September 25, 2015 – ICD-10 Coming To You Next Thursday!

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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September 25, 2015
Volume 15, Number 36

Dear Colleagues:

October 1st and the ICD-10 compliance date is only 6 days away!

For better or worse, we have to deal with it. The biggest complaint is that ICD-10 contains lots more codes: 68,069 in the 10th edition compared with the 14,035 currently in use. It is here. And now— what we need to do is to identify problems early on so they can be addressed and resolved so that physicians will not experience cash flow problems.

As the transition date approaches, the regional office and CMS want to provide us with the best possible service. We may intensely dislike this change, but CMS has bombarded us in every possible media over the past two years to prepare us. MSSNY has done its due diligence in informing you of educational resources to ensure a smooth and successful transition.

CMS notified us yesterday that they will have real people available to answer your ICD-10 related questions or concerns. Anthony Jamrozy and Rebecca Birnbach will be our CMS New York Regional Office points of contact for ICD-10 related inquiries.  Anthony and Rebecca can be reached at anthony.jamrozy@cms.hhs.gov and rebecca.birnbach@cms.hhs.gov and will research and respond to any ICD-10 transition issues or concerns.

Also, as announced on the National Provider Call on August 27, the CMS ICD-10 Ombudsman is available to address ICD-10 related issues for individual physicians and stakeholders at icd10_ombudsman@cms.hhs.gov. Many resources are available to assist you with the transition, including the CMS ICD-10 website including Frequently Asked Questions the CMS ICD-10 Quick Start Guide and the Road to 10: CMS Online Tool for Small Practices.

Please check the website often, as content will be updated regularly. You can also keep up on breaking ICD-10 news by signing up for email update messages.

Just yesterday, a member sent this question to Regina McNally, VP of Socio-Medical Economics:

Question: What about resubmitting a previous claim which was ICD-9. Must it be resubmitted after Oct 1 with ICD -10 codes? 

Answer: This is Date of Service specific. For dates of service on or before September 30, 2015, you need to use ICD-9 diagnosis codes.  For dates of service on or after October 1, 2015, you must use ICD-10-CM diagnosis codes.

Regina is available to answer your questions. You can email her at rmcnally@mssny.org. This service is an excellent Members Only benefit!

JOSEPH R. MALDONADO Jr

Please send your comments to comments@mssny.org


MLMIC


Update: EmblemHealth Will Follow CMS’ Lead on Relaxed ICD-10-CM Rules
We asked EmblemHealth whetherthey will follow CMS’ leniency regarding ICD-10 coding specificity and whether they anticipated an impact to COB claims where Medicare is primary and CMS paid their portion of the claim based on a less specific code within the same family.  EmblemHealth’s ICD-10 experts reviewed the CMS FAQs we sent them and determined that their policies are aligned with CMS’. Providers must bill with valid ICD-10 codes with all of the expected digits accounted for. Specificity will not come into play as part of their claim systems’ adjudication processes as long as the code is valid. This holds true whether EmblemHealth is the primary or secondary payer. For more information on EmblemHealth’s ICD-10 approach, we recommend visiting their web site page “Getting Ready for ICD-10 Together” where you can find a robust set of useful resources:

                                                                        –Regina McNally, VP MSSNY Socio-Med


NYS Bureau of Narcotic Enforcement Fall Update On Electronic Prescribing
The NYS Department of Health’s Bureau of Narcotic Enforcement has released its Fall 2015 newsletter and it contains information on Electronic Prescribing of Controlled Substances (EPCS). Along with a general overview of EPCS, there is information on the registration process of EPCS with the NYS DOH, the electronic prescribing exceptions, out of state electronic prescription and electronic recordkeeping of controlled substances. A copy of the newsletter can be found HERE on the MSSNY website.  Further information on EPCS can also be found here.

Electronic prescribing of controlled and non-controlled substance will be required for all prescribers effective March 27, 2016.


MSSNY Hosts Three E-Prescribing Webinars During Fall; Sign Up Now!
The Medical Society of the State of New York will host three free continuing medical education webinars on E-prescribing. The first webinar will be held as part of MSSNY’s Advocacy Matters on Tuesday, October 13th at 12:30 p.m. Registration is now open to MSSNY physicians by clicking here.

Select training session and the upcoming tab.

A copy of the flyer can be found here.

Additional webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances.

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

Further information can be obtained by contacting Miriam Hardin at mhardin@mssny.org or Terri Holmes at tholmes@mssny.org

E-prescribing of all substances will be required in New York State by March 27, 2016. ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.   


New FCC Ruling Affects Medical Debt Collecting
Question: How does the new FCC ruling on medical debt collections affect my practice? Can I be held responsible and fined for my vendor’s violation of the new rule?

Answer: The Federal Communications Commission (“FCC”) issued an interpretive ruling this summer clarifying an area of much confusion under the Telephone Consumer Protection Act. Prior to the FCC’s ruling, there was little guidance regarding autodialing, consent to call and reaching wrong numbers, particularly for cellphones. The new FCC ruling, though, will present a challenge to medical-debt collectors seeking to contact patients on their cellphones.

Pursuant to the ruling, the onus is on debt collectors to confirm express consent before autodialing a cellphone. Debt collectors complain that the ruling provides no relief or viable alternative when a collection agency does not know they have the wrong number for someone.

The FCC’s ruling does provide some exceptions for appointment reminders and test results; however, the FCC was explicit that the exemptions did not extend to bill collection efforts. Industry wide, medical debt collectors are now working to implement this ruling and be in compliance with the new requirements. Under the rule, debt collection companies’ penalties start at $500 and can swell to $1,500 for willful violations.

Healthcare providers also need to be aware of the interpretive ruling since they too can be held liable even when it is their vendors who fail to comply with regulations. Healthcare providers must obtain express written consent to call patients on their cellphones about billing issues.

This issue must be addressed immediately by all practices, as a number of health systems are reporting an increase in bad debt due to the increase of patients coming in with high-deductible plans. Patients’ failure to pay their deductibles adds up to millions of calls from healthcare debt collectors each year.

If you have any questions, please contact Kern Augustine Conroy & Schoppmann, P.C. at

1-800-445-0954 or via email at info@DrLaw.com. 


“Cadillac Tax” Repeal Legislation Introduced in the US Senate
Senator Charles Schumer (D-NY) was among the several members of the US Senate this week to co-sponsor legislation introduced this week that would repeal the so-called “Cadillac Tax” on higher cost health insurance policies offered by employers.  Included as part of the ACA, the “Cadillac Tax” is a provision that would, beginning in 2018, impose a 40% excise tax on group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. It would undoubtedly have a greater impact in higher cost states such as New York, and would further discourage employers from offering comprehensive health insurance policies to their employees. MSSNY adopted policy at its 2013 House of Delegates meeting calling for legislation to repeal this tax.

The legislation was introduced by Senator Sherrod Brown (D-OH), and in addition to Senator Schumer, is co-sponsored by Senators: Patrick Leahy of Vermont; Mazie Hirono of Hawaii; Jeanne Shaheen of New Hampshire; Chris Murphy and Richard Blumenthal of Connecticut; Michael Bennet of Colorado and Bob Casey of Pennsylvania.  Senator Dean Heller (R-NV), and Martin Heinrich, D-NM, have also co-sponsored repeal legislation and Reps. Joe Courtney, D-CT, and Frank Guinta, R-NH, have both introduced separate repeal proposals.

