November 20, 2015 – Doctors Owed Millions by HR

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 20, 2015
Volume 15, Number 44

Dear Colleagues:

MSSNY continues to communicate regularly with key staff at the New York Department of Financial Services (DFS), the New York State of Health, and the Governor’s office to obtain necessary information for physicians to be able to help their patients with the enrollment decisions they will have to make, as well as to assure that physicians are fully compensated for the care they have provided to patients insured by Health Republic.

This week, MSSNY’s advocacy on behalf of physicians treating Health Republic insured patients received much press attention across New York State this week after publicly releasing the results of its survey regarding the huge amounts of payments outstanding to these physicians. Of the over 850 respondents to MSSNY’s survey, 42% have outstanding claims to Health Republic, of which:

  • 9% are owed $100,000 or more
  • 19% are owed $25,000 or more
  • 47% are owed $5,000 or more

At the same time, MSSNY has heard from multiple physician practices that are owed between $1 and $5 million. Combining the survey results with financial data received from numerous physician practices across the state, it’s estimated that physicians across New York State are owed at least tens of millions of dollars from Health Republic.

Articles were printed in Crains Health Pulse, Newsday, the Syracuse Post-Standard; Buffalo Business First and the Riverhead Local.

At a time when the State is seeking to engage physicians and patients in new payment models and new networks, it is imperative that the State insure that physicians are treated fairly by insurance companies when they participate in such state-promoted products and innovation.  We are very concerned that physicians may be very reluctant to participate in what they view as risky health reform initiatives that promise upside benefits but ultimately could put their medical practices at risk.

Last week, DFS announced that Health Republic enrollees who do not select a new plan by November 30 will be auto-enrolled in Excellus, MVP or Fidelis for the remainder of 2015, provided consumers pay their premium by December 10.  In addition, Fidelis, Excellus, and MVP agreed to credit any deductible and out-of-pocket amounts that consumers have already paid through their Health Republic coverage during 2015 – helping ensure that individuals who make the transition will not be required to restart these payments in 2015.

Physicians who have not completed MSSNY’s survey yet may do so here.

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Advice from Socio-Medical Economics re Closing of Health Republic (HR), Effective November 30, 2015
We are aware that there are misconceptions and confusion regarding the patient’s financial liability with this Co-Op failure. The fact that the Co-Op is closing on November 30th does not make medical care and treatment not covered when provided by an HR in-network practitioner to HR enrollees.

If an in-network HR physician is treating a HR enrollee, by contract, the physician is prohibited from billing the patient beyond any applicable deductible, coinsurance or copayment for covered services.  Billing beyond these amounts is considered “balance billing.” This balance billing prohibition is good for the term of the contract which ends on November 30, 2015.  HR and the NYS Department of Financial Services (DFS) have issued notices for patients to call a special hotline number (1-800-342-3736) with concerns about being billed beyond their cost sharing amounts. Staff from DFS indicated that they are trying to create a user-friendly system for physicians to research the patients’ 2015 deductible standing. If possible, if DFS can create a central repository for this research, it would be very helpful for physicians and their staffs.

For those physicians who have outstanding claims with Health Republic (HR) and want to be on record with regard to their debt resulting from this closure, please utilize one consumer complaint form from the following link to record the total dollar value expected from HR.  Submitting this information to DFS will not constitute any commitment from DFS or HR with respect to your recovery concerning your claims.

The HR patient is financially responsible for any unmet 2015 deductible and charges for non-covered services.  These would be the only exceptions that an HR in-network physician could bill an HR enrollee for through 11/30/15.

The New York State of Health has prepared the following Q&A to assist HR enrollees with the transition.   Some of this information should be helpful for our MSSNY members, as well:  http://info.nystateofhealth.ny.gov/sites/default/files/Health%20Republic%20FAQs%2011-16-15.pdf

Part of the Q&A for the patients reads as follows:

  1. What if I have already met or have paid towards my deductible in my current plan?
  2. If you are enrolled in a Health Republic plan that has an annual deductible, the NYS Department of Financial Services is working to ensure that your new health plan will not charge you for the amount of deductible you already met in 2015. Keep your records. You may need to provide your new plan with evidence that you have met all or part of the 2015 deductible.

We are in the process of asking HR, Excellus, Fidelis, and MVP if there will be a computer system for you to be able to verify a patient’s 2015 deductible status.  So far, we have been told that the specific mechanism has not yet been defined.  As soon as we are advised, we will be sure to alert you.

However, if you are scheduling a visit for a former HR enrollee for services rendered from 12/1 through 12/31/15, it is urged that you ask the patient to bring their latest HR EOB that shows their 2015 deductible standing.  If it has been met, the patient would only be liable for their co-payment or co-insurance.  If their 2015 deductible has not been met, you would be able to charge them that amount up to your contracted fee schedule with Excellus, Fidelis, or MVP.

If you have additional questions concerning this matter, please email Regina McNally, VP, Division of Socio-Medical Economics at rmcnally@mssny.org


Survey of the Week

How is your ICD-10 Implementation Working?
Please answer this one question survey.



Opportunity for Physician Peer Reviewers
The Empire State Medical, Scientific and Educational Foundation, Inc. (ESMSEF) would like to invite you to participate in physician peer review with our organization.  We have a need for physician reviewers who are board certified and in active practice.  We have an urgent need for physicians in all specialties.

ESMSEF is a subsidiary of the Medical Society of the State of New York (MSSNY) and has been performing independent medical peer review since 1984.  The Foundation currently has several contracts in New York State to perform medical peer review services.  The reviews to be performed are retrospective in nature and are time sensitive.  We generally allow approximately 10 days for completion of the physician review.  Reviews may be sent to your home or office or may be performed in our offices in either Westbury or Camillus (Syracuse).  Issues to be reviewed include medical necessity, diagnosis assignment and/or quality of care issues.

If you are interested in participating in peer review, please contact Jane Steinman, Physician Reviewer Coordinator at 1-800-437-2234 or via email at jsteinman@esmsef.com to request an application.  Or, you may download our application from the “Careers” section of the Foundation website at www.esmsef.com

CMS Finalizes Rule for Medicare “Virtual” Bundled Payments for Lower Joint Replacement
Despite concerns expressed by many physician and hospital groups, Medicare payments for hip and knee replacements in Buffalo and New York City metropolitan areas, as well as 65 other regions across the country, will be subject to a “virtual bundling” program, according to an announcement this week from CMS.   For more information, click here, here  and here.

Under the new program, the “Comprehensive Care for Joint Replacement (CCJR)” model, acute care hospitals in certain 67 geographic areas will receive retrospective reward payments or face financial liability relating to episodes of care for lower extremity joint replacement (LEJR).  While Medicare payments to hospitals, physicians and other providers would continue to be made on a fee for service basis, the acute care hospital that is the site of surgery would be held accountable for spending during the episode of care. There is a 5 year performance period, beginning April 1, 2016, and ending December 31, 2020.

Under the program, the episode of care begins with an admission to a participant hospital of a beneficiary who is ultimately discharged under MS-DRG 469 (Major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (Major joint replacement or reattachment of lower extremity without major complications or comorbidities) and ends 90 days post-discharge in order to cover the complete period of recovery for beneficiaries. The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions.  Depending on the hospital’s quality and cost performance during the episode, the hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs.

In the first year, 2016, there would payment rewards only for the hospital, no penalties.  Starting in 2017, the financial penalties are phased in.  In 2017, the potential penalty is capped at 5%.  In 2018, the penalty would be capped at 10%, and in 2019 and 2020, the penalty is capped at 20%.

