continuing education on pain management, palliative care, and addiction.  Its companion measure, Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, is on the Assembly Debate list and can be voted on as early as Monday.  While several legislators have urged that this bill be defeated, we need more.  Physicians are urged to send a letter urging defeat of this measure.

Assembly Bill 355/Senate Bill 4348 would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration 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.                                                                      (CLANCY, DEARS) 

HEALTHCARE PROFESSIONAL TRANSPARENCY BILL ON SENATE FLOOR
PLEASE CONTACT YOUR ELECTED REPRESENTATIVES. 

MSSNY, working closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, is aggressively pursuing legislation (S.4651-A, Griffo/A.7129-A, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public.  Importantly, this bill will require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional.  In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information.  Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.  Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship.  Importantly, this measure would also require health care practitioners to wear an identification name tag during patient encounters that includes the type of license held by the practitioner.  The bill would also require the health care practitioner outside of a general hospital to display a document in his or her office that clearly identifies the type of license that the practitioner holds.

Physicians are encouraged to contact their elected representatives in both houses of the Legislature to ask that the bill be passed this year.                                                  (DEARS, ELLMAN)

SCHOOL-BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION MOVES FORWARD IN BOTH HOUSES
Assembly Bill 791C/Senate Bill 4324, sponsored by Assemblywoman Aileen Gunther and Senator Kemp Hannon,  is moving forward in the legislative process, and physicians are urged to send a letter to their legislators urging support. Assembly Bill 791C  is in the Assembly Codes Committee, and Senate Bill 4324A is now on the Senate floor for a vote.  The Medical Society of the State of New York has been part of a coalition of organizations supporting this legislation and is urging physicians and their patients to advocate in legislation requiring school-based immunizations against the meningococcal disease.   Assembly Bill 791C/Senate Bill 4324 would require that every person entering seventh grade and 12th  grade shall have been immunized against meningococcal disease.  Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill.

MSSNY has also developed a patient-support letter that patients can use to urge support of this legislation.                                                                                                              (CLANCY)

SCOPE-OF-PRACTICE BILLS STATUS AT END OF SESSION
The following are among many scope-of-practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  • S.816 (Libous)/A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area.  This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill remains  in the Higher Education Committee in both the Senate and Assembly.
  • A.5805 (McDonald)/S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states.  It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol.  The bill includes nursing homes in the definition of facility.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • A.123 (Paulin)/S.4739 (Hannon) – a bill that would authorize pharmacists to, in addition to those immunizations currently allowed to be administered by pharmacists, administer immunizations to prevent tetanus, diphtheria, pertussis, acute herpes zoster, and meningococcal pursuant to a patient specific or non-patient specific order, and would remove the sunset provisions currently in the law.   Pharmacists are currently allowed to administer influenza, pneumococcal, acute herpes zoster and meningococcal pursuant to a patient specific order from a physician.   This bill remains in the Higher Education Committee in both the Senate and Assembly.
  • A.719 (Pretlow)/S.4600 (Libous) –  a bill that would expand on a bill enacted in 2012, and would  allow podiatrists to provide care for up to the knee.  This would include diagnosing, treating, operating or prescribing for cutaneous conditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves.

This bill is in the Higher Education Committee in the Senate and Assembly.

  • A.7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice.  It would allow them to practice as primary care providers, and call themselves naturopathic doctors.   Despite claims that the bill would not enable them to perform invasive procedures, this bill would allow them to immunize and perform cryotherapy.  This bill remains in the Higher Education Committee in the Senate and Assembly.
  • S.2063 (Libous)/A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with.  Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • S.215-A (Martins)/A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners.  This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill passed the Senate, and remains in the Higher Education Committee in the Assembly.   Physicians are urged to send a letter to their legislators.  (ELLMAN) 

LEGISLATION TO ENABLE PATIENTS TO END LIFE IS INTRODUCED IN NYS LEGISLATURE
There have been various bills introduced in the New York State Legislature that would enable patients to request assistance from their physician to end their life.  Senate Bill 5814, introduced by Senator John Bonacic, and Assembly Bill 5261A, introduced by Assemblywoman Amy Paulin, would amend the public health law and allow a patient to self-determine the end of life and would allow a physician to prescribe a lethal dose of drugs after they have received a written request from a patient who is terminally ill.  This bill is called the “Patient Self-Determination Act.”   Earlier in the year, Senator Diane Savino introduced Senate Bill 3685, the “New York End of Life Options Act,” which would allow physicians to assist and provide aid-in-dying medication to terminally ill patients.  Assemblywoman Linda Rosenthal has introduced Assembly Bill 2129, which would establish the “Death with Dignity Act” and would allow patients who have a terminal disease to voluntary self-administer a lethal dose of medications that have be prescribed by a physician for that purpose.  All of these bills are in the Assembly or Senate Health Committee.  There is also court action in the Supreme Court, County of New York, that has been filed by End of Life Choices New York and several physicians against New York State based on New York State assisted-suicide statute claiming that the provisions should not be interpreted to prohibit a physician’s prescription of lethal medications to a terminally ill patient who wished to end his/her life.  The introduction of these bills stem, in part, from the case  of Brittany Maynard, who took her own life after she was diagnosed with a terminal illness.  She lived in Oregon, where physicians can dispense lethal doses of drugs to terminally ill patients. The Medical Society of the State of New York’s House of Delegates in May 2015 adopted a revised policy on assisted suicide, MSSNY Policy 95.989 Physician Assisted Suicide and Euthanasia:

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.                    (CLANCY)

HEALTH SYSTEMS TRANSFORMATION REGIONAL MEETING TO BE HELD JUNE 18TH
NYSDOH Commissioner Howard Zucker, MD, JD will be among the speakers at a  Health Systems Transformation Regional meeting to be held on Thursday, June 18, 2015 at the Albany School of Public Health, George Education Center Auditorium, One University Place Rensselaer, NY 12144.   This event is co-sponsored by American College of Preventive Medicine and the University of Albany.  The half-day conference will feature state officials representing New York, Vermont, and Massachusetts who will present their experiences, insights and lessons learned related to CMS’s State Innovation Model Initiative.   Representatives from organizations such as the New York Academy of Medicine, The Commonwealth Fund, Xerox, the Finger Lakes Health Systems Agency, and Maine Health Management Coalition will present on private-sector collaborations and involvement in fostering health systems transformation.   The intended audience is physicians, public health officials, students and residents, payers, and anyone with an interest in this important topic.  Registration for the Northeast Regional Meeting is open until Wednesday, June 10th.
The $30 registration includes lunch and up to four CME credits. To register, please click here.                                                                                                                       (CLANCY)

CMS RELEASES 2013 MEDICARE PAYMENT DATA; AMA RELEASES GUIDE TO PROVIDE CONTEXT
This week CMS released new data related to Medicare payments to hospitals and physicians for services provided during calendar year 2013.  The Medicare Part B data includes information on 950,000 distinct health care providers including physicians, and allows for comparisons by physician, specialty, location, types of medical services and procedures delivered, Medicare payment, and submitted charges. The Medicare hospital utilization and payment data includes information for services provided in connection with the 100 most common Medicare inpatient stays and 30 selected outpatient procedures at over 3,000 hospitals in 2013.  To view the report, click here.

Recognizing the potential inaccurate conclusions that could be drawn based upon media reports of this data, the American Medical Association released a media guide to help provide necessary context for this data release.  To read the media guide, click here.  The media guide notes that the AMA “is committed to transparency and supports the release of data that can help improve quality of care. For that reason, the AMA believes that certain safeguards are needed to ensure accurate information is presented to the public. Given that CMS has once again released Medicare claims data without pre-verification by physicians to ensure accuracy and with little context, members of the media will be integral to ensuring that the public gets clear, accurate information.”                                                                                 (AUSTER) 

CMS RELEASES NEW ACO PARTICIPATION RULES
This week CMS adopted new rules for the Medicare Shared Savings Program (MSSP), including provisions relating to the payment of Accountable Care Organizations (ACOs) participating in the MSSP.   To read more, click here.

