November 18, 2016 – Alphabet Soup Mania!

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
November 18, 2016
Volume 16, Number 41

mssny_enews_dividend

Dear Colleagues:

MACRA, MIPS, APNs, EHR, PQRS, MU, SGR, IPA, HMO, PPO, PPN, CMS, CSC, NGS, PAC, CAC, etc.

Yes, the alphabet soup continues. If you have been around long enough, you know what most of these acronyms mean. Historically, we had traditional indemnity health insurance plans. We had usual customary and reasonable charges. We had prevailing community fees.  Ah, the good old days.

Next came what was supposed to be the best thing since sliced bread— managed care.  Pre-certifications and prior authorizations reigned. Then, the pendulum swung the other way and gave us capitation with a mix of fee-for-service. This worked well for a little while—until the plans figured out that under capitation, some providers made more money than under fee-for-service.  Uh-oh, switch back to fee-for-service stat.

Now, the pendulum swings again.  The government comes up with MACRA.  They describe it as a new payment methodology. Really?  Again, if you have been around long enough, it is just the pendulum swinging back yet again.

The government is just trying to see what they are paying for – call it MIPs, APNs, call it value-based medical care.  Call it what you will –quite simply, it is just the government demanding to know what it is paying. To do so, it forces physicians to jump through hoops and put square pegs into round holes to justify being paid for the care provided to patients.

If you need help with the payment games, reach out to your medical society. For dues paying members, we are here to help.

If you really want or need a description of the acronyms, call Regina McNally, VP, Socio-Medical Economics, 516 488 6100, ext. 332.

Now, for the good news! This week MLMIC declared a new 20% general dividend for policyholders. The dividend — which will apply to policyholders who are insured on May 1, 2017, and maintain continuous coverage through July 1, 2017 — will be based upon the annual rate of premium in effect on May 1, 2017. MLMIC has always had strong standing and stability in the challenging New York insurance market, and this dividend in addition to their arrangement with Berkshire Hathaway will bring policyholders continued peace of mind.

(See story below)

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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MLMIC Board Declares 20% Dividend for Policyholders
MLMIC’s board has declared a new 20% general dividend for policyholders. The dividend — which will apply to policyholders who are insured on May 1, 2017, and maintain continuous coverage through July 1, 2017 — will be based upon the annual rate of premium in effect on May 1, 2017.  It will provide meaningful financial relief to policyholders.

The board’s decision to declare this dividend is based on MLMIC’s statutory admitted assets of approximately $5.8 billion, a surplus of $1.9 billion and statutory net income of approximately $100 million. These figures, available in the company’s September 30, 2016, statutory financial statement, show the company’s overall financial condition remains sound.

The new dividend is separate and apart from MLMIC’s agreement to become part of the Berkshire Hathaway family of companies. That process takes a while and is on track to be completed by next year’s end. In the meantime, MLMIC’s strong financial performance enables it to offer a 20% dividend.

An overview of the September 30, 2016, statutory financial statement is available here, and the full financial statement has been filed with New York State Department of Financial Services.

Governor Signs MSSNY-Backed Administrative Simplification Bills into Law
Governor Cuomo this week signed into law two bills supported by MSSNY designed to reduce some of the administrative burdens on physicians in their dealings with health insurers.

  • The first bill (A.501-E, Cusick/S.2545-D, Lanza) would reduce from 90 to 60 days the time within which a health insurer must complete its review of the application of a physician to participate in the network of a health insurer, as well as reducing from 90 to 60 days the time within which a physician in some situations can become “provisionally credentialed” if the plan does not complete its review.   The bill also eliminates some ambiguous statutory language that currently gives discretion to a health insurer to delay a decision on a physician’s application after these deadlines have passed.   The new law applies to credentialing applications received by health insurers on or after April 1, 2017.
  • The second bill (A.6983-A, McDonald/S.4721-A, Hannon) would direct the Commissioner of Health and Department of Financial Services to create standards to provide greater uniformity among health insurers of the processes to be followed when physicians request insurers to cover their patients’ needed prescription medications.  MSSNY worked closely with the New York Chapter of the American College of Physicians in advocating for this legislation.   The law takes effect immediately.

Urge Gov. to Sign Law to Permit E-Prescription Transfers between Pharmacies
All physicians are urged to contact the Governor to urge that he sign into law legislation (A.10448. Schimmel/S.7537, Martins) supported by MSSNY that would permit a pharmacy to transfer an e-prescription to another pharmacy. 
Physicians can send a letter to the Governor from here.  

This law would address concerns faced by both patients and physicians when a pharmacy may be out of stock of a particular medication, and may be unable to fill the prescription.  Current laws pertaining to e-prescribing do not allow for the transfer of an e-prescription from one pharmacy to another. In such instance the only recourse available to the patient is to return to the physician’s office – if it is open—to have him/her send the e-prescription to another pharmacy. This creates unnecessary duplication for the physician, and unnecessary delays for the patient waiting to receive their needed medications. This legislation would help to address these concerns.

Counting Absentee Ballots for 2 Senate Races; 24 Newly Elected to NY Legislature
With the absentee ballots of 2 Long Island State Senate races still being counted, it has not yet been officially determined which party will have majority control of the New York State Senate. Of the 63 seats in the State Senate, 30 Republicans have been elected, and 31 Democrats. However, one of the Democrats, Simcha Felder, has previously “conferenced” with the Republicans. The 2 State Senate seats not yet officially decided are currently held by Republicans Carl Marcellino and Michael Venditto.  Also unclear at this time is the role of the 7-member Independent Democratic Caucus led by Senator Jeff Klein.

