July 29, 2016 – The Empire Strikes Back

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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July 29, 2016
Volume 16, Number 27

MLMIC

Dear Colleagues:

We can’t declare victory in the battle against anti-competitive health insurance mergers just yet.

In response to last week’s lawsuit by the US Department of Justice challenging the proposed mergers of Anthem/Cigna and Aetna/Humana, this week Anthem (the parent of Empire) purchased full-page ads in several national papers including the Washington Post, USA Today and the New York Times to present a letter to the public from its chair, Joseph Swedish, that it was “surprised and disappointed” by the DOJ’s actions.

“Given the Justice Department’s flawed analysis and misunderstanding of the dynamic, competitive, and highly regulated health care landscape, Anthem is committed to rigorously defending this transaction in court on behalf of all health care consumers,” Swedish’s letter stated.

Unprecedented in Scale

As reported in last week’s e-news, we are pleased that the DOJ took action to block these takeovers.  In announcing the suit, DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country “are unprecedented in their scale and in their scope” (See the press release here.)

Several state Attorneys General, including New York AG Eric Schneiderman, joined in the litigation to block the proposed merger of Anthem and Cigna.  Specifically, AG Schneiderman noted that “By reducing competition, this proposed merger has the potential to significantly increase the merged firm’s power in the marketplace, to the detriment of consumers. Employers will be left with fewer choices, and ultimately consumers could be saddled with higher premium costs, reduced access to providers, and lower quality care.  I stand with my federal and state partners in fighting to stop this merger before it harms New Yorkers.” (See his full statement here.

The action by DOJ shows the power of organized medicine, particularly when we can work proactively with patient advocates.

We Strongly Oppose Merger

MSSNY along with the AMA, state medical societies, hospital associations and consumer groups have opposed these proposed mergers. Specifically, we argued to both DFS and the AG that the merger between Anthem and Cigna would significantly increase health insurer market concentration in the metropolitan New York City area, and in particular on Long Island. This, in turn, would undoubtedly lead to even greater insurer control of health care delivery and further weaken our ability to advocate on behalf of our patients to assure they have coverage for the care they need.

The AMA’s Advocacy Resource Center (which MSSNY staff sits on its Executive Committee) has been extensively involved in a national campaign to prevent these mergers from going forward.  These efforts included written submissions to the US DOJ in opposition to the mergers, a public relations campaign, and assistance to state medical societies including MSSNY with essential background information that has helped to make compelling arguments to state policymakers regarding the mergers’ potentially significant adverse impact on patients and care providers.

These proposed mergers have also been fiercely opposed by the Coalition to Protect Patient Choice, a group comprised of some of the most powerful patient advocacy groups in New York State and in the country, including 1199, Consumers Union, USPIRG, and Health Care for All New York.

Despite all these efforts, the insurers are clearly not going to walk away from these transactions.  The full page ads this week were likely an effort to demonstrate the financial resources they will expend to fight the action of the DOJ, both in court and in the court of public opinion.

Buckle up.  This could become a bumpy ride.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org


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CMS Proposes Expansion of Bundled Payments Program for Cardiac Care Episodes
The use of “bundled payments” in Medicare will likely expand once again.  This week CMS announced a proposed rule to create a new Medicare bundled payment model for heart attacks and bypass surgery using 90-day episodes of care.  The program would be applicable in nearly 100 regions across the country, including in the New York City metropolitan statistical area (MSA), as well as in the Elmira, Rochester, Syracuse and Utica MSAs.  The model would be tested for 5-year performance period, beginning July 1, 2017, and ending December 31, 2021.

At the same time, CMS is proposing to expand the existing Medicare Joint Replacement Bundled Payment program implemented earlier this year to cover surgical hip/femur fracture treatment.  The Joint Replacement bundled payment program is currently applicable to 67 MSAs including the Buffalo and New York City MSAs

To read the proposed regulation describing this proposal, click here.

To read the CMS fact sheet describing these new programs click here.

According to the CMS fact sheet, once the models are fully in effect, participating hospitals would be paid a fixed target price for each care episode, with hospitals that deliver higher-quality care receiving a higher target price.   At the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) would be compared to the target price that reflects episode quality for the responsible hospital. Hospitals that work with physicians and other providers to deliver the needed care for less than the quality-adjusted target price, while meeting or exceeding quality standards, would be paid the savings achieved. Hospitals with costs exceeding the quality-adjusted target price would be required to repay Medicare.

As with the current hip surgery bundle program, upside and downside risk is limited the first few years of the program, with the amounts at risk to hospitals going up significantly by years 4 and 5 of the program.

Importantly, the CMS proposal would permit these bundled payments in certain circumstance to qualify as an Alternative Payment Model (APM) as set forth in the MACRA law passed by Congress last year.  Participation in an APM “pathway” could enable a physician to not have to participate in the Medicare Merit Based Incentive Payment System (MIPS) program as enacted through MACRA and further spelled out in a regulation proposed by CMS earlier this year. The proposed policy, for which the CMS is seeking comment, would be mandatory and would take effect July 1, 2017. It would affect hospitals in 98 randomly selected metropolitan areas.

The CMS also proposed Monday to expand its first and currently only existing bundled payment model to include hip and femur fractures. That program, which took effect in January, currently covers total joint replacements.

In a bundled payment model, the government reimburses providers a set amount per patient for one episode of care, such as a knee replacement, rather than paying for every individual service rendered as part of that procedure. The idea is to create a financial incentive for providers to better coordinate care and keep costs down.

DSRIP Provider Performance Scorecards (PPS) Ready for Viewing
Fourth-quarter reviews and scorecards for each performing provider system, covering activity through March 31 of this year, have been posted online. In DSRIP Year 1, the PPSs earned about 99.44% of the funds available to them, or $1.2 billion. 

DFS Warns Insurers Not To Create More Restrictive Limits for Mental Health
On July 27, in a new guidance, the New York State Department of Financial Services advised health plans that they cannot create financial requirements or treatment limitations for mental health and substance-use disorders that are more restrictive than the same standards applied to medical and surgical benefits.  

Patient Advocacy Groups to Governor Cuomo:  Sign Step Therapy Override Bill Into Law;
MSSNY representatives joined several other patient advocacy groups in a meeting with Governor Cuomo’s top health policy staff this week to urge that he sign into law legislation (A.2834-D/S.3419-C) supported by MSSNY that would establish specific criteria for physicians to request an override of a health insurer “step therapy” medication protocol when it is in the best interest of their patients’ health.  

In addition to staff, MSSNY was represented by Interspecialty Committee and Committee to End Healthcare Disparities member Dr. Inderpal Chhabra, who spoke regarding the hassles he regularly experiences with some insurers when trying to assure his patients have coverage for the medications they need.  Also joining the meeting were representatives of the NYS Society of Dermatology and Dermatologic Surgery (MSSNY member Dr. Mary Ruth Buchness), the NYS Academy of Family Physicians, the National Psoriasis Foundation, the Global Healthy Living Foundation, National Lupus Foundation, Mental Health Association of New York State, National Alliance on Mental Illness-NY, and the American Cancer Society.

To assist in our collective efforts to convince Governor Cuomo to sign this important bill into law, we ask you send a letter to him in support of this legislation.  A customizable template is available from MSSNY’s Grassroots Action Site here.   We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

Specifically, the bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.  While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

Oscar Will Narrow NY Network to Keep Losses Down
Oscar, the health insurance start-up, plans to dramatically narrow its network in New York, a move aimed at keeping premiums and health care costs in check, according to a blog post from the company’s CEO. (Politico 7/27)

Beginning in 2017, the insurer’s network will have 31 hospitals in three systems — Mount Sinai, Montefiore, and the Long Island Health Network — and 20,000 physicians. That’s down from more than 70 hospitals and 40,000 physicians at the beginning of 2016. NYU Langone and Northwell Health are no longer in network. The insurer had 53,000 members at the end of 2015 and saw a 20% increase in membership during the first quarter of 2016, a boost that likely resulted from the collapse of Health Republic Insurance of New York.