According to a summary provided by federal legislative counsel to the Physicians Advocacy Institute, among the significant revisions to the existing ACO program:

  • Adding a process for an ACO to renew its 3-year participation agreement for an additional agreement period, including factors (such as historical program compliance) that CMS will use to make a determination on the ACO’s renewal;
  • Finalizing a policy that permits ACOs to participate in an additional agreement period under one-sided risk with the same sharing rate as was available to them under the first agreement period and offering an alternative performance-based risk model (creating a new “Track 3” for ACOs);
  • Streamlining the data sharing between CMS and ACOs;
  • Establishing a streamlined process to allow prior Pioneer ACOs to apply for participation in the Shared Savings Program

CMS also states that it “intends to address other modifications to program rules in future rulemaking in the near term to improve ACO willingness to take on performance-based risk,” including waiving the geographic requirement for use of telehealth services.

CMS estimates that “at least 90 percent of eligible ACOs” will renew their participation in the MSSP when given the new options outlined in the final rule.                                              (AUSTER) 

HOUSE WAYS &MEANS COMMITTEE ADVANCES IPAB REPEAL LEGISLATION
This week the U.S. House Ways & Means Committee advanced to the full House of Representatives legislation to repeal the Independent Payment Advisory Board (HR 1190) and repeal the medical device tax (HR 160), provisions enacted as part of the ACA.   Among the 235 co-sponsors of the IPAB repeal legislation are New York Congressional delegation members Chris Collins, Peter King, Sean Patrick Maloney, Chris Gibson, Tom Reed, Elise Stefanik, Richard Hanna and John Katko.  The IPAB is a board charged with making cuts to Medicare payments if expenditures reach a certain level, with limited ability of Congress to reverse such cuts.

MSSNY recently signed on to a patient and provider association advocacy letter in support of repeal of the IPAB.  The letter contains over 500 signatories.  The letter notes that “The Independent Payment Advisory Board (IPAB), a provision of the Patient Protection and Affordable Care Act (PPACA), not only poses a threat to that access but also, once activated, will shift healthcare costs to consumers in the private sector and infringe upon the decision making responsibilities and prerogatives of the Congress. We request your support to repeal IPAB.”  The AMA also released a statement in support of the legislation, noting that: “IPAB is a flawed policy and the AMA has been advocating for the repeal of it since the ACA was passed. It would put significant health care payment and policy decisions in the hands of an independent body of individuals with far too little accountability. Additionally, IPAB’s arbitrary, annual cost cutting targets would lead to short term strategies that would threaten access to care for millions of Medicare patients across the country.”                                                                     (AUSTER)

HOUSE WAYS & MEANS COMMITTEE REQUESTS CMS DEVELOP ICD-10 CONTINGENCY PLANS
This week US House Ways & Means Health Subcommittee Chair Kevin Brady (R-TX) and 12 members of the Committee sent a letter to Acting CMS Administrator Andy Slavitt urging that CMS take steps to instill confidence among physicians that the October 1, 2015 implementation deadline for the required use of the ICD-10 coding system “will not cause widespread disruption.”  To read the letter, click here.

Among the recommendations in the letter were:

  • Make public any contingency plan for how Medicare will process claims in the event that CMS is unable to process claims with ICD-10 codes on October 1;
  • Make public a description how ICD-10 codes will be applied to current Medicare incentive programs for reporting on quality care and other metrics;
  • Expand “end to end” testing beyond the current 2,500 providers; and
  • Educate providers on resources in the event that CMS can accept ICD-10 codes but providers are unable to submit ICD-10 codes

In a press release accompanying the letter, Chair Brady stated, “Our local health-care providers have already taken on the financial and administrative burden of transitioning from ICD-9 to ICD-10.  Unlike the disastrous rollout of healthcare.gov in the Affordable Care Act, this Administration owes it to our local doctors to ensure a smooth transition to ICD-10.”

MSSNY also continues to support legislation (HR. 2126, Poe) that would postpone ICD-10 implementation, and physicians can send a letter in support of this legislation here.

(AUSTER) 

AMA URGES CHANGES BEFORE IMPLEMENTING MEANINGFUL USE STAGE 3
The American Medical Association recently wrote to CMS Acting Administrator Andy Slavitt to urge that CMS hold off on implementing Meaningful Use Stage 3 given the number of challenges facing physicians with implementing existing Meaningful Use standards.  Despite the fact that a large number of physicians are now using electronic health records (EHRs), less than 10 % of eligible professionals were able to attest for Stage 2 Meaningful Use in 2014.  The AMA letter highlights the following concerns that must be addressed before MU Stage 3 is implemented:

  • Patient Safety: There remains no thorough evaluation of how implementing EHRs and meeting complex MU requirements impact patient safety;
  • Modifications Rule Impact: Sufficient time is needed to ascertain physicians’ ability to meet the modified versions of Stages 1-2 now that some needed changes have been made;
  • Privacy and Security: There remain huge gaps in how to protect patient data, which must be addressed before expanding the program to include additional technology and other requirements;
  • Focus on Interoperability: More time is needed to prioritize interoperability, reduce barriers to data exchange, and promote the use of innovative technologies through pilot projects;
  • Quality Measures: The technology and infrastructure are still lacking to handle the next generation of quality measures and electronic reporting; and
  • Merit-Based Incentive Payment System (MIPS): The structure and requirements of the MIPS value-based payment program included as part of the recently enacted SGR Repeal legislation have yet to be outlined to ensure physicians have the appropriate tools to improve health care.                                                                (AUSTER, DEARS) 

ADVOCACY MATTERS CME WEBINAR JUNE 9, 2015
The next “Advocacy Matters” CME webinar will be held on Tuesday, June 9, 2015, from 12:30 to 1:30 PM.  The faculty will include David Whitlinger, CEO of NYeC, New York e-Health Collaborative (NYeC), Inez Sieben, COO, and Lisa Halperin Fleischer, NYeC CMO,, New York e-Health Collaborative (NYeC), presenting on the topic “SHIN-NY Statewide Patient Record Look-Up.”

Course objectives:

  • Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
  • Give Healthcare Providers Information on how they will be able to access and share patient records through the SHIN-NY
  • Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access. 

To register for this webinar, click here and fill out registration form.

The flyer for the program may be accessed here.                                          (DEARS, HARDIN) 

FINAL MEDICAL MATTERS CME WEBINAR TO BE HELD JUNE 9TH; PHYSICIANS URGED TO REGISTER
The Medical Society’s final “Medical Matters” webinar for the spring will be conducted on June 9, 2015 at 7:30 a.m.  William Valenti, MD, chair of MSSNY Infectious Disease Committee will present “Emerging Infections 2015-A look at EV-D68 and Chikungunya.”  Physicians are encouraged to register by clicking on https://mssny.webex.com.  Click on “Training Center” and then on the “Upcoming” tab to register.

The educational objectives are:

  • Recognize and describe Enterovirus D68 (EV D68)
  • Recall the importance of continued immunizations
  • Recognize symptoms of Chikungunya and describe measures for reporting

Physicians may also contact Melissa Hoffman at mhoffman@mssny.org or at 518-465-8085 to register.