The November 8 elections also saw 24 candidates newly elected to the New York State Legislature, including 18 new Assemblymembers and 6 new Senators. 
Below is a list of these newly elected members, and the members of the Legislature they will be replacing:

Chamber District FIRST Last Party Replaced
Assembly 30 (NYC) Brian Barnwell Dem Margaret Markey
Assembly 94 (Hudson Valley) Kevin Byrne GOP Steve Katz
Assembly 44 (NYC) Robert Carroll Dem James Brennan
Assembly 72 (NYC) Carmen De La Rosa Dem Guillermo Linares
Assembly 70 (NYC) Inez Dickens Dem Keith Wright
Assembly 16
(Long Island)
Anthony D’Urso Dem Michelle Schimel
Assembly 133 (Western NY) Joe Errigo (former Assemblyman) GOP Bill Nojay
Assembly 115 (North Country) D. Billy Jones Dem Janet Duprey
Assembly 20
(Long Island)
Melissa Miller GOP Todd Kaminsky
Assembly 101 (Central NY) Brian Miller GOP Claudia Tenney
Assembly 145 (Western NY) Angelo Morinello GOP John Ceretto
Assembly 65 (NYC) Yuh-Line Niou Dem Alice Cancel
Assembly 144 (Western NY) Michael Norris GOP Jane Corwin
Assembly 23 (NYC) Stacey Pheffer Amato Dem Phil Goldfeder
Assembly 33 (NYC) Clyde Vanel Dem Barbara Clark
Assembly 143 (Western NY) Monica Wallace Dem Angela Wozniak
Assembly 112 (Capital District) Mary Beth Walsh GOP James Tedisco
Assembly 56 (NYC) Tremaine Wright Dem Annette Robinson
Senate 31 (NYC) Marisol Alcantara Dem Adriano Espaillat
Senate 36 (NYC) Jamaal Bailey Dem Ruth Hassell-Thompson
Senate 54 (Central NY) Pamela Helming GOP Michael Nozzolio
Senate 60 (Western NY) Chris Jacobs GOP Marc Panepinto
Senate 7
(Long Island)
Elaine Phillips GOP Jack Martins
Senate 49 (Capital District) James N. Tedisco (former Assemblyman) GOP Hugh Farley

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


MSSNY Veterans’ Matters Now Includes CME Programs on Substance Use and Suicide; Physicians Strongly Urged to Attend
The Medical Society of the State of New York is expanding its Veterans’ Matters mental health training initiative by including additional programming on substance use disorders and suicide in returning veterans.  Veterans’ Matters is conducted through webinars and live grand rounds presentations all over the state.

Presenting faculty for Veterans’ Matters includes Frank Dowling, MD and John McIntyre, MD. The Medical Society will present a PTSD and TBI webinar on Wednesday, December 7th at 7:30 a.m.  On December 15th, a Substance Use Disorders webinar will be conducted at 8 a.m.   Registration is required.

 

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

MSSNY designates each live activity for a maximum of 1 AMA PRA Category 1 Credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

To register for a webinar, click on a date below:

Information and the educational objectives for each webinar can be found here:

PTSD and TBI – 12/7/16
Substance Use Disorders –12/15/16

If your hospital is interested in having one of these programs presented, or if you need assistance with registering, please contact Greg  Elperin at gelperin@mssny.org or call (518)465-8085. 

MACRA Educational Program This Monday Evening from 7-8:30PM
Do you have questions about how to comply with the new Medicare MIPS requirements taking effect in 2017?  This
Monday, November 21, from 7-8:30 PM
is the first of several programs being offered by the AMA to help physicians better understand  the requirements of the new Quality Payment Programs (QPP) that were created by the Medicare Access and CHIP Reauthorization Act (MACRA). To register for Monday night’s program, click here:  https://cc.readytalk.com/r/y70aavsqh5g0&eom

Other similar programs upcoming include:

  • Thursday,  Dec. 1 – 6:30 pm – 9 pm ET
    Register here:
  • Tuesday,  Dec. 6, 8:00 pm – 9:30 pm ET
    Register here.
  • Saturday,  Dec. 10, 12 PM -1:30 ET
    Register here.

DOH Recommends Four Brooklyn Hospital Merge
A new report commissioned by the state Department of Health recommends that four financially struggling Brooklyn hospitals merge into one regional health system, with one of the hospitals drastically reducing inpatient services.

The four hospitals—Brookdale University Hospital and Medical Center, Kingsbrook Jewish Medical Center, Interfaith Medical Center and Wyckoff Heights Medical Center—will require $310 million in operating subsidies from the state in fiscal 2017, which ends March 31, 2017. The report was authored by Northwell Ventures, the consulting arm of Northwell Health. The combined losses of the four hospitals are expected to grow to $405 million by fiscal 2021. Over the five-year period the hospitals will have lost $1.8 billion. Gov. Andrew Cuomo and the state Department of Health must now determine whether they support Northwell’s proposals. To move forward, the plan must also be approved by the boards of the four Brooklyn hospitals. 

AMA Statement Re Principles of Health Care Reform That Congress Must Address
With the entire Affordable Care Act likely to be revisited in the New Year by the Congress and President-elect Trump, the AMA released the following statement after receiving extensive testimony from physicians representing a wide array of perspectives at its House of Delegates meeting this past weekend.

“The AMA House of Delegates, reflecting more than 170 state and specialty medical societies from across the country, today reaffirmed its commitment to health care reform that improves access to care for all patients. 

“Using a comprehensive policy framework that has been refined over the past two decades, the AMA will actively engage the incoming Trump Administration and Congress in discussions on the future direction of health care. The AMA remains committed to improving health insurance coverage so that patients receive timely, high quality care, preventive services, medications and other necessary treatments.  

“A core principle is that any new reform proposal should not cause individuals currently covered to become uninsured. We will also advance recommendations to support the delivery of high quality patient care.  Policymakers have a notable opportunity to also reduce excessive regulatory burdens that diminish physicians’ time devoted to patient care and increase costs. 

“Health care reform is a journey involving many complex issues and challenges, and the AMA is committed to working with federal and state policymakers to advance reforms to improve the health of the nation.”

Among the key principles highlighted by the AMA in its policy framework that they urge policymakers to consider:

  • Individually owned and selected health insurance using refundable and advanceable tax credit
  • Support a requirement that individuals and families who can afford health insurance be required to obtain it;
  • Required coverage of pre-existing conditions;
  • Expanded availability of Health Savings Accounts (HSAs);
  • Continued availability of those under 29 to stay on parents’ coverage;
  • Adequate Provider Networks in Medicare, Medicaid and Commercial Insurance;
  • Health Plan Transparency/Accurate Network Listings;
  • Medical Liability Reform;
  • Fair Medicaid Payment/Parity with Medicare payments; and
  • Affordable Prescription Medications


CMS Launches New Online Tool to Make Payment Program Easier for Clinicians
Today, CMS released a tool to share automatically electronic data for the Medicare Quality Payment Program. This new release is the first in a series that will be part of CMS’s ongoing efforts to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients.

