September 30, 2016 – Best of the Best Member Benefits

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
September 30, 2016
Volume 16, Number 34

MLMIC

Dear Colleagues:

MSSNY membership is not just about our hardworking Government Affairs Division. One of the many perks of being a MSSNY member is our Member Benefits program. The companies we have chosen are carefully vetted to enhance your practices and your lives. In addition to screening each firm for you, MSSNY monitors member satisfaction to ensure that you are receiving quality services.

I would like to highlight a few that might be of assistance to you and your practice:

  • MLMIC- Medical liability insurer that offers superior protection with at-cost rates at www.MLMIC.com or call 888-782-3821
  • Division of Socio-Economics Ombudsman Program- this program intervenes on behalf of the physician when an insurance claim is in dispute, is reduced or is denied. MSSNY staff has been often able to recoup payments or clarify policy to correct plan indiscretions. For information, call Regina McNally at 516-488-6100 ext. 332.
  • Athenahealth– MSSNY members receive a 6% discount on an integrated suite of practice management services. Our ONLY approved EHR and billing company can be reached at www.athenahealth.com or call 866.927.2843
  • Bank of America– cash reward credit cards at
    personalize.bankofamerica.com/mssny
  • DrFirst– e-prescribing solutions at a discounted price for members at www.DrFirst.com
  • Jerome Associates/Hilb Group-life insurance, long term care, primary healthcare for large and small employers, and disability insurance at http://www.eaijjj.com
  • Kern Augustine Law Firm– attorneys specializing in health law matters offer a free consult and reduced hourly rates for practice- or employment-related matters. Take advantage of a FREE coding and documentation review under attorney-client privilege – avert compliance violations AND correct undercoding mistakes that leave money on the table http://www.drlaw.com/
  • Liberty Mutual– Reduced insurance rates for auto and home exclusively for MSSNY physicians at www.libertymutual.com/mssny
  • Mercer– Data breach insurance and Workers’ Compensation, to cover a wide range of risks that you face as a physician with a practice. Call 800-626-9063 or visit www.MSSNYMemberInsurance.com
  • Merrill Lynch– Mortgage point discounts at http://www.merrillhomeloans.com/mlhl/pages/home.aspx?corpurl=mssny or email dennis.singh@ml.com
  • NYrx Card– for your patients, a discounted prescription card for you to distribute to patients that have no insurance; it also can be used when insurance companies will not pay for a specific drug.  Call Roseann Raia at 516-488-6100 ext 302 for cards to distribute to your patients.

This is just a sample of what MSSNY membership has to offer physicians.

If you have any ideas or suggestions for a member benefit that you think would enhance our current program, please contact Christina Southard at csouthard@mssny.org 516-488-6100 ext 355.

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

Please send your comments to comments@mssny.org


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Governor Signs Bill to Reduce Reporting Burdens When A Physician Issues Paper Prescription
Governor Cuomo has signed legislation (S.6779, Hannon/A.9335,Gottfried) strongly supported by MSSNY which eliminates the requirement for a physician to report a litany of information to a DOH website when he/she issues a paper prescription.  Instead, effective immediately, the physician must make a notation in the patient’s medical record that a paper/oral/fax prescription was issued. Upon learning that the bill was signed into law, MSSNY President, Malcolm Reid, MD issued the following statement: “We are pleased that Governor Cuomo has signed into law legislation to reduce the reporting burdens in those situations when a physician must issue a paper prescription. We thank Senator Hannon and Assemblyman Gottfried for championing this legislation. We look forward to working with the Governor and the Legislature to address other obstacles related to e-prescribing that interfere with patients timely receiving needed medications.”

At the same time, the Governor vetoed two other bills also designed to address burdens associated with e-prescribing:

  • 9334/S.6778 – would have continued to permit oral prescriptions for nursing home residents.  The Governor’s veto message noted that a waiver had previously been granted to permit such oral prescriptions, and that this waiver will now be extended until October 31, 2017.
  • 9837/S.7334 – to permit sending of an e-prescription to a secure centralized site that can be downloaded by the pharmacy filling the prescription.  The Governor’s veto message noted that the bill would “create significant risk of data breaches and unauthorized access to confidential information”.  Instead, the Governor noted that he “is looking closely at a separate bill” (supported by MSSNY) that would permit a pharmacy to transfer an e-prescription to another pharmacy, which “would more directly and safely address the concern addressed by this bill”.

Healthcare Providers Required to Comply with “Non-Discrimination” Reporting Provisions by Mid-October
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which including most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.

To read a comprehensive summary prepared by Donald Moy, Esq. from the firm of MSSNY’s General Counsel, Kern Augustine P.C, to assist physicians with compliance, click here.

According to the AMA, the rule does not apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court.

Covered physicians must comply with the following requirements:

  • Submit an assurance of compliance form to OCR
  • Post a notice of nondiscrimination and taglines in multiple languages
  • Develop and implement a language access plan
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)

To help reduce burden and costs, the HHS Office of Civil Rights (OCR) has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rule, factsheets on key provisions and a list of frequently asked questions.


Patients Fill Out MOLST Forms Incorrectly, Often Countermanding Wishes
University at Buffalo researchers, writing in the Journal of the American Medical Directors Association, say that end-of-life forms are too often ambiguous. Patients often leave forms, which are supposed to specify their requests, blank and that means they will receive the most aggressive form of treatment. Sixty-nine percent of forms reviewed had at least one section left blank. Inconsistencies were found in patient wishes among a subset (14%) of patients, wherein their desire for “comfort measures only” seemed contradicted by a desire to be sent to the hospital, receive IV fluids, and/or receive antibiotics. The conclusion was that patients and proxies may believe that making choices and documenting some, but not all, of their wishes on the MOLST form is sufficient for directing their end-of-life care. The result of making some, but not all, choices may result in patients receiving undesired, extraordinary, or invasive care. http://bit.ly/2dB37Lk


NY Medicaid Statewide Patient Centered Medical Home Program Incentive Payment Program Policy: Update on Retroactive Incentive Payments
The New York State Medicaid Statewide Patient Centered Medical Home (PCMH) Incentive Payment Program provides financial incentives to primary care practices who achieve PCMH recognition from the National Committee for Quality Assurance (NCQA). Payments are given as either per-member-per-month (PMPM) capitation payments for Medicaid Managed Care (MMC) members or as an add-on payment for eligible claims billed for services provided to Medicaid Fee-For-Service (FFS) members. Rates for both PMPM payments and add-ons depend on a provider’s NCQA recognition standard and level. For more information on the current established rates, please see the November 2015 Medicaid Update.

During the first week of each month, the New York State Department of Health’s Office of Health Insurance Programs (OHIP) posts the most recent list of PCMH-recognized practices and their providers to the Health Commerce System (HCS). The list contains the most recent PCMH recognition information the Department has on file from NCQA at that time. MMC plans to  use this list to identify which practices and providers in their networks are eligible to receive the PCMH incentive payments and the rate they should receive.

Due to the monthly schedule of data transmissions from NCQA to the Department of Health and from the Department of Health to HCS, it takes approximately 60 to 90 days after recognition is awarded for health plans to be notified of a new or changed recognition status. This lag has historically caused a two to three month delay in practices receiving PCMH incentive payments.

Policy Change:

Effective January 1, 2017, all MMC plans will be required to pay incentives for the New York State Medicaid Statewide PCMH Incentive Payment Program as of the month of PCMH recognition. This ensures incentives will be paid for every month of PCMH eligibility to practices and their providers. This may require plans to process retroactive payments to recognized practices and providers in their network when affected by this initial lag of information. Regardless of the NCQA recognition effective date, payments due to practices must account for the entire first month of their recognition, and should not be prorated.

MMC plans are required to distribute PCMH incentive payments to practices at least bi-annually, and MMC plans are encouraged to process on a more frequent basis if possible. Providers with questions regarding the frequency of payment for individual plans should contact their MMC plan representatives directly.

Finally, to ensure accurate incentive payments from both MMC plans and FFS Medicaid, providers must supply NCQA with the full address of the site’s physical location, not a billing site address. The National Provider Identifier (NPI) for the group and the individual NPIs of practitioners working at the practice should be provided to NCQA to ensure payments are made accurately.