CMS notes that “a participant hospital may wish to enter into certain financial arrangements with collaborating providers and suppliers who are engaged in care redesign with the hospital and who furnish services to the beneficiary during an episode. Under these arrangements, a participant hospital may share payments received from Medicare as a result of reduced episode spending and hospital internal cost savings with collaborating providers and suppliers, subject to parameters outlined in the rule. Participant hospitals may also share financial accountability for increased episode spending with collaborating providers and suppliers.”

The 67 areas across the country encompass numerous major population centers including 800 hospitals.  The locations where this “virtual bundling” program will occur include Erie and Niagara counties in Western New York, and Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk and Westchester counties in downstate New York.


Medicare Advantage Plan to Shut Down
Touchstone Health HMO, a Medicare Advantage plan, will wind down operations at the end of the year, ending coverage for more than 10,000 members.

The White Plains insurer posted a notice on its website that informed members in New York City and Westchester and Orange counties that they would “no longer be enrolled beginning January 1, 2016.”

In October 2010, the insurer had about 17,000 members, with optimistic projections of clearing the 20,000 threshold. But membership fell 36%, to 10,864, in October 2015, according to CMS data.

Founded in 1998, the company is majority-owned by Essex Woodlands, a health care venture-capital fund, and Garden City, L.I.’s HealthCare Partners IPA. Essex Woodlands has a 60% stake—its managing director, Steve Wiggins, a founder of Oxford Health Plans, is on Touchstone’s board—with the rest held by HCP.

By the end of 2014, Touchstone was $8.5 million below its minimum net worth requirements, with assets exceeding liabilities by $9.6 million. The insurer earned $402,000 in net income on $157.9 million in revenue, with a profit margin under 1%.

A spokesman for the state Department of Financial Services said the closure “was a voluntary decision by the company. We’re working with the company and other regulators to help ensure consumers are protected.” (Crains 11/12/15)


MSSNY Announces Physician’s Emergency Preparedness Toolkit; Earn up To 15 Free CMEs
The Medical Society of the State of New York announces the creation of the Physician’s Emergency Preparedness Toolkit.  This toolkit provides resources necessary to enhance public health security and preparedness for all hazards and contains an extensive list of electronic resources for physicians to use during, or in preparation of, public health emergencies.   Upon completion of the toolkit, physicians can receive up to 15 hours of free continuing medical education credits.

The toolkit is comprised of four modules and is available at the MSSNY CME website here.   Physicians new to the MSSNY CME site will need to create a username and password.   Once registered, and logged into the site, click “My training page” on the toolbar located at the top of the instruction page.   The modules discuss liability protections for physicians during a public health emergency, provides information on the federal and state framework for responding to a public health emergency, and the best practices for a public health emergency.

The toolkit also includes:

  • A physician “go” bag checklist
  • An emergency preparedness checklist
  • A Psychological Impact desk reference card
  • A Biological, Chemical and Radiological Terrorism desk reference card

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 designated this enduring material for a maximum of 15 AMA PRA Category 1 Credits TM. Physicians should claim only the credits commensurate with the extent of their participation in the activity.

MSSNY has also created an Emergency Preparedness Podcast.  The podcast features discussions with several of New York’s preeminent experts on emergency preparedness and focuses on a remembrance of the events of September 11th, 2001 and on MSSNY’s efforts toward an aware and prepared physician and healthcare provider community in New York State.  The podcast can be accessed here.

The toolkit was created by members of the MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response Committee in cooperation with the New York State Department of Health.  A copy of the flyer for the toolkit and podcast is here.

For further assistance and/or questions please contact Pat Clancy at pclancy@mssny.org or Melissa Hoffman at mhoffman@mssny.org


“With 44 Rx Opioid Related Deaths A Day, What Can One Physician Do?”
The Medical Society of the State of New York announces that its website has resources, tools, best practices, and voluntary education programs to help physicians to better understand the opioid epidemic.  The Medical Society is one of eight state societies that is part of the AMA’s Task Force to Reduce Opioid Abuse.   Established in 2014, this task force has embraced five concepts for implementation throughout the nation. The Task Force believes that physicians have a professional obligation to reverse the nation’s opioid epidemic. The five goals of The Task Force are:

  • Increase physicians’ registration and use of effective PMPs
  • Enhance physicians’ education on effective, evidence-based prescribing
  • Reduce the stigma of pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing

MSSNY recognizes the severity of this public health epidemic and is committed to implementing solutions to combat it.  In New York, we have already reduced the incidence of doctor shopping by 86% because physicians are checking the Prescription Monitoring Program prior to prescribing a controlled substance. MSSNY also supported legislation to increase access to naloxone to reduce deaths from overdose.  MSSNY also supports efforts increase voluntary education and training for physicians on safe prescribing practices.   According to IMS data, New York has seen substantial decreases in the number of prescriptions written for oxycodone, hydrocodone and other controlled substances. New York’s utilization rate for these medications is below other states that currently require prescriber education of opioid medications. But there’s more to do.   The MSSNY website provides information on best practices that physicians may find helpful when considering a controlled substance and common recommendations found in opioid prescribing guidelines, including tools such as opioid calculators. Additionally, there are free continuing medical education programs through the PCSS-O and prevention and other information for your patients.  To learn more, click here.

MSSNY representatives to the AMA Task Force to Reduce Opioid Abuse are MSSNY Councilor, Frank Dowling, MD and Pat Clancy, MSSNY Vice President for Public Health and Education. Further information can be obtained by contacting Pat Clancy at pclancy@mssny.org.


Register Now For Final 2015 E-Prescribing CME Webinar on Dec. 9th
The Medical Society of the State of New York will host its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here. Select training session and the upcoming tabs.

The webinar will be held on 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 Terri Holmes at tholmes@mssny.org.

E-prescribing of all substances will be required in New York State by March 27, 2016.   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.


MSSNY Announces 2016 Medical Matters Schedule for 2016
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled “Immunizations During A Disaster,” with Dr. William Valenti as faculty.  All programs will begin at 7:30am.

Registration is now open to physicians and other public health officials:

https://mssny.webex.com/mw3000/mywebex/default.do?siteurl=mssny

Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016. Further information on these programs can be found here

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


Informal Review Request Period for 2016 Value Modifier Open Now Through November 23, 2015
The period for requesting an informal review of the 2016 Value Modifier is open now and ends November 23, 2015. For groups with 10 or more eligible professionals (EPs) that are subject to the 2016 Value Modifier, CMS established an Informal Review Period to request a correction of a perceived error in their 2016 Value Modifier calculation. These groups may request an informal review of their 2016 Value Modifier determination, now through November 23, 2015 11:59pm EST.

The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician EPs.

The 2014 Annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. For groups with 10 or more EPs that are subject to the 2016 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who bill under the group’s TIN in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2016.

Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.

Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).


NY Worker’s Compensation Board Proposes Regulation Changes
As of November 12, 2015, the following proposed regulation changes have been published to the Board’s website:

Amendment of 12 NYCRR 324.3 (Variances)

Amendment of 12 NYCRR 324.4 (Optional Prior Approval)

Amendment of 12 NYCRR 311.1 (Funeral Expenses)

Amendment of 12 NYCRR 325-1.4 (Authorization for Medical Services)

Amendment of 12 NYCRR 300.5 (Stipulations)

Repeal of 12 NYCRR 300.13, 300.15 and 300.16 and Addition of 12 NYCRR 300.13 (Administrative Review, Full Board Review and Reconsiderations)

Amendment of 12 NYCRR 300.27 (Meetings of the Board)

Amendment of 12 NYCRR 300.36 (Section 32 and Voluntary Binding Review)

The proposed regulation changes will be published in the November 10, 2015 edition of the State Register. Comments on the proposed regulations will be accepted for 45 days, from November 10, 2015 through December 28, 2015.