CMS Releases Quality Ratings for Hospitals
CMS released its ratings for about 3,500 hospitals. Under CMS’ quality rating system, medical facilities are assigned “one to five stars based on how well they care for patients,” providing consumers with “a new tool for making health-care choices for themselves and loved ones.”
CMS rated 155 hospitals in New York, but only one of them, the Hospital for Special Surgery in Manhattan, got five stars. Of the remaining 142 hospitals, 49 received three stars, 58 got two stars, and 35 were given one star.

US News & World Report says CMS released the “consumer-friendly hospital star ratings over the objections of hospitals and members of Congress, who call the ratings deeply flawed and say they penalize teaching hospitals and those that treat the poor.”

Last week, in an analysis designed to anticipate and blunt criticism, Medicare reported that 102 hospitals would be given five stars, 934 would receive four stars, 1,770 would get three stars and 133 would get just one star. Nearly one out of five U.S. hospitals – 934 – could not be rated because they treat such small numbers of patients the government couldn’t reliably grade them.

CDC Offering One-Hour Zika Virus Webinar Aug. 10 at 7PM
The Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) invite you to join an important webinar focused on Zika virus. CDC Medical Epidemiologist Susan Hills, MBBS, MTH, will present an update on the epidemiological and clinical aspects of the current outbreak. CDC Medical Officer Kiran Perkins, MD, MPH, will present on the implications for pregnant women, including CDC’s updated interim clinical guidance, before fielding questions from webinar participants. Register Here.

Syracuse’s Upstate Medical University announced it will use a five-year, $1 million grant to support a program that seeks to “keep vulnerable populations free of HIV.”

Upstate Med University Granted $1M to Keep Youth Free of HIV
The New York State Department of Health awarded the grant for the school’s new program called “pre-exposure prophylaxis (PrEP) services for general and HIV primary care,” Upstate said in a recent news release.

The program “closely aligns” with Gov. Andrew Cuomo’s “Ending the Epidemic Blueprint2” to reduce the annual number of new HIV infections in New York to 750 by the end of 2020.

The program is available to healthy, HIV-negative adults and adolescents ages 13 and over who are at-risk for HIV and/or sexually transmitted infections (STI).

It is available through Upstate’s Immune Health Services and the pediatric infectious disease/young adult specialized-care center, a program of the Pediatric Designated AIDS Center.

USPSTF: Not enough Evidence for Total-Body Screenings for Skin Cancer
On July 26, the US Preventive Services Task Force [USPSTF] said…that there still isn’t enough evidence to recommend total-body screenings” for skin cancer “and declined to take a position on the practice.” The USPSTF  said “that it could not determine – after reviewing thousands of research papers and studies from around the world – whether the benefits of screening outweighed the potential for harm if unnecessary or excessive procedures were performed.”

Calling Artistic Physicians: Boost Your Clinical Skills with Art!
Join us for MEDICINE AT THE MET: ART IN CLINICAL PRACTICE a new series of ArtMed inSight workshops!

When:  August 12, 2016 from 6 to 8.30pm: Enhancing Observation and Presence

August 13, 2016 from 5 to 7.30pm: Increasing Self-Awareness and Empathic Intelligence

Location: The Met Museum in NYC

Cost:        $125 per;$225 for two

Space is limited! For more information and to register go here. 

Protecting Patient Personal Health Information
Recently, the Centers for Medicare & Medicaid Services (CMS) learned of a potential security breach in which someone was offering for sale over 650,000 records of orthopedic patients. Remember that a covered entity must notify the Secretary of Health and Human Services if it discovers a breach of unsecured protected health information. See 45 C.F.R. § 164.408. Also, keep abreast of any issues that your business associates, especially those entities that provide you with hardware and/or software support for your patient electronic health records. Be sure they are required to report any actual or potential security breaches to you, especially threats that compromise patient PHI.


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please email gumd3@aol.com to arrange for a viewing.


Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

July 22, 2016 – 7-Day Opioid Limitation Begins TODAY!!

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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July 22, 2016
Volume 16, Number 26

MLMIC

Dear Colleagues:

MSSNY will join several other patient advocacy groups next week in a meeting with Governor Cuomo’s top health policy staff to urge that he sign into law legislation (A.2834-D/S.3419-C) supported by MSSNY that would establish specific criteria for physicians to request an override of a health insurer “step therapy” medication protocol when it is in the best interest of their patients’ health.

To assist in these efforts, we ask you to do the following:

  1. Send a letter from MSSNY’s Grassroots Action Site asking Governor Cuomo to sign the bill into law; We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.
  2. Please share with us any recent examples you may have regarding unnecessary hassles health insurance companies have imposed when trying to request an override of such insurer’s step therapy protocol for your patient. Send your examples to mauster@mssny.org. . (Before sending, please remove any patient-identifying information such as patient names, ID numbers or claim numbers.)

Specifically, the bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present:

  • the drug required by the insurer is contraindicated or could likely cause an adverse reaction;
  • the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history;
  • the patient has already tried the required medication, and it was not effective or caused an adverse reaction;
  • the patient is stable on the medication requested by the physician;
  • the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within three days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.

Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org


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Please Take Our 10-Question Telemedicine Survey NOW!
MSSNY developed a brief 10-question survey to measure the membership’s interest in a member benefit related to telemedicine.

Seven Day Initial Opioid Prescribing Limitation Effective On Friday, July 22nd
TODAY, Friday, July 22, 2016 prescribing limitations will go into effect for prescribers under a new law signed as part of New York State’s efforts to curb opioid abuse.   The measure limits to seven days the prescription of Schedule II, III, or IV opioid upon initial consultation or treatment of acute pain.

  • Under the NYS Public Health law “acute pain” is defined to mean pain, whether resulting from disease, accidental or intentional trauma or other cause that the practitioner reasonably expects to last only a short period of time. Such term SHALL NOTinclude chronic pain, pain being treated as part of cancer care, hospice or other end-of-life- care or pain being treated as part of palliative care practices.
  • The new limitation applies to the initial prescription ONLY.  The measure gives flexibility to the prescriber to, upon any subsequent consultations for the same pain, issue  any appropriate renewal, refill or new prescription for the opioid or any other drug consistent with existing 30-day or 90-day statutory limits for Schedule II, III and IV medications.
  • The measure also limits application of co-pays for the limited initial prescription of an opioid to either (i) proportionate amount between the copayment for a thirty day supply and the amount of drugs the patient was prescribed or the equivalent to the copay for the full thirty-day supply provided that no additional copays may be charged for any additional prescriptions for the remainder of the thirty-day supply.
  • The New York State Department of Health has put into place temporary procedure for billing for the Medicaid Fee for Service Program.   The department’s letter can be found HERE.
  • The letter does stipulate that pharmacists are NOT required to verify with the prescriber whether an opioid prescription writer for greater than a seven-day period.
  • Additional information on opioids and this law may be obtained by contacting the NYS Department of Health’s Bureau of Narcotic Enforcement at 1-866-811-7957 or click HERE.
  • For billing questions please contact CSC at 1-800-343-9000.
  • Questions specific to Medicaid FFS policy can be directed to ppno@health.ny.gov or call 518-486-3209. 

Federal Government, New York AG Seeks to Block Health Insurance Mega-Mergers
Noting that the proposed mergers involving four of the five largest health insurance companies in the country “are unprecedented in their scale and in their scope”,  the US Department of Justice announced this week that it was initiating litigation to block the proposed mergers of Anthem (the parent of Empire) and Cigna, as well as Aetna and Humana.

MSSNY, along with hospital and consumer groups, have opposed the proposed merger between Anthem and Cigna as it would significantly increase health insurer market concentration in the metropolitan New York City area, and in particular on Long Island. MSSNY’s letter of opposition here.

Since Humana has very little market penetration in New York (aside from Medicare Advantage), MSSNY had concerns but did not issue a formal statement of opposition to its proposed merger with Aetna.  However, last week, while the New York DFS approved the merger between Aetna and Humana, it imposed several significant conditions including: approval by DOJ; requiring the combined entity to continue offering the same health insurance products; prohibiting acquisition costs from being passed on to consumers and providers; and assuring robust networks.