Questions regarding this policy change may be directed to pcmh@health.ny.gov. Questions regarding claim eligibility and/or billing guidance for Medicaid FFS claims should be directed to the eMedNY call center at 1-800-343-9000. For more information on how to achieve NCQA PCMH recognition, providers may contact NCQA at 1-888-275-7585 or visit the NCQA website at www.ncqa.org.


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


New Fact Sheet Details Physician Efforts to Address Nation’s Opioid Epidemic
The AMA Task Force to Reduce Opioid Abuse has released the attached fact sheet that details the extensive efforts that physicians across the country have taken recently to reverse the nation’s opioid epidemic.  Specifically, the fact sheet notes the following:

.        Every state in the nation saw a reduction in opioid prescribing in 2015—an overall 10.6 percent decrease nationally.

·        State-based prescription drug monitoring programs (PDMPs) were checked nearly 85 million times in 2015—a 40 percent increase over 2014

·        From 2012 to 2016 there has been an 81 percent increase in physicians certified to treat substance use disorders—more than 33,000 across all 50 states.

While not noted specifically in the fact sheet, here in New York State there have been over 50 million searches to New York’s PDMP, with a resulting 90% decrease in so-called “doctor shopping” (patients who visit multiple doctors and pharmacies to get multiple prescriptions for controlled substances)

MSSNY is one of the 25 state medical and national specialty associations represented on this AMA Task Force.  MSSNY Assistant Treasurer Dr. Frank Dowling and MSSNY VP for Public Health Pat Clancy have made extensive efforts to support the work of this group.


Handwriting on Claims Submitted to Medicare
Beginning 10/1/2016, NGS will return to the provider any paper claim submitted with handwriting on the face of the claim that does not meet the criteria of being a signature field for Items 12, 13, or 31. You will receive a notice attached to the front of the claim when it is returned notating this as well. NGS continues to receive claims in which providers are inappropriately writing information on the claim by hand. Some claims are typed or computer generated, then revised with handwritten information prior to submission.

The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 26, Section 30, “Printing Standards and Print File Specifications Form CMS-1500” (596 KB) contains the printing specifications for the CMS-1500 claim form. These printing specifications do not provide instructions to submit handwritten claims.

The only fields on the CMS-1500 claim form that have space and allows for any type of handwriting for signatures of the beneficiary or provider are Items 12, 13, and 31. Other than the signatures, handwriting should not appear on any claim submitted to Medicare. Please refer to CMS IOM 100-04, Chapter 26, Section 30 (596 KB) to make sure you are completing paper claims correctly.


Correction
In last week’s Enews, it was incorrectly stated that MSSNY signed a letter along with the Pennsylvania Medical Society regarding “no confidence” in ABIM (American Board of Internal Medicine). The “no confidence” letter was referencing ABMS (American Board of Medical Specialties) NOT ABIM. Councilor Dr. Parag Mehta, who presented a comprehensive Power Point at the Council Meeting regarding ABMS, wrote to us about the error.

Physicians Foundation Results
The Physicians Foundation is pleased to reveal the results of its fifth Biennial Physician Survey. They received an overwhelming response with over 17,000 physicians providing a glimpse into their current practice environment and anticipated future of medicine.

The bottom line is that physicians are struggling to maintain morale levels, adapt to changing delivery and payment models, and to provide patients with reasonable access to care. While respondents agreed the most satisfying part of their job is the patient relationship, about two-thirds said third-party intrusions detract from the quality of care they can provide.

Even more striking, nearly half (49 percent) of survey respondents say they are either often or always feeling burnt out. This may lead to shifting practice patterns that could reduce the physician workforce by tens of thousands of full-time equivalents (FTEs).

For a deeper look at the findings, the entire report here.


Screening Colonoscopy Provides Little Benefit to Adults Aged 70–79
Screening colonoscopy appears to offer a modest benefit to adults aged 70–74 and little to no benefit to those aged 75–79, according to a study in the Annals of Internal Medicine. The U.S. Preventive Services Task Force recommends routine colorectal cancer screening for those aged 50–75, and screening on a case-by-case basis for those aged 76–85.

Researchers used Medicare data to follow a large group of older adults who hadn’t undergone colonoscopy in the 5 years before baseline. Among adults aged 70–74, the estimated 8-year risk for colorectal cancer was 2.19% among those who subsequently underwent screening colonoscopy, versus 2.62% among those who did not. Among those aged 75–79, this modest benefit was even smaller: 2.84% versus 2.97%.

Screening colonoscopy was associated with an excess 30-day risk for adverse events requiring hospitalization or an emergency department visit: 5.6 excess events per 1000 adults aged 70–74 and 10.3 per 1000 among those aged 75–79.

Annals of Internal Medicine article

Some Physicians Want to Make More House Calls
The New York Times (9/23) in its “Your Money” blog reported on the efforts of some physicians to revive house calls to care for the sick at home rather than in hospitals. The article points out that many practitioners work exclusively in hospitals, but also points out that house calls for Medicare patients increased from 1.5 million in 1995 to 2.6 million in 2014, according to the Centers for Medicare & Medicaid Services. The article also mentions the Independence at Home Act (S. 3130) http://bit.ly/2cR4SoN a bill with bipartisan support that “would expand a Medicare home care demonstration program.”


Elephant Tranquilizer Implicated in Recent Overdose Deaths
The Drug Enforcement Administration is blaming a spate of recent overdose deaths on carfentanil, a synthetic opioid that is roughly 100 times as potent as fentanyl. Just 2 mg of fentanyl can be fatal, while the lethal dose of carfentanil is unknown.

Carfentanil is estimated to be 5000 times as potent as heroin and 10,000 times as potent as morphine. A Schedule II substance, carfentanil is used to sedate large animals like elephants. It is often sold on the streets as heroin. Like with fentanyl, multiple doses of naloxone may be needed.

DEA news release https://www.dea.gov/divisions/hq/2016/hq092216.shtml


CLASSIFIEDS


Well-Established Nassau County Internal Medicine Practice Available for Acquisition
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to surendralal1@yahoo.com


Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

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

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

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


A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



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
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 23, 2016 – Tell Gov Now: Remove E-Prescribing Hassles

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

September 23, 2016
Volume 16, Number 33

MLMIC

Dear Colleagues:

E-prescribing has become a fact of life. Over the last few years, most of us have accepted and adapted to issuing prescriptions electronically, except for those who have a waiver. However, we all know that there are times when circumstances beyond our control require exceptions to e-prescribing—and it’s time to reduce the hassles associated with those situations.

Legislation advanced by MSSNY to rectify E-Prescribing issues encountered by physicians passed both Houses in June—and has now been delivered to the Governor for his signature.

We need your help in urging the Governor to sign into law this recently passed legislation (A.9335, Gottfried/S.6779, Hannon).

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. Presently, the Bureau of Narcotic Enforcement (BNE) requires physicians to electronically submit to the department an onerous amount of information about the issuance of each and every paper prescription. The bill on the Governor’s desk affords a much better 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 letter urging the Governor to sign the bill can be accessed by clicking here.

The second bill (A.10448, Schimel/S. 7537, Martins) would authorize a pharmacy that does not have a particular medication in stock to transfer the prescription to another pharmacy. 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. This creates unnecessary burdens on the patient and delays timely access to their medication. The letter urging the Governor to sign the bill can be accessed by clicking here.

The Governor needs to hear from all of us—the New York physicians who take care of our patients every day. Our focus should remain on the patients who depend on us—not on onerous hassles that take us away from patient care. Please take a minute and contact Governor Cuomo now.

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

Please send your comments to comments@mssny.org


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Physicians Must Post Nondiscrimination Statements by Oct. 19
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which includes most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.

According to the AMA, the rule does NOT apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court. This new rule is the first federal civil rights law to broadly prohibit discrimination on the basis of sex in federally funded health programs. It also includes important protections for individuals with disabilities and enhances language assistance for people with limited English proficiency.

Covered physicians must comply with the following requirements:

  • Post a notice of nondiscrimination and taglines in the top 15 languages spoken by individuals with limited English proficiency
  • Develop and implement a language access plan
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)
  • Submit an assurance of compliance form to OCR

To assist with implementation, OCR has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rulefactsheets on key provisions and a list of frequently asked questions. 