In October, CMS released the Quality Payment Program website, an interactive site to help clinicians understand the program and successfully participate. Today’s release, commonly referred to as an Application Program Interface (API), builds on that site by making it easier for other organizations to retrieve and maintain the Quality Payment Program’s measures and enable them to build applications for clinicians and their practices. The API, available at www.qpp.cms.gov/education, will allow developers to write software using the information described on the Explore Measures section ofwww.QPP.cms.gov

.Based on interviews with clinicians, CMS created the Explores Measures tool, which enables clinicians and practice managers to select measures that likely fit their practice, assemble them into a group, and print or save them for reference. Already, tens of thousands of people are using this tool.

Several groups have applauded the release of this information, including: the American Academy of Ophthalmology, the Network for Regional Healthcare Improvement (NHRI), American College of Radiology (ACR), American College of Physicians (ACP), National Rural Accountable Care Consortium, Great Lakes PTN, Pacific Business Group on Health, Compass PTN, TMF QIN-QIO, and the Mountain Pacific Quality Health Foundation.

As the program and its supporting website mature, CMS will continue to release data and APIs to spur innovation and keep participants up-to-date.

To see the API Swagger documentation, please visit: https://qpp.cms.gov/api/

CMS Finalized Claims-Based Data Collection Process that Is “Less Burdensome”
CMS finalized a claims-based data collection process on the frequency of and inputs involved in global surgical services that is much less burdensome for physicians than CMS’ earlier proposal. Key changes include:

  • CMS’ decision to use 99024 for reporting post-operative services rather than the proposed set of time-based G-codes
  • Reporting is no longer required for pre-operative visits
  • Reporting is only triggered for services that meet certain minimum thresholds annually—CPT codes billed by more than 100 practitioners over 10,000 times or have allowed charges in excess of $10 million

The final rule increases payments for Chronic Care Management services by accepting CPT and RUC recommendations urging CMS to ease the administrative burden and expand the opportunities for physicians. CPT codes 99358 and 99359 for non-face-to-face prolonged E/M services will also be billable under Medicare beginning in 2017.

Medicare Announces New RAC Contracts
Last week, Medicare announced the new Recovery Auditor contracts, which sets limits for the post-claims review process and dictates when Recovery Audit Contractors (RAC) will be eligible to receive their contingency fees.

Among the changes specified in the new contracts, RACs will no longer automatically receive contingency fees for each identified overpayment. This new policy requires the RACs to pass the second level of a five-level appeals process before receiving their contingency fee. The new RAC contracts also establish new audit timelines—the RAC lookback period for inpatient claims is reduced from three years to six months—and the two midnights rule will continue to be exempted from RAC audits.

These changes are in addition to Medicare’s recent pilot program that directs RACs to consider as a low-priority reviewing claims from providers participating in Advanced Alternative Payment Models under the new Quality Payment Program.

Medical Matters CME Webinar Series Continues in 2017; Registration Now Open
The Medical Society of the State of New York will continue its Medical Matters webinars on
January 18, 2017 at 7:30 am with Triage in a Disaster Event
.  Arthur Cooper, MD, vice-chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee and Zachary Hickman, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee, will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are: 1) Describe the importance of immediate bleeding suppression during a disaster event; 2) Describe the SALT methodology for triage and where to access SALT training; 3) Recognize the importance of not just general triage training, but triage training for bio-events as well.

February’s webinar will be:
The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team
. This program will be held on Wednesday, February 15, 2017 at 7:30 a.m. and faculty will be Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event; 2) Identify means by which members of the healthcare team can manage the stress during and after an active shooter/bombing event; 3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

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.

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. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

MSSNY Participates in Antimicrobial Resistance Prevention Task Force
The New York State Department of Health (NYSDOH) convened the first-ever multidisciplinary New York State Antimicrobial Resistance Prevention and Control Task Force (NYS-ARTF) Summit this week. The summit addressed the need for prevention strategies throughout the health system and built on the work outlined at the July roundtable discussion on “Antimicrobial Resistance in Healthcare Facilities,” which was hosted by NYSDOH, Greater New York Hospital Association, and the Healthcare Association of New York State.

The engagement of stakeholders in the summit and roundtable is a key element in New York State’s comprehensive strategy to address the persistent and growing threat of multi-drug resistant bacteria. Cases of drug resistant Candida auris, a serious and sometimes fatal fungal infection andmcr-1, a novel drug resistant gene present in some bacteria, have been reported in New York. The Centers for Disease Control and Prevention (CDC) estimate that each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result of these infections.

“Through this Summit, the Task Force is working with New York State’s healthcare leaders to shape a state-wide response to the growing public health threat of multi-drug resistant bacteria,” said Commissioner of Health Dr. Howard Zucker. “If antimicrobial resistance is not addressed, we face a future where these medicines may no longer work, and infections will become difficult or impossible to treat. The most vulnerable among us will be the most at-risk.”

The summit involved experts from various disciplines including healthcare, agriculture, and veterinary care, as well as academia, community groups, and federal, state, and local government.

Stakeholders participating in the summit were previously asked to outline New York State’s top priorities in the efforts to combat antibiotic resistance. Among the priorities listed were:

  • To expand antimicrobial stewardship programs and improve infection prevention and control practices in all hospitals and nursing homes
  • To limit antibiotic use in food producing animals
  • To educate and support healthcare providers to optimize antibiotic prescribing
  • To educate consumers about appropriate antibiotic prescribing and use
  • To develop rapid diagnostic tests to distinguish bacteria from viruses and identify antibiotic resistance
  • To improve communication when patients are transferred between healthcare facilities

During the Summit, participants collaborated on designing practical solutions to achieve these priorities. The input from participants will be compiled to develop and implement a statewide strategic approach to combatting antimicrobial resistance as well as a report of recommendations that will be submitted to Governor Andrew M. Cuomo, by December 31, 2016.