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 Credit.    Physicians should claim only the credit commensurate with the extent of their participation in the activity. It is anticipated that Medical Matters programing for fall/spring 2015-2016 will be announced shortly.                               (CLANCY)

pschuh@mssny.org ldears@mssny.org     mauster@mssny.or
pclancy@mssny.org bellman@mssny.org  

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Some Upstate NY Cities Have Some the U.S.’s Most Affordable Healthcare
Upstate New York cities have some of the most affordable health care in the country.

A report by the Niagara Quality Health Coalition found that three upstate cities rank among the cheapest places in the nation for the amount that health insurers pay hospitals, doctors and other care providers in their network.

Buffalo was the second most affordable city of 274 regions studied. Rochester ranked fourth and Syracuse was 19. The most affordable city in the United States was Honolulu. The Bronx ranked third. Albany ranked 83 rd.

The most expensive cities in the country were Santa Cruz, California followed by Huntington and Charleston in West Virginia.

Here is the report by the nonprofit coalition. The report analyzed data insurers submitted to the Institute of Medicine.

ACPM Meeting in Albany on June 18
The American College of Preventive Medicine is proud to be hosting a series of three Health Systems Transformation Regional Meetings across the United States in May and June 2015.  The northeastern regional event will be co-sponsored by ACPM and the University of Albany. A copy of the agenda is attached for your perusal.

Register here: Northeastern Regional Meeting

Where: University at Albany School of Public Health, Renselaer, New York
When:  Thursday, June 18, 2015

This half-day conference will feature state officials representing New York, Vermont, and Massachusetts who will present their experiences, insights and lessons learned related to CMS’s State Innovation Model Initiative.  Representatives from organizations such as the New York Academy of Medicine, The Commonwealth Fund, Xerox, the Finger Lakes Health Systems Agency, and Maine Health Management Coalition will present on private sector collaborations and involvement in fostering health systems transformation.   For physicians, public health officials, students and residents, payers, and anyone with an interest in this most important of topics, this promises to be a fascinating event. Registration for the Northeast Regional Meeting is open until Friday, June 12th.  The $30 registration includes breakfast, coffee/tea, and snacks. Attendees have an opportunity to register for up to 4 CME/MOC credits. 

NYU Langone Makes Deal with 42-Physicians L.I. Practice
NYU Langone completed a deal with the Huntington Medical Group, a 42-physician Long Island practice that has been renamed NYU Langone Huntington Medical Group. The group has a total staff of 288 at two locations, in Huntington Station and Commack, and leases both those sites. The hospital did not disclose the details of the transaction. NYU Langone said in a statement that it plans to add cardiothoracic surgery, electrophysiology and cancer treatment services to the sites. The multispecialty practice already offers most specialties and primary care. The practice will be moved to NYU Langone’s billing platform and to its EPIC electronic health record system. (Crains, 6/5) 

Transitioning to ICD-10-CM
This webinar will provide Part B providers with an overview of ICD-10-CM and will assist you with planning for the mandated ICD-10-CM transition. This session will include testing opportunities and transition stages that will help you prepare your office for the upcoming implementation.

As per the CMS IOM Publication 100-09, Chapter 6, Section 30.1.1, National Government Services cannot make determinations about the proper use of codes for the provider. Questions related to ICD-9-CM and ICD-10-CM are handled by the American Hospital Association’s Coding Clinic. Details about this resource are available at http://www.ahacentraloffice.org.

Registration is open for the following dates:

Provider and Supplier Participation Requested for the 2015 MAC Satisfaction Indicator; Attention NGS providers and suppliers: Your feedback matters!
Your opinion is important to NGS. Please help them by participating in the 2015 MAC Satisfaction Indicator (MSI) survey. Please watch for their Email Updates with the survey link specific to providers and suppliers in the NGS jurisdiction. The survey will be available beginning June 15, 2015.

Complete the quick 10-minute survey to share your experience with the services we provide. The CFI Group is conducting this survey on behalf of the CMS. We appreciate your willingness to participate and assure you your responses will be kept completely confidential.

Roughly 150 People Being Monitored for Lassa fever After N.J. Man’s Death
At least 150 people may have had contact with a New Jersey man who died from Lassa fever after returning from Liberia. All are being monitored for symptoms, the Associated Press reports. Six of the contacts are at high risk of exposure, and 33 are at low risk. The virus, which can cause hemorrhagic fever, is not as lethal as the Ebola virus; but like Ebola, it is spread through contact with bodily fluids. CDC Lassa website: http://www.cdc.gov/vhf/lassa/

New York Blue Light Symposium
June 26-27, 2015 (Fri-Sat), Marriott Marquis, New York

With the explosion of blue light-emitting LEDs in homes, illuminated screens in personal devices, and increase in time-shift working hours, humans today are exposed to more light than they have ever been before. Recent studies have demonstrated the adverse effects of blue light on human health, including susceptibility to metabolism disorders and cancer.

To highlight this issue, the International Blue Light Society was founded in 2013 with 21 charter members from five countries. The 1st International Blue Light Symposium was held in Tokyo that same year, attracting 300 attendees from all over the world.

The New York Blue Light Symposium is a venue to discuss and heighten awareness in light studies. Basic scientists, clinicians, students, and other professionals are welcome to attend. Register early to avail of discounted rates.

For more information, visit http://blue-light.biz/2isbls/ 

New York County Medical Society Honors Anthony A. Clemendor, MD
At its annual meeting on June 2, New York County Medical Society President Joshua M. Cohen, MD, MPH presented the Society’s Nicholas Romaine, MD Lifetime Achievement Award to Anthony A. Clemendor, MD.

“Dr. Clemendor has worked tirelessly on behalf of physicians and patients throughout his career,” said Dr. Cohen. “He embodies the finest attributes represented by this award and its namesake, Dr. Romaine.”

The award is named for Doctor Nicholas Romaine, who in addition to serving as the Society’s first president in 1806, was also a founder of the New York College of Physicians and Surgeons.  It was said of Doctor Romaine that “he was unwearied in toil and of mighty energy, dexterous in legislative bodies, and at one period of his career was vested with almost all the honors the medical profession can bestow.”   In recognition of the caliber of physician this award honors, this year the Society presents it to a physician of equally impressive stature.

A graduate of the Howard University College of Medicine, Dr. Clemendor is board certified in obstetrics and gynecology. He is Clinical Professor of Obstetrics and Gynecology at New York Medical College, where he served as a dean for 23 years.

As a member of both New York County Medical Society and the Medical Society of the State of New York, Dr. Clemendor has served in a number of capacities: he chaired the MSSNY Task Force to Eliminate Ethnic and Racial Disparities in Health Care, and served on the AMA Commission to End Disparities in Health Care.  He served on the New York State Board for Professional Medical Conduct; as treasurer of the Empire State Medical Scientific and Educational Foundation; and on the New York State Council on Graduate Medical Education. In addition, he served on the Executive Committee of the Medical Society of the State for New York as Treasurer and as Councilor representing Manhattan and the Bronx.

Dr. Clemendor is a fellow of the New York Academy of Medicine. He continues to serve as vice chair of the Society’s delegation to the Medical Society of the State of New York.

Debate Begins on Single Payer

 drmaldonado PRESIDENT’S MESSAGE

Dr. Joseph R.Maldonado, President

Dear Colleagues:

In the coming weeks, you will be reading more about MSSNY’s progress in moving or stalling numerous legislative bills pertaining to healthcare delivery in New York State.  We anticipate Assemblyman Richard Gottfried’s bill on the New York Health Plan (a single payer plan initiative) will move to the floor of the Assembly for debate next week.

Our country and state are both divided on how best to remedy the complex problems associated with our present multi-payer healthcare system.  These problems are so wicked that many have looked to other countries for alternative models of healthcare delivery.  The vision of a single payer that can obviate the problems inherent in a multi-payer system is enticing.  The ease of access and the administrative attraction of dealing with one payer is appealing.  However, in studying many of these single payer systems, it is clear that physicians are unhappy and frustrated in these systems—albeit for different reasons.