New Report: New York Leads Nation in Medical Home Adoption
A new report from United Hospital Fund (UHF) titled The Growth of Medical Homes in New York State, 2014 to 2016 examines the continued growth of the medical home model in New York, breaking it out by region, degree of certification, and type of facility. New York State continues to lead the nation in adoption of the medical home model; a notable finding of the report is that much of the overall recent growth of medical homes is occurring in hospital clinics as they expand their primary care programs, the explicit goal of several state initiatives.

The report also explains the number of concurrent and competing medical home models, several of which are being supported by New York State initiatives. The proliferation of models has created some confusion among providers, and raises some logistical questions for the State as it continues to promote primary care: how to align the competing programs, how to encourage multipayer support, how to ensure that medical homes can still start up under value-based payment systems, and how to make sure small practices aren’t left behind in these efforts. 


MSSNY Makes Endorsements for the 2016 November Elections
At the September 15, 2016 meeting of the MSSNY Council, the following legislators/candidates were endorsed for election by the Medical Society of the State of New York.   Each has demonstrated themselves to be champions of issues to preserve the ability of patients to continue to receive needed and timely physician care. 

To see which candidates were endorsed by MSSNY, click here.


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


AMA Releases Updated Competition in Health Insurance Report
The AMA released its 2016 Update to its Competition in Health Care Report this week that once again indicated the need for more competition in health insurance markets, and efforts to block the proposed mergers among four of the nation’s biggest health insurance companies.   To read the press release, click here.

MSSNY President Dr. Malcolm Reid recently presented testimony at a New York Department of Financial Services hearing expressing significant concerns about the impact to patient care if the Anthem-Cigna merger to be approved.  The Anthem-Cigna and Aetna-Humana proposed mergers have been challenged by the US Department of Justice.  New York Attorney General Eric Schneiderman joined the action by the DOJ in seeking to block the proposed Anthem-Cigna merger.

The AMA press release noted that, on an individual basis, the Anthem-Cigna proposed merger would diminish competition in 121 metropolitan areas located throughout the 14 states where Anthem is licensed to provide commercial coverage, including: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. The AMA press release also noted that the Aetna-Humana proposed merger would diminish competition in 57 metropolitan areas located throughout 15 states, including: Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas, Utah, Wisconsin and West Virginia.

On an individual basis, the Anthem-Cigna merger would diminish competition in 121 metropolitan areas located throughout the 14 states where Anthem is licensed to provide commercial coverage, including: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Nine of these 14 states are working to block the Anthem-Cigna merger. States that have yet to take an antitrust position on the merger include: Indiana, Kentucky, Nevada, Ohio and Wisconsin.


Liquidator’s Adjudication of Policy Claims Against Health Republic Insurance
On September 15, 2016, the Supreme Court for the State of New York signed an order setting October 11, 2016 at 10:00 a.m. as the date and time for any interested parties or their attorneys to appear and show cause why an order approving certain procedures (the “Claims Adjudication Procedure”) for adjudicating claims for payment under Health Republic’s insurance policies should not be entered.

If you are a health care provider and have a Policy Claim against Health Republic, you should have submitted your Policy Claim in accordance with the deadlines and procedures set forth in the contract governing your provision of services to former members of Health Republic (your “Health Republic Contract”). If you already properly submitted a Policy Claim in accordance with the requirements of your Health Republic Contract, you do not need to re-submit it.

It is anticipated that EOBs will begin to be mailed to Providers and Members in the first quarter of 2017. If a Provider accepts the EOB, they are not required to take any further action. If a Provider disagrees with the EOB, they will have the opportunity to appeal any and all determinations set forth in the EOB through Health Republic’s website at www.healthrepublicny.org or by paper copy to the address indicated in the Claims Adjudication Procedure. The written appeal and supporting documentation must be submitted within 60 days of the date of mailing of the EOB. The Liquidator and her agents, utilizing the appropriate resources to investigate the appeal, will review each appeal and, within 60 days, either grant the appeal and issue a revised EOB or deny the appeal and provide the reasons for the denial.

If a Provider objects to the determination of the appeal, the Provider will have 30 days from the date the notice of denial is sent to file an objection to the denial of the appeal. PROVIDERS WHO WOULD LIKE TO RECEIVE A HARD COPY OF THE CLAIMS ADJUDICATION PROCEDURE SHOULD CONTACT THE GARDEN CITY GROUP VIA THE HEALTH REPUBLIC HOTLINE at (866) 680-0893. Requests for further information or questions may be directed to (866) 680-0893 or www.healthrepublicny.org.


 “When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

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

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly. 


YP/Resident Leadership Seminar Slated for Syracuse Oct 21-22
Following an exciting Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has now slated a Leadership program for upstate physicians in Syracuse from late afternoon Friday, Oct 21 through Saturday, Oct 22.

The program is scheduled for the Doubletree Inn at Syracuse Thruway exit 36. A renowned faculty from Brandeis and Harvard University will lead the program, which 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 covered under a grant from The Physicians Foundation.  For further information, contact MESF Executive Director at Tom Donoghue tdonoghue@mssny.org. 


Pediatrics Group: “Time to Say ‘No’” to Codeine for Children
The American Academy of Pediatrics is urging clinicians and parents to stop giving codeine to children, citing risks for respiratory depression and death.

Highlights of the clinical report, published in Pediatrics, include:

  • Genetic variation in codeine metabolism can lead to excessive morphine levels in some children, and is a particular concern in those with sleep-disordered breathing. From 1965 to 2015, the FDA Adverse Event Reporting System recorded 64 children with severe respiratory depression and 24 deaths associated with use of codeine.
  • Despite warnings from the FDA and international groups, codeine continues to be used widely for pediatric pain and cough. In 2011, it was prescribed to more than 800,000 U.S. children younger than 11 years. Codeine is available in over-the counter cough medicines in 28 states.
  • Among the limited alternatives for pediatric analgesia, other opioids are not recommended due to similar safety concerns. Nonopioid options, chiefly nonsteroidal anti-inflammatory agents and acetaminophen, may be effective for mild-to-moderate pain.

Pediatrics online-first page

Full NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of AAP clinical report


CLASSIFIEDS


Well-Established Nassau County Internal Medicine Practice Available for Acquisition
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to surendralal1@yahoo.com


Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

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

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

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



A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



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
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 16, 2016 – What Is Really Discussed at Council?

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

September 16, 2016
Volume 16, Number 32

MLMIC

Dear Colleagues:

Yesterday, the Council meeting to plan for 2016-2017 activities met in Westbury. The six meetings we convene in a year’s time are usually quite lively in spite of the fact we always have an ambitious agenda. Yesterday’s was 127 pages.

The following items were deliberated and voted upon:

  • Council voted to sign-on to the Pennsylvania Medical Society MOC letter making the official declaration of No Confidence in the ABIM. The voting was preceded by an informative presentation by Dr. Parag Mehta outlining the case against the necessity of MOC requirements and highlighting the growing protest over the MOC process.
  • Council approved the following resolution as amended: Whereas CMS is permitting a process of “seamless conversion” wherein seniors are transitioned from traditional MCR insurance products into Medicare Advantage options with seniors having little understanding of the implications, MSSNY will prepare a simple, easy to read modifiable model letter for physician members to provide their Medicare enrollees this month as well as a poster for physicians to post. Additionally, MSSNY will work with appropriate stakeholders to collaborate with senior groups to raise awareness among physicians and seniors on the implications of the practice of seamless conversion and will work with appropriate stakeholders to advocate with legislators and CMS to implement an immediate moratorium on the practice of seamless conversion. MSSNY will bring the resolution to the AMA.
  • Council approved an in-person, rather than a virtual meeting, for the January 2017 Council meeting.
  • Council approved the Congressional, State Senate and State Assembly candidates for MSSNYPAC endorsement http://bit.ly/2cPkoUb
  • The 2017 House of Delegates will be held April 21-23 at the Westchester Marriot in Tarrytown. Speaker of the House Dr. Geraci-Ciardullo announced the Resolution deadlines for the 2017 House of Delegates: February 17, 2017 and March 17, 2017 (final deadline).