Please send questions or comments on the proposed regulations to: Heather M. MacMaster, Associate Attorney, Workers’ Compensation Board, 328 State Street, Schenectady, New York 12305-2318, telephone: (518) 486-9564, or email your comments to the Board atregulations@wcb.ny.gov.


From NY Workers Compensation Board: December District Dialogue Sessions
Thank you to all who attended our Fall District Dialogue Sessions. We are very fortunate for everyone’s participation and contribution, making our District Dialogues a continued success. Please join us for our Winter 2015 District Dialogue Sessions. This will be the Board’s sixth District Dialogue Session since we began holding these sessions in September 2014. We hope you will join us at one of our District Offices. The locations, dates and times are as follows:

WC Schedule_Updated

 

*Due to the relocation of the Albany District Office, the Albany District Dialogue date is still to be determined. An update will be sent when a location, date and time are decided.

It will be here before you know, so be sure to mark your calendars! We look forward to seeing and hearing from you.

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


Classifieds

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


Modern 3000 sq. ft. medical office to rent near the United Nations.
Handicapped accessible; private reception area; secretarial area available; 6 exam rooms.  Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.


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.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

November 13, 2015 – Does Health Republic Owe You Money?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 13, 2015
Volume 15, Number 43

Dear Colleagues:

The news of the financial meltdown of Health Republic has grown increasingly grim.

Questions are being raised if or how much physicians, hospitals and others will be paid for the care they have provided to HR-insured patients.  As such, it is imperative that physicians complete a MSSNY survey sent to you multiple times this week to aggregate the amounts that you are due from Health Republic. Hospital associations have been quoted in numerous news reports as being owed over $150 million.

We need to get similar hard data from physicians to help MSSNY advocate on your behalf to be treated fairly.  If you have not already responded, please complete this survey NOW by clicking here.

As of this writing, more than 40% of the survey respondents have outstanding claims to Health Republic, of which:

  • 7% are owed $100,000 or more
  • 15% are owed $25,000 or more
  • 43% are owed $5,000 or more
  • 74% are owed $1,000 or more

Combining the survey results we have received so far with financial data received from numerous physician practices across New York State, it is estimated that physicians across New York State are owed at least tens of millions of dollars from Health Republic.

MSSNY has been in continuous contact with DFS and New York State of Health officials to obtain necessary information for physicians to be able to help their patients with the enrollment decisions they will have to make.  We have also been advocating to these officials to assure that physicians be fully paid for the care they have provided to patients insured by Health Republic.

Certainly, the financial meltdown of Health Republic is a strong reason why many have called for the New York State Legislature to enact a special fund to assure claims will be paid and prevent against similar problems in the future.

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance

For Late-Breaking News: See item below

Health Republic Enrollees to Transition to Excellus, MVP or Fidelis Coverage
Health Republic enrollees who do not select a new plan by November 30 will be auto-enrolled in Excellus, MVP or Fidelis for the remainder of 2015, according to an announcement today by the NYS Department of Financial Services and NY State of Health.

In addition, Fidelis, Excellus, and MVP have agreed to credit any deductible and out-of-pocket amounts that consumers have already paid through their Health Republic coverage during 2015 – helping ensure that individuals who make the transition will not be required to restart these payments in 2015.

According to the press release, during the third week of November, individuals enrolled in Health Republic through NYSOH and who have not yet selected a new health plan for December 1, 2015, will receive an auto-enrollment notice from NYSOH telling them — based on their county of residence – whether they will be auto-enrolled in either Fidelis Care, Excellus, or MVP.  Individuals who reside in the Rochester area (including Livingston, Monroe, Ontario, Seneca, Wayne and Yates counties) will receive an offer to enroll from Excellus. Individuals who reside in Ulster County will receive an offer to enroll in MVP.  Individuals who reside in all other counties of the state will receive an offer to enroll from Fidelis Care. In order for coverage to become effective, individuals will need to make their premium payment for the month of December 2015. Consumers will be auto enrolled into the same metal tier or option that is most similar to the coverage the individual selected through Health Republic.

As noted in the DFS press release, under New York law, Health Republic members who are: a) in an ongoing course of treatment with a physicians for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when their new coverage becomes effective, may be able to continue to receive care from their physician for up to 60 days (or through pregnancy) under their new health insurance policy, even if the physician does not participate with the new health insurer (subject to agreement by that physician).


Affiliation between Albany Med and Saratoga Hospital Still Being Worked Out
The Albany (NY) Business Review (11/9, French, Subscription Publication) reported that “details of the planned affiliation between Albany Medical Center, the second-largest health system in the Albany area, and Saratoga Hospital are still being worked out” and may not be finalized for months. However, “another affiliation being pursued by Albany Med provides a roadmap for what the agreement might look like,” a deal with “Columbia Memorial in Hudson.” Under that agreement, “Albany Med’s board” would have “a say in approving new board members for Columbia.” However, “Columbia Memorial’s board of directors would still recruit and select those new directors.” 


PTSD and TBI in Returning Veterans: Identification and Treatment 

Date and time:   December 4, 12:30 – 1:30 PM via WebEx

Presenter:          Dr. Joshua Cohen

Program Summary: A look into the two most common disorders facing returning veterans today, from symptoms and diagnosis to treatment and recovery, and how to overcome the unique challenges posed by military culture.

For any questions, contact: Greg Elperin at gelperin@mssny.org

Please register here. 


REGISTER NOW FOR FINAL 2015 E-PRESCRIBING CME WEBINAR ON DEC. 9TH
The Medical Society of the State of New York will host     its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here. Select training session and then upcoming tabs.

The webinar will be held on 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 Terri Holmes at tholmes@mssny.org 

E-prescribing of all substances will be required in New York State by March 27, 2016.   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.   


Startup Cureatr Targeting Albany Market.
The New York Business Journal (11/11, French) reports healthcare startup Cureatr, which notifies “a patient’s primary care doctor in real-time if that patient goes to the emergency room,” will start by targeting the Albany area. The company is currently working at Albany Medical Center “and is now working on partnering with the other major hospital systems in the region, CEO Dr. Joe Mayer said.”


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations during a Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.

Registration is now open to physicians and other public health officials here. Go to training session and upcoming sessions tab.

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include:  Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Further information or assistance in registering for any of these programs, may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 


AMA Urges Department of Justice to Reject Further Health Insurer Consolidation; MSSNY Makes Similar Request to NY-DFS
The AMA has written to the Department of Justice, Antitrust Division, to urge that DOJ block the proposed mergers of health insurance giants Anthem (the parent of Empire BC/BS) and Cigna, as well as Aetna and Humana.  MSSNY had previously written to the New York Department of Financial Services (DFS) to urge that either the proposed Anthem-Cigna merger be rejected in New York State, or require that the merged entity agree to reform numerous market conduct issues that were identified in the recent DFS 2015 Guide to Health Insurers.  Concerns with the proposed mergers has also been the subject of numerous op-eds written by County Medical Society Presidents across New York State, including in the Binghamton, Buffalo and Jamestown papers.

According to a recent AMA report, the proposed health insurer consolidation would significantly enhance the market power and/or raise competitive concerns of these combined entities in multiple states across the country, including, within New York State, Long Island, New York City and the Hudson Valley.

Among the key points in the AMA letter to the DOJ were:

  • The proposed mergers are occurring in markets where there has already been a near total collapse of competition.
  • A growing body of peer-reviewed literature suggests that greater health insurer consolidation leads to price increases, as opposed to greater efficiency or lower health care costs.  The mergers would reduce pressures on plans to offer broader networks to compete for members and would create fewer networks that are simultaneously under no competitive pressure to respond to patients’ access needs.
  • Health insurer monopsony, or buyer power, acquired through the proposed mergers would, as the Department of Justice has found in earlier cases, likely degrade the quality and reduce the quantity of physician services.  In the long run health insurer exercise of monopsony power may motivate physicians to retire early or seek opportunities outside of medicine that are more rewarding. This would exacerbate an already significant shortage of primary care physicians in the United States;
  • There is no evidence supporting the insurer’s claim that the proposed mergers would lead to greater efficiencies and innovative payment and care management programs; and
  • Fostering competition, not consolidation, benefits American consumers through lower prices, better quality, and greater choice.