A single payer system may not be the panacea some think it to be.

Several weeks ago, MSSNY’s House of Delegates expressed its views when it declined to support the concept of a single payer system.  As New Yorkers, we find ourselves in tremendous turmoil as our state leadership advances healthcare reform initiatives that will fundamentally change how we practice medicine in New York State.  MSSNY has been engaged in these efforts at the level of DSRIP, SHIP, PHIP and the SHIN-NY.  We are proud of our work in collaborating with the state to implement changes in a manner that will advance healthcare delivery improvements for decades to come.  The disruption of these efforts with the addition of another payment methodology threatens to undermine the physician workforce environment and the state’s efforts in healthcare delivery improvement.  Accordingly, the Society is opposing the New York Health Plan bill currently in the Assembly.

I will continue to support the dialogue within our profession and this state that explores improvements to our healthcare delivery system.  However, at this time, support for a single payer system threatens the viability of thousands of small practices throughout the state that are focused on preparing for ICD-10, e-prescribing, SHIP, SHIN-NY and DSRIP.  Let’s give the profession the opportunity to meet the immediate challenges facing our profession in the coming year before embarking on another megaproject such as transforming NY into a single payer state.

We will continue to work with Governor Cuomo, Assemblyman Richard Gottfried and Senator Kemp Hannon to better define the legislative and regulatory environment in which physicians operate in NY, thus improving the health of our state’s residents.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC 

MSSNY President

Please send your comments to comments@mssny.org

CapitalUpdate

ASSEMBLY WILL VOTE ON SINGLE PAYER BILL
Despite significant opposition from Republican and Democratic Assemblymembers, the Assembly Codes and Ways & Means Committees reported Assemblyman Gottfried’s single payer bill (A.5062/S.3525) to the floor of the Assembly. It can be voted on as early as Wednesday of next week.

Many physicians support this bill as a means to create health system efficiencies while reducing insurer control and influence over the practice of medicine. A significant number of physicians, however, feel that they will lose clinical autonomy under a single payer system. Moreover, based upon their experience with the Medicare and Medicaid systems, they are also concerned that a single payer system will result in a significant and unwarranted reduction in payment for the services they render.

At MSSNY’s most recent House of Delegates held earlier this month, a resolution which called upon MSSNY to support legislation to implement a single payer system was passionately debated by the physician delegates. While there was significant support among the physician delegates there was also overwhelming opposition. The Resolution was not adopted.

All physicians are encouraged to let your perspective be known to your Assembly representative by calling 1-518-455-4100, and asking to speak to your Assemblymember.  (DEARS, AUSTER)

PLEASE CONTACT YOUR LEGISLATORS IN SUPPORT OF HEALTH INSURANCE REFORM LEGISLATION
With just a few weeks left to go in the New York State legislative session, MSSNY continues to strenuously advocate for a number of critically needed health insurer reforms to better assure patients can receive coverage for the care they need from the physician of their
choice, and to reduce the extraordinary administrative burden imposed on physicians and their staff to assure patients can receive the care and medications they need.   Next week, Thursday, May 28, MSSNY President Dr. Joseph Maldonado will participate in a press conference with a number of patient advocacy groups, Assembly Health Committee Chair Richard Gottfried and Assemblymember Matthew Titone to urge the passage of legislation (A.2834-A, Titone/S.3419-A, Young) that would provide physicians with an expeditious method to override a health insurer step therapy/Fail-first protocol when prescribing needed medications for their patients.   To send a letter, click here.

In addition, physicians are urged to send letters to their legislators in support of these bills:

  • A.336 (Gottfried)/S.1157 (Hannon) – permits independently practicing physicians to collectively negotiate patient care contract terms with health insurers under close state supervision.  In the Senate Finance and Assembly Ways & Means Committees.  To send a letter in support, click here.
  • A.3734 (Rosenthal)/S.1846 (Hannon) – requires health insurers to offer Out of network coverage in New York’s Health Insurance Exchange.  In Assembly and Senate Insurance Committees.  To send a letter in support, click here(AUSTER, DEARS)

CME MANDATE BILL ON PAIN MANAGEMENT ON THE FLOOR OF BOTH HOUSES; CAN BE VOTED ON AT ANY TIME
Legislation that would require physicians to take three hours of continuing education on pain management, palliative care, and addiction is now on the floor of both houses in the New York State Legislature and can be voted on at any time.

Senate Bill 4348 passed out of the Senate Health Committee and has gone to the Senate floor.  Its companion measure, Assembly Bill 355 is also pending on the Assembly floor.   Immediate physician action is needed to stop this measure from passing.   Physicians are urged to send a letter urging defeat of this measure.

Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal, and Senate Bill 4348, sponsored by Senator Kemp Hannon would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration 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.  Given the success of New York’s I-Stop law and the wide variety of educational tools that prescribers are already using to educate themselves regarding the risks and benefits of various controlled medications, MSSNY remains opposed to the measure.        (CLANCY, DEARS)

SCOPE OF PRACTICE BILLS STATUS AT END OF SESSION
The following are among many scope of practice bills that MSSNY is opposing as the Legislative Session draws to a close for 2015:

  • 816 (Libous)/ A.3329 (Morelle) – a bill that would permit certain dental surgeons to perform a wide range of medical surgical procedures involving the hard or soft tissues of the oral maxillofacial area. This could include cosmetic surgery, such as face lifts, rhinoplasty, bletheroplasty, and other procedures, and would allow them to do these procedures in their offices, although they are not included in the office-based surgery law that govern office-based surgery for physicians.  This bill is in the Higher Education Committee in both the Senate and Assembly.
  • 5805 (McDonald)/ S.4857 (LaValle) – a bill that would expand the definition of “collaborative drug therapy management” to include patients being treated by PAs and NPs, not just physicians, and extend collaboration to unspecified disease states. It allows a pharmacist to prescribe in order to adjust or manage a drug regimen, and adds a non-patient specific protocol.  The bill includes nursing homes in the definition of facility.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 123 (Paulin)/ S.4739 (Hannnon) – a bill that would authorize pharmacists to, in addition to those immunizations currently allowed to be administered by pharmacists, administer immunizations to prevent tetanus, diphtheria, pertussis, acute herpes zoster, and meningococcal pursuant to a patient specific or non-patient specific order, and would remove the sunset provisions currently in the law. Pharmacists are currently allowed to administer influenza, pneumococcal, acute herpes zoster and meningococcal pursuant to a patient specific order from a physician.   This bill is in the Higher Education Committee in both the Senate and Assembly.
  • 719 (Pretlow)/ S.4600 (Libous) – a bill that would expand on a bill enacted in 2012, and would allow podiatrists to care for up to the knee. This would include diagnosing, treating, operating or prescribing for cutaneousconditions of the ankle up to the level of the knee, which could include skin cancers or diabetic wounds.  It does not have to be a wound that is “contiguous with”, but only has to be “related to” a condition of the foot or ankle.  It would eliminate the requirement for direct supervision of podiatrists training to do this additional work, and would allow them to basically train themselves.

This bill is in the Higher Education Committee in the Senate and Assembly.