Your Councilors make a concerted effort to attend these meetings on their own time and take their posts very seriously. Your interests as a practicing physician are utmost in their minds when issues come up for discussion. You can read your county report that was submitted on behalf of your geographic area. You might want to call your Councilor to discuss your issues and concerns about your practice. You might even want to thank your Councilor for their service to your county and the personal time spent on our pressing issues. They are:

  1. Kings/Richmond Report– Parag H. Mehta, MD
  2. Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
  3.  Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
    (no written report submitted)
  5. Suffolk County Report – Maria A. Basile, MD, MBA
  6. Third District Branch Report – Brian P. Murray, MD
  7. Fourth District Branch Report – John J. Kennedy, MD
  8.  Fifth District Branch Report –Howard H. Huang, MD
  9. Sixth District Branch Report – Robert A. Hesson, MD
  10.  Seventh District Branch Report – Mark J. Adams, MD
  11. Eighth District Branch Report – Edward Kelly Bartels, MD
    (no written report submitted)
  12. Ninth District Branch Report – Thomas T. Lee, MD
  13.  Medical Student Section Report –Christina Kratschmer
  14.  Organized Medical Staff Section Report –Richard A. Ritter, MD (no written report submitted)
  15. Resident & Fellow Section Report – Robert A. Viviano, DO
  16. Young Physician Section Report – L. Carlos Zapata, MD(no written report submitted)
  17. Resident & Fellow Section Report– Robert A. Viviano, DO16.
  18. Young Physician Section Report – L. Carlos Zapata, MD (no written report submitted) 

We are all working hard for you and your practice.

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

Please send your comments to comments@mssny.org


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MSSNY Makes Endorsements For The November Elections
At the September 15, 2016 meeting of the MSSNY Council, the following legislators/candidates were endorsed for election by the Medical Society of the State of New York.   Each has demonstrated themselves to be champions of issues to preserve the ability of patients to continue to receive needed and timely physician care. 

NEW YORK STATE ASSEMBLY

  • Kevin Cahill (D, 103rdAD – Dutchess and Ulster counties)
  • Michael Cusick (D, 63rd AD- Richmond County)
  • Deborah Glick (D, 66th AD, NY County)
  • Richard Gottfried (D, 75th AD, NY County)
  • Charles Lavine (D, 13th AD, Nassau County)
  • Joseph Morelle (D, 136thAD, Monroe County
  • Robin Schimminger (D, 140th AD, Erie and Niagara counties)

NEW YORK STATE SENATE

  • Tom Croci (R, 3rdSD, Suffolk County
  • Kemp Hannon (R, 6th SD, Nassau County)
  • Robert Ortt (R, 62ndSD, Monroe, Niagara and Orleans Counties)
  • Michael Ranzenhofer (61stSD, Erie, Genesee and Monroe Counties)
  • James Seward (51stSD, Cayuga, Chenango, Cortland, Delaware, Herkimer, Otsego, Schoharie, Tompkins and Ulster counties)
  • James Tedisco (Candidate For 49thSD, Fulton, Hamilton, Herkimer, Saratoga and Schenectady Counties)
  • Catherine Young (57thSD, Allegany, Cattaraugus, Chautauqua and Livingston Counties)

US CONGRESS

  • Chris Collins (R, 27thCD – Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans and Wyoming Counties)
  • Joseph Crowley (D, 14thCD – Bronx and Queens counties)
  • Elise Stefanik (R, 21stCD – Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, St. Lawrence, Saratoga, Warren and Washington counties)
  • Paul Tonko (D, 20thCD – Albany, Montgomery, Rensselaer, Saratoga, and Schenectady counties)  

NEW YORK STATE ASSEMBLY

Assembly Member Kevin Cahill 103rd AD (Ulster and Dutchess counties)  Chairs the Assembly Insurance Committee, and a member of the Health, Higher Education and Ways & Means Committee. Assemblyman Cahill works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.  This past legislative session, he led efforts to assure that the Assembly rejected cuts to the Excess Medical Malpractice program proposed in the Executive Budget, which preserved coverage for 13,000 physicians across New York who otherwise would have been dropped from the program.  He also was a forceful vocal opponent to legislation rejected by the Assembly proposed in the State Budget and on a “stand-alone” basis that would have permitted corporate-owned retail clinics.  Moreover, as Chair of the Assembly Insurance Committee, he was integral in helping to shape legislation supported by MSSNY and passed by the Legislature that provides physicians with a mechanism to override a health insurer step therapy medication protocol.  He is also one of the principal co-sponsors of legislation to permit physicians to collectively negotiate with health insurers.

Assembly Member Michael Cusick 63rd AD (Richmond County) Sits on the Assembly Higher Education and Ways & Means Committees. Assemblyman Cusick works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.   He was chief sponsor of legislation that passed the Legislature to hasten the time for insurers to complete review of applications for physicians to participate in the insurer’s network.  Despite his sponsorship of the I-STOP legislation, hHis efforts were critical in helping to greatly improve the final version bill of the I-STOP bill over earlier versions, including working to assure a physician could delegate the “duty to consult” to staff.  He also was very helpful in efforts to help shape legislation so as to reduce the hassles to physicians associated with required CME for pain management, and limitations on specific opioid medications. In 2015-16, he supported a number of bills of importance to MSSNY in floor votes, including legislation to require health insurers to use similarly trained physicians before denying patient care, and legislation to assure due process protection for physicians when health plans do not renew physician participation contracts with them.   He is also a co-sponsor of legislation to permit physicians to collectively negotiate with health insurers.

Assembly Member Deborah J. Glick (D) 66th AD New York County) Assemblywoman Glick chairs the Assembly’s Higher Education Committee.   She has been tenacious in opposing legislation to permit corporate owned “retail clinics” and has been a strong advocate in opposition to CME mandates.    She has been a fierce opponent to inappropriate scope of practice expansion bills, including those that the Senate had passed in recent years such as the podiatric, athletic trainer and a bill to allow chiropractors to co-own medical practice in contravention of the corporate practice of medicine doctrine.  She and her staff have an outstanding working relationship with MSSNY.

Assembly Member Richard Gottfried 75th AD (New York County). Chairs Assembly Health Committee and sits on the Assembly Higher Education Committee. In that capacity, Assemblyman Gottfried has introduced and secured passage of legislation to protect physician and patient concerns with e-prescribing.  He also the long time sponsor of numerous MSSNY priority bills, including legislation to provide peer review confidentiality protections and to permit physician collective negotiations. He also opposed changes to the Excess Medical Liability Insurance program. He works closely with MSSNY staff and has a good record of taking action consistent with MSSNY’s positions.

Assembly Member Chuck Lavine 13th AD (Nassau County). Sits on the Assembly Codes, Health, Higher Education, Insurance, and Judiciary Committees. Assemblyman Lavine works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.  In 2015-16, he sponsored multiple bills to address concerns raised by physicians, including legislation (which passed the Assembly) to assure due process protection for physicians when health plans do not renew physician participation contracts with them, and legislation that would prohibit health insurers from using extrapolation when they audit physicians (which also passed the Assembly). In 2015-16, he supported a number of bills of importance to MSSNY in committee and floor votes, including legislation to permit physicians to collectively negotiate with health insurers (he is a co-sponsor), and legislation to require health insurers to use similarly trained physicians before denying patient care.  He also voted against multiple bills opposed by MSSNY, including stand-alone legislation to require physicians to take pain management CME and legislation that would have imposed a 5-day limit on medications to treat acute pain.

Assembly Majority Leader Joseph Morelle 136th AD (Monroe County). Assembly Majority Leader. Assemblyman Morelle was instrumental in efforts to delay passage of an overbroad pain management CME mandate and helped to assure that the final opioid legislation enacted addressed many concerns raised by physicians.  He was also helpful in efforts to prevent passage of legislation to permit corporate owned retail clinics. He is also opposed to most scope of practice changes and supports legislation to provide additional protections for physicians and patients to prevent insurers from denying or delaying necessary medical care. He opposed proposed changes to the Excess program and opposed changes to the workers compensation program that would have added certain non-physician providers to provide care to injured workers and a proposal to eliminate the county medical society role in review of applications to the workers’ compensation program.