To read more about this proposal, click here and here. 


Modules From The AMA Focus on Dealing With Physician Burnout
The problem of burnout and caregiver fatigue among physicians is real and immediate. In fact, research shows that the rates of overall burnout extend to about 40 percent of U.S. physicians, more than 10 percentage points higher than the general population. In response, the AMA has created an ambitious program aimed at successfully preventing burnout and promoting well-being by offering new online modules that help physicians learn their risk factors for burnout and adopt real-life strategies to reignite professional fulfillment and resilience.

“Physicians are professionals who at their core are called to self-sacrifice and inclined to always do what’s necessary to take care of patients,” said AMA President Steven J. Stack, M.D. “But modern medicine can take a toll over time, and the AMA wants physicians to know about the risks associated with burnout and the strategies to help combat it.”

Two new modules in the AMA STEPS Forward series offer key strategies for taking on burnout.

  • The first module,Improving Physician Resiliency, offers an internal approach to help physicians manage personal and professional stress. Physicians who are resilient are better equipped to manage the stress of relentless change in medical practice and less likely to experience burnout. The module provides simple, evidence-based solutions to help physicians foster resilience against stress and protect against burnout.
  • The second module,Preventing Physician Burnout, offers an external approach to help physicians make practice-level changes to improve workflow and reduce barriers to patient care. Increasing physician involvement in efforts to improve their practice environment results in better patient satisfaction, quality outcomes, and overall practice morale and productivity. The module provides assessment tools and targeted intervention strategies that reduce sources of stress and support professional well-being.


2016 PQRS Negative Payment Adjustment & The Informal Review Process
In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.

EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between September 9, 2015 and November 9, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 9, 2015 at 11:59 p.m. EST

Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment – Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website) for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. 


DOH/CMS Will Host Training for Fully Integrated Dual Eligibles
CMS and the New York State Department of Health (DOH) will host a training for providers on the Fully Integrated Duals Advantage (FIDA) program. The event will include:

  • Remarks by Jason Helgerson, State Medicaid Director.
  • Presentations by Menahem Dimant, Medical Director of AlphaCare Signature FIDA Plan, and Dr. Lisa George, Medical Director of VNSNY Choice FIDA Complete, on the benefits of FIDA and their best practices and experiences.
  • An overview of FIDA by Melissa Seeley, Technical Director from the CMS Medicare-Medicaid Coordination Office, and Joseph Shunk, Interim FIDA Project Director from DOH.

The event will be held on Wednesday, September 30, 2015 from 10:00 AM to 1:00 PM at:

CMS New York Regional Office

26 Federal Plaza on Broadway (between Duane and Worth Streets)

New York, NY 10278

Continuing Medical Education (CME) and Continuing Education Units (CEUs) are available for this training. Please see details, below.

RSVP by September 25, 2015 for the Wednesday, September 30 training here.


“Many Faces of Flu” CME Webinar On October 21; Registration Now Open
The Medical Society of the State of New York will begin its 2016 Medical Matters continuing medical education (CME) webinar series with “Many Faces of Flu 2015” on Wednesday, October 21, 2015 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are: 1) Recognize the distinction between seasonal, Avian and Pandemic flu; 2) Describe clinical and laboratory diagnostic features and treatment; 3) Identify recommended immunizations and antiviral medications for treatment. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2016 and topics include: public health preparedness; immunizations and recommendations during a disaster; and radiological emergencies.  Program dates for Medical Matters will be announced shortly. 


Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days!  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide!

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans, and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately!

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay!  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact rraia@mssny.org for your cards!


Classifieds

OFFICE SPACE – 1185 PARK AVE. (94TH ST.)
Full-time. Ideal for busy medical subspecialty. Exclusive use of consult, exam room.  Stress test, echo available. Beautiful  décor. Public  transportation nearby.                                            Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

 


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-SpecialtyGroup Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.

Job requirements:

  • Current Board Certification  / Recertification
  • Current & Unrestricted NYS license, DEA & NPI
  • Must be on panels of managed Medicaid and HMO plans
  • Working knowledge of EMR
  • Take detailed patient history
  • Do physical examinations
  • Order medically necessary tests, equipment, etc
  • Be able to make complex decisions
  • Write Prescriptions
  • Provide treatments
  • Venipuncture
  • Give injections
  • Follow-up – evaluation of test results and with patients
  • Provide referrals to specialists

NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to:
medicmiche@aol.com or hrld_weissman@yahoo.com 

 


CLASSIFIED

Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.

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


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central
Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’

Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com



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

September 18, 2015 – Addressing Stress BEFORE Doctor Burnout

NYRX
drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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September 18, 2015
Volume 15, Number 35

Dear Colleagues:

At our last House of Delegates, Resolution 200 was adopted. It calls for MSSNY to develop programs to “assist Physicians in early identification and management of stress.” The programs should concentrate on the “emotional and psychological aspects of handling stress in our professional and personal lives,” and most importantly, when to seek professional help. Resolution 200 was also adopted at the November AMA meeting.  What are we talking about—stress, anxiety, exhaustion—PHYSICIAN BURNOUT.

Physicians are generally hesitant to share their concerns regarding overloads of stress, depression or anxiety for many obvious reasons—stigma, fear of being perceived as weak or a professional failure.  While help through the Committee on Physician Health (CPH) exists for physicians whose coping skills have failed them deal with these stress, support for the rest of physicians coping sub-optimally is limited or often nonexistent.  Our concern is assisting physicians long before CPH monitoring or intensive treatment is required. We are talking about early intervention in physician burnout and what can be done to avoid it.

Sadly, we have all observed varying degrees of burnout in colleagues.  Its prevalence prompted much interest in the physician community. MSSNY’s Physician Burnout Working Group found 750 journal articles published in the last five years, with 87 published (so far) in 2015! They studied several effective programs, including one from the Canadian Medical Association and a private program in North Carolina that includes self-diagnostic tools and multi-media information and a confidential listserv.

MSSNY is looking at a collaborative approach with specialty societies, insurance carriers and large healthcare associations to address prevention strategies that can offer a helping hand long before burnout occurs. A comprehensive program could also be a valuable member benefit to medical staffs and independent physicians.

We will be seeking outside funding as we specify the scope of this important project. MSSNY’s MESF will also be working this critical area.

If you have a personal story to share about burnout and how you dealt with it, MSSNY would like to hear it. You may be able to assist us in this important project.

As Dr. Frank Dowling, a psychiatrist and Councilor from Suffolk County, and a member of the Working Group, said at the Council meeting yesterday, “If a doctor is not happy, his patients are usually not happy.”

I agree with his expert opinion.

JOSEPH R. MALDONADO Jr

Please send your comments to comments@mssny.org


MLMIC



Council Meeting Notes: September 17, 2015
Council discussed amended resolution 200, which was adopted at the HOD in May and resolved that MSSNY develop a series of programs to assist physicians in early identification and management of stress and that MSSNY introduce a similar resolution at the 2015 The AMA HOD. The AMA adopted a resolution to support these programs.  After discussion at the 9/17 Council meeting, the following recommendations by the working group were approved: MSSNY Council charges the Task Force, at the discretion of the president, with the responsibility of developing the physician burnout program for Council approval. The second approved recommendation expands the Task Force by inviting representation from all MSSNY district medical societies.