Office of National Coordinator Seeks Physician Input on Aspects of Meaningful Use
In an effort to improve the interoperability of EHRs the AMA is assisting the Office of the National Coordinator (ONC) with gathering information to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use.   The AMA has asked physicians to take a 5-10 minute survey that will help ONC create a new standard that will reduce the number of pages in the summary of care document, thus making it easier to find relevant information.     The survey link is here. The survey will close on November 30.


Doctors Without Borders Recruiting Doctors; Info Session on Nov. 19 in Manhattan
Doctors Without Borders is recruiting qualified MEDICAL AND NON-MEDICAL professionals in New York to respond to ongoing humanitarian crises and join their team of dedicated humanitarian aid workers. They are hosting a recruitment information session at their New York headquarters New York Recruitment Info Session Thursday, November 19, 2015 at 7:00 PM at Doctors Without Borders, 333 Seventh Ave, Second  Floor, NY, NY.  Click here to learn more. Click here to register for the New York session


Deadline for Review of Informal Review Extended until November 23

Question: When is the new deadline to appeal two penalties?

Answer: CMS has extended the deadlines for physicians and group practices facing two different Medicare penalties in 2016 to request an informal review if they believe the government made a mistake. The penalties, which whittle down reimbursement, are levied under Medicare’s Physician Quality Reporting System (“PQRS”) and the Value Based Payment Modifier (“VBM”) program. The original deadline for an informal review of both penalties had been November 9, 2015 but has now been extended until November 23, 2015.

In PQRS, Medicare penalizes physicians for unsatisfactory reporting of clinical quality data. The penalty in 2016, based on performance in 2014, will lower fee-for-service payments by 2%. Physicians, medical groups, and accountable care organizations can learn if they are due for a pay cut by obtaining a PQRS feedback report for 2014.

The CMS website explains how to obtain the report. Requests for an informal review can only be made online through the Quality Reporting Communication Support Page of CMS. CMS promises a decision, which is final, within 90 days.

To read more about this deadline extension and how to file for informal reviews, please visit:https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.

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.


AMA Summary of the 2016 Medicare Physician Fee Schedule Final Rule
On October 30, 2015, CMS released the (1,358 page) 2016 Medicare Physician Fee Schedule (PFS) Final Rule with comment period. CMS has issued a general fact sheet and a PQRS payment adjustment fact sheet. Table 62 shows the impact of the rule on individual specialties. The AMA submitted detailed comments on the Proposed Rule on September 8, 2015. The Final Rule is scheduled for publication in the Federal Register on November 16, 2015. CMS will accept comments by 5 PM on December 29, 2015, regarding interim final relative value units (work, practice expense, and malpractice); interim final HCPCS codes (in the Preamble and Addendum C); and changes to the physician self-referral HCPCS/CPT codes (tables 50-51). 

Physician Payment Update & Misvalued Codes Target
The Medicare Access and Chip Reauthorization Act (MACRA) called for annual updates of 0.5 percent from July 2015 through 2019. The Protecting Access to Medicare Act of 2014 (PAMA) set an annual target for reductions in PFS spending, from adjustments to relative values of misvalued codes. Then the Achieving a Better Life Experience (ABLE) Act of 2014 accelerated those targets, increasing the target to 1 percent for 2016 and keeping it at 0.5 percent for 2017 and 2018.

The AMA opposed these targets as completely unnecessary. The RUC and CMS have been engaged in intensive efforts to identify and address misvalued services for many years, long before Congress got involved. CMS has recognized the RUC’s vital role in helping value Medicare services. Since the RUC Relativity Assessment Workgroup began in 2006, the RUC and CMS have identified over 1,900 services through 16 different screening criteria for further review, and the RUC has recommended reductions and deletions for 1,045 services, leading to redistribution of nearly $4 billion.

In the final rule, CMS brought its methodology more in line with AMA and RUC recommendations, and rolled back planned payment reductions for both radiation treatment services (completely) and lower GI endoscopy (partially). Together with redistributions recommended by the RUC, this yields a net savings of 0.23 percent, requiring a 0.77 percent reduction to meet 1 percent target. Taking into account the 0.5 percent positive update (and a -0.02 percent budget neutrality adjustment), the 2016 Medicare conversion factor is reduced by 0.29 percent to $35.83, just 10 cents below the 2015 conversion factor of $35.93. 

Advanced Care Planning
CMS finalized separate Medicare payment for two CPT codes for advance care planning services, which include conversations between patients and their physicians before an illness progresses and during treatment. The rule specifically referenced the AMA recommendations. This represents not only a win for CPT, the RUC, and the AMA, but also a turning point towards a new approach to pay for advance care planning. The Medicare statute currently provides coverage for advance care planning under the “Welcome to Medicare” visit available to all Medicare patients, but they may not need these services when they first enroll. Separate payment for advance care planning codes recognizes the additional time needed to conduct these conversations, and provides a greater opportunity and more flexibility to have these planning sessions at the most appropriate time for patients and their families. CMS is also finalizing payment for advance care planning when it is included in the “Annual Wellness Visit.” 

“Incident to” Services
In the 2014 PFS final rule, CMS set explicit requirements that “incident to” services must be furnished consistent with applicable state law, including state licensure and other requirements for the “auxiliary personnel” providing the services. In the 2016 PFS final rule, CMS is also requiring that “the physician or other practitioner who bills for incident to service must also be the physician or other practitioner who directly supervises the auxiliary personnel who provide the incident to services.” (Incident to services may also be billed by clinical psychologists, PAs, NPs, CNSs, and certified nurse-midwifes. General supervision is sufficient for chronic care and transitional care management services, except patient visits.) The AMA and other physicians expressed concerns that this requirement – and CMS’ proposal to remove current regulatory language widely interpreted as allowing the supervising physician (or practitioner) to be someone different from the person who initiated the patient’s treatment and is overseeing their general care – would adversely impact the physician community, particularly group practices and multispecialty clinics. Fortunately, CMS agreed to continue its policy that the supervising physician (or practitioner) for a particular incident to service does not have to be the same person who is “treating the patient more broadly” and is adding clarifying regulatory language to that effect. The rule also finalizes regulatory changes that prohibit auxiliary personnel from providing incident to services if they have been excluded from Medicare, Medicaid, or other federal health programs or have had their enrollment revoked. 

Other Payment Issues

  • Primary Care Bonuses End: While not highlighted in the final rule, it is important to keep in mind that the 10 percent incentives – that section 5501(a) of the Affordable Care Act established for Part B services by primary care practitioners – are scheduled to end on December 31, 2015.
  • Phase-In of Significant RVU Reductions: The PAMA specified that a decrease in value for a service of 20 percent or more, without a change in the underlying code for the service, must be phased-in over a two-year period. CMS is adopting its proposal to reducing the value for a service by 19 percent in the first year, and by the remainder in the second year.
  • Misvalued Code Changes/Lower GI Endoscopy Services: CMS is adopting codes for lower gastrointestinal endoscopy as revised by the CPT Editorial Panel and related values “more closely tied” to the RUC’s recommendations.
  • Misvalued Code Changes/Radiation Therapy: CMS did not finalize the new code set for radiation therapy treatment. Changes will be implemented, over 2 years, to the utilization rate for capital equipment used in radiation therapy, to 35 hours per week (70 percent utilization) instead of 25 (50 percent utilization). CMS also seeks comment on the price and usage of linear accelerators.
  • Part B Drugs/Biosimilars: Payment for a biosimilar biological product will be based on the average sale price of all biosimilar biological products within the same billing/payment code.
  • Technical Errors: There are two errors in the Final Rule that will be corrected in a technical correction notice:

o The 0.5 percent update was not applied to the Anesthesia conversion factor. With the appropriate application, we estimate that the correct 2016 Anesthesia conversion factor should be $22.4426.

o The work GPCI (geographical practice cost index) floor, extended under MACRA until January 1, 2018, was not applied. The GPCI tables incorrectly list work GPCIs below 1.0 for 51 localities.

Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging
PAMA requires that providers who order advanced diagnostic imaging services consult with AUC via a clinical decision support mechanism. PAMA also requires CMS to specify AUC from among those developed or endorsed by national medical professional specialty societies and other provider-led entities; to approve clinical decision support mechanisms; to collect additional information on the Medicare claim form; and to develop a prior authorization program based upon the claims information. CMS is establishing which organizations are eligible to develop or endorse AUC, the evidence-based requirements for AUC development, and the process CMS will follow for qualifying provider-led entities. Consistent with concerns expressed by the AMA, CMS says it will not have AUC in place and ready for consultation by ordering physicians by the January 1, 2017 deadline, so the requirement for consultation will be delayed. Also consistent with AMA advocacy, CMS is reconsidering application of the AUC to emergency departments, and will review this issue in next year’s PFS rule. 

Medicare Opt-Out
Prior to MACRA, physicians and practitioners that wished to renew their opt-out were required to file new valid affidavits with their Medicare Administrative Contractors (MACs) every 2 years. CMS clarifies in the final rule that under MACRA, physicians and practitioners that filed valid opt-out affidavits on or after June, 16, 2015 are not required to file renewal affidavits. Such physicians and practitioners may cancel the renewal by notifying all MACs with which they filed an affidavit in writing, at least 30 days prior to the start of the new two-year opt-out period. 

Physician Quality Reporting System (PQRS)
Despite objections from the AMA and other physician specialty societies, CMS is maintaining the same strict minimum measure reporting requirements—of nine measures covering three National Quality Strategy domains—for the 2016 reporting period which determines the 2018 PQRS payment adjustment. Individual eligible professionals (EPs) or group practices that fail to satisfactorily report or otherwise participate in PQRS for 2016 will receive a 2 percent negative payment adjustment on covered professional services in 2018. CMS is finalizing additions to the PQRS measure set to fill gaps, and deleting measures considered “topped out,” duplicative, or replaced. The 2016 PQRS measure set will have 281 measures and the GPRO Web Interface will have 18. CMS will allow group practices to report quality measure data using a Qualified Clinical Data Registry (QCDR), as required under MACRA. 

Physician Compare
All 2016 individual EP and group practice PQRS measures will be available for public reporting on Physician Compare. This includes ACO measures and “CAHPS for PQRS survey” measures for groups of two or more EPs that have the required sample size and collect data via a CMS-specified certified CAHPS vendor. CMS is withdrawing its plan to indicate (on profile pages) which EPs and which group practices receive a VM bonus, but is finalizing the inclusion on Physician Compare of:

  • Certifying board, including the American Osteopathic Association Board;
  • An indicator for individual EPs who satisfactorily report PQRS Cardiovascular Prevention measures in support of the Million Hearts initiative (on profile pages);
  • Individual and group-level QCDR measures;
  • In the downloadable database: Value Modifier tiers for cost and quality; whether the EP or group practice is high, low, or neutral on cost and quality; the resulting payment adjustment; which eligible EPs or group practices did not report quality measures to CMS; utilization data for individual EPs; and
  • An item (or measure)-level benchmark based on the Achievable Benchmark of Care (ABC™) methodology, displayed as a five-star rating.

Value-Based Payment Modifier (VM)
CMS will no longer apply an automatic VM penalty to TINs receiving a PQRS penalty, if on informal review at least 50 percent of EPs avoid the PQRS penalty. If CMS does not have sufficient data to calculate their VM quality score, they will be considered “average quality.” CMS is finalizing the following key provisions for the 2016 reporting period/2018 payment adjustments:

  • The VM will apply to nonphysician EPs who are Physician Assistants (PAs), Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Anesthetists (CRNAs) practicing either in groups or as solo practitioners.
  • The quality-tiering methodology will apply to all groups and solo practitioners. However, PAs, NPs, CNSs, and CRNAs will not receive downward adjustments under quality-tiering in 2018.
  • The maximum upward adjustment under quality-tiering will continue at: o +4.0 times the adjustment factor for solo physicians and groups with 10 or more EPs.

o +2.0 times the adjustment factor, for solo physicians and groups with 2 to 9 EPs.

o +2.0 times the adjustment factor for solo and groups of PAs, NPs, CNSs, and CRNAs.

  • The amount of payment at risk is: o -4.0 percent for groups of physicians with 10 or more EPs.

o -2.0 percent for solo physicians and groups with 2 to 9 EPs.

o -2.0 percent for solo and groups of PAs, NPs, CNSs, and CRNAs.

Beginning with VM adjustments in 2017:

  • The VM is waived for EPs and groups if at least one EP who billed for PFS items and services under their TIN participated in the Pioneer ACO Model, Comprehensive Primary Care Initiative, or other similar Innovation Center model (such as Comprehensive ESRD Care Initiative, Oncology Care Model, and the Next Generation ACO Model).
  • The Medicare Spending per Beneficiary measure will only apply to EPs with at least 125 episodes.
  • For solo practitioners and groups with 2 to 9 EPs, the All-Cause Hospital Readmissions measure will not be used in the quality calculation.

Medicare Shared Savings Program (MSSP)

  • The final rule adds a “Statin Therapy for the Prevention and Treatment of Cardiovascular Disease” measure in the Preventive Health domain to align with PQRS reporting.
  • Measures can stay or revert to “pay for reporting” if a measure owner determines they no longer align with updated clinical practice or cause patient harm.
  • The rule clarifies how EPs in an ACO can meet their PQRS requirements.
  • “Primary care services” include claims submitted by Electing Teaching Amendment hospitals and exclude certain services furnished in Skilled Nursing Facilities.

Physician Self-Referral Law
The physician self-referral law prohibits: (1) a physician from making referrals for certain “designated health services” (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship, unless the requirements of an applicable exception are satisfied; and (2) the entity from filing claims with Medicare (or billing another individual, entity, or third party payer) for those DHS furnished as a result of a prohibited referral. The final rule establishes two new exceptions and clarifies certain terms and requirements.

New Exceptions: Permit payment to physicians by hospitals, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs), to compensate non-physician practitioners under certain conditions; and permit timeshare arrangements for the use of office space, equipment, personnel, items, supplies, and other services. CMS believes these will enhance access to care, particularly in rural and underserved areas.

Physician-Owned Hospitals: The ACA established new restrictions on physician-owned hospitals, including setting a baseline physician ownership percentage they cannot exceed, and requiring statements of physician ownership on websites and in advertising. CMS is clarifying that a broad range of actions comply with these requirements, and finalized changes to the physician ownership calculation, effective January 2017, to include all physicians, not just those who refer to the hospital.

Clarifying Terminology and Policy Guidance: Relating to settlement of overpayments resulting from physician self-referral law violations is designed to “reduce perceived or actual noncompliance.”