Several state Attorneys General, including New York AG Eric Schneiderman, joined in the litigation with the US DOJ to block the proposed merger of Anthem and Cigna.  To read AG Schneiderman’s statement, click here:.  Specifically, AG Schneiderman noted that “By reducing competition, this proposed merger has the potential to significantly increase the merged firm’s power in the marketplace, to the detriment of consumers. Employers will be left with fewer choices, and ultimately consumers could be saddled with higher premium costs, reduced access to providers, and lower quality care.  I stand with my federal and state partners in fighting to stop this merger before it harms New Yorkers.”

The AMA’s Advocacy Resource Center was extensively involved in both making arguments to DOJ in opposition to the mergers, as well as in assisting states with essential background information that better enabled state medical societies including MSSNY to make compelling arguments to state policymakers why these proposed mergers would have adverse impact on patients and care providers.

Bloomberg reports (7/20): “Aetna Inc. is ready to go to court if necessary to proceed with its $37 billion takeover of health insurance rival Humana Inc., the company said Wednesday. … The insurer is prepared to argue that there are several ways to ensure there’s enough competition in the market for health plans for the elderly, known as Medicare Advantage, according to a person familiar with the matter. In addition, it has already presented two separate divestiture proposals to U.S. officials, said the person, who spoke on condition of anonymity because the matter is private.” http://bloom.bg/29PB4of

JAMA: Medicare Beneficiaries Have Highest Rate of “Opioid Use Disorder”
research letter published Wednesday in JAMA Psychiatry found Medicare beneficiaries had the highest and most rapidly growing rate of ‘opioid use disorder.’” Data show six out of every 1,000 Medicare beneficiaries “struggle with the condition, compared with one out of every 1,000 patients covered through commercial insurance plans.” In addition, the letter suggested “Medicare beneficiaries may face a treatment gap,” because figures indicate that in 2013, physicians “prescribed a high number of opioid prescription painkillers for this population – which put patients at risk for addiction – but far fewer prescriptions for buprenorphine-naloxone, the only effective drug therapy for opioid use disorder covered by Medicare Part D.” 

Additional Information Regarding CMS Proposed 2017 Medicare Payment Rule
As reported last week, CMS has released its proposed revisions to the Medicare Part B payment system for 2017.  To read a summary prepared by the AMA of the highlights, click here.

Budget Neutrality Impact of “Add on” Codes

Of perhaps greatest significance, CMS is proposing an “add-on” code that could be billed with E/M codes for physicians treating people with mobility-related impairments.  While there is of course great merit in expanding access to patient care through increasing certain Medicare payments, this proposal is funded with an across-the-board cut in payment rates that would (due to “budget neutrality” requirements) completely nullify the 0.5% increase in Medicare payments that was required by MACRA.

2017 Potentially Misvalued Codes List

CMS has identified 83 services for reductions as “misvalued”.   This was required by the Protecting Access to Medicare (PAMA) and Achieving a Better Life Experience (ABLE) Acts of 2014 that set a 0.5% target for reductions for both 2017 and 2018.   To develop the list, CMS identified 0-day global codes that were billed with an E/M code 50 % of the time or more, on the same day of service, with the same physician and same beneficiary.  To prioritize its review, CMS identified codes that have not been reviewed in the last five years and have greater than 20,000 allowed services.

New York GPCI Adjustments

As is required every 3 years, CMS proposes changes to the Geographic Adjustment Factors (GAF) that   differentiates Medicare payments for over 100 different regions throughout the country, including within the 5 Medicare payment localities in New York State.  An initial review of the proposed revised GAFs shows that New York’s 5 payment localities would experience slight reductions in these regional adjustments, almost entirely due to a reduction in the malpractice cost component that helps to determine Medicare fees.  While there has been some leveling in recent years, New York’s malpractice premium costs still continue to far exceed almost all other states, calling into question CMS’ data.  Therefore, MSSNY has asked Senator Schumer’s office to question whether CMS’ data is accurate.

Other Highlights

  • Expand the duration and scope of the Diabetes Prevention Program (DPP), and changes the name to the Medicare Diabetes Prevention Program (MDPP).
  • Recognizing two new CPT codes for separate payment for non-face-to-face prolonged E/M services, which are currently considered to be bundled.
  • Require claims-based reporting regarding the number and level of pre- and post-operative services furnished for 10- and 90-day global services. Specifically, physicians would be required to report a set of time-based, G-codes that distinguish between the setting of care (hospital, office, email/telephone) and whether the services are furnished by a physician or by their clinical staff.
  • Expanding telehealth payment related to the use of a new place of service code specifically designed to report services furnished via telehealth, including for End-stage renal disease (ESRD) related services for dialysis, Advance care planning services; and Critical care consultations
  • changes to the quality measure set that ACOs are required to report to better align the MSSP quality measure set with the measures recommended by the Core Quality Measures Collaborative

To read the entire 856-page rule, click here:.  A chart detailing the specialty by specialty impact of the proposed changes to the Medicare fee schedule are on pp. 788-789.

MSSNY will be working with the AMA and the federation of medicine to review the rule and to make comments on key components. 

Congratulations to 61 NY Practices in the Million Hearts® Risk Reduction Model
The Centers for Medicare and Medicaid Services announced Thursday that 61 groups in New York State were selected for a new program that aims to reduce the risks for heart attacks and strokes among Medicare fee-for-service patients by applying select preventive measures.

The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model is a randomized controlled trial that seeks to bridge a gap in cardiovascular care by providing targeted incentives for health care practitioners to engage in beneficiary CVD risk calculation and population-level risk management. Instead of focusing on the individual components of risk, participating organizations will engage in risk stratification across a beneficiary panel to identify those at highest risk for atherosclerotic cardiovascular disease (ASCVD).

There are a total of 516 participating organizations (List) involved in the Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model. 

Court Case Examines Telemedicine Safety Regulations
A case before a United States Court of Appeals could restrict a state medical board from protecting patient safety through the regulation of telemedicine in that state.

At stake in Teladoc, Inc. v. Texas Medical Board is whether the Texas Medical Board has demonstrated immunity from federal antitrust laws.

The Court of Appeals is being asked to determine whether the Board may be held liable under the antitrust laws for its rule requiring a “defined physician-patient relationship to exist before a physician may prescribe dangerous or addictive medications. The necessary relationship is defined as established through either an in-person examination or an examination by electronic means with a health care professional present with the patient.

Teladoc, which uses telecommunications to connect patients and physicians, provides services in a way that would allow physicians to prescribe medications without the establishment of the required patient-physician relationship. Teladoc alleges that if the Board’s rule is valid, Teladoc would be limited in the way it could carry on business in Texas. It contends that this rule is anticompetitive and seeks to hold the Board liable under federal antitrust laws.

Telemedicine is advancing rapidly as a tool to improve access to care and reduce the growth in health care spending. Last month the AMA House of Delegates adopted new ethical ground rules for telemedicine. But the telemedicine standards of care and practice guidelines are constantly evolving and vary based on specialty and the services provided. It is important that state medical boards remain free to regulate the practice of medicine to ensure patient safety and appropriate prescribing.

“Telemedicine offers significant potential benefits to patients, including expanded access to medical care,” the Litigation Center of the AMA and State Medical Societies said in an amicus brief (log in). “At the same time, telemedicine is inappropriate for certain medical conditions, and it carries risks. Because a physician treating a patient remotely may be called upon to act with limited information, the quality of care may suffer, and a potential exists for fraud and abuse.”

“Given the complex and evolving state of telemedicine,” the brief said, “Texas’ balance of reliance on the expert board to act in the first instance, with state supervision as needed, is entirely appropriate—and should not be subject to second-guessing under the federal antitrust laws.”

Why Telemedicine Regulation Matters

Patient safety is the guiding force behind the Texas Board’s rule. With telephonic consultations, there may be no observation or physical examination of the patient, and there may be no laboratory or other diagnostic work that the physician can use to determine a diagnosis and course of treatment.

One patient case detailed in the brief offers an example of how telephonic consultation, without an in-person examination to establish a patient-physician relationship, led to treatment errors.