  • Dr. Frank Dowling presented information on the AMA Task Force to Reduce Opioid Abuse, which MSSNY has been involved with since the task force’s inception in November 2014. The task force consists of over 20 national medical specialty organizations and eight state medical societies. The goal is to change the dialogue so that physicians are working together to find solutions to the opioid epidemic. Council approved the goals of the task force and the concept of a media campaign, which MSSNY will implement in conjunction with the AMA.
  • Speaker of the House Dr. Geraci-Ciardullo announced the following dates for 2016:
    March 8-Advocacy Day in Albany (Council meeting will be held March 7)
    March 11-deadline for submission of resolutions (early submission of resolutions is encouraged by February 19)
    April 15-17-HOD in Tarrytown
  • MSSNY has sent a letter to Commissioner Zucker to encourage him to send a “Dear Colleague” letter reminding physicians of the March 27, 2016 e-prescribing mandate date. The letter also urged the publication of the “waiver process” as soon as possible to mitigate the potential influx of a significant number of waiver requests to the department in late March. Additionally, the letter urged Dr. Zucker to grant waivers to physicians who, due to their specialty or the voluntary or part time nature of their work, prescribe less than 25 prescriptions a year.


Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days!  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide!

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans, and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately!

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay!  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact rraia@mssny.org for your cards! 


Concerned about Transition to ICD-10? Website May Be Helpful
The following website should be helpful to any physician or his/her office practice staff that is concerned about the transition from ICD-9 to ICD-10 diagnosis coding:  http://www.aapc.com/icd-10/codes/.If you haven’t done so already before October 1, 2015 either you or your staff should crosswalk 10, 20 or 100 of your most common diagnosis codes that you use in your practice, today. Please be sure that if the ICD-10-CM diagnosis code contains the word left or right in its description, you should still include the LT and/or the RT modifier(s) when submitting your claim(s).  In addition, please be sure that your medical documentation contains the data to support the ICD-10-CM diagnosis/specificity selected. 


Dr. M. Monica Sweeney Named Vice Dean for Global Engagement and Clinical Professor and Chair of Health Policy and Management at SUNY Downstate

  1. Monica Sweeney, MD, MPH, FACP has been appointed vice dean for global engagement and clinical professor and chair of the Department of Health Policy and Management in the School of Public Health at SUNY Downstate Medical Center.

In these positions, Dr. Sweeney will provide leadership for the School of Public Health’s many globally-engaged teaching, service, and research activities both locally and internationally. As chair of the Department of Health Policy and Management, she will lead a department whose student enrollment is among the largest in the School’s five Master of Public Health degree tracks.

Dr. Sweeney’s most recent position was as the assistant commissioner for the Bureau of HIV/AIDS Prevention and Control in the New York City Department of Health and Mental Hygiene. Prior to that time, she served as medical director and vice president for medical affairs at the Bedford Stuyvesant Family Health Center in Brooklyn. Dr. Sweeney is the immediate past chair of the SUNY Downstate Council, and served on the Presidential Advisory Council on HIV/AIDS (PACHA), and as president of the Medical Society of the County of Kings. She has been a member of the board of directors of several prominent organizations, and has served as Co-Chair of the Physician Advisory Council of the New York State Department of Health AIDS Institute, and as President of the Clinical Directors Network.

In the fight against HIV/AIDS, Dr. Sweeney led the New York City Department of Health and Mental Hygiene’s prevention and control efforts for several years. Her service on the Presidential Advisory Council on HIV/AIDS resulted in new initiatives to control the disease globally.


New Dates for NYS Workers’ Comp Board’s District Dialogue Meeting
The New York State Workers’ Compensation Board’s District Dialogue meetings previously scheduled in Brooklyn on 9/22 and Manhattan on 9/23 have been rescheduled in recognition of Yom Kippur.

The new dates and times of the District Dialogues are as follows:

Brooklyn District Office
10/8/15
12:00pm – 1:00pm 
111 Livingston Street
Brooklyn, NY 11201
22nd Floor – Room 1917
 

Manhattan District Office
10/9/15
12:00pm – 1:00pm
215 West 125th Street
New York, NY 10027
Room 511

We apologize for any inconvenience this may have caused and thank you for your patience and understanding. We hope you are able to attend to hear the latest updates on BPR initiatives and discuss topics of interest to you during the Participant Dialogue Session.

If you have any questions, please contact Outreach@wcb.ny.gov.


Cucumbers Causing Salmonella Poona; Four Cases in NY to Date
CDC, multiple states, and the U.S. Food and Drug Administration(FDA) are investigating a multistate outbreak of Salmonella Poona infections. This investigation is ongoing. CDC will provide updates when more information is available. 418 people infected with the outbreak strains of Salmonella Poona have been reported from 31 states, an increase of 77 cases since the last update on September 9. New York has had 4 reported cases. Epidemiologic, laboratory, and traceback investigations have identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.

Several recalls of cucumbers that may be contaminated with Salmonella have been announced as a result of this investigation. The type of cucumber that has been recalled is often referred to as a “slicer” or “American” cucumber and is dark green in color. Typical length is 7 to 10 inches. In retail locations the cucumbers are typically sold in a bulk display without any individual packaging or plastic wrapping.

Consumers should not eat, restaurants should not serve, and retailers should not sell any of the recalled cucumbers. If you aren’t sure if your cucumbers were recalled, ask the place of purchase or your supplier. When in doubt, don’t eat, sell, or serve them and throw them out.

As of September 15, 2015, a total of 418 people infected with the outbreak strains of Salmonella Poona have been reported from 31 states. Among 290 people with available information, 91 (31%) report being hospitalized. Two deaths have been reported from California (1) and Texas (1). Please see the Timeline for Reporting Cases of Salmonella Infection for more details. 


CMS Releases 2014 QRURs and PQRS Feedback Reports
On September 9, 2015 CMS released the 2014 Quality and Resource Use Reports (QRURs) and 2014 Physician Quality Reporting System (PQRS) Feedback Reports. The 2016 PQRS and Value Modifier (VM) payment adjustments are based on 2014 reporting. For groups with 10 or more PQRS-eligible professionals (EPs) that are subject to the 2016 Value Modifier, the QRUR shows how the VM will affect Medicare’s 2016 payments to physicians. VM cost and quality scores will also be provided in the QRURs for other practices even though they are not yet subject to the VM. If physicians or group practices feel an incentive payment or penalty was performed in error they must file an Informal Review by November 9, 2015.

2014 EHR and QCDR Data Issues

As reported in the September 3, 2015 Advocacy Update Issue, CMS discovered various errors with the  2014 Physician Quality Reporting System (PQRS) data submitted by vendors on behalf of EPs and group practices that reported via electronic health records (EHR) and qualified clinical data registries (QCDR). CMS has stated there will be no need for physicians or group practices to submit a PQRS Informal Review request.