  • Compensation paid to a physician organization cannot take into account the referrals of any physician in the physician organization (as opposed to the referrals of a physician who stands in the shoes of the physician organization).
  • Employees and independent contractors do not have to sign arrangements with the physician organization and a DHS entity.
  • Exceptions to the referral and billing prohibitions can be based on a collection of documents.
  • The terminology that describes these types of arrangements was made more consistent.
  • The term of leases and personal service arrangements lasting at least 1 year, and otherwise compliant, does not have to be in writing.
  • Expired lease and personal services arrangements can continue indefinitely if otherwise compliant.
  • A 90-day grace period is allowed to obtain missing signatures, inadvertent or not.
  • DHS entities can give physicians items used solely for a purpose identified in the statute.
  • A financial relationship does not exist when a physician provides services to hospital patients in the hospital, if both the hospital and the physician bill independently for their services.
  • The exception for ownership in publicly traded entities allows over-the-counter transactions.
  • The definition of a locum tenens physician was simplified.
  • Geographic service areas were clarified for FQHC and RHC physician recruitment exceptions.
  • Under the retention exception, retention payments based on physician certification may be no more than 25 percent of the physician’s current annual salary averaged over 24 months 


 


Classifieds


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


Office Near UN for Rent
Modern 3000 sq. ft. medical office to rent near the United Nations. Handicapped accessible; private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.

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.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

November 6, 2015 – NY Is Not Part of the Herd

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 6, 2015
Volume 15, Number 42

Dear Colleagues:

Standing Up for Your Beliefs and Position

Our state medical society has a long history of leading change in many controversial areas, often being the lone voice of advocacy or opposition.  History has proven that those well-reasoned and critically analyzed positions have been spot on in their assessments and recommendations.  During the tenure of the previous two presidents, MSSNY took such positions, specifically on the SGR—when were the only state that did not sign onto the national letter.  Once again, our society has risen to lead by example.

This past week, I declined to sign onto a national letter asking for particular changes in the National Association of Insurance Commissioners’ Model Bill for network adequacy. Instead, we chose to draft our own letter highlighting the merits of the more robust network adequacy legislation accomplished in New York’s legislation wrought in part through the efforts of our Immediate Past President Dr. Andrew Kleinman.  Numerous attorney generals and legislators in other states have been looking at New York’s legislation as being more protective of patient needs in access to care via network adequacy.  In addition, our state’s legislation has protected both patients and physicians when these medical services have been sought out of network.  Other state medical societies have been looking at our efforts in this arena and are opting to follow our lead in this arena.

As New Yorkers, we have always understood the challenges that prompt us to go beyond conventional participation in advocacy efforts.  We are prepared to be contrarians when solutions proffered by others shortchange our patients and profession.  We are proud of the legislation on surprise bills and network adequacy that protects New York’s patients and physicians even when our lone voice of advocacy engenders bogus claims of “limited networks that are robust” or are alluded to as purveyors of conspiracy theories.

What gives us the fortitude to be the lone person advocating for the best interests of our patients and doctors?  It is our commitment to the oaths we made to protect our patients and profession when we first entered the profession.

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Council Notes
At the meeting on November 5, Council approved the following:

  • Childhood Vaccination Resolution
    MSSNY will support the repeal to eliminate all non-medical exemptions for childhood vaccinations prior to attending school in New York State.
  • Resolution 113:
    Resolution 113 was amended and adopted as follows: That the Medical Society of the State of New York investigate logistics of including MSSNY and County Medical Society opt-out dues in the NYS Department of Education biennial registration billing and payment.
  • Resolution 60:
    Council adopted substitute resolution 60, which states that MSSNY will work with the NY chapters of the American Academy of Pediatrics to advocate for the following: that health insurers comply with the law that required them to provide coverage for autism and related services; insurers take the necessary steps to include sufficient physicians in networks; work with AMA and other societies to advocate for federal legislation to require self-insured plans to provide such coverage; work with similarly interested organizations to identify gaps in services and treatment.
  • Resolution 117:
    MSSNY will seek legislation and regulation that vertically integrated hospital systems must prove to the DOH a need to employ an individual physician in the market place and obtain a Certificate of Need for each of their employed physicians and that the certificate of need process include an evaluation of the employment agreement, insofar as it be limited to fair market values of physician services and not include ancillary services.
  • Presidential Appointments to the Council Workgroup
    The workgroup will develop guidelines for collaborating with non-MSSNY physician groups seeking MSSNY engagement.
  • Presidential Nomination to AMA Senior Physicians Section
    Dan Koretz, MD will serve as the Senior Physician Section liaison with the AMA.  Dr. Koretz will provide two-way communication between MSSNY and the SPS through participation in virtual Assembly calls and the annual and interim meetings.
  • Virtual Council Meeting in January
    The January Council meeting will be held remotely, with various locations around the state connecting via WebEx.


NY Practices Waiting To See Impact Of New ICD-10 Coding System
POLITICO New York (11/3, Velasquez) reports healthcare providers in New York State “say it’s still too early to know what sort of repercussions the new [coding] system will have on their operations,” one month into the transition. As of October 1, those providers who are “covered by the Health Insurance Portability Accountability Act (HIPPA) had to transition to a tenth version of the International Statistical Classification of Diseases, also known as ICD-10.” Regina McNally, the vice president of socio-medical economics at the Medical Society of the State of New York, says, “If there are going to be some problems of any significance, we have to wait a little further down the road before those issues.”


Medical Journal Article Concludes that Higher Spending Physicians Sued Less; Profound Implications for Value-Based Payments
As was widely reported in the Washington Post  and the New York Times this week, a British Medical Journal article concluded that physicians who spent the most health-care resources on hospitalized patients had the lowest likelihood of being sued.   MSSNY will be sharing these articles with key legislators and Cuomo Administration officials, noting that the results of this study have profound consequences for efforts to shift commercial and Medicaid payments to a value-based construct.  Physicians could find themselves in a “Catch 22” situation, where in acting to assure their patients are able to get all the care they need and to reduce the risk of being sued, they may find themselves being penalized by public payors and commercial insurance companies for exceeding spending targets used under such value-based payment paradigms.

In the study, researchers tracked more than 24,000 Florida physicians over a nine-year period and found that in six specialties, physicians who were found to have spent the most health-care resources on hospitalized patients had the lowest likelihood of being sued.


MSSNY Joins AMA and Other Medical Societies in Seeking Congressional Intervention to Delay Unworkable Meaningful Use Requirements
As new CMS regulations will make Stage 3 of the electronic health record (EHR) meaningful use program even less achievable and more disruptive, MSSNY joined 110 other medical associations in a joint letter initiated by the AMA to members of the Senate  and the House urging Congress to intervene.  The letters point out that “the Centers for Medicare & Medicaid Services (CMS) has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.”

MSSNY Board of Trustees member and Saratoga Springs ENT Dr. Robert Hughes and MSSNY staff recently joined physician leaders from other states in Washington DC to advocate for numerous bills including legislation (HR 3309, Ellmers) to reduce the hassles associated with complying with onerous federal regulations governing the use of electronic medical records.  The bill contains a provision to postpone the implementation of Meaningful Use Stage 3 until 75% of physicians can meet Meaningful Use Stage 2.

Physicians are encouraged to email their members of Congress and tell them that the nation’s patients and physicians need significant changes to meaningful use Stage 3. They also can submit comments on the Stage 3 regulations during the 60-day comment period that ends Dec. 15. The AMA’s dedicated website BreakTheRedTape.org makes it simple to submit comments directly to Congress and CMS.


Final 2016 Medicare Physician Fee Schedule rule issued
Late last Friday, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Physician Fee Schedule rule for 2016, along with a fact sheet describing many of its most notable provisions.

The AMA notes that as a result of the interplay between numerous statutory provisions, the Medicare fee schedule conversion factor will be reduced by 0.29% in 2016, from $35.93 to $35.83.