“There can be real, material risk of harm from treatment without any physical examination,” the brief said. “That risk is amplified where, as in this complaint, treatment is provided to a patient who cannot even communicate his or her own condition but must rely solely on characterizations by a layperson.”


Telehealth Poised To Revolutionize Health Care
University of Rochester Medical Center, 07/20/2016
Telehealth is growing rapidly and has the potential to transform the delivery of health care for millions of persons. That is the conclusion of a review article appeared in the New England Journal of Medicine. The piece, co–authored by Ray Dorsey, MD, MBA, with the University of Rochester Medical Center and Eric Topol,MD, with the Scripps Research Institute, argues that the growth of telehealth over the next decade and beyond will have profound implications for health care delivery and medicine. This delivery of virtual care over a distance could help address long–standing concerns about the distribution and number of physicians and provide greater flexibility to both patients and clinicians. Telehealth holds the potential to disrupt established patterns of care, the authors argue, because it provides access in a manner that is convenient to the patient and at potentially lower cost.

Many entities, from traditional medical providers to newer start–up companies, now offer virtual visits with a physician around the clock and at an average cost of less than $50 per visit.
By contrast, it takes on average 20 days to secure a 20–minute appointment with a physician that, with travel and waiting, can consume two hours of an individual’s time. The authors identify three trends that are reshaping telehealth. The first is driven by the potential of telehealth to make care more accessible, convenient, and reduce cost. The second is the expanded application of telemedicine from its tradition use in acute conditions, such as telestroke programs that connect neurologists with physicians in distant emergency departments, to episodic conditions, such as a consultation between a pediatrician and a school nurse to diagnose an ear infection in a child, to the ongoing management of chronic conditions.


FDA approves first single injection PCSK9 inhibitor delivery system American College of Cardiology News, 07/18/2016
The U.S. Food and Drug Administration (FDA) has approved Amgen’s evolocumab (Repatha) Pushtronex system, which delivers a proprotein convertase subtilisin kexin 9 (PCSK9) inhibitor once per month. The hands–free system is the first of its kind and delivers 420 mg of evolocumab in a single dose. Evolocumab received FDA approval in August 2015 as a treatment to lower low–density lipoprotein cholesterol – in addition to diet and maximally–tolerated statin therapy – in patients with heterozygous familial hypercholesterolemia, homozygous familial hypercholesterolemia or clinical atherosclerotic cardiovascular disease


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please email gumd3@aol.com to arrange for a viewing.


Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

July 15, 2016 – Possible MACRA Delay

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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July 15,  2016
Volume 16, Number 25

Dear Colleagues:

We received some modestly good news this week suggesting that CMS is beginning to hear our concerns about the overwhelming complexity of the soon to be implemented Medicare Merit Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) programs.  As many of you know, these programs have the potential to significantly cut or increase Medicare physician payments.

CMS Acting Administrator Andy Slavitt stated publicly that the agency is considering delaying the January 1, 2017 start date for implementation of the MIPS and APM programs, and creating a shorter reporting period for physicians. The comments were made at a US Senate Finance Committee hearing this week examining CMS’ implementation of the MACRA law passed by Congress in 2015 to repeal the SGR and creating the MIPS and APM programs.

You can watch the roughly 90 minute hearing here 

We were pleased that Acting Administrator Slavitt, the only hearing witness, repeatedly stated that the success of small and rural practices under MACRA is a “very high priority” for CMS, and that CMS is considering policy measures to ensure that these providers are “set up for success” under the finalized MACRA rule.

Of course, the proof will be in the final rule that gets released by CMS in the fall.

Delaying the start date and creating a shortened reporting period were among the many suggestions offered by MSSNY and many other medical associations in their comments to CMS last month regarding how to revise the proposal.  MSSNY noted that the proposal by CMS to implement the MIPS and APM programs required by MACRA are “far too complex for many physicians who are already drowning in required paperwork from public and private payers”.  You can read MSSNY’s comments here

In addition, MSSNY has joined on to letters to CMS with the Coalition of State Medical Societies  and with 110 state and specialty medical societies initiated by the AMA .  Both joint letters stress to CMS the physician community’s strong concerns with the overwhelming complexity of this proposal, and the need to assure that physicians are exempted who have little possibility of earning more than it takes to comply.

While MACRA provides that payment adjustments under the MIPS and APM programs are not applied until 2019, it will be based upon care delivered to Medicare patients in 2017.  Under MIPS, Medicare payments could be adjusted up or down by 4% beginning in 2019, and up to +/ – 9% by 2022, with additional bonus payments possible.

Of course, it all comes down to whether our patients can continue to receive the timely and quality care they expect and deserve.  MSSNY and other advocacy associations have raised concerns that seniors’ access to needed physician care could be harmed if some or many physicians are forced to leave the Medicare program due to excessive administrative hassle.

Maybe, just maybe, policymakers are starting to understand this.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org

MLMIC


enews large

NYC: First Suspected Woman-to-Man Zika Infection Reported
The first case of sexual transmission of Zika virus from a woman to a man appears to have occurred in New York City, health officials there reported today.

The unnamed woman “engaged in a single event of condomless vaginal intercourse with a male partner the day she returned to NYC from travel to an area with ongoing Zika virus transmission,” according to Alexander Davidson, MPH, and colleagues in the city’s Department of Health and Mental Hygiene, during which she had already begun to show symptoms of infection.

A week later, the male partner also developed Zika symptoms, including fever, rash, joint pain, and conjunctivitis, the officials said in an early online release from Morbidity and Mortality Weekly Report. By this time, the woman had already tested positive for Zika infection, and subsequent testing in the man confirmed that he, too, had contracted the virus.

Because the man appeared to have no other opportunity to acquire the infection, Alexander and colleagues concluded that it must have been transmitted during the sex act.

“This case represents the first reported occurrence of female-to-male sexual transmission of Zika virus,” the researchers wrote in MMWR.

The Deadline for Nominations to Leadership Positions Is August 1
The deadline for nominations for MSSNY Councilors, Officers, Trustees and AMA Delegates is August 1. There is a link to the nomination form on the home page at www.mssny.org.

Physicians Urged to Send Letters of Support to Governor for ERX Changes
All physicians are urged to send letters to Governor Cuomo in support of 2 bills to address issues which have arisen with the implementation of the e-prescribing mandate.

The first bill, S. 6779, Hannon/A.9335-B, Gottfried would ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription in lieu of e-prescribing.  The letter urging the Governor to sign the bill can be accessed by clicking on this link.

In March, the Bureau of Narcotics Enforcement announced that when a physician invokes one of the three statutory exceptions and writes/faxes or calls in a paper script because:  their technology or power has failed; the prescription will be filled outside of New York; or it would be impractical for the patient to obtain medications in a timely manner, they must electronically submit to the department an onerous amount of information about the issuance of the paper prescription. DOH asks that each time a paper/fax/oral prescription is issued, the prescriber must electronically inform the DOH of their name, address, phone number, email address, license number, patient’s initials and reason for the issuance of the paper prescription.

This creates an onerous burden for all physicians, particularly in situations where there is a protracted technological failure, and the physician needs to report dozens upon dozens of paper prescriptions. In fact, Surescripts has stated publicly that there is a 3-6% e-prescription transmission failure rate. This means that in the state of New York anywhere between 7.6 million to 15 million e-prescriptions will fail every year and each prescriber involved with these failures who subsequently write a paper prescription will need to file this information with the state.  In some small communities, even the patient’s initials can convey information that will enable others who access this information to identify the patient who will receive the medication.

The bill passed by the Legislature affords a much more preferable alternative by allowing physicians and other prescribers to make a notation in the patient’s chart indicating that they have invoked one of the three statutory exceptions.

The second bill (A.10448, Schimel/S. 7537, Martins) would authorize a pharmacy which does not have a particular medication in stock to transfer the prescription to another pharmacy. The letter urging the Governor to sign the bill can be accessed by clicking on the following link.

Currently, e-prescriptions cannot be transferred by one pharmacy to another thereby requiring the patient to return to or call the prescriber’s office to ask that he/she transmit the e-prescription to another pharmacy creating unnecessary burdens on the patient and delaying timely access to their medication.