Because of the errors, the EHR and some of the QCDR data is inconsistent. Due to these errors, CMS will not post PQRS performance data for the affected practices on Physician Compare.  However, determination of PQRS and Meaningful Use payment will not be affected because they are based solely on whether the practice successfully reported rather than on their actual performance—simply receiving the data will allow CMS to deem a physician or group practice as successful for purposes of avoiding a payment adjustment in 2016 or for receiving a 2014 incentive.

For the value modifier, which involves calculating actual quality scores in addition to determining whether quality measures were reported, CMS has acknowledged the vendor data errors may create problems. Specifically, CMS will not be able to accurately calculate the PQRS portion of the Quality Composite Score. Instead, the quality score will be based solely on the claims-based outcomes measures and the Consumer Assessment of Healthcare Providers and Systems Survey, if applicable.

2014 PQRS Data Submission Problems

The AMA is aware of instances in 2014 where physicians and practices mistakenly registered for the PQRS group practice reporting option (GPRO) submission mechanism and/or at the last minute their EHR vendor would not support their preferred submission mechanism.  These groups or individuals, will have to file an Informal Review by November 9, 2015. We have been told this only affects a very small percentage of EPs and practices.

How to Access the Reports and File an Informal Review

In order to access the portal to review reports and/or file an Informal Review, an EIDM account is required. CMS transitioned the portal from the Individual Access to CMS Computer Services (IACS) to the Enterprise Identity Management System (EIDM) on July 13, 2015. The IACS system is now retired, but current PQRS and VM IACS users, their data, and roles have moved to EIDM, which is accessible from the portion of the CMS Enterprise Portal at http://portal.cms.gov. The EIDM system provides a way for business partners to apply for, obtain approval for, and receive a single user ID for accessing multiple CMS applications.

For more information on 2014 feedback reports and how to request them, see: How to Obtain a QRUR. 


MSSNY President Jos. Maldonado MD Receives Hispanic Health Leadership Award
Dr. Maldonado will receive the Hispanic Health Leadership Award from the National Hispanic Health Foundation (NHHF) and the Foundation of the National Hispanic Medical Association (NHMA) on December 3. The award is presented to “outstanding individuals who have served in significant leadership roles and have improved the health of Hispanics and other underserved populations.”

The award will be presented at the 12th Annual Hispanic Health Professional Student Scholarship Gala at the New York Academy of Medicine in New York City in recognition of Dr. Maldonado’s leadership and vision.

The goals of both the NHHF and NHMA are to improve the health of Hispanics and the underserved, to eliminate health disparities, to support Hispanic health services research and to advance culturally competent quality health care and diversity in the workforce. The vision of the NHHF was to develop this scholarship as the nation’s premier fund to encourage Hispanic health professional students complete their career goals.

Since 2005, the NHHF has awarded $585,000 to 175 outstanding Hispanic health professional students throughout the United States for exceptional academic performance, leadership and commitment to the Hispanic community. 


Touro College of Osteopathic Medicine Awarded NAACP Community Service Award
The National Association for the Advancement of Colored People (NAACP) Mid-Manhattan Branch has honored the Touro College of Osteopathic Medicine (TouroCOM) with its distinguished Community Service Award. The award was presented for TouroCOM’s commitment to training osteopathic physicians with an emphasis on practicing medicine in underserved communities and to increasing the number of underrepresented minorities and African Americans in medicine.

TuroPhoto Credit: Hubert Williams: TouroCOM’s Executive Dean Robert Goldberg, DO, surrounded by students, faculty and TouroCOM Community Board Members and partners, accepting the NAACP Mid-Manhattan Branch’s Community Service Award.

“TouroCOM has excelled in its commitment to expanding educational opportunities and careers in medicine, science, research and technology to underrepresented minorities and African Americans while also establishing linkages and programs for elementary and high school youth,” said Geoffrey E. Eaton, president of the NAACP Mid-Manhattan Branch.  “We salute your place in history and trumpet your achievements.”

“This is an award that was earned through the unified efforts of our students, faculty, staff and administration,” said TouroCOM Executive Dean Robert Goldberg, DO.  “It would not have been possible without the wisdom, guidance and support provided by our wonderful community advisory committee, led by Dr. John Palmer.  This recognition proves that with will, determination and fellowship, amazing things can happen!”

Among TouroCOM’s accomplishments noted at the luncheon were its success with MedAchieve, an after-school mentoring program for underserved Harlem high school students interested in medicine; Mentoring in Medicine, another program that brings high school students to TouroCOM’s anatomy labs and inspires them to pursue careers in medicine; and the Fund for Underrepresented Minority Students, which has held successful fundraising events in Harlem to fund scholarships for underrepresented minorities to attend the medical school.


Tourette Association Sponsoring Free Conference for Physicians in Ithaca

The Tourette Association of America / New York Centers of Excellence Consortium in partnership with Weill Cornell Medical College is offering a no-cost medical education conference for physicians and allied health professionals on Saturday, November 14, 8am-1pm Hilton Garden Inn Ithaca—Ithaca, NY. To learn more, visit the Tourette Association website. For questions, email NYprogram@tourette.org. Register here.

The conference will be offered through the Association’s partnership with the CDC, and has been approved for AMA PRA Category 1 Credit(s)TM*. Leaders of the New York Centers of Excellence Consortium have planned a practical update for providers on the recognition, diagnosis, treatment and management of Tourette Syndrome, other tic disorders, and commonly associated conditions (including ADHD and OCD).


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Council Meeting – September 17, 2015

AGENDA
Council Meeting
Thursday, September 17, 2015
Long Island Marriott
101 James Doolittle Blvd.
Uniondale, NY 11553

A. Call to Order and Roll Call

B. Approval of the Council Minutes of June 18, 2015

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

1. President’s Report:

a. Hospital Outreach Update
b. Executive Committee Minutes of the MSSNY Executive Committee Teleconference, July 15, 2015
c. MSSNY, Academy of Family Physicians NY Chapter and NYS Radiological Society Letter to Commissioner Zucker re E-Prescribing Mandate
d. NYS Radiological Society/MSSNY – Letter to Katherine Ceroalo, House Counsel, Regulatory Affairs Unit, NYSDOH re comments regarding proposed State regulations affecting the practice of Radiologic Technology published in the NYS Register, July 29, 2015
e. Summary of Medicaid Value Based Purchasing Workgroup
f. CPH Resolution 200, Physician Burnout and Wellness Programs (For Council Approval)

2. Secretary’s ReportNominations 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 (handout at Council)

8. Commissioners (All Action Items )

1. Committee of Membership, Parag H. Mehta, MD
    Recommended Procedures for Handling
    Special Requests for Life Membership Special Request for Life Membership on behalf of
George Anstadt, MD
    Adopting a Dues Requirement for Physicians who become Life Members in the Future
(FOR COUNCIL APPROVAL)
2. Commissioner of Science and Public Health, Frank G. Dowling, MD
Recommendations for MSSNY from AMA Task Force to Reduce Opioid Abuse
(FOR COUNCIL APPROVAL)

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 – Date of Discovery Meeting with Senate Staff (verbal report)
2. Office of the President-Elect – Malcolm D. Reid, MD, MPP
3. Office of the Vice President – Charles Rothberg, MD
4. Treasurer’s Report –Thomas J. Madejski, MD, FACP, Financial Statement for the period January 1, 2015 to August 31, 2015
5. Office of the Speaker – Kira A. Geraci-Ciradullo, MD, MPH