“Get Smart” Campaign on Antibiotic Resistance November 14-20th
The New York State Department of Health will hold its “Get Smart (Know When Antibiotics Work) Week” on Nov 14-20th and the campaign is intended to create awareness within the physician and patient community about the growing resistance to antibiotics.  Get Smart  About Antibiotics Week (Get Smart Week) is a national, annual observance intended to engage relevant stakeholders – including professional societies, advocacy groups, for-profit companies, state and local health departments, the general public, the media and others – around antibiotic stewardship in the outpatient, inpatient, and animal health settings.

New York’s “Get Smart Campaign” promotion of the “Get Smart Guarantee” , an easy way for healthcare providers to display their commitment to appropriate antibiotic prescribing and use. The provider may use the free poster within the office and place their own photo on the poster and sign it.

There are also patient palm cards, which are a nice educational “takeaway” for a patient if they can’t have antibiotics (if their illness is viral, for instance).

The NY Get Smart Campaign would be very happy to send materials to individual providers. Contact Mary Beth Wenger at marybeth.wenger@health.ny.gov   or at (518)-474-1036.


CLASSIFIEDS


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State of the Art Midtown Medical Office for Rent
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: hefderm@outlook.com for details. No Brokers.


Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities


Executive Director – Bronx County Medical Society
Bronx County Medical Society, a leader in promoting excellence in Clinical Care, Education & Public Policy, is seeking an executive director. Candidates should have either a bachelor degree and/or three years of work experience with non-profit medical groups. The Executive Director should be knowledgeable on healthcare policy and nonprofit compliance. Candidate must demonstrate strength in event planning and fundraising, member recruitment and retention, community outreach, and possess strong communication skills. We offer a competitive salary and benefits package. Please send resume and cover letter to Diane Miller, Executive Director at bxcms@msn.com


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.

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

 

 

 

 

 

 

 

 

 

 

 

 

 

November 11, 2016 – We Love Our Vets

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
November 11, 2016
Volume 16, Number 40

MLMIC Insurance

Dear Colleagues:

As we observe Veterans Day this year and thank veterans for their service, it makes me proud to be in a position where we, as physicians, can give something back.

Last year, MSSNY launched its Veterans’ Matters program, a primary-care training initiative focused on making sure that our returning veterans receive the best evidence-based treatment.  Since its implementation, Veterans’ Matters has educated hundreds of primary-care providers all over the state on how to identify, refer, and treat post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI), two of the most important mental health concerns that affect our veterans today. The program is built on the simple premise that veterans matter, and getting them the care they deserve starts with giving doctors the best resources to understand veterans and the unique challenges of military culture.

That’s why I’m happy to announce that MSSNY is expanding Veterans’ Matters to include new programs on substance use disorders and suicide prevention. These programs will feature monthly webinars and live grand rounds presentations across the state.

To register for a webinar, click on one of the following dates. More dates will be announced soon.

Veterans’ Matters: PTSD and TBI – 12/7/16, 7:30 am
Veterans’ Matters: Substance Use Disorders – 12/15/16, 8 am

To access a flyer, click on a program date below:
12/7/16, 12/15/16

If you are interested in scheduling a Veterans’ Matters grand rounds session in your community, please contact Greg Elperin (gelperin@mssny.org or 518-465-8085).

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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Statement by MSSNY President Malcolm Reid, MD, MPP Regarding Crains Article Examining the Reduction in Independent Practice
“Today’s Crains New York article highlighting the endangered species that is independent physician practice is the inevitable end product of federal and state policies that have resulted in extraordinary overhead cost burdens and paperwork responsibilities, and less time to deliver patient care. Physicians should have a fair choice of practice setting to deliver care to their patients, whether that is in a large health system, large medical group or within a smaller medical practice. Unfortunately, too many physicians find they have no choice but to become employed in large health systems due to the untenable squeeze between these huge and growing overhead costs, and unjustified cuts in payments from insurers if they are even allowed to stay in their networks.

This changing dynamic has profound implications for our patients.  Many physicians enjoy independent practice because of the personal attention that can be directed to their patients without external interference.  Indeed, that is the heart of the patient-physician relationship. Certainly, existing patient-physician relationships can be maintained (and even in some cases improved) as physicians change care delivery settings, but many of these treatment relationships can be disrupted due to new external demands placed on physicians from their new employers.  We urge our state and federal policymakers to be cognizant of these trends in health care delivery as they consider future measures that would only further increase these overhead costs and administrative burdens.”

MSSNY Participates in Antimicrobial Resistance Prevention Task Force
The NYSDOH convened the first-ever multidisciplinary New York State Antimicrobial Resistance Prevention and Control Task Force (NYS-ARTF) Summit this week. The summit addressed the need for prevention strategies throughout the health system and built on the work outlined at the July roundtable discussion on “Antimicrobial Resistance in Healthcare Facilities,” which was hosted by NYSDOH, Greater New York Hospital Association, and the Healthcare Association of New York State.

The engagement of stakeholders in the summit and roundtable is a key element in New York State’s comprehensive strategy to address the persistent and growing threat of multi-drug resistant bacteria. Cases of drug resistant Candida auris, a serious and sometimes fatal fungal infection and mcr-1, a novel drug resistant gene present in some bacteria, have been reported in New York. The Centers for Disease Control and Prevention (CDC) estimate that each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die as a direct result of these infections.

“Through this Summit, the Task Force is working with New York State’s healthcare leaders to shape a state-wide response to the growing public health threat of multi-drug resistant bacteria,” said Commissioner of Health Dr. Howard Zucker. “If antimicrobial resistance is not addressed, we face a future where these medicines may no longer work, and infections will become difficult or impossible to treat. The most vulnerable among us will be the most at-risk.”

The summit involved experts from various disciplines including healthcare, agriculture, and veterinary care, as well as academia, community groups, and federal, state, and local government.