Assembly Member Robin Schimminger 140th AD (Erie and Niagara counties) Sits on the Assembly Health, Codes and Ways and Means Committees.  Assemblyman Schimminger works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.    He is the long-time sponsor of the Medical Liability Reform Act, legislation which contains a number of provisions to address the high cost of medical liability insurance, including:

  • A cap on non-economic damages
  • Reducing joint and several liability
  • Identification of expert witnesses in medical liability cases
  • Identification of physician providing certification for Certificate of Merit

Assemblyman Schimminger also sponsored legislation to prohibit hospitals from requiring board certification as a condition of staff privileges, and health insurers from requiring board certification as a condition of participation. In 2015-2016, he supported a number of bills of importance to MSSNY in committee and floor votes, including the Collective Negotiation legislation, and legislation to assure due process protection for physicians when health plans do not renew physician participation contracts with them.   He also voted in opposition to a number of bills also opposed by MSSNY, including legislation to extend the medical liability statute of limitations, legislation to require physicians to complete CME for pain management, and legislation that would have imposed a 5-day limit on medications to treat acute pain

NEW YORK STATE SENATE

Senator Tom Croci (R) 3rd SD (Suffolk County). Chairs Senate Ethics, Veterans and Homeland Security & Military Affairs. In his capacity as chairman of the Senate Veterans Committee, Senator Croci worked with the Committee on Mental Hygiene to secure for MSSNY, NYSPA and NASW a grant to assist in the development and presentation of continuing medical education programming on the diagnosis and treatment of PTSD and TBI in returning veterans.

Senator Kemp Hannon (R) 6th SD (Nassau County). Chairs Senate Health Committee. Senator Hannon has, at the request of MSSNY, carried and successfully passed a number of bills including three bills to address issues with e-prescribing, standard prior authorization request forms, physician collective negotiation (2011) and has introduced medical liability reform legislation including a cap on noneconomic loss and peer review confidentiality legislation while advocating within his conference on behalf of MSSNY against the date of discovery bill.

Senator Robert Ortt (R) 62nd SD (Monroe, Niagara, Orleans Counties). Chairs Senate Mental Hygiene & Developmental Disabilities Committee. In his capacity as chair of the Mental Hygiene Committee, Senator Ortt, worked with the Committee on Veterans to secure for MSSNY, NYSPA and NASW a grant to assist in the development and presentation of continuing medical education programs on the diagnosis and treatment of PTSD and TBI in returning veterans.

Senator Michael Ranzenhofer (R) 61st SD (Erie, Genesee, Monroe Counties), is the Deputy Majority Leader for Economic Development and Chairs the Corporations, Authorities & Commissions Committee, and is a member of the Senate Finance Committee.  During the Senate caucus on the Date of Discovery Statute of Limitations bill in the final hours of session, Senator Ranzenhofer is reported to have stridently argued against the bill thereby aiding in its defeat.

Senator James Seward (R) 51st SD (Cayuga, Chenango, Cortland, Delaware, Herkimer, Otsego, Schoharie, Tompkins and Ulster counties), is the Chair of the Senate Insurance Committee, and member of the very powerful Senate Finance, Health and Rules Committees.  Senator Seward has long been a champion of medical liability reform and staunch opponent of liability expansion legislation.   He has also been a regular participant at MSSNY’s Annual Albany Physician Advocacy Day.  This year, as Chair of the Senate Insurance Committee, he was integral in helping to shape legislation supported by MSSNY and passed by the Legislature that provides physicians with a mechanism to override a health insurer step therapy medication protocol.

Jim Tedisco (R) Running to fill vacant 49th SD (Fulton, Hamilton, Herkimer, Saratoga and Schenectady Counties). Assemblyman Tedisco has represented voters in Schenectady and Saratoga Counties since 1982. He is very well known in his District and has been a long-time friend of medicine. He served as Minority Leader of the Assembly from 2005 to 2009. He has had a long and very good working relationship with MSSNY DGA staff and MSSNY physicians. He supported the step therapy override bill and legislation that would eliminate the requirement for physicians to report to the State each time they write a prescription in lieu of an e-prescription.

Senator Catherine Young (R) 57th SD (Allegany, Cattaraugus, Chautauqua, and Livingston Counties). Senator Young chairs the Finance Committee, as well as the Senate Republican Campaign Committee. As Chair of the Senate Finance Committee, working with the Chair of the Senate Health Committee, Senator Young steadfastly opposed the Governor’s proposal to reduce funding of the Excess program substantially reducing the number of physicians eligible for such coverage, opposed the retail clinic proposal and opposed the workers compensation proposal to add certain non-physician providers to provide care to injured workers and a proposal to eliminate the county medical society role in review of applications to the workers’ compensation program. She also sponsored legislation that would empower physicians to override step therapy protocols to assure that their patients have timely access to medically necessary medication.

US CONGRESS

Representative Chris Collins (R) CD 27 (Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Wyoming) Representative Chris Collins is running for his 3rd term.  He serves on the very powerful House Energy & Commerce Health Subcommittee. Representative Collins and his staff work closely with local physicians and MSSNY staff, and he has a strong record of advocating for policies consistent with the concerns of physicians and patients.  He is a co-sponsor of the Fair Medical Audits Act of 2015 which would restore some fairness in the conducting of audits by Medicare Recovery Audit Contractors.  He also signed unto a letter to CMS that expressed strong opposition with a CMS proposal that would significantly cut the payments to physicians for medications administered to patient under Medicare Part B.  Moreover, at a Congressional hearing last December, he aggressively questioned CMS Acting Administrator Slavitt regarding CMS response to the collapse of Health Republic and its impact on local physicians.

Representative Joe Crowley (D) 14th CD (Bronx and Queens Counties) Congressman Crowley is running for his 10th term. He serves on the very powerful House Ways & Means committee, which has jurisdiction over much of the health care policy considered by Congress. Representative Crowley and his staff work closely with local physicians and MSSNY staff, and he has a strong record of advocating for policies consistent with the concerns of physicians and patients. He is lead sponsor of legislation that would significantly increase the number of residency slots to address doctor shortages in New York and across the country. He was also very vocal in support of efforts that ultimately led to a repeal of the flawed Medicare Sustainable Growth Rate formula, including leading a bi-partisan effort to use the Overseas Contingency Operations (OCO) funds to pay for its repeal.  Moreover, he recently signed unto a letter to CMS that expressed strong concerns with a CMS proposal that would significantly cut the payments to physicians for medications administered to patient under Medicare Part B. 

Representative Paul D. Tonko (D) CD 20 (Albany, Schenectady and parts of Montgomery, Rensselaer and Saratoga Counties) He is serving his fourth term, and is one of New Yorkers on the very powerful House Energy and Commerce Committee – one of the Committees with health care jurisdiction.  Congressman Tonko served for over 20 years in NYS Assembly prior to running for Congress, and was the sponsor of the Mental Health Parity bill.    He has carried his advocacy for mental health parity to Congress.  He has also been a strong advocate to expand opioid treatment capacity for community caregivers – legislation that in May, passed the U.S. House of Representatives. Congressman Tonko is the vice co-chair of the Congressional Addiction, Treatment and Recovery Caucus.  He has an excellent working relationship with local physicians and with MSSNY staff.

Representative Elise Stefanik (R) 21st SD (Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, St. Lawrence, Saratoga, Warren, Washington). Running for second term, the Congresswoman serves on the House Armed Services Committee and the Committee on Education and the Workforce.   She authored the Be Open Act – legislation that was signed into law by the President to fix a flaw in ObamaCare by repealing the auto-enrollment mandate that reduces choices in health coverage and has created confusion that can lead to significant tax penalties on both the employer and employee. She also signed onto a House Republican Delegation letter to CMS in opposition to a Medicare Demonstration program that would significantly impair seniors’ access to care by reducing physician reimbursement for injectable medications.   She has worked closely with many local physicians, including several MSSNY leaders.

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.

The bill has not as of yet been delivered to the Governor.

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.

Over the summer, MSSNY representatives and several other patient advocacy groups met with the Governor’s office to urge that this bill be signed into law.  Moreover, in Augusts, dozens of patient advocates rallied at the State Capitol in support of this 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.