  • 7035 (Perry)/ S.4917 (LaValle) – a bill that would license naturopaths and create a scope of practice for them that could be interpreted in many ways, and is not clear as to their limits of practice. It would allow them to practice as primary care providers, call themselves naturopathic doctors, claims that they cannot do invasive procedures, yet allows them to immunize and perform cryotherapy.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 2063 (Libous)/ A.2803 (Paulin) – a bill that would authorize optometrists to use and prescribe various oral therapeutic drugs, which have a systemic effect on the body, which they are not trained to deal with. Most of the requested drugs are rarely, if ever, used by ophthalmologists, and are unnecessary for optometrists to use.  This bill is in the Higher Education Committee in the Senate and Assembly.
  • 215-A (Martins)/ A.4391 (O’Donnell) – a bill to permit chiropractors to form LLCs with physicians as partners. This bill could allow chiropractors, who own a controlling interest in the LLC to tell employed physicians, or even a minority partner, how to practice and what tests to conduct.  This bill is on 3rd reading in the Senate, and is in the Higher Education Committee in the Assembly. (ELLMAN)

HEARING AID ACCESS BILL GAINS MOMENTUM IN ASSEMBLY
A.127 (Buchwald)/ S.4080 (Murphy) is gaining momentum in the Assembly, with twenty-five co-sponsors and signing on to the bill, and many memos in support being sent to Legislators from physicians and groups.  The bill is in the Consumer Affairs and Protection Committee in the Assembly and in the Consumer Protection Committee in the Senate.  Physicians are urged to contact their Assembly Member and Senator to support the bill, which would allow an audiologist or hearing aid dispenser, employed in an ENTs office, to sell hearing aids at fair market prices, and calls for a report after two years to show the impact of the bill.  This can be done by clicking on the following link.

New York is currently one of only two states in which physicians are not allowed to sell hearing aids for profit.  (ELLMAN)

MSSNY URGES PHYSICIANS AND PATIENTS TO ADVOCATE IN SUPPORT OF SCHOOL BASED MENINGOCOCCAL IMMUNIZATION
The Medical Society of the State of New York is urging physicians and their patients to advocate in legislation requiring school-based immunizations against the meningococcal disease.  Assembly Bill 791/Senate Bill 4324, sponsored by Assemblywoman Aileen

Gunther and Senator Kemp Hannon, would require that every person entering 6th grade and 11th grade shall have been immunized against meningococcal disease.   This recommendation is consistent with the Advisory Committee on Immunization Practices.  Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis.  The bacteria are spread through the exchange of nose and throat droplets, coughing, sneezing or kissing.  Young people, between the ages of 10-25 years of age, are most at risk for this disease.   If not treated quickly, it can lead to death within hours or lead to permanent damage to the brain and other parts of the body.  Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill:

MSSNY has also developed a patient support letter that patients can use to urge support of this legislation:

The bills are in the respective health committees in each house of the legislature.  (CLANCY)

CADILLAC TAX REPEAL LEGISLATION INTRODUCED IN CONGRESS
Legislation (HR 2050) to repeal the so-called “Cadillac Tax” on comprehensive health insurance coverage contained in the Affordable Care Act was recently introduced by Rep. Joe Courtney (D-CT).  Eight members of New York’s Congressional delegation representing many regions of New York State have joined as co-sponsors, including Representatives
Chris Gibson, Brian Higgins, Hakeem Jeffries, Nita Lowey, Sean Patrick Maloney, Jerrold Nadler, Jose Serrano, and Paul Tonko.  The “Cadillac tax” refers to an excise tax on high-premium health insurance plans that will be implemented in 2018.  It will be a 40% tax on health premiums above a threshold of $10,200 a year for individuals and $27,500 for families.

At its 2013 House of Delegates, MSSNY adopted a policy calling for to repeal of this tax, which will particularly hurt high cost states like New York and dis-incentivize employers from offering their employees comprehensive health insurance benefits.  The negative impact of this tax on patient care access in New York State was recently the subject of a forum where Assembly Health Committee Chair Richard Gottfried and Senate Health Committee Chair Kemp Hannon each expressed their concerns with this tax. For more information about this forum, please see the linked article from Capital New York (AUSTER)                                                                                                    

BILL TO DELAY ICD-10 IMPLEMENTATION INTRODUCED
The AMA recently sent a letter to Rep. Ted Poe (R-TX) in support of his legislation, HR 2126, introduced in the US Congress to postpone the ICD-10 code sets required to be used by physicians in claim submissions as of October 1, 2015.  MSSNY has urged support for a
further delay of the ICD-10 mandate, though prospects for the bill’s passage remain unclear given the commitment of the leaders of the House Energy & Commerce Committee to permitting ICD-10 to be implemented as planned given the support of many healthcare stakeholders including health plans and hospitals.  The letter notes that “the differences between ICD-9 and ICD-10 are substantial, and physicians are overwhelmed with the prospect of the tremendous administrative and financial burdens of transitioning to ICD-10. ICD-10 includes 68,000 codes—a five-fold increase from the approximately 13,000 diagnosis codes currently in ICD-9. Implementation will not only affect physician claims submission; it will impact most business processes within a physician’s practice, including verifying patient eligibility, obtaining pre-authorization for services, documentation of the patient’s visit, research activities, public health reporting, and quality reporting. This will require education, software, coder training, and testing with payers.”

Physicians can send a letter in support of this legislation here. (AUSTER)                                                                                                                         

MSSNY OFFERS FREE PATIENT BROCHURE ON DIABETES FOR USE WITHIN PHYSICIANS OFFICE
The Medical Society of the State of New York Committee’s on Preventive Medicine and Family Health and the Committee to Eliminate Health Care Disparities, has developed a patient brochure that physicians can offer within their office.  The patient brochure discusses risks associated with pre-diabetes and diabetes and is available in English and Spanish.  If you would like copies of this brochure, please contact the Medical Society of the State of New York at (518) 465-8085 or email Terri Holmes at tholmes@mssny.org and request copies of the Diabetes brochure.  The development of the brochure was made possible from a grant from AstraZeneca.  (CLANCY, ELLMAN)

FINAL MEDICAL MATTERS CME WEBINAR TO BE HELD JUNE 9TH; PHYSICIANS URGED TO REGISTER
The Medical Society’s final webinar for the spring will be conducted on June 9, 2015 at 7:30 a.m. William Valenti, MD, chair of MSSNY Infectious Disease Committee will present “Emerging Infections 2015-A look at EV-D68 and Chikunguya”. Physicians are encouraged to register by clicking on https://mssny.webex.com . Click on “Training Center” and then on the “Upcoming” tab to register.

The educational objectives are:

  • Recognize and describe Enterovirus D68 (EV D68)
  • Recall the importance of continued immunizations
  • Recognize symptoms of Chikungunya and describe measures for reporting

Physicians may also contact Melissa Hoffman at mhoffman@mssny.org or at 518-465-8085 to register.

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

It is anticipated that Medical Matters programming for fall/spring 2015-2016 will be announced shortly.  (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 ldears@mssny.org     mauster@mssny.or
pclancy@mssny.org bellman@mssny.org  

Enews May 2015 550x150

Medicare Eligible Professionals: Take Action by July 1 to Avoid 2016 Medicare Payment Adjustment
Payment adjustments for eligible professionals that did not successfully participate in the Medicare EHR Incentive Program in 2014 will begin on January 1, 2016. Medicare eligible professionals can avoid the 2016 payment adjustment by taking action by July 1 and applying for a 2016 hardship exception.

The hardship exception applications and instructions for an individual and for multiple Medicare eligible professionals are available on the EHR Incentive Programs website, and outline the specific types of circumstances that CMS considers to be barriers to achieving meaningful use, and how to apply.

To file a hardship exception, you must:

  • Show proof of a circumstance beyond your control.
  • Explicitly outline how the circumstance significantly impaired your ability to meet meaningful use.

Supporting documentation must also be provided for certain hardship exception categories. CMS will review applications to determine whether or not a hardship exception should be granted.