Urge Governor Cuomo to Sign Step Therapy Override Bill
All physicians are urged to send a letter to Governor Cuomo requesting that he sign into law a bill (A.2834-D/S.3419-C) that would establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health.

MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations, specialty societies, hospitals, and pharmaceutical manufacturers to achieve passage of this legislation.      We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

Long Island Newsday recently had an editorial in strong support of the bill.

The bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

DFS Approves Aetna’s Purchase of Humana with Conditions to Reduce Impact on Consumers and Health Providers; Still Requires DOJ Approval
The New York Department of Financial Services has reportedly sent a letter to Aetna indicating that it conditionally approved its proposal to acquire Humana.  While Humana has very little market penetration (limited almost exclusively to Medicare Advantage) in New York, DFS imposed several significant conditions in its approval of the purchase.  While a formal publication of the agreement or a summary has not yet been publicly released, several media reports (including Crains and Bloomberg) note that these conditions will include:

  • That the purchase must first be approved by the federal Department of Justice (DOJ), whose review is still ongoing;
  • No assets from New York insurance products can be used to finance the transaction;
  • None of the acquisition costs including executive compensation can be passed along to New York consumers or providers;
  • No dividends (ordinary or extraordinary) for 3 years from the date of the closing of the transaction;
  • The companies would be prohibited from reducing benefits within plans for 3 years except as required by Medicare
  • The companies would be prohibited from eliminating products for 3 years;
  • The companies would maintain adequate networks “as determined by the Department” for all plans including Medicare Advantage with additional levels of concerns in adequacy for rural and underserved areas.

At the same time, MSSNY, along with hospital and consumer groups, continues to strongly oppose the proposed merger between Anthem and Cigna, which would if approved have a far greater impact in New York’s health insurance market than the Aetna purchase of Humana.  This merger is still under review by DFS and the DOJ.  To read MSSNY’s letter in opposition to DFS, click here.  To read a letter in opposition to DFS from the Coalition to Protect Patient Choice, click here.

Congress Passes Comprehensive Addiction and Recovery Act (CARA) to Address Opioid Epidemic
Early this week, Congress reached agreement and passed the Comprehensive Addiction and Recovery Act (CARA) to address the opioid epidemic. This measure provides a comprehensive framework that includes prevention, treatment and recovery support and also recognized that addiction is a disease.

The legislation calls for the creation of a task force on pain management and calls upon the Secretary of Health and Human Services to advance an educational and awareness campaign regarding prevention and detection of opioid abuse.  In addition, the bill will:

  • improve access to overdose treatment and allow prescribers to co-prescribe naloxone.
  • provide grants to states to establish, implement and improve state-based prescription drug monitoring programs (PDMPs).
  • expand drug take back locations with state and local law enforcement agencies, manufacturers and distributors of prescription medications, retail pharmacies, narcotic treatment programs, hospitals with one site pharmacies and long term care facilities.
  • authorize nurse practitioners and physicians’ assistants to prescribe buprenorphine in an office based setting for up to 30 patients in the first year and 100 patients after the first year.
  • Clarifiy that a doctor or patient may request that a Schedule II prescription be “partially filled.”

A full summary of CARA can be found HERE.

MSSNY has advocated for many of these provisions and has worked with the American Medical Association’s Task Force to Reduce Opioid Abuse in developing positions on many of these issues related to opioids. MSSNY’s Assistant Treasurer, Frank Dowling, MD and Pat Clancy, Vice President for Public Health and Education, are MSSNY’s representatives to the AMA’s Task Force.

In support of the passage of CARA, MSSNY signed onto a joint thank you letter to Congress and also urged that Congress build upon CARA’s achievement by ensuring that appropriate funding is made available for providers to have the resources they need to “prevent opioid addiction from claiming more livers and causing more devastation to families and communities.” MSSNY and 77 other health care advocacy organizations signed this letter. A copy of the letter can be found HERE.

CMS Releases Proposed Medicare Rule for 2017
Late last week, CMS released its proposed rule to update the Medicare Part B physician fee schedule effective January 1, 2017.  To read the CMS summary of highlighted changes, click here.

To read the entire 856-page rule, click here.  A chart detailing the specialty by specialty impact of the proposed changes to the Medicare fee schedule are on pp. 788-789.

In its press release, CMS has highlighted the following proposed changes to Medicare payment:

  • Primary Care and Care Coordination: The rule proposes revisions to payment for chronic care management, including payment for new codes and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health:CMS is proposing to pay for specific behavioral health services furnished using the Collaborative Care Model, in which patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also proposing to pay more broadly for other approaches to behavioral health integration services.
  • Cognitive Impairment Care Assessment and Planning: CMS is proposing a new code to pay for cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s).
  • Care for Patients with Mobility-Related Impairments: CMS is proposing to pay physicians more accurately for furnishing services to beneficiaries with mobility-related impairments.

As is required every 3 years, CMS also proposes changes to the Geographic Adjustment Factors that specify how to differentiate Medicare payments in over 100 different regions throughout the country, including within the 5 Medicare payment localities in New York State.

MSSNY will be working with the AMA and the federation of medicine to review the rule and to make comments on key components.

WHY NICE PEOPLE COLLECT BAD DEBT
Learn how to collect from the experts! This information-packed webinar assists office management in preventing and recovering past due accounts.

Live online Jul 19 11:00 am United States – Chicago or after on demand (45 mins) https://www.brighttalk.com/webcast/10535/212633

MLMIC Advice: Treating Patients with Whom You Have a Close Relationship
The Risk: Physicians are often asked by close friends, relatives, or colleagues for medical advice, treatment, or prescriptions both inside and outside of the office. At times, these individuals may be seen at no charge as a courtesy. Although the American Medical Association advises physicians not to treat immediate family members except in cases of emergency, or when no one else is available, this practice continues to exist.

Unfortunately, over the years, we have seen a number of lawsuits filed against physicians by close friends, colleagues, and even their own family members because of care provided by our insureds. The defense of these suits is frequently hampered by the fact that there are often sparse or entirely non-existent medical records for the patient. The failure to maintain a medical record for every patient is defined as professional medical misconduct in Education Law § 6530(32). Providing care under these circumstances may pose unique risks. Here are some suggestions on how to handle these situations:

Recommendations:

  1. Always create a medical record for friends, relatives, and colleagues for whom you provide care of any kind.
  2. All patient encounters must be documented in the medical record, including those that occur outside the medical office.
  3. A thorough medication history should be obtained to avoid potential drug interactions and identify any contraindications.
  4. Take a complete history when seeing friends, relatives, or colleagues as patients. If indicated, this should include issues that may be uncomfortable to discuss such as the use of psychotropic medications and sexual history.
  5. Perform a thorough physical examination. Sensitive portions of a physical examination should not be deferred when pertinent to the patient’s complaints. These may include a breast, pelvic, or rectal examination. A chaperone may be necessary for those portions of the exam.
  6. Do not write prescriptions for individuals with whom you do not have an established professional relationship and always document the reasons for prescribing the medication and dose. If narcotics are prescribed, the Prescription Monitoring Program (I-STOP) must be checked.
  7. If a surgical procedure is to be performed, a signed informed consent must be present in the record, with accompanying documentation that the requisite risks, benefits, and alternatives to the treatment have been discussed with the patient.

This risk management tip was published in the spring 2016 issue of Dateline.  For a more detailed analysis of the subject of treating friends and family, including two pertinent case studies, please visit MLMIC.com to review the summer 2016 issue of Case Review.

This article has been reprinted with permission from: MLMIC Dateline (Spring 2016, Vol. 15, No. 2), published by Medical Liability Mutual Insurance Company, 2 Park Avenue, Room 2500, New York, NY 10016.  

MSSNY’s Dr. Frank Dowling and AMA Panel Offer Recommendations to Treat Chronic and Acute Pain
At the AMA Annual Meeting last month, a panel of physician experts—which included MSSNY’s Dr. Frank Dowling—offered actions every physician can take to appropriately treat patients with acute or chronic pain, including using PDMPs to improve care and managing chronic pain by focusing on the patient’s goals.