Gov. Signs Laws to Improve Voluntary Organ Donation
New York State has the third highest need for donors – with 10,000 residents currently waiting for organ transplants – but the lowest number of registered donors. Governor Cuomo has now signed three laws that will help improve voluntary organ donation in New York.

  • Lauren’s Law, which requires individuals who apply for a New York State Driver’s License to affirmatively decide whether or not to participate in the state’s organ donor registry, was extended for four years.
  • The Organ Donor Registration Opportunity/Health Benefit Exchange law requires applications for insurance coverage through the State’s Health Benefit Exchange to include an opportunity for individuals to participate in New York’s Donate Life Registry.
  • Another new law lowers the minimum age for organ donation designation to 16 years old. The law, taking effect February 14, 2017, allows individuals age 16 and older to enroll in the New York State Donate for Life Registry and to consent to making lifesaving organ and tissue donations. The vast majority of other states have this law. 


Empire Bluecross/Blueshield to Participate in CMS Multi-Payer Initiative
Empire BlueCross BlueShield has been selected to participate in the Centers for Medicare and Medicaid Services’ Comprehensive Primary Care Plus program, a five-year multi-payer model.

The program, according to CMS, is designed to bolster primary care through regionally-based multi-payer payment reform by bringing different payers, like CMS, commercial insurance plans and state Medicaid agencies, together to make changes to health care delivery.

CPC+ will have two primary care tracks with “incremental advanced care delivery requirements” and payment options, in the hopes each will have better infrastructure to deliver care to patients, according to CMS. Practices will be centered on certain functions, like access and continuity, care management, comprehensiveness and coordination, patient and caregiver engagement and planned care and population health, according to CMS.

Providers that want to participate in CPC+ need to apply through CMS and will be announced later this year.


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


NYSDOH Offering “A September 2016 Series of Zika Virus Webinars”

  • Zika Virus: An Update for Obstetric and Neonatal Providers and the Birth Facility Team
    When: Tuesday, September 20, 12 – 1 p.m.
    Speakers: Lou Smith, MD, MPH, Medical Director, Bureau of Communicable Disease                       

Control

  • Zika Virus: An Update for the NYS Healthcare Provider             When: Wednesday, September 21, 12 – 1 p.m.
    Speakers:
    P. Bryon Backenson, MPH, Director of Vector-Borne Diseases and   Elizabeth Dufort, MD, FAAP, Medical Director, Division of Epidemiology, NYSDOH
  • Zika Virus: An Update on Transplant Associated Concerns             When: Thursday, September 22, 12 – 1 p.m.
     Host: NYSDOH and the NYS Transplant Council
    Speakers: Kirsten St. George, MAppSc, PhD, Chief Viral Diseases, Wadsworth Center,                                                                        NYSDOH; Lewis Teperman, MD, FACS, Vice Chair of Surgery & Director of Organ Transplantation at Northwell Health, Manhasset NY and Region 9 Councillor to the United Network for Organ Sharing (UNOS); Marian Michaels, MD, MPH, Professor of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Disease Transmission Advisory Committee (DTAC) Vice Chair, United Network for Organ Sharing (UNOS)
  • Zika Virus: An Update for the Pediatric Provider
    When: Wednesday, September 28th 2016, 12 – 1 p.m.

Please click here for more information and to register.

UnitedHealthcare Physician Advocacy Council: Any Questions to Ask Them?
As part of the last legal settlement with United that was concluded in 2015, United agreed to the formation of a Committee referred to as the PAC – Physician’s Advisory Council.  The Medical Society of the State of New York has 4 physician members who are on the UHC PAC.  The Committee meets 4 times a year with similarly named physicians from United.  One criteria for being on this group is that the physician must be participating with United.

The Committee is charged with addressing any issue of contention, either operational or administrative, that might be encountered in dealing with United. While issues are discussed at length, the agreement stipulates that UHC is there to listen and report back to the UHC leadership on items discussed.  United does not present new policy matters to the PAC.  However, the group could discuss United policy issues that cause concern and these concerns would then be taken back the leadership for their thoughts and/or action.  The spirit of the settlement agreement is that MSSNY could share subject matters at a high level to garner a better relationship with UHC.

In this spirit, MSSNY is asking members if they have specific issues with United that we can address and advocate for your behalf.  If you have a concern, please send an email to Regina McNally, VP, Socio-Medical Economics.  Please state the subject as UHC PAC Item and send your email to rmcnally@mssny.org  MSSNY email is not HIPAA-secure, so please do NOT include any PHI!

Many Seniors Wrongly Denied Medicare Coverage
The New York Times (9/13,) reports that beneficiaries are often told Medicare will no longer cover physical therapy or nursing home stays because they are “stable and chronic,” or have reached “maximum functional capacity,” or they have plateaued.

Seniors “with chronic and progressive diseases – dementia, Parkinson’s, heart failure” – are typically given this incorrect assessment, even though a 2013 settlement of a class-action suit mandated that Medicare “cover skilled care and therapy when they are ‘necessary to maintain the patient’s current condition or prevent or slow further deterioration.’”

In addition, last month, a Federal judge ordered CMS “to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect.” The judge said that while CMS does not have to further update its manuals, it must do a better job of educating the medical community about these changes. 

YP/Resident Leadership Seminar Slated for Syracuse Oct 21-22
Following an exciting Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has now slated a Leadership program for upstate physicians in Syracuse from late afternoon Friday, Oct 21 through Saturday, Oct 22.

The program is scheduled for the Doubletree Inn at Syracuse Thruway exit 36. A renowned faculty from Brandeis and Harvard University will lead the program, which 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 covered under a grant from The Physicians Foundation.  For further information, contact MESF Executive Director at Tom Donoghue tdonoghue@mssny.org. 

“When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

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

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.

22% of Generic Drugs Billed to Part D Had 100% Increase between 2010-2015
About 22 percent of generic drugs billed to Medicare Part D had at least one price increase of 100 percent or more between 2010 and 2015, states a new GAO report titled, “Generic Drugs Under Medicare Part D Generic Drug Prices Declined Overall, but Some Had Extraordinary Price Increases.”  http://www.gao.gov/assets/680/679022.pdf

Exercise in Self-Assessment of Your Orthopaedic Knowledge: Preparation for MOC
The 2016 Annual New York State Society of Orthopaedic Surgeons Symposium will take place on Saturday, September 24, 2016 from 7:00am – 4:30pm at the NYU Langone Medical Center – Hospital for Joint Diseases in the Loeb Auditorium (301 East 17th Street, NY NY 10003).

NYSSOS is committed to designing programs that help orthopaedists achieve and comply with educational requirements. This one-day event features presentations on topics including sports, pediatrics, trauma, adult reconstruction, spine, geriatrics, metabolic bone disease, upper extremity, foot & ankle and hand surgery.

Participants who purchase and pass the AAOS OKU 11 exam will receive up to 20 SAE credits. Participants who review the AAOS OKU 11 educational material and complete and pass the AAOS OKU 11 exam will be eligible to receive up to 70 CME credits. AAOS OKU 11 products will be available for purchase at the time of registration.  Pre-registration is required to attend.

Residents and Fellows are encouraged to attend. Three discounted registration packages are available. Register Online or download the Brochure. 

 “Light the Path” Walk at LI’s Sunken Meadow State on October 6
The Long Island Health Collaborative is hosting a “Light the Path” walk for Behavorial Health Awareness on Thursday, October 6 at 4:00PM at Sunken Meadow State Park, Rte. 25A and Sunken Meadow Parkway, Kings Park, NY 11754. Parking is available in Field 2. Register to receive updates here. For questions or more information visit www.LIHealthCollab.org


CLASSIFIEDS



Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

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

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

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



A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



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
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 9, 2016 – Reject Anthem-Cigna Merger

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

September 9, 2016
Volume 16, Number 31

MLMIC

Dear Colleagues:

The following is a summary of my testimony at the Department of Financial Services hearing yesterday strongly opposing the proposed Anthem-Cigna merger:

On behalf of our over 20,000 members, I thank you for the opportunity to present our concerns regarding the impact to patient care if Anthem, the parent of Empire Blue Cross/Blue Shield, is permitted to acquire Cigna. The recent litigation initiated by the US Department of Justice to block this proposed merger as well the proposed Aetna-Humana merger validated the very serious concerns held by many physician and patient advocacy groups in New York State and across the country.   Specifically, the DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country were “unprecedented in their scale and in their scope.”