Here’s why: The Medicare Access and Chip Reauthorization Act (MACRA), which repealed the SGR, increased the conversion factor by 0.5% on July 1 and called for additional annual updates of 0.5% from 2016 through 2019.  However, the Protecting Access to Medicare Act of 2014 enacted in April 2014, established an annual target for reductions in Medicare payment schedule expenditures that result from adjustments to misvalued codes.  The Achieving a Better Life Experience Act of 2014, enacted in December 2014, accelerated the application of the expenditure reduction target, setting targets of 1% for 2016 and 0.5% for 2017 and 2018.  Unfortunately, the Medicare payment rule only identified “misvalued code” changes that achieved 0.23% in net reductions, which required CMS to impose a 0.77% reduction to all Medicare professional services, more than offsetting the increases contained in MACRA.

Among its numerous provisions, the Medicare fee schedule rule for 2016 includes provisions to establish payments for advanced care planning.  It also sets forth terms for the bonus and penalties physicians will face in the Value-Based Modifier Program in 2018 based upon 2016 performance.  Groups of physicians with 10 or more face a bonus or penalty of +/- 4%; while solo practitioners and or physicians in groups of 9 or less face a bonus or penalty of +/- 2%.  The program will sunset after 2019 as part of the transition to the Merit Based Incentive Payment System (MIPS).


More Leeway in Two-Midnight Rule
CMS issued changes to the two-midnight rule last week that give physicians broader leeway to determine if someone should be treated on an inpatient basis. But the controversial policy is largely intact. Whether a hospital will be reimbursed for an inpatient stay that lasts fewer than two nights will depend on such factors as the severity of a patient’s symptoms and the likelihood of an adverse event. Inpatient stays that do not keep a patient in the hospital overnight will be prioritized for review. “We will continue to monitor hospital admission practices and look for any evidence of gaming,” CMS told Modern Healthcare. But instead of sending recovery audit contractors who are paid to dispute claims to conduct the initial review, quality improvement organizations will be the first to investigate. GNYHA was among the plaintiffs in a class-action suit filed earlier this year that challenged reimbursement cuts made in association with the two-midnight rule. The group voiced support for the changes in a memo released on October 30.


MSSNY’S Advocacy Matters CME Series on November 10: Foster Gesten, MD to Focus on State Health Innovation Plan (SHIP)
Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.   

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please click here.

The objectives of November 10th Advocacy Matters  program are as follows:

1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.

  1. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  2. Describe the five strategic pillars and three enablers of system transformation.
  3. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please go to mssny.webex.com and click on the “Upcoming” tab.  A “Register” link appears to the right of the program name.

To read the flyer, please click here.

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

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment.  Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

Accreditation Statement: 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.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified.

The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.


Avoid Medicare Penalties
Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, – 2.0% but it could be more. Understanding the rules can be confusing but is necessary. MSSNY has arranged special rates for members from Covisint – a service to help practices with PQRS reporting.  With Covisint PQRS you can confidently avoid the 2017 payment adjustment of -2.0%.

Covisint features include:

  • Paper and electronic data collection methods
  • Web-based application access and data entry
  • Easy and Quick …
    The measures group option only requires 20 patients

HIPAA-compliant database

Automated data submission

MSSNY Members save $100. Call (516) 488-6100, Extension 403 or email: eskelly@mssny.org for your MSSNY Member discount code. Use it at the time of submission and receive a discounted submission rate of $199.

Have questions about PQRS? Plan to attend one of our live Q&A sessions to get all of your questions answered and more. Thursday, November 19, 2015 at 11:00 am ET – Click here to add this meeting to your calendar.

Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more 


MSSNY To Conduct E-Prescribing Webinars Monday, Nov. 9 and Monday, Dec. 9
MSSNY will host two free continuing medical education webinars on E-prescribing for MSSNY members on Monday, November 9th and Wednesday, December 9, 2015 at 7:30 a.m.

Registration is now open to MSSNY physicians by clicking here.

Select “Training Center” and the “Upcoming” tab.  Then click “Register” link to the right of desired session.

A copy of the flyer can be found here.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,”  includes the following educational objectives are:

  • 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.   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 from March 27, 2015 to March 27, 2016.  


Buyer Beware: Too Good to Be True?
There are now over 40 insurers competing for medical liability insurance in NYS. Sometimes premium quotes can seem too good to be true.  This might be because insurers are providing less coverage, shifting coverage from occurrence to claims made, or offering an attractive discount that may not persist.  If a quote seems too good to be true, give MLMIC a call at (716) 648-5923. We’ve seen a lot in our 40 years in NYS and can often spot differences that may make a difference. 


MEDCO Offering Free Crosswalk Guides
FREE Crosswalk Guides (18 Specialties) are available here:www.medcoconsultants.com.


Do You Want to Present Your Project at MSSNY’s 11th Annual Symposium on April 15?
MSSNY is pleased to announce our 11th Resident/Fellow/Medical Student Poster Symposium on Friday, April 15, 2016 at the Westchester Marriott in Tarrytown, New York from 2 pm – 4:30 pm. Click here for detailed guidelines.Deadline for abstract submission is 4 pm, Monday, January 25, 2016.We welcome the participation of your residents and fellows. Participants must be MSSNY members, and membership is free for first-time resident members.
Join online at www.mssny.org.


Be There! Fall Residents,YPS and Students Get Together in NYC Next Friday
Anuradha Khilnani, MD and the New York County Medical Society, in collaboration with the AMA, is hosting a networking social for physicians, residents and medical students.

When:   Friday, November 13

When:   7-9 pm

Where: The Royalton Hotel 44 W. 44th St


For Your Patients: Q&A for Health Republic Members

Q. I was previously notified that my Health Republic coverage would end on December 31, 2015. Is this a change?

A. Yes, this is a change. Your Health Republic coverage will end one month earlier on November 30, 2015.

Q. Why is my Health Republic coverage ending sooner?

A. Based on an in-depth review by the NYS Department of Financial Services and the federal Center for Medicare and Medicaid Services (CMS), it has been determined that it is in the best interest of consumers to wind-down coverage under Health Republic on November 30, 2015 rather than at the end of the year.

Q. How do I select a new plan?

A. You can:

Log in to your Marketplace account before November 16th and visit the “Plans” tab at the top of the screen.

  • Select “Find a New Plan” at the bottom of the screen to see your health plan options.
  • Once you have chosen your plan, be sure to select “confirm and checkout” to confirm your enrollment in your new plan for December 1, 2015 coverage.
  • Or, you can call our special customer service helpline at 1-855-329-8899 and our customer service representatives will help you select a new plan or give you contact information for an in-person assistor in your area who can help you.

Q. What should I consider when I select my new plan?

A. You should consider:

  • Whether your health care providers are in the new health plan’s network.
  • Whether the prescription drugs you take are covered by the new plan.
  • The premium cost of the new plan.

To find contact information for the health plans offered on NY State of Health and links to each health plan’s provider network directory visit http://info.nystateofhealth.ny.gov/PlanCustomerService 1

Q. Do I have to select the same metal tier (platinum, gold, silver, bronze) as I am enrolling in Health Republic?

A. No. You can select any health plan that is available in your area and any metal tier.

Q. What happens if I don’t select a plan by November 15?

A. In order to ensure you are covered during the month of December 2015 you must pick a new plan by November 15th.

Q. Do I still have coverage for the month of November?

A. Yes. Provided that you pay any required premium for the month of November 2105, you are covered by Health Republic through November 30, 2015.

Q. What if I have already met or have paid towards my deductible in my current plan?

A. If you are enrolled in a Health Republic plan that has an annual deductible, the NYS Department of Financial Services is working to ensure that your new health plan will not charge you for the amount of deductible you already met in 2015. Keep your records. You may need to provide your new plan with evidence that you have met all or part of the 2015 deductible.