You do not need to submit a hardship application if you:

  • are a newly practicing eligible professional
  • are hospital-based: a provider is considered hospital-based if he or she provides more than 90% of their covered professional services in either an inpatient (Place of Service 21) or emergency department (Place of Service 23), and certain observation services using Place of Service 22; or
  • Eligible professionals with certain PECOS specialties (05-Anesthesiology, 22-Pathology, 30-Diagnostic Radiology, 36-Nuclear Medicine, 94-Interventional Radiology)

CMS will use Medicare data to determine your eligibility to be automatically granted a hardship exception. The application must be submitted electronically or postmarked no later than 11:59 p.m. ET on July 1, 2015 to be considered. 

If approved, the exception is valid for the 2016 payment adjustment only. If you intend to claim a hardship exception for a subsequent payment adjustment year, a new application must be submitted for the appropriate year.

In addition, providers who are not considered eligible professionals under the Medicare program are not subject to payment adjustments and do not need to submit an application. Those types of providers include:

  • Medicaid only
  • No claims to Medicare
  • Hospital-based

CDC Report Shows Most Distinct Causes Of Death In Each State
The CDC published a report this week in the journal Preventing Chronic Disease: Public Health Research, Practice and Policy that showed the most distinct causes of death in each state from 2001 to 2010. The report labels each state with a cause of death higher on
average than the rest of the country. Pelvic inflammatory disease (PID) is the number 1 unusual cause of death in New York State. The lead author, Francis Boscoe, a research scientist at the New York State Health Department, told ABC News that “they looked for outliers in each state to determine the most distinctive cause of death.”

YouTube Video: What Medicare Professionals Need to Know in 2015
A video recording of the “PQRS/Value-Based Provider Modifier: What Medicare Professionals Need to Know in 2015” presentation has been posted to the CMS MLN Connects® page on YouTube.  This presentation is the same as the webinars that were delivered on March 31, 2015 and April 7, 2015.  A link to the video can be found here.

Last Call for GME Task Force Members|
The GME task force will be charged with making recommendations to MSSNY as to how best address the growing shortage of residency training positions. It will make recommendations to the Council regarding how to advance solutions that address the problem while minimizing the onerous consequences of one-sided solutions.

MSSNY welcomes inquiries from those interested in serving on the taskforce; please contact Eunice Skelly at eskelly@mssny.org 516-488-6100 ext.389.

Take a CME Cruise to Everywhere!
New York physicians are again being offered the chance to sail the Mediterranean while updating their practice skills through a series of onboard CME programs offered through Continuing Education, Inc. Based in Tampa, Florida the organization had just announced
15 cruises with CME programs focused on such topics as cardiology, family medicine, pulmonology, palliative medicine, pediatrics, gastroenterology and a host of other clinical topics. In addition, the company has a variety of other CME cruises available to Alaska, Northern Europe, Hawaii and the Caribbean. Working in concert with major cruise lines, each onboard program is scheduled while the individual ship is at sea to enable physicians and families to enjoy the ports on the ship’s itinerary. For further information, click here.

 

Legislation Introduced re Unfair RAC Audit – May 28, 2015 –


Dr. Joseph R. Maldonado
MSSNY President
May 28, 2015
Weekly Update for New York State Physicians
Volume 16, Number 20
Christina Cronin Southard, Editor
Julie Vecchione DeSimone, Assistant Editor
mssnye-news@mssny.org  www.mssny.org

Colleagues:

Representative George Holding of North Carolina recently introduced legislation (HR 2568) entitled “The Fair Medical Audits Act of 2015.” This legislation reflects several MSSNY-supported provisions and addresses many concerns that physicians have with regard to the extraordinary lack of transparency and expensive, time-consuming and often unfair processes that plague the current Medicare audit program.

Currently, Medicare pays recovery audit contractors or “RACs” on a contingency basis to find overpayments to health care providers, providing these contractors with undue monetary incentives to audit doctors. The five regional firms contracted by the government are paid up to 12.5 percent of all claims they successfully identify as invalid. The burden this places on physicians from both a resource, financial liability and record-keeping standpoint is significant, as the RAC auditors can go back as far as three years.

This legislation would establish incentives for RACs to make more accurate audit findings and increase educational efforts to help physicians avoid common mistakes.  Since 2006, MSSNY has worked closely with the Physicians Advocacy Institute to advocate for more fair and transparent medical audits.

It is time to address fundamental problems that have contributed to the backlog of audit appeals and caused a great deal of unnecessary expense and confusion for physicians in New York. We commend Congressman Holding for his leadership on this critically important issue. Rep. Holding is a member of the House Ways and Means Subcommittee on Health, which has jurisdiction to consider legislation to reform the RAC program.

MSSNY has contacted each of the members of New York’s Congressional delegation to urge them to co-sponsor this important legislation, and we urge you contact your local Representative as well.

Joseph R. Maldonado, Jr, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


 

PHYSICIAN ACTION URGED TO DEFEAT DISASTROUS LIABILITY EXPANSION BILL

All physicians must contact their respective Assemblymembers to urge that they oppose legislation (A.285, Weinstein/S.911, Libous) that would drastically increase medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.  The bill will be considered by the Assembly Codes Committee at its Tuesday, June 2 meeting.  The letter can be sent here:   http://cqrcengage.com/mssny/app/write-a-letter?1&engagementId=105729.  Physicians are also encouraged to contact individual members of the NYS Assembly Codes Committee to express their opposition to this one-sided disastrous legislation.   A list of the members with links to their contact information is provided here: http://assembly.state.ny.us/comm/?sec=mem&id=7.  As New York physicians continue to pay liability premiums that are among the very highest in the country and face reduced payments from Medicare and commercial insurers, as well as rapidly increasing overhead costs to remain in practice, no liability increases can be tolerated.

List of members of the Assembly Codes Committee:

Joseph Lentol, Chair(AD 50)         518-455-4477            718-383-7474

Robin Schimminger (AD 140)        518-455-4767            716-873-2540

Helene Weinstein    (AD 41)          518-455-5462            718-648-4700

James Brennan       (AD 44)          518-455-5377            718-788-7221

Keith Wright              (AD 70)         518-455-4793            212-866-5809

Gary Pretlow             (AD 89)         518-455-5291            914-667-0127

Vivian Cook              (AD 32)          518-455-4203           718-322-3975

Steven Cymbrowitz (AD 45)           518-455-5214            718-743-4078

Michele Titus            (AD 31)          518-455-5668            718-327-1845

Daniel O’Donnell     (AD 69)           518-455-5603            212-866-3970

Charles Lavine         (AD 13)          518-455-5456            516-676-0050

Nick Perry                  (AD 58)        518-455-4166            718-385-3336

Kenneth Zebrowski (AD 96)           518-455-5735            845-634-1091

Thomas Abinati        (AD 92)          518-455-5753            914-631-1605

David Weprin            (AD 24)          518-455-5806           718-454-3027

Walter Mosley           (AD 57)          518-455-5325           718-596-0100

Alfred Graf                 (AD 100)       518-455-5355           845-794-5807

Joseph Giglio           (AD 148)         518-455-5241           716-373-7103

Thomas McKevitt     (AD 17)           518-455-5341           516-228-4960

Michael Montesano (AD 15)            518-455-4684            516-937-3571

Edward Ra                (AD 19)          518-455-4627           516-535-4095

ClaudiaTenney        (AD 101)         518-455-5334            315-736-3879

(DIVISION OF GOVERNMENTAL AFFAIRS)

ASSEMBLY PASSES SINGLE PAYER BILL

Earlier this week, by a vote of 92-52, the NYS Assembly passed Assemblyman Gottfried’s Single Payer bill (A.5062/S.3525). Click on the here to see how your Assembly representative voted on the bill.