Greatest Impact on Smaller Practices

We agree that this proposed merger could have serious adverse implications for care delivery, with the greatest adverse impact upon smaller physician practices, which are already reeling from the profound changes arising from policy advanced from both the federal and state governments.  Indeed, these concerns regarding insurer market concentration have been made by physicians and physician advocacy groups for years as many insurers have merged or have been purchased, or converted to for-profit status.  More specifically, this concern was expressed by many of our physician members when we sought their feedback on this proposed merger of these two insurance giants.  Many physicians already feel powerless to negotiate for fairer treatment by existing insurance behemoths, and believe that this merger will exacerbate an already extremely difficult practice environment. Many feel they have no choice but to become employees of large systems, which can cause disruptions to existing physician-patient relationships.

Based upon information reported by the American Medical Association within its 2015 Competition in Health Insurance report, this proposed merger would substantially increase the market share of the combined entity in several New York State regions. We believe this would have a serious detrimental impact on patient access to care, as Empire has a mixed record in assuring patients can receive the care they need based upon DFS’ own 2015 Guide to Health Insurers.

Based upon data contained in the AMA’s 2015 Competition report, if Anthem were to purchase Cigna, the market share for Empire could:

  • increase from 17% to 27% in the Lower Hudson Valley and New York City;
  • increase from 21% to 27% in Long Island; and
  • increase from 20% to 26% in the mid-Hudson Valley.

Another AMA report, written specifically to assess the market impact of this proposed merger across the country, notes that the resulting Anthem-Cigna entity “would be presumed to likely enhance the market power” of the combined entity in Long Island, and “raises significant competitive concerns” and “warrants scrutiny” for the combined entity in New York City and the Hudson Valley.  The report makes these determinations using the Horizontal Merger Guidelines developed by the U.S. Department of Justice and Federal Trade Commission.

Merger Would Increase Anthem’s Market Share Considerably 

Additionally, the DFS Superintendent’s letter highlighted the impact of this takeover on the large employer health insurance market. She noted that it would increase Anthem’s market share across commercial products to 31.2% statewide, of which Anthem would command nearly 10% of New York’s fully insured market and nearly 50% of the self-insured market.  The biggest impact would be felt in the New York City metro area, where Anthem would control nearly 70% percent of the commercial self-insured market in the Bronx and Staten Island, 63% in Queens and Brooklyn, and 55% in Putnam County. United, which purchased Oxford, and Emblem, which formed from the merger of HIP and GHI, have been publicly reported in the last few years to have drastically reduced their physician networks, reducing patient access for many.

Moreover, it is important to note that, according to DFS’ public data, Empire has at best a mixed record with regard to addressing the care needs of their insureds. Specifically, the 2015 Consumer Guide to Health Insurance prepared found that in 2014:

  • Empire had the worst overall consumer complaint ratio among HMO products offered in New York State;
  • Empire had the worst overall prompt payment complaint ratio among HMO products offered in New York State; and
  • Empire had the highest number of external appeals taken against it (705) among any health insurer operating in New York State.

It stands to reason that with less competition, there will be less incentive for Empire and the remaining health insurers to have comprehensive physician networks and to fix prior authorization abuses identified by physicians and patients.

In summary, we are very concerned that these problems will only get worse as insurers’ market shares increase. We appreciate that the DOJ, the DFS and the NY AG have recognized these concerns and urge that this proposed merger be rejected on the grounds that it would harm patient access to needed care.

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

Please send your comments to comments@mssny.org


enews large

CMS Announces Flexibility Options for MACRA Participation for 2017
This week CMS Acting Administrator Andrew Slavitt  announced in a blog posting its plans to provide some flexibility to physicians complying with the MACRA Medicare value-based payment programs scheduled to begin January 1, 2017.   While the final rule will not be released until later this fall, CMS announced that the final MACRA regulation will exempt physicians from any risk of Medicare payment penalties for 2019 within the Merit Based Incentive Payment System (MIPS) program if they choose one of three distinct reporting options in 2017, in addition to the option of participating in an advanced APM:

  • Full-year reporting that begins on January 1;
  • Partial year reporting for a reduced number of days; and
  • A “test” option under which physicians can report minimal amounts of data.

Physicians who report in 2017 may be eligible for bonus payments in 2019, depending on which option they choose.  According to the blog posting, those who opt for full-year reporting will be eligible to receive a “modest positive payment adjustment;” and those who choose partial year reporting will be eligible for a “small positive payment adjustment.”  Physicians who choose the “test” option will not be eligible for a bonus, but also not subject to any payment penalties.  Qualified participants in advanced APMs will be eligible for 5 percent incentive payments in 2019.

AMA President Dr. Andrew Gurman praised the action taken by the federal government, stating it “strongly applauds Secretary Burwell and Acting Administrator Slavitt – and their teams – for listening to physicians’ concerns about the timeline that was originally proposed for MACRA.  By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA.  This approach better reflects the diversity of medical practices throughout the country.  “The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.” 

CMS Offers Session on PQRS Feedback Reports on September 27 at 1PM
The Centers for Medicare & Medicaid Services (CMS) announced a Virtual Office Hours (VOH) session regarding Physician Quality Reporting System (PQRS) feedback reports for program year 2015 results. This VOH session will include information on the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.

The session, titled “2015 PQRS Feedback Reports,” will take place on Tuesday, September 27, 2016 from 1:00 – 2:00 p.m. ET. Topics to be discussed in this session include information about how the 2017 PQRS negative payment adjustment is assessed and how and where to access 2015 PQRS feedback reports depicting payment adjustment results. Additionally, this PQRS VOH session will allow stakeholders an opportunity to ask a CMS representative questions about the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.

Event Registration:

You must register to participate in this session, and spots are limited. Registration begins on Tuesday, September 13, 2016 at 12:00 p.m. ET. Click here to access the registration page.

A few notes about this VOH session:

  • You will only be able to register on or after 12:00 p.m. ET on September 13, 2016. If you attempt to register before this time you will receive an error message.
  • Only a limited number of participants will be allowed to register.
  • Only questions related to the 2015 PQRS feedback reports and 2017 negative payment adjustment will be addressed on this call. All other questions, including questions regarding program requirements and policy or reporting specifics, should be directed to the QualityNet Help Desk.

Complete information about PQRS is available on the CMS PQRS website.

For questions about PQRS or the VOH registration process, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. – 7:00 p.m. Central Time.


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


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.

The bill has not as of yet been delivered to the Governor.

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.

Over the summer, MSSNY representatives and several other patient advocacy groups met with the Governor’s office to urge that this bill be signed into law.  Moreover, in August, dozens of patient advocates rallied at the State Capitol in support of this bill, which received significant media attention, including from WNYT. TWC’s Capital Tonight and Politico-NY.

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.

Decline In Teenage Pregnancy Due to Use of Contraceptives, Study Suggests.
The New York Times (9/1) reports a new study published in the Journal of Adolescent Health found the “sharp decline in American teenage pregnancy and birthrates in recent years was driven exclusively by the use of contraceptives.” The study of a “nationally representative sample of more than 3,000 women ages 15 to 19” in 2007, 2009 and 2012 concluded “that sexual activity in the last three months of each time period did not vary — about one-third of the young women had had sex during that time.” However, the “percentage of teenagers who reported using contraception increased to 86 percent from 78 percent, and the share using more than one method increased to 37 percent from 26 percent

Zika Virus Commissioner’s Grand Rounds to Be Held on September 29
The 2016-2017 Commissioner’s Medical Grand Rounds series first session will be held Thursday, Sept. 29th from 6-8 p.m.   The program, entitled, “From A to Zika: An Update on Zika Virus for Primary Care Providers” will be presented as a live seminar and webinar at Stony Brook Medicine, Health Science Center, Level 2, Lecture Hall 2, 101 Nicolls Road, Stony Brook NY. The presentation will inform clinicians on current evidence about transmission, best practices for laboratory testing and evaluation, potential health effects and prevention of Zika virus infection. 