E. Reports of Councilors (Informational)

1. Kings Richmond Report – Parag H. Mehta, MD
2. Bronx / Manhattan Report 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 Report – Harold M. Sokol, MD
7. Fourth District Branch Report – John J. Kennedy, MD (No Report Submitted)
8. Fifth District Report –Howard H. Huang, MD
9. Sixth District Branch Report – Robert A. Hesson, MD
10. Seventh District Report – Mark J. Adams, MD
11. Eight District Report – Edward Kelly Bartels, MD
12. Ninth District Report – Thomas T. Lee, MD
13. Medical Student Section Report – Charles A. Kenworthy  (No Report Submitted)
14. Resident & Fellow Section Report – Robert A. Viviano, DO  (No Report Submitted)
15. Young Physician Section Report – L. Carlos Zapata, MD  (No Report Submitted)

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

1. Commissioner of Science & Public Health, Frank G. Dowling, MD

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

G. Report of the Executive Vice President
1 .Membership Dues Revenue Schedule
2. State Coalition Conference Call, July 7, 2015
3. Physician Advocacy Council Meeting, July 21, 2015

H. Report of the General Counsel
     1. NYS Psychiatric Association v. United Healthgroup Decision
2. Request to submit an amicus brief (handout at Council)

I. Report of the Alliance
    1. Alliance Report

J. Other Information/Announcements

1. Draft AMA Comments on 2016 Physician Fee Schedule
2. Dr. Maldonado’s Press Statement – Proposed Insurer Mergers
3. AMA News Release Merger – Health Insurer Mergers
4. Whatley/Kallas Letter – Proposed Insurer Mergers
5. Letter from Commissioner Zucker re Grand Rounds
6. Joint Letter to NY Times editor re Op Ed on Lavern’s Law
7. EHR Survey
8. AMA-CMS Press Release re ICD-10
9. ACCME Announcment re American Board of Internal Medicine and Accreditation Council for CME     Announce Collaboration in Support of Physician Lifelong Learning
10. Medicare Payment Advisory Commission Letter to Andrew Slavitt, Acting Administrator Centers
      for Medicare and Medicaid Services
11. National Hispanic Health Foundation Letter – Leadership Award to Dr. Maldonado
12. Recipients of the Duane and Joyce Cady Physicians of Tomorrow Awards 

K. Adjournment

September 11, 2015 – AMA’S ANALYSES OF PROPOSED INSURANCE MERGERS

STATEMENT FROM MSSNY PRESIDENT JOSEPH MALDONADO, MD IN RESPONSE TO AMA’S ANALYSES OF PROPOSED INSURANCE MERGERS

“Today’s announcement by the American Medical Association analyzing the consequences of the proposed consolidation of the health insurance industry is a clarion call to our federal and state regulators to closely review the patient care implications of these proposed mergers.

Undoubtedly, the merger of Anthem (the parent of Empire BC/BS) with Cigna, and Aetna with Humana, will give these companies far greater market power to reduce physician and hospital choice for our patients by further restricting networks and moving towards more burdensome administrative requirements as a precondition of our patients receiving needed care.

In addition to preventing these mergers from going forward, policymakers need to enable physicians to better advocate on their patients’ behalf by enacting legislation (A.336, Gottfried S.1157, Hannon) to permit independently practicing physicians to come together to negotiate patient care terms with health insurers in regions where just a few plans dominate the delivery of care.”

Joseph R. Maldonado, Jr., MD, MSc, MBA, DipEBHC
President, Medical Society of the State of New York

Council – Sept. 17, 2015

AGENDA
Council Meeting
Thursday, September 17, 2015
Long Island Marriott
101 James Doolittle Blvd.
Uniondale, NY 11553

A. Call to Order and Roll Call

B. Approval of the Council Minutes of June 18, 2015

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

1. President’s Report:

a. Hospital Outreach Update
b. Executive Committee Minutes of the MSSNY Executive Committee Teleconference, July 15, 2015
c. MSSNY, Academy of Family Physicians NY Chapter and NYS Radiological Society Letter to Commissioner Zucker re E-Prescribing Mandate
d. NYS Radiological Society/MSSNY – Letter to Katherine Ceroalo, House Counsel, Regulatory Affairs Unit, NYSDOH re comments regarding proposed State regulations affecting the practice of Radiologic Technology published in the NYS Register, July 29, 2015
e. Summary of Medicaid Value Based Purchasing Workgroup
f. CPH Resolution 200, Physician Burnout and Wellness Programs (For Council Approval)

2. Secretary’s ReportNominations 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 (handout at Council)

8. Commissioners (All Action Items )

1. Committee of Membership, Parag H. Mehta, MD
    Recommended Procedures for Handling
    Special Requests for Life Membership Special Request for Life Membership on behalf of
George Anstadt, MD
    Adopting a Dues Requirement for Physicians who become Life Members in the Future
(FOR COUNCIL APPROVAL)
2. Commissioner of Science and Public Health, Frank G. Dowling, MD
Recommendations for MSSNY from AMA Task Force to Reduce Opioid Abuse
(FOR COUNCIL APPROVAL)

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 – Date of Discovery Meeting with Senate Staff (verbal report)
2. Office of the President-Elect – Malcolm D. Reid, MD, MPP
3. Office of the Vice President – Charles Rothberg, MD
4. Treasurer’s Report –Thomas J. Madejski, MD, FACP, Financial Statement for the period January 1, 2015 to August 31, 2015
5. Office of the Speaker – Kira A. Geraci-Ciradullo, MD, MPH

E. Reports of Councilors (Informational)

1. Kings Richmond Report – Parag H. Mehta, MD
2. Bronx / Manhattan Report 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 Report – Harold M. Sokol, MD
7. Fourth District Branch Report – John J. Kennedy, MD (No Report Submitted)
8. Fifth District Report –Howard H. Huang, MD
9. Sixth District Branch Report – Robert A. Hesson, MD
10. Seventh District Report – Mark J. Adams, MD
11. Eight District Report – Edward Kelly Bartels, MD
12. Ninth District Report – Thomas T. Lee, MD
13. Medical Student Section Report – Charles A. Kenworthy  (No Report Submitted)
14. Resident & Fellow Section Report – Robert A. Viviano, DO  (No Report Submitted)
15. Young Physician Section Report – L. Carlos Zapata, MD  (No Report Submitted)

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

1. Commissioner of Science & Public Health, Frank G. Dowling, MD

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

G. Report of the Executive Vice President
1 .Membership Dues Revenue Schedule
2. State Coalition Conference Call, July 7, 2015
3. Physician Advocacy Council Meeting, July 21, 2015

H. Report of the General Counsel
     1. NYS Psychiatric Association v. United Healthgroup Decision
2. Request to submit an amicus brief (handout at Council)