Stakeholders participating in the summit were previously asked to outline New York State’s top priorities in the efforts to combat antibiotic resistance. Among the priorities listed were:

  • To expand antimicrobial stewardship programs and improve infection prevention and control practices in all hospitals and nursing homes
  • To limit antibiotic use in food producing animals
  • To educate and support healthcare providers to optimize antibiotic prescribing
  • To educate consumers about appropriate antibiotic prescribing and use
  • To develop rapid diagnostic tests to distinguish bacteria from viruses and identify antibiotic resistance
  • To improve communication when patients are transferred between healthcare facilities

During the Summit, participants collaborated on designing practical solutions to achieve these priorities. The input from participants will be compiled to develop and implement a statewide strategic approach to combatting antimicrobial resistance as well as a report of recommendations that will be submitted to Governor Andrew M. Cuomo, by December 31, 2016.

AMA: Educational Opportunities to Fully Understand QPP Created by MACRA
The AMA is offering several educational opportunities to help physicians understand the requirements of the new Quality Payment Program (QPP) that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).   The sessions have been scheduled to give physicians an understanding of what the final rule means for their practice and what they need to do as part of the QPP. All of the sessions are open to physicians and medical society staff. We hope you will take advantage and register for these opportunities to learn what you need to know and pass along the registration information to your physician members.

  • Monday,  Nov. 21, 7 pm – 8:30 pm EST  Physician/Staff  webinar     Registration
  • Thursday,  Dec. 1 – 6:30 pm – 9 pm EST
    Atlanta regional seminar (streaming and webinar)
    Cobb Galleria Center
    Atlanta Georgia
    Registration
  • Tuesday,  Dec. 6, 8:00 pm – 9:30 pm EST Physician/staff  webinar
    Registration
  • Saturday,  Dec. 10, 9 am -11:30 PST
    San Francisco regional seminar (streaming and webinar)
    Marriot Marquis
    San Francisco, CA
    Registration

Take MSSNY Survey Now: Current Responses Highlight Problems of Pared Down/Inadequate Insurer Networks
MSSNY’s recent survey of physicians has highlighted the concerns of many physicians regarding whether health insurance networks are adequate to truly meet patient care needs.  Nearly 80% of physician respondents to the survey indicated that they had experienced a situation where one of their patients could not quickly receive the care they need due to the inadequacy of a health insurer’s network.

Moreover, limited networks continue to be a problem, with over 25% of responding physicians indicating that they were, within the last 2 years, dropped from a health insurer’s network, and over 40% indicating that an insurer with whom they participate had not included them in a new coverage product.   Addressing inadequate insurer networks, including assuring the availability of out of network coverage in New York’s Exchange, will be an important part of MSSNY’s 2017 Legislative Program.

The survey has also sought physician perspective on their participation in value-based payment programs.  There is still time to add your voice to this survey if you have not already.  Please click here.


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


“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. 

Electronic Prescribing Waivers Expire on March 26, 2017
As of March 27, 2016, practitioners must electronically prescribe both controlled and non-controlled substances. Current Department of Health (DOH)-approved waivers from the requirement to electronically prescribe will expire on March 26, 2017.

Practitioners requiring a waiver after March 26, 2017, must submit a new request which includes an updated statement of facts describing the continuing circumstances supporting the waiver. Beginning December 27, 2016, a renewal request can be submitted for review to the DOH Bureau of Narcotic Enforcement (BNE). Please note, practitioners who no longer need a waiver are required by law to notify BNE, within five business days of gaining the capability to issue an electronic prescription.

Practitioners issuing less than 25 prescriptions per year for both controlled and non-controlled substances combined should submit a certification (DOH-5221) in lieu of a waiver request. Unlike a waiver request, a certification does not require DOH approval. It is a simpler process which only requires a practitioner’s attestation and upon submission, allows low-volume prescribers (25 prescriptions or less per year) to continue to issue paper prescriptions. To request a new waiver or to submit a certification online, log into the Health Commerce System here and access the “Electronic Prescribing Waivers” (EPW) application. If you need to request a paper form, please call 1-866- 811-7957. Additional information regarding electronic prescribing can be found on our website here.

Practitioners issuing less than 25 prescriptions per year for both controlled and non-controlled substances combined should submit a certification (DOH-5221) in lieu of a waiver request.  Unlike a waiver request, a certification does not require DOH approval. It is a simpler process which only requires a practitioner’s attestation and upon submission, allows low-volume prescribers (25 prescriptions or less per year) to continue to issue paper prescriptions.   To request a new waiver or to submit a certification online, log into the Health Commerce System here and access the “Electronic Prescribing Waivers” (EPW) application. If you need to request a paper form, please call 1-866-811-7957. Additional information regarding electronic prescribing can be found on our website at www.health.ny.gov/professionals/narcotic.

A copy of the letter can be found HERE.

Register Now for NY eHealth Collaborative on December 6-7
The New York eHealth Collaborative’s Digital Health Conference (DHC) on December 6-7 at New World Stages in Manhattan brings together 500 senior-level healthcare industry leaders to learn about new innovations and to foster dynamic conversation addressing how healthcare is being redefined through technology. This year, the conference is a Who’s Who of New York’s healthcare and health tech community gather for two days of networking, lively intellectual exchange, and exploration to see what’s new, what’s cutting edge, and what will shape the future of healthcare. Join your peers and register today!

MSSNY Members will receive a 10% registration discount. Use code MSSNY when registering at www.DigitalHealthConference.com.

“Get Smart” Campaign On Antibiotic Resistance To Be Held November 14-20th
The New York State Department of Health will hold its “Get Smart (Know When Antibiotics Work) Week” on Nov 14-20th and the campaign is intended to create awareness within the physician and patient community about the growing resistance to antibiotics.  Get Smart  About Antibiotics Week (Get Smart Week) is a national, annual observance intended to engage relevant stakeholders – including professional societies, advocacy groups, for-profit companies, state and local health departments, the general public, the media and others – around antibiotic stewardship in the outpatient, inpatient, and animal health settings.

New York’s “Get Smart Campaign” promotion of the “Get Smart Guarantee,” an easy way for healthcare providers to display their commitment to appropriate antibiotic prescribing and use. The provider may use the free poster within the office and place their own photo on the poster and sign it.