Well in advance of this vote, MSSNY sent its respectful letter of opposition to Assemblyman Gottfried and the entire NYS Assembly

All sources have indicated to MSSNY representatives that this is a one-house bill which will not be taken up by the NYS Senate.  See article here wherein the passage of the bill was characterized  as a “largely symbolic step toward universal health insurance.”                        (DEARS, AUSTER)

HEALTHCARE PROFESSIONAL TRANSPARENCY BILL ON SENATE HIGHER EDUCATION COMMITTEE AGENDA

PLEASE CONTACT YOUR ELECTED REPRESENTATIVES.

MSSNY, working closely with several state and national specialty societies including the NYS Society of Anesthesiology and the NYS Society of Dermatology and Dermatologic Surgery, is aggressively pursuing legislation (S.4651-A, Griffo/A.7129-A, Stirpe) to assure that health care professionals are appropriately identified in their one-on-one interaction with patients and in their advertisements to the public.  Importantly, this bill will require that advertisements for services to be provided by health care practitioners identify the type of professional license held by the health care professional.  In addition, this measure would require all advertisements to be free from any and all deceptive or misleading information.  Ambiguous provider nomenclature, related advertisements and marketing, and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty.  Further, patient autonomy and decision-making are jeopardized by uncertainty and misunderstanding in the health care patient-provider relationship.  Importantly, this measure would also require health care practitioners to wear an identification name tag during patient encounters that includes the type of license held by the practitioner.  The bill would also require the health care practitioner outside of a general hospital to display a document in his or her office that clearly identifies the type of license that the practitioner holds.

Physicians are encouraged to contact their elected representatives in both houses of the Legislature to ask that the bill be passed this year.                                           (DEARS, ELLMAN)

MSSNY JOINS PATIENT ADVOCACY ORGANIZATIONS IN EFFORT TO LIMIT INAPPROPRIATE INSURER DRUG STEP THERAPY PRACTICES

MSSNY President Dr. Joseph Maldonado this week participated in a press conference with several patient advocacy organizations in support of legislation (A.2834-A/S.3419-A) to permit physicians to have an expeditious method to override a health insurer drug step therapy protocol so that patients can timely receive the medications best able to treat their particular conditions.   Assembly Health Committee Chair Richard Gottfried and Assembly bill sponsor Matthew Titone also participated in the press conference.  The event garnered significant media coverage from across the state, including quotes from Dr. Maldonado in Crains’ Health Pulse and the Albany CBS Affiliate.  Meetings were held with key legislative leaders thereafter.  The bill is currently before the Assembly and Senate Insurance Committees.  All physicians are urged to express their support for this legislation by sending an e-mail from MSSNY’s Grassroots Action Center.     (AUSTER, DEARS)

CME MANDATE BILL ON PAIN MANAGEMENT ON THE FLOOR OF BOTH HOUSES; CAN BE VOTED ON AT ANY TIME

Legislation that would require physicians to take three hours of continuing education on pain management, palliative care, and addiction is now on the floor of both houses in the New York State Legislature and can be voted on at any time. Senate Bill 4348 passed out of the Senate Health Committee and has gone to the Senate floor.  Its companion measure, Assembly Bill 355, is also pending on the Assembly floor.   Immediate physician action is needed to stop this measure from passing.  Physicians are urged to send a letter urging defeat of this measure.

Assembly Bill 355, sponsored by Assemblywoman Linda Rosenthal and Senate Bill 4348, sponsored by Senator Kemp Hannon would require three hours of course work every two years for physicians and other healthcare workers.   Under the bill’s provisions, the course work would include each of the following topics:  I-STOP and drug enforcement administration 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.  MSSNY remains oppose to the measure.                 (CLANCY, DEARS)

SCHOOL BASED MENINGOCOCCAL IMMUNIZATION LEGISLATION MOVES FORWARD IN BOTH HOUSES

Assembly Bill 791B and Senate Bill 4324, sponsored by Assemblywoman Aileen Gunther and Senator Kemp Hannon, were advanced from the Assembly and Senate Health committees this week.  Assembly Bill 791B will now go the Assembly Codes Committee and Senate Bill 4324 will go to the Senate floor for a vote. The Medical Society of the State of New York has been working with a number of provider and patient advocacy organizations in support of this legislation and is urging physicians and their patients to advocate in support of legislation requiring school-based immunizations against the meningococcal disease.  Assembly Bill 791B/Senate Bill 4324 would require that every person entering seventh grade and 11th  grade shall have been immunized against meningococcal disease.   Physicians are encouraged to go to MSSNY’s Grassroots Action Center to send a letter to their legislators and urge support of this bill.

MSSNY has also developed a patient support letter that patients can use to urge support of this legislation.

This bill is consistent with the Advisory Committee on Immunization Practices.  Meningococcal disease is caused by bacteria and is a leading cause of bacterial meningitis.  The bacteria are spread through the exchange of nose and throat droplets, coughing, sneezing or kissing.  Young people, between the ages of 10-25 years of age, are most at risk for this disease.   If not treated quickly, it can lead within hours to death or to permanent damage to the brain and other parts of the body.  Organizations in support of this measure include GMHC, the American Academy of Pediatrics NYS Chapter, District II, Latino Commission on AIDS, Kimberly Coffey Foundation, March of Dimes, Meningitis Angels, National Meningitis Association, the Nurse Practitioner Association New York State, New York State Academy of Family Physicians, and the New York Chapter of the American College of Physicians.                  (CLANCY)

STANDARDIZING PRESCRIPTION PRIOR AUTHORIZATION LEGISLATION ADVANCESLegislation to standardize the processes for insurer-required prior authorization of prescription medications is advancing in the New York State Legislature.  This week, legislation (S.4721, Hannon) supported by MSSNY to require the New York State DFS and DOH to develop a standardized form for requesting prior authorization for prescription medications was reported from the Senate Health Committee to the Senate floor.  Similar legislation (A.6983-A, McDonald) is before the full Assembly.  However, the Assembly bill was amended this week.  Instead of requiring the development of a uniform prior authorization form, the Assembly bill has been broadened to require DFS and DOH to develop “standards for prior authorization requests of prescription medications to be utilized by all health care plans for the purposes of submitting a request for a utilization  review  determination  for  coverage  of prescription  drug  benefits under this article”, including standards developed by the National Council for Prescription Drug Programs (NCPDP).  MSSNY is currently reviewing the amended bill.                         (AUSTER, DEARS)

MSSNY OFFERS FREE PATIENT BROCHURE ON DIABETES FOR USE WITHIN PHYSICIANS OFFICE

The Medical Society of the State of New York Committee’s on Preventive Medicine and Family Health and the Committee to Eliminate Health Care Disparities, has develop a patient brochure that physicians can offer within their office.  The patient brochure discusses risks associated with pre-diabetes and diabetes and is available in English and Spanish.  If you would like copies of this brochure, please contact the Medical Society of the State of New York at (518) 465-8085 or email Terri Holmes at tholmes@mssny.org and request copies of the Diabetes brochure.  The development of the brochure was made possible from a grant from AstraZeneca.                                                                                                                                                (CLANCY, ELLMAN)

ADVOCACY MATTERS CME WEBINAR JUNE 9, 2015

The next “Advocacy Matters” CME webinar will be held on Tuesday, June 9, 2015, from 12:30 to 1:30 PM.  The faculty will include David Whitlinger, CEO of NYeC, New York e-Health Collaborative (NYeC), Inez Sieben, COO, and Lisa Halperin Fleischer, NYeC CMO, presenting on the topic “SHIN-NY Statewide Patient Record Look-Up.”