I. Report of the Alliance
    1. Alliance Report

J. Other Information/Announcements

1. Draft AMA Comments on 2016 Physician Fee Schedule
2. Dr. Maldonado’s Press Statement – Proposed Insurer Mergers
3. AMA News Release Merger – Health Insurer Mergers
4. Whatley/Kallas Letter – Proposed Insurer Mergers
5. Letter from Commissioner Zucker re Grand Rounds
6. Joint Letter to NY Times editor re Op Ed on Lavern’s Law
7. EHR Survey
8. AMA-CMS Press Release re ICD-10
9. ACCME Announcment re American Board of Internal Medicine and Accreditation Council for CME     Announce Collaboration in Support of Physician Lifelong Learning
10. Medicare Payment Advisory Commission Letter to Andrew Slavitt, Acting Administrator Centers
      for Medicare and Medicaid Services
11. National Hispanic Health Foundation Letter – Leadership Award to Dr. Maldonado
12. Recipients of the Duane and Joyce Cady Physicians of Tomorrow Awards 

K. Adjournment

September 11, 2015 – NYT Prints MSSNY/GNYHA Letter to Ed

NYRX
drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
September 11, 2015
Volume 15, Number 34

Dear Colleagues:

Yesterday, the New York Times published a letter to the editor written by Ken Raske, president of the GNYHA and me.  The original op-ed, written by two attorneys, supported Lavern’s Law which sought expansion of dates of discovery.

To the Editor:

Re “Legislative Malpractice,” by Thomas Moore and Steve Cohen (Op-Ed, Aug. 31):New York’s medical malpractice system needs comprehensive reforms. The writers note that many states allow patients to file suit based on when they discover that there was a medical error, but, unlike New York, most of those states also have caps on damages and other laws that balance the effects of wider discovery rules. Pegging New York’s statute of limitations to a patient’s subjective knowledge will potentially lead to far more claims and greater financial exposure for the state’s doctors and hospitals.

Despite scoring high on various quality indicators, New York’s hospitals and doctors have among the highest medical malpractice costs in the United States. Many doctors logically conclude that the state is simply too hostile an environment to practice medicine.

Finally, the same study that the writers cite to blame hospitals and doctors (“To Err is Human) emphasizes that improving patient safety requires a shift away from a culture of blame. Other studies have concluded that the drivers of malpractice liability are varied and not necessarily related to the quality of care.

Medical malpractice is a complex issue that deserves thoughtful discourse. Only through comprehensive reform — not narrow, piecemeal legislation — can we achieve appropriate balance and minimize inequities.

KENNETH E. RASKE­
JOSEPH R. MALDONADO Jr

­The writers are presidents of the Greater New York Hospital Association and Medical Society of the State of New York, respectively.

Please send your comments to comments@mssny.org


MLMIC



Excellus BCBS Target of Cyberattack; 7M People Affected
On Sept. 9, Excellus BlueCross BlueShield announced that its Information Technology (IT) systems were the target of a sophisticated cyberattack and steps are being taken for the protection of its members and individuals who do business with the health plan.

As a result of cyberattacks on other insurance companies, Excellus BCBS engaged FireEye’s Mandiant incident response division, one of the world’s leading cybersecurity firms, to conduct a forensic assessment of its IT systems. On August 5, 2015, Excellus BCBS learned that cyber attackers gained unauthorized access to its IT systems.

The investigation has not determined that personal information on the company’s IT systems was removed or used inappropriately. However, the investigation has determined that attackers may have gained unauthorized access to approximately 7 million individuals’ information, which could include name, date of birth, Social Security number, mailing address, telephone number, member identification number, financial account information and claims information.

Excellus BCBS is beginning to mail letters to affected individuals today and is providing two years of free identity theft protection services through Kroll, a global leader in risk mitigation and response solutions, including credit monitoring powered by TransUnion. A dedicated call center also has been set up for members and other affected individuals. And, the company has established a dedicated website (www.excellusfacts.com), where members and other affected individuals can view frequent questions and answers and sign up for the free credit monitoring service and identity theft protection services. Individuals who believe they are affected by this cyberattack but who have not received a letter by November 9, are encouraged to call the number listed at that website.


WCB Issues Guidance for Complying With ICD-10 as of October 1
The New York State Workers Compensation Board today issued a bulletin to set forth how it will implement the use of ICD-10 codes as of October 1. To read the bulletin, click here.

The bulletin notes that “to promote consistency between medical systems and to avoid imposing significant costs to support multiple systems, the Board will require use of ICD-10 consistent with CMS for dates of service after 10/1/15. In particular, the Bulletin notes the following:

• Providers may not submit a combination of ICD-9 and ICD-10 codes on the same bill. Separate bills must be submitted for dates of service on or before September 30, 2015 and on or after October 1, 2015.
• In the event a provider has not completed the full transition to ICD-10, medical bills shall be processed and paid regardless.

• Carriers must accept both ICD-9 codes and ICD-10 codes effective October 1, 2015. Provider miscoding, such as the use of ICD-9 codes for dates of service on or after October 1, 2015, or the use of ICD-10 codes for dates of service prior to October 1, 2015, are not valid reasons to deny or reduce a medical bill.

• In order to ease the transition to ICD-10, the Board will accept the CMS-1500 (or HCFA-1500) form with a detailed narrative report or office note effective October 1, 2015. Authorized physicians, podiatrists, and chiropractors statewide may submit a CMS-1500 with a detailed narrative report or office note in lieu of C-4 or C-4.2 forms. If a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A narrative report or office note is considered detailed when it contains the necessary information for the insurance carrier to properly process the submission. The narrative attachment requirements can be found on the Board’s website.


Dr. Maldonado: More Mergers Provide Less Choice
The transition from five major health insurers to three would “erode competition” across the country in major metropolitan markets, including New York, the American Medical Association said yesterday. The Chicago group asserts that the Anthem-Cigna and Aetna-Humana mergers would slash competition in 154 metro areas in 23 states. Only the Anthem-Cigna union would have a notable impact on New York’s commercial insurance market, according to the AMA analysis: Competition in the combined HMO, PPO and POS markets would fall about 12%. The report used a method to measure market competition called the Herfindahl-Hirschman Index. The Anthem-Cigna deal would give the state an HHI score of 1,921—still well within the range of a moderately concentrated market. Scores below 1,500 are considered unconcentrated, and, above 2,500, highly concentrated. The mergers “will give these companies far greater market power to reduce physician and hospital choice for our patients receiving needed care,” said Dr. Joseph Maldonado, president of Medical Society of the State of New York. (Crain’s 9/9/15) 


Key New York Congressman Backs Fair Medicare Audits Legislation
Western New York Congressman Chris Collins has joined on as a co-sponsor of HR 2568, for the Fair Medical Audits Act of 2015, legislation supported by several state medical societies to increase the transparency of Medicare Recovery Audit Contractor (RAC) audits.  Rep. Collins is a member of the US House of Representatives Energy & Commerce Health Subcommittee.  As noted by the Physicians Advocacy Institute, the legislation, sponsored by Rep. George Holding (R-NC), would:

  • Makes the audit process much more transparent. The FMAA requires RACs to provide pre-audit notification and post audit reporting to physicians and other health care providers regarding specific information relating to an audit. Increasing transparency will help address confusion and create a more educational audit process by helping physicians to better understand audit findings and reduce the risk of repeated errors.
  • Establishes more rigorous qualifications for RAC officials performing claim reviews. The complex nature of medical audits and the need to address the high reversal rate for appealed overpayment determinations warrant more rigorous qualifications for RAC reviewers.
  • Increases accountability of RACs for Inaccurate findings. The current system is a bounty hunter approach that creates financial incentives for auditors to make overzealous and often-inaccurate audit findings. FMAA establishes financial penalties for RACs for inaccurate audit findings, while creating new incentive payments for RACs who voluntarily educate providers on common errors.
  • Delays payment to auditors until after an external appeal. The FMAA would delay RAC payments until claims are subject to external review – currently the third level of appeal – to help ensure providers are not subject to premature and unfair recoupment.
  • Promotes more targeted documentation requests by RAC auditors. Physician practices have struggled with the administrative and financial burdens that RAC correspondence and production requests often impose. The FMAA would help to address this by compensating providers for certain documentation requests.
  • Requires a sound extrapolation formula for determining overpayment amounts and shortens “look-back” period from 4 years to 2 years. Shortening the look-back period to 2 years would more effectively address the appeals backlog and provide much-needed administrative relief for providers. 