The panel was comprised of physician representatives from the AMA Task Force to Reduce Prescription Opioid Abuse. In light of the opioid epidemic, the task force has put forth recommendations for physicians. “These recommendations come from our colleagues,” Patrice A. Harris, MD, psychiatrist and chair of the AMA Board of Trustees, said. “We are better physicians when we learn from one another.”

Dr. Dowling specifically addressed NY’s PDMP—called I-STOP—and noted that the tool is not just for when a physician plans to prescribe but can also aid in treatment.  “Any time I’m assessing and making a treatment decision, I can look up that information that may be useful, even if I’m not going to prescribe,” Dr. Dowling said. “Some docs will look up all patients in their practice who may be on the schedule … others may look up only when they feel it’s clinically indicated because of a suspicion or a worry or they’re considering a prescription.”

To read the full story, go here.

Governor Announces Crackdown on Synthetic Marijuana after Massive Overdose
The AP (7/14) reports New York Gov. Andrew Cuomo (D) said on Thursday that the state will take steps to crack down on the illegal sale of the drug K2, a type of synthetic marijuana, after 33 people were hospitalized in Brooklyn after overdosing on the drug. Gov. Cuomo said state police, health officials, and others will focus on stopping sales of the drug in bodegas and other shops.

MSSNY IN THE NEWS
·        AMA Wire – 06/22/16
3 things every physician should do when treating pain
(MSSNY Assistant Treasurer, Dr. Frank Dowling, MD quoted)

(MSSNY Mentioned)

Dr. Michael Goldstein, President of the New York County Medical Society quoted)

(MSSNY Mentioned)

Also ran in:

WFXG FOX 54

Syracuse.com – 07/08/16
·        Company News: David Moorthi joined St. Joseph’s Physicians Spine Care
(MSSNY member Dr. David Moorthi mentioned)

·        Politico Pro Health Newsletter – 07/14/16
Listen Up! – Zika Press Release picked up


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please call 516-259-1877 to arrange for viewing.



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

July 8, 2016 – Keep Up Advocacy for More Victories!

 

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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July 8,  2016
Volume 16, Number 24

Dear Colleagues:

With your grassroots efforts and working together with strong allies, your MSSNY was able to achieve a number of important legislative victories this past legislative session to reduce your administrative hassles.

However, the need for our continued advocacy on these issues did not end with the Senate and Assembly passing these bills.

We must now turn our attention to pressing the Governor to sign these important bills into law.  We need you to send letters to the Governor urging that he sign into the law following bills:

  1. Legislation that would establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health. A letter can be sent here.
  2. Legislation that would ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription in lieu of e-prescribing.  A letter can be sent here.
  3. Legislation to permit a pharmacy to transfer an e-prescription to another pharmacy, such as when the initial pharmacy does not have the medication in stock. The letter can be sent here.

The step therapy bill (S.3419-C, Young/A.2834-D, Titone) would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.   An insurer decision must be made within 3 days, 24 hours where the patient’s health is in serious jeopardy if they do not receive the physician requested medication.

We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

The e-prescribing exception reporting simplification bill (S. 6779-B, Hannon/A.9335-B, Gottfried) would allow physicians and other prescribers to make a notation in the patient’s chart when they have had to invoke one of the three statutory exceptions to the mandatory e-prescribing law in lieu of having to report such information to DOH every single time they must write a paper prescription.  Currently, DOH asks that each time a paper/fax/oral prescription is issued, the prescriber must electronically inform the DOH of their name, address, phone number, email address, license number, patient’s initials and reason for the issuance of the paper prescription.

This creates an onerous burden for all physicians, particularly in situations where there is a protracted technological failure, and the physician needs to report dozens upon dozens of paper prescriptions.  This legislation would address this needless burden.

The e-prescription transfer bill (A.10448, Schimel/S. 7537, Martins) would address the situation where a physician must re-submit e-prescriptions to multiple pharmacies if the initial pharmacy receiving the e-prescription is out of stock of the requested for the medication for the patient.   Currently, e-prescriptions cannot be transferred by one pharmacy to another thereby requiring the patient to return to or call the prescriber’s office to ask that he/she transmit the e-prescription to another pharmacy creating unnecessary burdens on the patient and delaying timely access to their medication.

Malcolm Reid, MD, MPP
MSSNY President

Please send your comments to comments@mssny.org

MLMIC


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MSSNY Files Class Action Suit against United Healthcare re Facility Fees
On July 1, MSSNY and other plaintiffs filed a class action complaint against United Healthcare and its subsidiary and affiliate companies (United) alleging that United has unlawfully refused to pay facility fees to physicians and other health care professionals who perform outpatient surgeries at accredited office based surgery (OBS) practices.  The lawsuit was filed in the United States District Court Southern District of New York.

Most United plans allow United insureds to receive insurance benefits from in-network (INET) providers and out-of-network (ONET) providers.  The lawsuit concerns United’s handling of ONET claims, and alleges that United’s refusal to pay facility fees to OBS practices violates the terms of United’s plan documents, including the United plan’s “Certificate of Coverage.”

The Certificate of Coverage sets forth the basic terms under which the United plan provides medical/surgical benefits.  According to the complaint, United’s standard Certificate of Coverage contains a lengthy list of “Covered Health Services,” including “Surgery-Outpatient,” which is defined in the Certificate as “surgery and related services received on an outpatient basis at a Hospital or Alternate Facility or in a Physician’s office.” In such cases, the Certificate states that the benefits not only include coverage for physician services, but also includes coverage for “facility charge and the charge for supplies and equipment.” According to the complaint, the typical United Plan promises to pay for OBS facility charges, and makes no distinction between facility charges of OBS practices and facility charges of hospitals or other facilities.

According to the complaint, until recently, United honored these plan terms.  When a United insured received medically necessary ONET outpatient surgery, United caused the insured’s United Plan to make payment for the surgeon’s services,  and another for the facility fee, and the facility fee was paid regardless whether the entity performing the outpatient surgery was a hospital, ambulatory surgery center (“ASC”) or an OBS practice. More recently, however, United has adopted a uniform policy to refuse to pay OBS facility fees, despite the fact that the overwhelming majority of United plans have not changed the terms of the plan’s Certificate of Coverage with respect to ONET outpatient surgeries. The complaint refers to the policy as United’s “Uniform Refusal to Pay.”

The class action complaint alleges that:

  • United has systematically violated the terms of the United Plans by adopting its Uniform Refusal to Pay and, among other violations of law;
  • United  has systematically violated ERISA by failing to honor plan terms and adopting the Uniform Refusal to Pay that violates plan terms.

MSSNY President Malcolm Reid, M.D. stated that United’s Uniform Refusal to Pay is unfair to the many MSSNY physician members who operate OBS practices and the patients they serve, by failing to adequately reimburse OBS practices for the expenses incurred to operate the operating room.  In the end, the patients are hurt when the OBS practice is not reimbursed for its facility costs, said Dr. Reid.

The other plaintiffs in the lawsuit include the Society of New York Office Based Surgery Facilities (“NYOBS”) and Podiatric OR of Midtown Manhattan, P.C.  MSSNY and NYOBS are seeking injunctive and declaratory relief on behalf of their respective members and patients.

Among the relief requested by the plaintiffs, it is requested that:

  • the court issue an order to require United to reprocess all denied OBS claims in compliance with ERISA and the plan terms; and
  • to notify all Class Members and all  MSSNY and NYOBS members of the right to resubmit claims for services provided through an OBS practice for which facility fees were not submitted in which such facility fees should be covered under the plan terms, and ordering United to reprocess such claims in compliance with ERISA and the plan terms.

The firms Zuckerman Spaeder, LLP and Buttaci & Leardi, LLC represent MSSNY and the other plaintiffs in this action.  MSSNY wishes also to thank its general counsel Kern Augustine, P.C. for its advice and counsel.

If you have any questions concerning the litigation, or have issues relating to coverage for OBS fees, please contact Anant Kumar at Zuckerman Spaeder, LLP at akumar@zuckerman.com or by telephone at 646-746-8841.” 