There are also patient palm cards, which are a nice educational “takeaway” for a patient if they can’t have antibiotics (if their illness is viral, for instance).

The NY Get Smart Campaign will send materials to individual providers. Contact Mary Beth Wenger at marybeth.wenger@health.ny.gov   or at (518)-474-1036. 

Multidrug-Resistant Yeast Identified in U.S.
Cases of multidrug-resistant Candida auris infection have been identified for the first time in the U.S., the CDC reports in MMWR. This follows a CDC alert this summer requesting that clinicians report any cases to their health departments. The invasive yeast has been reported on four other continents.

Based in part on a retrospective review of microbiology records, seven cases in four states from 2013 to 2016 were found. All of the affected patients had preexisting medical conditions, such as blood malignancies or brain tumor. Four patients died soon after C. auris was identified. Many of the isolates were resistant to multiple antifungals.

The agency cautions that the infections may have been transmitted in healthcare settings and that the pathogen may initially be misidentified as other Candida species.

The CDC advises healthcare workers to use standard and contact precautions in patients colonized or infected with C. auris.

MMWR article here.

Monroe County Welcomes Their New Executive
The Monroe County Medical Society Search Committee has hired a new Executive to replace Nancy Adams, who is retiring shortly. Christopher Bell has an MBA from the Simon School of Business and an MS in Marriage and Family Therapy form the University of Rochester School of Medicine and Dentistry. He comes to MCMS with knowledge of the key challenges facing physicians and is looking forward to supporting our membership and their staffs.

Chris previously worked with the Finger Lakes Performing Provider System and UR Medicine, supporting state and federal programs that are transforming health care, including the Delivery Service Reform Incentive Payment Program, Patient Centered Medical Home, Meaningful Use, and Physician Quality Reporting System. Additionally, Chris has supported the implementation of Electronic Medical Record systems in New York, New Orleans, and Illinois which has helped him understand the challenges physicians face in using these systems.

Chris lives in Fairport with his wife and daughter.


CLASSIFIEDS


Bronx Office Space for Lease
Morris Park-Van Nest, Bronx. Brand New Construction at  Highly Desirable Intersection. 2,350 sq.  ft. + Ground Level + 1,300 sq. ft. Lower Level; Open Floor Plan.  Please Call Anthony Mameli 347-387-9768 or Email to: anthony@md-cre.com. Charles Rutenberg Realty – Exclusive.


State of the Art Midtown Medical Office for Rent
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: hefderm@outlook.com for details. No Brokers.



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

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.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

November 4, 2016 – “Fail First” Is a Total Failure

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
November 4, 2016
Volume 16, Number 39

MLMIC Insurance

Dear Colleagues:

The following Letter to the Editor was printed in the Albany Times Union on Oct. 31, 2016.

New York’s physicians are proud to partner with patients and patient advocacy groups to support legislation to strongly regulate health insurance company prescription “fail first” protocols. Unsurprisingly, insurers oppose it (“Patients benefit from step therapy,” Oct. 20).

While these protocols are often medically appropriate, legislation is necessary due to many instances where patients’ health has been adversely impacted by overly strict application of these protocols.

Patients most affected by these “fail first” practices have serious medical conditions such as mental illness, arthritis and cancer. Many physicians report policies requiring their patients to switch blood pressure or cholesterol maintenance medications even though they had been stabilized.

This legislation would simply assure greater specificity in New York’s laws when a health insurer must approve coverage for the medication recommended by the patient’s doctor. Circumstances include where the insurer’s preferred medication is contraindicated, where the insurer’s preferred medication has already proven ineffective, or when the patient has already been stabilized on a medication that is not the insurer’s preferred one.

Importantly, a physician would have the burden of proof as to why the insurer’s “preferred” medication would not be as beneficial. The insurer could still limit coverage to the insurer’s “preferred” medication if the physician does not meet this burden.

Insurance companies seek to deflect the need for these imperative reforms with inflammatory rhetoric about drug company spending. This is nothing more than a distraction from the real issue – removing harmful insurance company roadblocks to patients getting the medications they need.

Gov. Andrew Cuomo needs to sign this important bill into law.

P.S. We have almost 400 responses to our Value-Based Survey. This topic concerns ALL physicians. Please give it two minutes of your time.   https://www.surveymonkey.com/results/SM-2N6FZBDN/

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

Please send your comments to comments@mssny.org


enews large

Council Notes of November 3 Meeting in Westbury

  • Resolutions that were referred to Council by the House of Delegates were approved. They topics involved: expansion of the Independent Dispute resolution process to address claims denied by insurers if existing statutory remedies do not timely address the problem; continue to examine the feasibility of a No-Fault system for resolving medical liability claims and support such system if there can be significant premium savings; MSSNY should form an Employed Physician Section and explore legal avenues to becoming a negotiating agent for these physicians; re-affirm existing policy calling on all healthcare providers to wear ID tags with big bold letters stating their professional designation
  • Resolutions deadline for the 2016 House of Delegates in March 17 at 5pm. Early submission is February 17. After March 17, resolutions will be considered late. In that case, the resolution is forwarded to the Rules Committee that decides whether or not the late resolution can be moved forward.
  • Don Fager, VP of MLMIC reported that regarding the Berkshire-Hathaway partnership, the Insurance Department examination is the longest process and should be completed by March of 2017. Mr. Fager also reported that frequency of claims has leveled off, but severity of claims has increased.
  • MSSNY Leadership Conference for young physicians in Syracuse was fully subscribed. Dr. Thomas Madejski, MSSNY Councilor and one of the conference speakers, said “It was an excellent opportunity for young doctors to network and discuss and develop leadership skills. The presentations on burnout and empathy were particularly well received. Hopefully it will improved our agenda for practice sustainability.”
  • Immediate Past President Dr. Joseph Maldonado, who sits on a FAIR HEALTH Committee, reported that there is a pilot program that will target the top 100 procedures performed in NY and that the physicians’ fees will be reported. The four communities targeted in 2017 are: Buffalo, Syracuse, Albany and Westchester.
  • Cynthia Brown, VP Government Affairs, AMA presented a comprehensive report on MACRA and the two Medicare payment model pathways for physicians. “MACRA is more “than a replacement for SGR,” she said.