Press-Ganey: Patients Like Healthcare Teamwork and Clean Rooms
A health care team’s ability to work together is a major factor in hospital inpatient ratings linked to loyalty, according to an analysis more than 1 million HCAHPS responses by Press Ganey, the largest patient-experience consulting firm http://bit.ly/1KHJnS8

Of inpatients who believed staff worked well together, 87% gave their experience high ratings;36.7% of patients who did not think staff were coordinated gave top ratings overall. In hospitals, once teamwork was accounted for, room cleanliness emerged as a major ratings driver. Regarding emergency room care, empathy for patient concerns and communication about delays and pain management were most highly related with a patient’s likelihood to recommend the facility. In outpatient facilities, confidence in the clinician, along with effective care coordination and empathy, were paramount. 


AMA Report Highlights Concerns of Proposed Health Insurer Consolidation, including New York; MSSNY Issues Statement
The American Medical Association released a study this week raising an alarm with the significantly enhanced health insurer market concentration that would arise within14 states across the country, including New York State, if the recently announced proposed merger of Anthem and Cigna was permitted to go forward.  To read more, click here. The report also discussed the enhanced market concentration in several states across the country as a result of the proposed merger of Aetna and Humana, though no specific consequences for New York State were noted.

The report and its possible consequences on patients and physicians were highlighted in an article in the New York Times.

Moreover, the issue of the consequences of insurer consolidation was the subject of a House Judiciary Committee hearing this week.

The AMA report noted that the proposed Anthem-Cigna merger would be presumed to significantly enhance the market power of the combined company for the entire commercial market in Long Island, as well as raising significant competitive concerns in New York City and the Hudson Valley.  As a result, MSSNY President Dr. Joseph Maldonado gave the following press statement which was reported in Politico New York and Crains’ Health Pulse regarding the need to better level the playing field between market dominant insurers and physicians advocating on behalf of their patients:

“Today’s announcement by the American Medical Association analyzing the consequences of the proposed consolidation of the health insurance industry is a clarion call to our federal and state regulators to closely review the patient care implications of these proposed mergers.

Undoubtedly, the mergers of Anthem (the parent of Empire BC/BS) with Cigna, and Aetna with Humana, will give these companies far greater market power to reduce physician and hospital choice for our patients by further restricting networks and moving towards more burdensome administrative requirements as a precondition of our patients receiving needed care.

In addition to preventing these mergers from going forward, policymakers need to enable physicians to better advocate on their patients’ behalf by enacting legislation (A.336, Gottfried S.1157, Hannon) to permit independently practicing physicians to come together to negotiate patient care terms with health insurers in regions where just a few plans dominate the delivery of care.” 


 “Many Faces of Flu” CME Webinar on October 21; Registration Now Open
MSSNY will begin its 2016 Medical Matters continuing medical education (CME) webinar series with “Many Faces of Flu 2015” on Wednesday, October 21, 2015 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are: 1) Recognize the distinction between seasonal, Avian and Pandemic flu; 2) Describe clinical and laboratory diagnostic features and treatment; 3) Identify recommended immunizations and antiviral medications for treatment.   The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.  Additional programs will be conducted in January-May 2016 and topics include: public health preparedness; immunizations and recommendations during a disaster; and radiological emergencies.  Program dates for Medical Matters will be announced shortly.


Get Ready Now: Assess How ICD-10 Will Affect Your Practice
With ICD-10 less than 30 days away, now is the time to get ready. You can make sure your practice is prepared by following the ABCs of ICD-10:

  • Assess how ICD-10 will affect your practice and make a plan
  • Be sure your systems are ready
  • Contact your vendors 

Access to ICD-10 codes – You can find codes from a variety of sources, including:

  • Code books
  • CD/DVD and other digital media
  • Online (e.g., go to cms.gov/ICD10 and select “2016 ICD-10-CM and GEMS” to download 2016 Code Tables and Index)
  • Practice management systems
  • Electronic health record (EHR) products
  • Free and low-cost smartphone apps
  • CMS ICD-10 Code Lookup
  • Coding Conversion Tool 

Clearinghouse services – Some providers who are not ready could benefit from contracting with a clearinghouse to submit claims.

  • Clearinghouses can help by:
    • Identifying problems that lead to claims being rejected
    • Providing guidance about how to fix rejected claims (e.g., more or different data need to be included)
  • Clearinghouses cannot help you code in ICD-10 codes unless they offer third-party billing/coding services.

Clinical documentation and coding training

  • Train staff on ICD-10 fundamentals using the wealth of free resources from CMS, which include the ICD-10 website, Road to 10, Email Updates, National Provider Calls, and webinars. Free resources are also available from:
    • Medical societies, health care professional associations
    • Hospitals, health systems, health plans, vendors
  • Training for clinical staff—e.g., physicians, nurse practitioners, physician assistants, registered nurses—should focus on documentation, new coding concepts captured in ICD-10.
  • Training for coding and administrative staff—e.g., coders, billers, practice managers—should focus on ICD-10 fundamentals.

New forms – It is crucial to update hard-copy and electronic forms (e.g., superbills, CMS 1500 forms).

Systems upgrades – Double check that you’ve identified all systems that use ICD codes and need upgrades (e.g., practice management systems, electronic health record (EHR) products).

  • Call your vendors to confirm the ICD-10 readiness of your practice’s systems
  • Confirm that the health plans, clearinghouses, and third-party billing services you work with are ICD-10 ready
  • Ask vendors, health plans, clearinghouses, and third-party billers about testing opportunities
  • Transition costs for small medical practices could be substantially lower than projected earlier:
    • Many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers
    • Software and systems costs for ICD-10 could be minimal for many providers\


NYS DOH Announces New Vaccine Rules for Children Entering School
The NYS-DOH announced new vaccine rules for school children. Children in New York schools must now receive two doses of the measles, mumps, rubella vaccine, before entering school. Children in grades K-5 need five doses of DTaP, and children entering kindergarten and grades 1, 6 and 7 must have four doses of polio vaccine.  Previously, kindergarteners were allowed to attend school before completing the MMR DTaP and polio vaccine series. The new regulations follow recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (ACIP). A physician letter on these changes was issued on August 26, 2015 from Elizabeth Rausch-Phung, MD, MPH, NYS DOH, Director, Bureau of Immunization and is available here.  Additional information on the regulatory changes may be obtained here.