Q. Will my providers be in my new plans’ network?

A. You should ask both your providers and the plan you are considering joining about whether your providers participate with the new plan. To find contact information for your health plan and a link to the plan’s provider network directory visit at: http://info.nystateofhealth.ny.gov/PlanCustomerService

Q. What if I am receiving treatment when my Health Republic coverage ends on November 30, 2015 and my provider is not in the new plan’s network?

A. If you are either: a) in an ongoing course of treatment with a provider for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when your new coverage becomes effective on December 1, 2015, then you may be able to continue to receive care from your provider for up to 60 days (or through pregnancy) under your new health insurance policy, even if your provider does not participate in your new health insurer’s network. To receive transitional care, your provider must agree to accept as payment your new health plan’s reimbursement for such services and to certain other conditions of providing care under the new policy. If your provider agrees, you will receive the services as if they were being provided by a participating provider. You will only pay for any applicable in-network cost sharing. You, your representative or your provider should contact your new health insurer to determine if you are eligible for transitional care. To request transitional care, call your new health plan’s customer service and let them know that you are new the plan and ask how to request transitional care. If you experience any problems with the process, you can call the NYS Department of Financial Services toll free number 1-800-332-3736 for assistance in filing this request with your health plan.

Q. What should I do if I have scheduled procedures or medical care in December 2015?

A. If you have care scheduled during the month of December 2105, you should do the following:

  • Visit the NY State of Health website, call the NY State of Health Customer Service Center at 1-855-329-8899 or visit an in-person assistor to review your plan options.
  • Ask your provider which health plans they participate with.
  • Select your health plan.
  • Call your new plan’s customer service to tell them that you have scheduled procedures or care in December 2015 and ask if you need prior-authorization.

Q. If I select a plan for December 1, 2015 will I be automatically enrolled into that plan for January 1 or do I need to make a separate plan selection for January coverage?

A. Current Health Republic enrollees will need to return to the Marketplace beginning on November 16 to select a plan with an effective date of January 1, 2016.

Q. Can assistors offer support to current Health Republic members by phone instead of only providing in-person assistance?

A. Yes. Assistors can provide support telephonically to current Health Republic enrollees in order to assist in selecting plans for December 1, 2015 and January 1, 2016.


CMS Extends Deadline for PQRS Informal Review Process

CMS is extending the 2014 Informal Review period. Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, PQRS group practices, and Accountable Care Organizations (ACOs) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment now have until 11:59 p.m. Eastern Time on November 23, 2015 to submit an informal review requesting CMS investigate incentive eligibility and/or payment adjustment determination. This is an extension from the previous deadline of November 9, 2015.

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 23, 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 PQRS Analysis and Payment webpage) 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. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.

 

 

 

 


Classifieds


Office for Rent Near UN
Modern 3000 sq. ft. medical office to rent near the United Nations. Handicapped accessible; private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-Specialty Group 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


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.


PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room; large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

Council Meeting – November 5, 2015

       AGENDA
Council Meeting
Thursday, November 5, 2015, 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 September 17, 2015

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

1. President’s Report: 
    a. DISRIP and  Value Based Payments Presentations by the following: (VIA Webinar)
         Greg Allen, Director, NYSDOH
          Division of Financial Planning & Policy
         Marc Berg, MD, PhD., Principal, Advisory
         KPMG, LLP
         Douglas Fish, MD, Medical Director, NYSDOH
         Division of Program Development & Management Office of Health Insurance Program

    b. Presidential Appointments to the 2016 Nominating Committee

c.  Presidential Appointments to the Council Workgroup – Pursuant to the decision for developing guidelines for collaborating with non-MSSNY physician groups seeking MSSNY engagement, I am appointing the following Councilors and individuals to work on the development of these guidelines:

        Kira Geraci-Ciardullo, MD – Speaker, HOD
        (to insure that the guidelines are consistent with MSSNY Bylaws)
        Howard Huang, MD- Councilor and Chair of the group
        Mark Adams, MD – Councilor
        Parag Mehta, MD  –  Councilor
        Michael Goldstein, MD – President, New York County Medical Society
        (to represent interests of  OON group in Manhattan)
        Robert A. Viviano, DO  –  Resident & Fellow Section Councilor
        (to represent issues related to NYSOMS engagement)
        Liz Dears, Esq.  – VP MSSNY and liaison for Coalition of Specialty Societies

    d. Presidential Nomination to be appointed to the AMA Senior Physicians Section
             (For Council Approval)

 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 –  Edward Amsler will present a verbal report

6. AMA Delegation Update – Dr. Kennedy will present a verbal update (handout at Council)

7. MESF Update – Dr. Kleinman will present the report (handout at Council)

8.  Commissioners  (All Action Items )
1. Commissioner of Science and Public Health, Frank G. Dowling, MD
          (FOR COUNCIL APPROVAL)
                a. MSSNY Infectious Diseases Committee, Childhood Vaccination Resolution
This Resolution was submitted to Council by the Medical Society of the County of Queens and referred to the Infectious Diseases Committee for review and recommendation to the Council
(Dr. Valenti will be on the phone)

2. Commissioner of Governmental Relations, Gregory Pinto, MD (FOR COUNCIL APPROVAL)
           Legislative and Physician Advocacy Committee
     a. MSSNY’s 2016 Legislative Program
     b. MSSNY HOD Resolution 60,
           Third-Party Payment for Evaluation and Management of  Developmental Disorders
             c. MSSNY HOD Resolution 65, Patients’ Compensation System
             d. MSSNY HOD Resolution 109, Mandatory Reporting of Elder
             e. MSSNY HOD Resolution 113, Medical Society Dues as Part of Biennial Registration
             f. MSSNY HOD Resolution 117,
          Monopolization of Healthcare by Vertically Integrated Health Systems

  1. Councilors  (All Action Items from County Societies and District Branches)
    (no written reports submitted)

D. Reports of Officers (Verbal Reports)       

  1.      Office of the President
  2.      Office of the President-Elect
  3.      Office of the Vice President
  4.      Office of the Treasurer – Financial Statement for the period 1/1/15 – 9/30/15
  5.      Office of the Speaker

E. Reports of Councilors  (Informational)

  1.          Kings and Richmond Report – Parag H. 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  (no written report submitted)
  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 (no written report submitted)
  14.          Resident and Fellow Section Report – Robert A. Viviano, DO
  15.          Young Physician Section Report – L. Carlos Zapata, MD (no written report submitted

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

  1. Commissioner of Science & Public Health, Frank G. Dowling, MD
    a. Long Term Care Subcommittee Minutes, September 30, 2015
    b. Eliminate Health Care Disparities Minutes, October 9, 2015
  1. Commissioner of Communications, Joshua M. Cohen, MD, MPH
    a. MSSNY Communications Division Report                       
  1. Commissioner of Governmental Relations, Gregory Pinto, MD
    a. Conference Call with Dave Whitlinger, CEO, NYeC
    b. Health Information Committee Minutes, June 22, 2015
    c. HIT Committee Minutes, September 25, 2015z
    d. Quality Improvement Committee Minutes, September 30, 2015       

G. Report of the Executive Vice President

  1. Membership Dues Revenue Schedule
  2. Report of the Coalition of State Medical Societies

H. Report of the General Counsel
                    (no written report submitted)

I. Report of the Alliance
1. Alliance Report

J.  Other Information/Announcements

  1. Sign on letter re State funding to be dedicated to improving healthy food options
  2. VBP Workgroup Meeting (handout at Council)
  3. Technical Design Subcommittee Draft Recommendations (handout at Council)
  4. Letter to Troy Oechsner, Executive Deputy Superintendent, NYS Department of Financial Services re merger of Anthem BC/BS and Cigna
  5. AMA Letter to Dr. Simon re appointment to the Joint Commission Board of Commissioners
  6. Letter dated October 27, 2015 re Comments on Draft NAIC Network Adequacy Model Bill 

K. Adjournment