Presenters will be Samuel Stanley, MD, president, Stony Brook University and Chair, National Science Advisory Board for Biosecurity; Burton Rochelson, MD, Chief of Maternal Fetal Medicine at Northwell Health, Director of Maternal-Fetal Medicine Fellowship Program, Northwell Health; Philip Kurpiel, PhD, MPH; Program Supervisor, MARO Regional Epidemiology Program, NYS Department of Health; Louis Manganas, MD, PhD, Assistant Professor, Department of Neurology, Stony Brook University Medical Center.   The program is free of charge for all providers in New York State and advance registration is required.  To register, please see the flyer HERE.

The program will be streamed as a live webcast for those unable to attend in-person and will also be archived for future viewing.   Participants are eligible for CME credits whether they view in-person, via the live webcast, or the archived webcast. More Info.

Medicine at the Metropolitan Museum: Art in Clinical Practice
Learn how to use art to enhance your observation and communication skills in order to strengthen your clinical practice! 

When:
September 16, 2016 from 6 to 8.30pm:
Enhancing Observation and Presence
September 18 from 10.30am to 1pm:
Expanding Point of View and Creative Thinking
Location: The Met Museum in NYC

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

From the participants:
“Fantastic course. Therapeutic, informative and reformative.”
“Very interesting and I think it’ll make me a better doctor.”

MSSNY in the News

The Buffalo News – 08/27/16
Opinion – Another Voice: I-STOP changes won’t hurt fight against opioid abuse
(Letter to the Editor from MSSNY president Dr. Malcolm Reid, MD & VP, Dr. Thomas Madejski)
Healthcare Business Daily News – 09/07/16
AMA and MSSNY urge New York State officials to reject Anthem-Cigna merger as anticompetitive
(MSSNY President, Dr. Malcolm Reid quoted)
Becker’s Hospital Review – 09/08/16
AMA, physicians press NY state to reject Anthem-Cigna deal
(MSSNY President, Dr. Malcolm Reid quoted)
The Canadian Business Journal – 09/08/16
AMA and MSSNY: Anthem-Cigna Deal Is Bad Medicine For New York State
(MSSNY President, Dr. Malcolm Reid quoted)
Modern Healthcare – 09/08/16
AMA, consumers urge N.Y. regulators to reject Anthem-Cigna merger
(MSSNY President, Dr. Malcolm Reid quoted)


CLASSIFIEDS


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

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!

Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty).  Space is located in concierge building on 3rdAvenue (3 blocks to Grand Central Station).2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft).  The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable.  Serious inquiries only, may contact us at 201-615-6963 or email us: cahnmd@gmail.com

Midtown1Midtown2


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
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

Council – September 15, 2016

AGENDA
Council Meeting
September 15, 2016, 9:00 am
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590

A.Call to Order and Roll Call

B. Approval of the Council Minutes of June 2, 2016

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

   1. President’s Report

a.  Resolution 2016-200, Combine MSSNY HOD with Legislative Day in Albany (For Discussion)

b.  Pennsylvania Medical Society Sign-On MOC Letter (For Council Approval)

c.  Medicare Advantage Resolution Submitted by
Joseph R. Maldonado, MD, MSc, MBA, DipEBHC
(For Council Approval)

d. Minutes of the Executive Committee Teleconference,
August 17, 2016 (For Council Information)

e.  AMA Response Letter re Resolution 2016-263, Continued Surgical Care (For Council Information)

f. AMA Response Letter re Resolutions 111 & 115, Electronic Health Records and Resolve E-Prescribing Problems
(For Council Information

    2.  Board of Trustees Report  – Minutes of the Board of Trustees
Teleconference
  August 23, 2016.
Dr. Leah McCormack will present the BOT report at
Council (handout)

    3. Secretary’s Report – Dr. Arthur Fougner will present the report
for Nominations for Life Membership & Dues Remissions

    4. MLMIC Report – Mr. Donald Fager will present a verbal report

    5.  AMA Delegation Update Dr. John Kennedy will present the
report

   6.  MSSNYPAC Report – DrJoseph Sellers will present the report

   7. Commissioners (All Action Items)

Commissioner of Governmental Relations, Gregory Pinto, MD,
MSSNYPAC Executive Committee Action Items
 MSSNY Council Approval of Congressional Candidates for
MSSNYPAC Endorsement;
MSSNY Council Approval of State Senate Candidates for
MSSNYPAC Endorsement;
MSSNY Council Approval of  State Assembly Candidates for
MSSNYPAC  endorsement

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

D. Reports of Officers (Informational)
1. Office of the President – Meetings attended:

Gottfried Legislative Breakfast
Presentation at the Westchester Academy of Medicine
Television interview with Marcia Kramer (Channel 2 News)
Westchester County Annual Meeting
IPRO Meeting
New York County Annual Meeting
National Medical Association Meeting
Richmond County Medical Society Annual Meeting
Andrew Cuomo’s Reception/Gala Fundraiser
New Jersey Annual Gala
Fundraiser for Senator Hannon
MLMIC Executive Committee Meeting
Bronx County Annual Meeting

 

  1. Office of the President Elect – Charles Rothberg, MD
  2. Office of the Vice President – Thomas J. Madejski, MD
  3. Office of the Treasurer – Joseph R. Sellers, MD, Financial Statement for the period  January 1, 2016  to July 31, 2016
  4. Office of the Speaker  –  Kira A. Geraci-Ciradullo, MD, MPH DRAFT – Proposed Revisions to MSSNY Bylaws

E. Reports of Councilors (Informational)
1. Kings/Richmond Report – Parag H. Mehta, MD
2. Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
3. Nassau County Report – Paul A. Pipia, MD
4. Queens County Report – Saulius J. Skeivys, MD
                  (no written report submitted)
5. Suffolk County Report – Maria A. Basile, MD, MBA 
6. Third District Branch Report – Brian P. Murray, MD
7. Fourth District Branch Report – John J. Kennedy, MD
8. Fifth District Branch Report –Howard H. Huang, MD
9. Sixth District Branch Report – Robert A. Hesson, MD
10. Seventh District Branch Report – Mark J. Adams, MD
11. Eighth District Branch Report – Edward Kelly Bartels, MD
                     (no written report submitted)
12. Ninth District Branch Report – Thomas T. Lee, MD
13. Medical Student Section Report
Christina Kratschmer 
14. Organized Medical Staff Section Report –
Richard A. Ritter, MD (no written report submitted)
             15. Resident & Fellow Section Report – Robert A. Viviano, DO 16. Young Physician Section Report – L. Carlos Zapata, MD
                     (no written report submitted) 

F. Commissioners (Committee Informational Reports/Minutes)
   
Commissioner of Communications
Joshua M. Cohen, MD, MPH
         1. Report of the Division of Communications      

Commissioner of Socio Medical Economics,
         Howard H. Huang, MD
         2. Interspecialty Committee Minutes, June 30, 2016

G. Presentations
     1 Update on the activities of the Long Island Health
Collaborative
Bruce Berlin, MD, President-Elect
Suffolk County Medical Society

2.  Patient-Centered Medical Home Practice
Salvatore Volpe, MD

H. Report of the Executive Vice President, Philip Schuh, CPA, MS
      Membership Dues Revenue Schedule

I. Report of the General Counsel, Donald Moy, Esq.
United Class Action Complaint

J. Report of the Alliance – Valerie Semeran
    Alliance Report 

K. Other Information/Announcements

  1. Final Version of the Sunshine Act Letter
  2. Sign-On Coalition of State Medical Societies VA Letter
  3. Sign-On VHA APRN Letter
  4. Letter to Andrew Slavitt, Acting Administrator, re Refinement Panel Process
  5. Sign On MACRA Letter
  6. AMA Amicus Brief, National Restaurant Association v. NYC Department of Health
  7. Physician Foundation Minutes, August 2016
  8. MSSNY Letter to CMS re MIPS and APM Incentive Under the Physician Fee Schedule
  9. EpiPen Letters & News Release
  10. Letter to United States Congress re Comprehensive Addiction & Recovery Act (CARA)
  11. Letter to Honorable Burwell re MACRA

L. Adjournment