CMS Releases 2014 QRURs and PQRS Reports
On September 9, 2015 CMS released the 2014 Quality and Resource Use Reports (QRURs) and 2014 Physician Quality Reporting System (PQRS) Feedback Reports. The 2016 PQRS and Value Modifier (VM) payment adjustments are based on 2014 reporting. For groups with 10 or more PQRS-eligible professionals (EPs) that are subject to the 2016 Value Modifier, the QRUR shows how the VM will affect Medicare’s 2016 payments to physicians. VM cost and quality scores will also be provided in the QRURs for other practices even though they are not yet subject to the VM. If physicians or group practices feel an incentive payment or penalty was performed in error they must file an Informal Review by November 9, 2015.

2014 EHR and QCDR Data Issues

 As reported in the September 3, 2015 Advocacy Update Issue, CMS discovered various errors with the  2014 Physician Quality Reporting System (PQRS) data submitted by vendors on behalf of EPs and group practices that reported via electronic health records (EHR) and qualified clinical data registries (QCDR). CMS has stated there will be no need for physicians or group practices to submit a PQRS Informal Review request.

Because of the errors, the EHR and some of the QCDR data is inconsistent. Due to these errors, CMS will not post PQRS performance data for the affected practices on Physician Compare.  However, determination of PQRS and Meaningful Use payment will not be affected because they are based solely on whether the practice successfully reported rather than on their actual performance—simply receiving the data will allow CMS to deem a physician or group practice as successful for purposes of avoiding a payment adjustment in 2016 or for receiving a 2014 incentive.

For the value modifier, which involves calculating actual quality scores in addition to determining whether quality measures were reported, CMS has acknowledged the vendor data errors may create problems. Specifically, CMS will not be able to accurately calculate the PQRS portion of the Quality Composite Score. Instead, the quality score will be based solely on the claims-based outcomes measures and the Consumer Assessment of Healthcare Providers and Systems Survey, if applicable.

2014 PQRS Data Submission Problems

 The AMA is aware of instances in 2014 where physicians and practices mistakenly registered for the PQRS group practice reporting option (GPRO) submission mechanism and/or at the last minute their EHR vendor would not support their preferred submission mechanism.  These groups or individuals, will have to file an Informal Review by November 9, 2015. We have been told this only affects a very small percentage of EPs and practices.

How to Access the Reports and File an Informal Review

 In order to access the portal to review reports and/or file an Informal Review,  an EIDM account is required. CMS transitioned the portal from the Individual Access to CMS Computer Services (IACS) to the Enterprise Identity Management System (EIDM) on July 13, 2015. The IACS system is now retired, but current PQRS and VM IACS users, their data, and roles have moved to EIDM, which is accessible from the portion of the CMS Enterprise Portal at http://portal.cms.gov. The EIDM system provides a way for business partners to apply for, obtain approval for, and receive a single user ID for accessing multiple CMS applications.

For more information on 2014 feedback reports and how to request them, see: How to Obtain a QRUR.


E-PRESCRIBING of All Substances Required By March 27, 2016
Physicians and other prescribers are reminded that New York State’s e-prescribing requirements for non-controlled and controlled substances will go into effect on March 27, 2016.The NYS Department of Health’s Bureau of Narcotic Enforcement has provided information to physicians and other prescribers to assist them in their transition to electronic prescribing. Practitioners should continue their efforts to become compliant with the law, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances (EPCS), and registering their certified software applications with the Bureau of Narcotic Enforcement.   According to state officials, over 22,000 prescribers have registered their systems with DOH.

DrFirst and MSSNY have partnered to bring MSSNY members the industry’s leading e-prescribing solution at a special discounted price and information on this program can be found here: http://www.drfirst.com/mssny/mssny-lp

For physicians who prescribe controlled substances, there are additional steps to complete in order to electronically prescribe controlled substances.  These include the following:

  • First, the software you currently use must meet all the federal security requirements for EPCS, which can be found on the Drug Enforcement Agency’s (DEA) web page. http://www.deadiversion.usdoj.gov/ecomm/e_rx/

Note that federal security requirements include a third party audit or DEA certification of the software.

  • Second, you must complete the identity proofing process as defined in the federal requirements.
  • Third, you must obtain a two-factor authentication as defined in the federal requirements.
  • Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found here.

EPCS systems must be registered through the ROPES system.  ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

  • Login to the Health Commerce System (HCS) at https://commerce.health.state.ny.us
  • Under “My Content” click on “All Applications”
  •  Click on “R”
  •  Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

EPCS became permissible in New York State and over 90% of the pharmacies can now accept e-prescribing for controlled substances, according to officials from BNE.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so before January 1. The waiver process will be electronic. Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance. OH has indicated that more information on the waiver process will be available shortly.

E-prescribing of non-controlled substances is also required under the law; however, registering of this system with the state is not necessary.

The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.   The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.

Information regarding e-prescribing may be accessed at the following links:

http://www.health.ny.gov/professionals/narcotic/electronic_prescribing/

http://www.op.nysed.gov/prof/pharm/pharmelectrans.htm 


Alzheimer’s Disease & Advance Directives Webinar to Be Held On September 17
The Albany School of Public Health will hold a free education webinar on Alzheimer’s Disease & Advance Directives: A Primer for Primary Care Physicians on Thursday, September 17th from 9-10 a.m.

Learning objectives are: 1)  Discuss the dramatic impact that the growing number of new Alzheimer’s patients has on both patients and caregivers 2) Describe healthcare providers’ professional obligation within their window of opportunity to have and document conversations with patients with remaining capacity about advance directives and 3) Identify the criteria for determining capacity.  The program will be conducted by Wayne Shelton, PhD, MSW, Professor of Medicine and Bioethics, Alden March Bioethics Institute, Albany Medical College and Kevin Costello, MD, Assistant Professor of Medicine and

Attending, Department of Medicine, Albany Medical College. The program will provide critical information and tools to prepare physicians and healthcare providers to have constructive conversations with patients that have remaining capacity about their preferences for medical care in the advance stage of disease.  Continuing medical education credits are available.   To register go to: www.phlive.org


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HOME FOR SALE – 500+ ft. of Lighted Cascading Waterfalls
Alongside architect-designed, year-round, custom, one-of-a-kind home on 5.1 wooded acres; 5-deck levels, 90 min to NYC; Catskill Mts. Tiled in-ground pool with full-service cabana. $489,000.For more info, go to www.buyawaterfall.com. Or call 845-647-3914

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Pain Medicine Practice for Sale
Near Rochester, NY- Very active and established practice grossing $1,000,000+ on 4 days per week. Income after expenses averages $550-650K+ annually. Fully equipped 2,500 sq. ft. office with 5 exam rooms. Office lease available for extension. This is a “turn-key opportunity” with excellent staff, fully trained. Physician will stay to introduce new practitioner to patients. Contact: Gary N. Wiessen at 631-281-2810 Website: buysellpractices.com or email: gary@buysellpractices.com  All inquiries considered strictly confidential. 

Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.

 

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



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