CMS Releases Finalized Medicare Payment Rule for 2017
This week CMS finalized the Medicare payment rule for 2017.  To read the CMS fact sheet summarizing major changes in the proposed rule, click here.

To read the entire 1,400 page rule, click here.

Table 52 on pp.1329-1330 highlighted the anticipated specialty by specialty impact of the payment rule.  The chart notes that CMS anticipates that most specialties will see a 0% impact as a result of these changes.  However, they also anticipate that allergists, family practice physicians, internists and geriatricians will see a 1% increase in allowed charges, that ENTs, gastroenterologists, neurosurgeons, radiologists, and vascular surgeons will see a 1% decrease in allowed charges, and ophthalmologists and urologists will see a 2% decrease in allowed charges.

The fact sheet also notes that CMS finalized misvalued code changes that achieve 0.32 % in net expenditure reductions.  Since these changes do not fully meet the statutorily required misvalued code target of 0.5 %, it requires an adjustment to the 2017 overall physician update.   Therefore, the 2017 Part B conversion factor is $35.89, an increase to the 2016 PFS conversion factor of $35.80.

Among the changes highlighted by CMS include:

  • Primary Care and Care Coordination: The rule finalizes revisions to payment for chronic care management, including payment for new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health: CMS is finalizing payments for codes that describe specific behavioral health services furnished using the psychiatric Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also finalizing payment for a new code that broadly describes behavioral health integration services, including payments for other approaches and for practices that are not yet prepared to implement the Collaborative Care Model.
  • Cognitive Impairment Care Assessment and Planning: CMS finalizes payment to physicians to perform cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s)
  • Data Collection for Global Services: The 2017 payment rule also finalizes a data collection strategy for global services with significantly reduced burden for practitioners compared to the proposal. Required reporting will be limited to a sample of practitioners for selected services, and those practitioners who do report will report less information.

Review of the Final rule is ongoing.

MIPs Quality Measures
Based on MSSNY’s Council meeting of November 3, 2016, some of our members might like some help in finding their specialty specific quality measures for MIPs reporting.  Please see these links https://qpp.cms.gov/and https://qpp.cms.gov/measures/quality If you have questions, send an email to rmcnally@mssny.org .  Remember, MSSNY email is not HIPAA-secure, so please do NOT include any PHI!

Register Now for NY eHealth Collaborative on December 6-7
The New York eHealth Collaborative’s Digital Health Conference (DHC) on December 6-7 at New World Stages in Manhattan brings together 500 senior-level healthcare industry leaders to learn about new innovations and to foster dynamic conversation addressing how healthcare is being redefined through technology. This year, the conference is a Who’s Who of New York’s healthcare and health tech community gather for two days of networking, lively intellectual exchange, and exploration to see what’s new, what’s cutting edge, and what will shape the future of healthcare. Join your peers and register today!

MSSNY Colleagues: Receive a 10% registration discount. Use code MSSNY when registering at www.DigitalHealthConference.com.

Physicians Vote 9% Less than General Population
Despite the government’s huge influence on health care, doctors vote 9% less than the general population. They’re 22% less likely to cast ballots than lawyers, another group of highly educated professionals.

“If you look back at the history of the medical profession, there’s the sense that physicians are leaders in their community, and people historically looked up to doctors around broad community issues,” says Dr. David Grande, assistant professor of medicine at the University of Pennsylvania and co-author of the article. But that’s not the case anymore. Their reputation eroded, many experts believe, as they got less time with patients and more and more burned out. (Annals of Internal Medicine 11/1/16 Commentary).

“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.


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

Patient Survey On Pain Should Be Adjusted Physicians Are Pressured To Prescribe Unnecessary
The Buffalo (NY) News (10/31) editorialized that a patient survey on pain management that affects hospital funding “needs to be adjusted,” if it is putting pressure on physicians to prescribe opioids more often than is necessary. The editorial quotes Dr. Timothy Gabryel, the president of the Medical Society of Erie County, who said that treating pain as “the fifth vital sign” created “an expectation that there should be a pill for every problem and there should be no discomfort at all.”


Retired Physicians Can Get a Waiver for License Registration Fee
A point of information for those physicians who have retired and are no longer compensated for medical care provided – a waiver of the fee for the registration of your license as a physician in the State of New York is allowed under the provisions of Section 6524(10) of the New York State Education Law.  This law allows a waiver of the registration fee requirement for physicians who certify to the State Education Department that, for the period of their registration, they will only practice medicine without compensation or the expectation or promise of compensation. The waiver of the registration fee is limited to the duration of the registration period indicated of the affidavit. Affidavit of Non-Compensation.The American Medical Association (AMA) is offering several educational opportunities to help physicians understand the requirements of the new Quality Payment Program (QPP) that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).   The sessions have been scheduled to give physicians an understanding of what the final rule means for their practice and what they need to do as part of the QPP.

All of the sessions, except the November 29th, are open to physicians and medical society staff. We hope you will take advantage and register for these opportunities to learn what you need to know and pass along the registration information to your physician members. 

The November 29th session will be focused on helping medical society staff to gain a better understanding of the new regulations so you will be prepared to answer your members’ questions. 

30 Days Remaining to Submit an Informal Review for 2017 PQRS Results
In 2017, CMS will apply a downward payment adjustment to those who did not satisfactorily report PQRS in 2015 including:

·        Individual eligible professionals (EPs)
·        Comprehensive Primary Care (CPC) practice sites
·        PQRS group practices
·        Accountable Care Organizations (ACOs)

If you have any questions regarding the status of your 2015 PQRS reporting or are concerned about potentially receiving the PQRS downward payment adjustment in 2017, please do not hesitate to submit an informal review request. CMS will be in contact with every individual EP or PQRS group practice that submits a request for an informal review of their 2015 PQRS data.

If you believe you have been incorrectly assessed the 2017 PQRS payment adjustment, submit an informal review between September 26, 2016 and November 30, 2016 requesting CMS investigate your payment adjustment determination. All informal review requestors will be notified via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

Follow these steps to submit an informal review request:

·        Go to the Quality Reporting Communication Support Page (CSP)
·        In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
·        Select “Informal Review Request”
·        Select “PQRS Informal Review”
·        A new page will open

Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”

Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

Please see the PQRS informal review fact sheet for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 6:00 p.m.