New: Survival of Independent Practice Section on the MSSNY Website
MSSNY’s Task Force on Survival of Independent Practice, co-chaired by Thomas T. Lee, MD, and Paul Lograno, MD, was formed last fall based on a directive from the House of Delegates. It was charged with exploring options for independent physicians to collaborate and create practice models to deal with current challenges for independent practices and to achieve the goals of diversity of service, economy of scale and collective negotiations.

The Task Force has put together a series of recommendations on options physicians can consider in order to practice successfully in an independent environment. These are real practice models that have been employed successfully by task force members in different specialties and in different parts of the state and that have made them financially successful and free from many administrative frustrations. They are offered as options for MSSNY members to consider, modify or build on.

Please take a look at the new Survival of Independent Practice site here.

Leadership Seminar Slated for Syracuse Oct 21-22
Following a highly successful Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has slated a Leadership program for upstate physicians in Syracuse October 21-22.

The program will be held at the Doubletree Inn at NYS Thruway (Syracuse Exit 36). A renowned faculty from Brandeis and Harvard University will lead the program that is focused on management techniques needed by physicians in an integrated health care environment.

Attendees at the April downstate Leadership Seminar gave the program rave reviews. The program is limited to 40 physician attendees aged 40 and under with all costs are covered under a grant from The Physicians Foundation.  MESF Chairman Joseph Maldonado MD termed the program a “unique opportunity to hear from an outstanding faculty” and better understand the direction of health care delivery in the next 10 years. To see the agenda and faculty click here.  For application forms, contact MESF Executive Director at tdonoghue@mssny.org. 

CMS’ Slavitt to Testify Before Senate Finance Re MACRA Implementation
Next Wednesday, July 13, at 10 AM, US Senate Finance Committee Chair Orrin Hatch (R-Utah) will convene a hearing on to examine CMS’ implementation of the MACRA law passed by Congress in 2015 to repeal the SGR and creating the MIPS and APM Medicare value-based payment programs.   The sole witness for the hearing will be CMS Acting Administrator Andy Slavitt.  Video of the hearing will be available here.

Noting that the proposal by CMS to implement the MIPS and APM Medicare value-based payment programs required by MACRA are “far too complex for many physicians who are already drowning in required paperwork from public and private payers”, MSSNY recently submitted extensive comments to CMS to urge significant changes before the rule is finalized.  To read MSSNY’s comments, click here. 

In addition, MSSNY has joined on to letters to CMS with the Coalition of State Medical Societies and with 110 state and specialty medical societies initiated by the AMA .  Both joint letters stress to CMS the physician community’s strong concerns with the overwhelming complexity of this proposal, and the need to assure that physicians are exempted who have little possibility of earning more than it takes to comply.

While MACRA provides that payment adjustments under the Merit Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) are not applied until 2019, it will be based upon care delivered to Medicare patients in 2017.  Under MIPS, Medicare payments could be adjusted up or down by 4% beginning in 2019, and up to +/ – 9% by 2022, with additional bonus payments possible.

The key points made by MSSNY and other associations in its comments included:

  • The need to significantly raise the MIPS exemption threshold from 100 Medicare patients and $10,000 in Medicare revenue.
  • The need to postpone the implementation start date to at least several months after January 1, 2017, and for a shorter “performance period”
  • The need for a mechanism for physicians to receive comprehensive periodic feedback from CMS as to how they are performing in each of the 4 categories before a “performance period” ends
  • The need to assure that the MIPS program for determining bonuses or penalties compares physicians practicing in similar specialties, and practice sizes rather than all being lumped into one big pool. 


HHS Announces Measures to Address Opioid Abuse
This week HHS announced a series of measures to address the opioid epidemic including:

  • a proposal by CMS that would remove the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey pain management questions from the hospital payment scoring calculation in order to “eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions;”
  • a final rule issued by the Substance Abuse and Mental Health Services Administration (SAMHSA) that would increase from 100 to 275 the number of patients a physician can treat with buprenorphine; and
  • a new policy that would require Indian Health Service (IHS) prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain.

To read the full press release, click here.

House Passes Legislation to Overhaul Mental Health System
The House passed legislation on July 6 to overhaul the nation’s mental health system, the first effort by lawmakers to specifically tackle federal policies on serious mental illness. The bill passed 422-2, overwhelming support that reflected a decision by sponsors to defer debates on some of its most controversial aspects. The bill would reorganize the federal agency overseeing mental health policy, direct funding to combat serious mental illness as opposed to general mental health programs, and change Medicaid reimbursements for treating patients with illnesses like schizophrenia.

The bill passed Wednesday would require the Health and Human Services Secretary to seek public comment and write new regulations on how to handle privacy law in cases of serious mental illness. It would also reauthorize grants for states that already run compelled treatment programs and largely drop restrictions on patient advocacy groups’ work.

It would also boost requirements for private insurers to cover mental health care on an equal footing with physical health, and open official studies on other areas that could support changes in the future. One boost for the House bill came Tuesday from the Congressional Budget Office, which said the measure wouldn’t increase federal spending, and would reduce spending on the Medicaid program by $5 million over 10 years. (Modern Healthcare, 6/28) 

Important Reminder about Billing Requirements for Certain Dual-Eligibles
As part of the AMA’s ongoing work with the Centers for Medicare & Medicaid Services on issues affecting Medicare providers and beneficiaries, the AMA would like to remind physicians that balance billing is prohibited for Medicare beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program. CMS has conveyed their concern that some physicians are still billing QMB beneficiaries, despite the existing prohibition.

The QMB program is a Medicaid program that helps very low-income dual eligible beneficiaries—e.g., individuals who are enrolled in both Medicare and Medicaid—with Medicare cost-sharing.  Beneficiaries in the QMB program have annual incomes of less than $12,000.  Federal law protects QMBs from any cost-sharing liability and prohibits all original Medicare and Medicare Advantage providers—even those who do not accept Medicaid—from billing QMB individuals for Medicare deductibles, coinsurance, or copayments. 

All Medicare and Medicaid payments that physicians receive for furnishing services to a QMB individual are considered payment in full.  It is important to note that these billing restrictions apply regardless of whether the state Medicaid agency is liable to pay the full Medicare cost-sharing amounts (federal law allows state Medicaid programs to reduce or negate Medicare cost-sharing reimbursements for QMBs in certain circumstances).  Physicians may be subject to sanctions for failing to follow these billing requirements, and CMS has indicated that they may start conducting more frequent audits to address this practice. 

For further information, see MLN Matters, Prohibition on Balance Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program.

FDA Approves First Hepatitis C Drug That Treats All Six Strains
The Wall Street Journal (6/28) reports that the Food and Drug Administration has approved Gilead Sciences Inc.’s Epclusa (sofosbuvir/velpatasvir), the first drug that treats all six strains of hepatitis C. According to Gilead, the drug’s list price will be $74,760 for a course of treatments, which is lower than its older hepatitis C treatments. The AP (6/28, Perrone) reports that Epclusa “cures 95 percent of patients in three months, according to clinical trial data reviewed by the FDA.” It is “designed to be used in combination with ribavirin, an older antiviral drug.”

Additional coverage is provided Bloomberg News (6/28), MedPage Today (6/28).

Oxford pulls more plans from NY market
Oxford Health Plans is leaving the individual market in New York in 2017, and also plans to discontinue its small and large group products, UnitedHealthcare announced in a notice to brokers last Friday. While United indicated in the letter that few large groups currently offer an Oxford plan, the loss of the Liberty Network HMO plans and Oxford Metro Network plans will likely leave significant gaps in the small-group and individual markets, respectively, said Alex Miller, a partner at Millennium Medical Solutions, an employee-benefits consulting agency based in Westchester County. “In the last five years, the Liberty HMO has been our most popular product,” he said. But Oxford has requested high premium increases for its small-group plans in recent years, including an average rate hike of 10.58% for 2016.

Instead, the state approved an average increase of 3.9%. BlueCross BlueShield exited New York’s small-group market a few years ago, but is considering re-entering to pick up Oxford’s members, Miller said.

EmblemHealth and 13 oncology practices across New York State are participating in an experimental care delivery model, the U.S. Department of Health and Human Services announced Wednesday. Read the HHS press release here. 