 

Course objectives:

  • Provide an update and overview of the Statewide Healthcare Information Network of New York (SHIN-NY) and its value to healthcare providers
  • Give Healthcare Providers Information on how they will be able to access and share patient records through the SHIN-NY
  • Provide an overview of what capabilities will be available for healthcare providers this year and what they may already be able to access.

To register for this webinar, click here and fill out registration form.  (DEARS, HARDIN)

FINAL MEDICAL MATTERS CME WEBINAR TO BE HELD JUNE 9TH; PHYSICIANS URGED TO REGISTER

The Medical Society’s final webinar for the spring will be conducted on June 9, 2015 at 7:30 a.m. William Valenti, MD, chair of MSSNY Infectious Disease Committee will present “Emerging Infections 2015-A look at EV-D68 and Chikungunya”. Physicians are encouraged to register by clicking on https://mssny.webex.com . Click on “Training Center” and then on the “Upcoming” tab to register.

The educational objectives are:

  • Recognize and describe Enterovirus D68 (EV D68)
  • Recall the importance of continued immunizations
  • Recognize symptoms of Chikungunya and describe measures for reporting

Physicians may also contact Melissa Hoffman at mhoffman@mssny.org or at 518-465-8085 to register.

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

 

It is anticipated that Medical Matters programing for fall/spring 2015-2016 will be announced shortly.                                                                                                                     (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 ldears@mssny.org   mauster@mssny.or  
pclancy@mssny.org bellman@mssny.org    

 

 

Step Therapy or Fail Therapy?

Controversy is heating up over a state bill to limit step therapy, the insurance process that requires patients to try less expensive drugs to treat their conditions before their plans will cover more expensive ones recommended by their doctors. The bill (S.2711-A /A.5214-A) would increase pharmaceutical costs while exposing patients to less proven treatments, said the New York Health Plan Association in a statement Thursday. But Dr. Joseph Maldonado, president of Medical Society of the State of New York, said the measure may cut hospital costs incurred when patients are treated with the wrong medication. “There are many instances in which step therapy is very appropriate, but there are instances when this is the medication the patient needs, and they shouldn’t have to jump through unnecessary hoops to get it,” said Dr. Maldonado, who spoke at an Albany press event yesterday hosted by supporters of the legislation.

HANYS Offers Ready. Set. Code!  ICD-10-CM by Specialty.
This series of coding workshops helps physician practices understand the structure of the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) and successfully assign diagnosis codes for their specialty.

These two-hour workshops are being held from 1 to 3 p.m. on multiple dates, and are led by American Health Information Management Association certified ICD-10 trainers.  The registration fee for each workshop is $150.

Specialties are grouped as follows:

  • Workshop 1: Cardiology/Vascular/Respiratory
  • Workshop 2: Orthopedic/Podiatry/Spine
  • Workshop 3: OB-GYN/Pediatrics/Urology
  • Workshop 4: Internal Medicine/Family Practice
  • Workshop 5: General Surgery/Gastro/ENT/Plastic Reconstructive/Colon
  • Workshop 6: Mental Health/Neurology/Neuro Surgery/Ophthalmology

Ready. Set. Code!  ICD-10-CM by Specialty has been approved for two American Academy of Professional Coders continuing education units (CEUs) and is eligible for two American Health Information Management Association CEUs.

Registration is available online or by mail by downloading the program information and registration form. Contact: Terry August 

Boston Children’s Hospital Buys Westchester Physician Group
Children’s and Women’s Physicians of Westchester agreed to be acquired by Boston Children’s Hospital, an unusual deal for New York. The 280-doctor practice, which largely focuses on pediatrics, has offices in New York, New Jersey, and Connecticut. It is based in Valhalla, down the road from Westchester Medical Center and the New York Medical College. Both those institutions also are in negotiations with the Boston hospital, said Dr. Leonard Newman, CWPW’s president. (Crain’s 5/26)

If the deal goes through this summer as projected, CWPW will continue to refer to Maria Fareri Children’s Hospital at Westchester Medical Center and NYMC, where its staff has academic faculty appointments. Boston Children’s affiliate is Harvard Medical School, which does not allow faculty appointments outside Massachusetts.

AG: Alzheimer Drug Namenda Will Be Available for 30 Days after Patent Expires
A federal appeals court has rejected a drug manufacturer’s appeal and affirmed a judge’s order that Actavis PLC keep distributing its widely used Alzheimer’s medication until after its patent expires this summer. New York Attorney General Eric Schneiderman, who sought the order, calls the Court of Appeals ruling a victory for consumers. His office says the drug Namenda should remain on shelves 30 days after the patent expires July 11. He alleged anti-trust and state law violations by Actavis in an effort to push patients to its new patented drug and avoid losses from cheaper generics. Dublin-based Actavis says its new drug Namenda XR—taken once daily instead of twice—is better and demand is growing. 

Too Many Women Who Need Bone Screening Aren’t Getting It
Too few women at high risk for osteoporosis are being tested for the bone-depleting condition, while too many women at low-risk are being screened, a new study suggests.

A team led by Dr. Anna Lee Amarnath of the University of California, Davis, examined the medical records of nearly 51,000 women, aged 40 to 85, living in the Sacramento area.

The researchers looked at whether or not women were getting a dual-energy X-ray absorptiometry (DXA) test, which measures bone mineral density.( Journal of General Internal Medicine, news release, May 19, 2015)

The result: Osteoporosis screening rates jumped sharply at age 50, despite guidelines suggesting that screening only begin at age 65, unless a woman has certain risk factors.

However, the study also found that those risk factors — a small body frame, a history of fractures, or taking medications that could thin bones — had only a slight effect on a woman’s decision to get her bones tested.

Over seven years, more than 42 percent of eligible women aged 65 to 74 were not screened, Amarath’s team found, nor were nearly 57 percent of those older than 75.

However, nearly 46 percent of low-risk women aged 50 to 59 were screened, as were 59 percent of low-risk women aged 60 to 64.

The study was published online May 19 in the Journal of General Internal Medicine.

“DXA screening was underused in women at increased fracture risk, including women aged 65 years and older. Meanwhile, it was common among women at low fracture risk, such as younger women without osteoporosis risk factors,” Amarnath said in a journal news release.

What to do? Reminder notes to doctors and patients might help, one expert said.

“Health systems should invest in developing electronic health records systems that prompt providers at the point-of-care when screening is needed and when it can be postponed,” study senior author Joshua Fenton, an associate professor of family and community medicine at UC Davis, said in the news release. 

Medicine Considers What Defines Professionalism
Physicians take an oath to uphold ethical standards, but rapid changes in the health care system may have begun to blur lines across the practice of medicine. What measures should physicians be held accountable to, and who should regulate the profession?

The May 12 issue of JAMA takes a deep dive into professionalism, including viewpoints from scholars and academic leaders about the responsibility and accountability of medicine to self-govern, self-regulate and ensure the highest degree of professionalism.

Prominent physicians among the authors include AMA Executive Vice President and CEO James L. Madara, MD; Ezekiel J. Emanuel, MD, vice provost for global initiatives and chair of the department of medical ethics and health policy at the University of Pennsylvania; Thomas J. Nasca, MD, CEO of the Accreditation Council for Graduate Medical Education; and Lois Margaret Nora, MD, president and CEO of the American Board of Medical Specialties.

The issue examines the key roles and responsibilities of modern governing and accrediting bodies and of professional organizations and societies. Find out what these entities are doing—and what they should do differently—to enhance self-governance, safeguard self-regulation and foster professionalism. 

On a related note, this month’s issue of the AMA Journal of Ethics tackles this topic. The issue examines where professional boundaries start and stop, and how far physicians may go to assist patients with nonclinical matters. Learn about key areas where establishing boundaries with patients may be challenging and issues outside the patient-physician relationship where boundaries are essential.