CME on Waterborne Diseases Available at MSSNY CME Site
There’s been a recent outbreak of Legionnaires’ Disease in the Saratoga area of upstate New York.  Go to http://cme.mssny.org/index.jsp  to view our Medical Matters program Waterborne Diseases and learn more about this devastating illness and how it’s spread.  The educational objectives for this program are:

  • Describe how waterborne diseases occur and the national surveillance system for waterborne diseases
  • Identify possible symptoms of waterborne diseases that could occur in the US
  • Understand the prevention and treatment methodology for outbreaks 

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. 

AMA: Educational Opportunities to Fully Understand QPP Created by MACRA
The AMA is offering several educational opportunities to help physicians understand the requirements of the new Quality Payment Program (QPP) that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).   The sessions have been scheduled to give physicians an understanding of what the final rule means for their practice and what they need to do as part of the QPP. All of the sessions are open to physicians and medical society staff. We hope you will take advantage and register for these opportunities to learn what you need to know and pass along the registration information to your physician members.

  • Monday,  Nov. 21, 7 pm – 8:30 pm EST  Physician/Staff  webinar

Registration: https://cc.readytalk.com/r/y70aavsqh5g0&eom

  • Thursday,  Dec. 1 – 6:30 pm – 9 pm EST

Atlanta regional seminar (streaming and webinar)

Cobb Galleria Center

Atlanta Georgia

Registration:   https://www.eventbrite.com/e/macra-regional-seminar-atlanta-tickets-28840143646

  • Tuesday,  Dec. 6, 8:00 pm – 9:30 pm EST Physician/staff  webinar

Registration: https://cc.readytalk.com/r/j8d0v8kh1qr3&eom

  • Saturday,  Dec. 10, 9 am -11:30 PST

San Francisco regional seminar (streaming and webinar)

Marriot Marquis

San Francisco, CA

Registration:  https://www.eventbrite.com/e/macra-regional-seminar-san-francisco-tickets-28863673023

Physicians Feel Pressure to Prescribe Opioids for Pain
In an over 2,200 word article, the Buffalo (NY) News (10/30, Becker) reports that physicians feel pressure to prescribe opioids for pain from hospital administrators, patients, and pharmaceutical companies. The article highlights two sources of such pressure: the patient survey on pain treatment used by the Centers for Medicare and Medicaid Services as part of its formula for calculating hospital reimbursements, and the Joint Commission on Accreditation of Healthcare Organizations’ “Pain Management Standards.” The article mentions that earlier this year, CMS announced that it is considering alternatives to the patient surveys in its formula, but it will continue using the survey results in the meantime. It goes back to the 1990s, when there was a call for pain to be treated as “the fifth vital sign,” said Dr. Timothy Gabryel, president of the Medical Society of Erie County and medical director of Mercy Hospital.

“That set an expectation that there should be a pill for every problem and there should be no discomfort at all,” Gabryel said. “Doctors have been caught in the middle of this,” said Dr. Nancy H. Nielsen, former president of the American Medical Association. 

CMS Releases Finalized Medicare Payment Rule for 2017
This week CMS finalized the Medicare payment rule for 2017.  To read the CMS fact sheet summarizing major changes in the proposed rule, click here.

To read the entire 1,400 page rule, click here.

Table 52 on pp.1329-1330 highlighted the anticipated specialty by specialty impact of the payment rule.  The chart notes that CMS anticipates that most specialties will see a 0% impact as a result of these changes.  However, they also anticipate that allergists, family practice physicians, internists and geriatricians will see a 1% increase in allowed charges, that ENTs, gastroenterologists, neurosurgeons, radiologists, and vascular surgeons will see a 1% decrease in allowed charges, and ophthalmologists and urologists will see a 2% decrease in allowed charges.

The fact sheet also notes that CMS finalized misvalued code changes that achieve 0.32 % in net expenditure reductions.  Since these changes do not fully meet the statutorily required misvalued code target of 0.5 %, it requires an adjustment to the 2017 overall physician update.   Therefore, the 2017 Part B conversion factor is $35.89, an increase to the 2016 PFS conversion factor of $35.80.

Among the changes highlighted by CMS include:

  • Primary Care and Care Coordination: The rule finalizes revisions to payment for chronic care management, including payment for new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health: CMS is finalizing payments for codes that describe specific behavioral health services furnished using the psychiatric Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also finalizing payment for a new code that broadly describes behavioral health integration services, including payments for other approaches and for practices that are not yet prepared to implement the Collaborative Care Model.
  • Cognitive Impairment Care Assessment and Planning: CMS finalizes payment to physicians to perform cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s)
  • Data Collection for Global Services: The 2017 payment rule also finalizes a data collection strategy for global services with significantly reduced burden for practitioners compared to the proposal. Required reporting will be limited to a sample of practitioners for selected services, and those practitioners who do report will report less information.

Review of the Final rule is ongoing.

AMA Perspective on Reduction Opioid Abuse
This week, in a presentation to MSSNY, Patrice A. Harris, MD, MA, Chair of the American Medical Association’s (AMA) Board of Trustees provided the national and AMA perspective to physicians of the Medical Society of the State of New York on how to reduce opioid abuse.

“Since 2012, there has been an 81% increase in physicians nationally who have trained to provide Medication Assisted Therapy (MAT) to patients and a 1,170% increase during 2013-15 in physicians who are co-prescribing naloxone, said Dr. Harris.  “Additionally, physicians are taking more education on the prescribing of opioid and there are over 50,000 courses that are available.”

Dr. Harris also noted that New York State will now hold insurers accountable and has reached a settlement agreement with Cigna to halt pre-authorization for opioid addiction drugs and to remove barriers to other potential life-saving treatments.

MSSNY is one of eight state medical society members of the AMA’s Task Force to Reduce Opioid Abuse.


CLASSIFIEDS


State of the Art Midtown Medical Office for Rent
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: hefderm@outlook.com for details. No Brokers.


Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

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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.


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