New York’s Zika Numbers on the Rise
The State Health Department reported that as of Tuesday, there were 260 confirmed cases of Zika in New York City, and 74 in the rest of the state. State health officials said there are no cases of reported microcephaly in the state. Speaking on a conference call with reporters on July 1, Dr. Bassett said 24 of those cases were pregnant women for whom Zika can be especially dangerous because of the virus’ effects on the fetus.

FDA: Do Not Eat Raw Cookie Dough Due to E.coli Contaminated Flour
On July 6, the FDA issued a message warning people not to eat raw dough because of a recent outbreak of E. coli linked to contaminated flour.

So far, a reported 38 people in 20 states have been infected by a strain of bacteria called Shiga toxin-producing E. coli O121 found in flour. The infections began last December, and 10 of those infected have been hospitalized.

Symptoms of the bacterial infection include severe stomach cramps, diarrhea (often bloody), and vomiting. Most people get better within a week, but in some cases, infections can lead to a type of kidney failure called hemolytic uremic syndrome. Those who are most vulnerable to severe illness include children under 5, older adults and people with weakened immune systems.

Investigations by the Centers for Disease Control and Prevention and the FDA traced the source of the outbreak to flour that was produced in November 2015 at the General Mills facility in Kansas City, Mo. General Mills has issued a voluntary recall of 10 million pounds of flour produced between Nov. 14 and Dec. 4, sold under three brand names: Gold Medal, Signature Kitchens and Gold Medal Wondra. Flour that is part of the recall should be thrown away.

Unlike other raw foods, like eggs or meat — which many people recognize as contamination risks — “flour is not the type of thing that we commonly associate with pathogens,” said Jenny Scott, a senior adviser in the FDA’s Center for Food Safety and Applied Nutrition.

In this case, investigators believe that the grain became contaminated in the field, where it is exposed to manure, cattle, birds and other bacteria. “E. coli is a gut bug that can spread from a cow doing its business in the field, or it could live in the soil for a period of time; and if you think about it, flour comes from the ground, so it could be a risk,” said Adam Karcz, an infection preventionist at Indiana University Health in Indianapolis.

MACRA Rule Raises Patient Privacy Concerns
Physicians and healthcare organizations have flooded the CMS with concerns about MACRA, the proposed changes to the way Medicare pays providers. They say the rule puts patient data at risk and could actually push providers away from participating in payment models meant to lower costs while increasing quality of care. (Modern Healthcare 6/28)

The Medicare Access and CHIP Reauthorization Act aims to consolidate three existing payment models: the Physician Quality Reporting System, the Physician Value-based Payment Modifier and Medicare’s incentive program for achieving meaningful use of electronic health records.

Agency officials said the new consolidated program will offer physicians greater simplicity and flexibility, providing two paths for physician payments when it goes into effect in 2019. Physicians can choose to participate in the Merit-based Incentive Payment System, or MIPS, or have a significant amount of their revenue generated under a qualifying alternative payment model, or APM.

The agency received nearly 4,000 comments by the June 27 deadline. The majority of comments were critical of the proposed rule.

Several providers said a requirement to submit quality information via a registry or EHR oversteps by asking providers not only for data on Medicare patients, but patients with other forms of coverage as well. Experts say providers are raising a valid point.

Others say the rule could discourage providers from participating in value-based purchasing initiatives. For instance, to quality for a 5% bonus, providers must participate in models that require significant financial risk.

“Although the clinicians participating in shared savings-only models are working hard to support CMS’s goals to transform care delivery, under CMS’s proposal they will not be recognized for those efforts,” Tom Nickels, the American Hospital Association’s executive vice president of government relations and public policy, said in a statement

“We fear this could have a chilling effect on experimentation with new models of care among providers that are not yet prepared to jump into two-sided risk models.”

Providers across the country said the 963-page rule is simply too complex to understand, making it difficult to adhere to.

The rule is expected to be finalized by Nov. 1.

NIH Awards $55 Million to Build Million-Person Precision Medicine Study
The National Institutes of Health announced $55 million in awards in fiscal year 2016 to build the foundational partnerships and infrastructure needed to launch the Cohort Program of President Obama’s Precision Medicine Initiative (PMI). The PMI Cohort Program is a landmark longitudinal research effort that aims to engage 1 million or more U.S. participants to improve our ability to prevent and treat disease based on individual differences in lifestyle, environment and genetics. The project is expected to launch later this year.

The awards will support a Data and Research Support Center, Participant Technologies Center and a network of Healthcare Provider Organizations (HPO). An award to Mayo Clinic, Rochester, Minnesota, to build the biobank, another essential component, was announced earlier this year. All awards are for five years, pending progress reviews and availability of funds. With these awards, NIH is on course to begin initial enrollment into the PMI Cohort Program in 2016, with the aim of meeting its enrollment goal by 2020. The PMI Cohort Program is one of the most ambitious research projects in history and will set the foundation for new ways of engaging people in research. PMI volunteers will be asked to contribute a wide range of health, environment and lifestyle information. They will also be invited to answer questions about their health history and status, share their genomic and other biological information through simple blood and urine tests and grant access to their clinical data from electronic health records. In addition, mobile health devices and apps will provide lifestyle data and environmental exposures in real time. All of this will be accomplished with essential privacy and security safeguards. As partners in the research, participants will have ongoing input into study design and implementation, as well as access to a wide range of their individual and aggregated study results. (NIH News, 07/08/2016


CDC Issues Alert on Multidrug-Resistant Yeast
U.S. healthcare facilities should be alert for Candida auris — an emerging multidrug-resistant yeast that causes invasive disease and carries a high mortality rate — the CDC has warned.

Since 2009, C. auris infections — including bloodstream, wound, and ear infections — have been identified in Africa, Asia, Europe, and South America. In addition, an isolate was identified in the U.S. in 2013. Patients usually become infected several weeks into their hospital stay. The organism appears to spread within healthcare facilities, although the exact mechanism is unknown. Some 60% of infected patients have died, the CDC reports. However, this figure is based on limited case numbers, and many patients had other conditions that put them at increased mortality risk.

Almost all tested isolates have been resistant to fluconazole, more than half resistant to voriconazole, one-third resistant to amphotericin B, and several resistant to echinocandins. Some isolates have been resistant to all three major classes of antifungal drugs.

Commercially available biochemical tests cannot differentiate C. auris from other Candida species; accordingly, the CDC offers advice on laboratory diagnosis at the link below. The agency also advises healthcare facilities on case reporting, patient isolation, and appropriate environmental cleaning.
CDC clinical alert (Free)
CDC Q&A on C. auris (Free)


CLASSIFIEDS


Brand-New Medical Office for Sale in Lynbrook. Ground Floor in Medical Office Bldg. Parking Available
Close to all area hospitals. Ideal for any specialty. Two spacious exam rooms with sinks, cabinetry and two brand-new exam tables. One consultation room, receptionist’s space, waiting area, one bathroom and lab area. Fully furnished. Asking $125,000 (negotiable). Please call 516-259-1877 to arrange for viewing.



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Medical Office For Rent – 715 West 170 Street
Two to five examination rooms available plus Reception,secretarial areas. Two bathrooms and entrances. Ethernet and cable ready. $4000 – $9500/ month. 917.861.8273 drdese@gmail.com Can build to suit including accredited O.R.s


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment



Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777



Board Eligible-Board Certified Adult & Pediatric Allergist – Full Time /Part Time MD, DO
Unique opportunity with a successful, established and respected Allergy, Asthma, Immunology and Internal Medicine practice in the prestigious Main Line suburb of Philadelphia. Highly desirable area with award-winning public school systems. Close proximity to Center City Philadelphia, Pocono Mountains, New Jersey Seashore and New York City. Affiliation with an exceptional suburban health system with active residency program.

Academic appointment a possibility. Large-volume practice with established base built on close personal patient relationships. We offer a professional caring environment supported by an experienced dedicated staff. Competitive salary, pension & profit sharing, paid health insurance and med-mal insurance, and CME stipend. Competitive compensation with bonus structure. Partnership/Equity opportunities available after initial period of employment. Send resume to allergypa@aol.com or call 610-649-9300.


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