April 14, 2017 – Budget’s High Points for Us

Dr. Reid - MSSNY President
Dr. Malcolm Reid
April 14, 2017
Volume 17
Number 15

MLMIC Insurance

Dear Colleagues:

The New York State Legislature completed passage of a $153 Billion State Budget 9 days after the State due date of April 1, and after several weeks of “round the clock” negotiations on an extraordinary number of difficult issues including raising the age of criminal responsibility, ride-sharing, education funding, emergency Budgetary powers, a Medicaid prescription drug price cap and Workers Compensation reform.  While the Legislature passed a two-month Budget extender, this final Budget deal overrides that legislation.

Thanks to strong advocacy by MSSNY physician leaders, MSSNY member physicians, county medical societies, and the many specialty societies with whom MSSNY works closely, the final Budget enacted DID NOT contain several objectionable provisions that had been opposed by MSSNY.  The final Budget:

  • Deleted a proposal opposed by MSSNY that would have required a physician to receive a “tax clearance” as a pre-condition of receiving Excess Medical Liability Insurance coverage, while assuring that the more than 20,000 physicians who currently receive Excess coverage continue to receive such coverage;
  • Deleted a proposal opposed by MSSNY that would have expanded burdensome prior authorization requirements by repealing statutory provisions that assure that the prescriber has the final say for all prescriptions for fee for service Medicaid patients as well for several drug classes for patients covered through Medicaid managed care;
  • Deleted a proposal opposed by MSSNY that would have permitted pharmacists to enter into “comprehensive medication management protocols” with nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or who have not met clinical goals of therapy;
  • Deleted a proposal opposed by MSSNY to create a Regulatory Modernization Team that could have empowered state agencies to override existing scope of practice laws without legislative approval;
  • Substantially revised provisions to permit Medicaid to sanction or remove a health care practitioner who violates a statutory limit on opioid prescribing, by assuring that a prescriber has appropriate due process protections before a sanction is imposed.
  • Continues necessary funding for MSSNY’s Committee for Physician’s Health and MSSNY’s Veterans Mental Health Care educational program;
  • Deleted several problematic elements that had been under serious consideration to be included in Workers’ Compensation Reform package enacted as part of the Budget, including provisions that would have:
    • Limited injured worker choice of treating physician by expanding the required use of Workers Compensation PPOs;
    • Removed the authority of county medical societies to recommend physicians to be approved to be WC-authorized providers or IMEs;
    • Expanded the penalties that the Board could impose on WC-authorized physicians;
    • Expanded the list of authorized health care providers in Workers Compensation, without any requirement for several of these providers to collaborate with a physician.

It should be noted that the final package includes a number of notable reforms that will have a significant long-term impact on New York’s Workers Compensation system including provisions that will:

  • Implement new impairment guidelines by year end 2017 after “consultation with  representatives of labor, business, medical providers, insurance carriers, and  self-insured employers”;
  • Create a prescription drug formulary by year end 2017 which “shall  include  a tiered list of high-quality, cost-effective medications that are pre-approved to be  prescribed  and  dispensed,  as well as additional non-preferred drugs that can be prescribed with prior approval”.
  • Create a workgroup in 2018 to review the criteria for those who provide Independent Medical Exams (IMEs);
  • Expedite the timeframe for Workers Compensation coverage disputes to be resolved; and
  • Grant additional powers to the Workers Compensation Board to impose “performance standards” on Workers Compensation carriers.

MSSNY’s Division of Governmental Affairs

Please send your comments to comments@mssny.org

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MLMIC Hosting Physician Meetings throughout State to Discuss Strategies
MLMIC will be hosting Healthcare Law Review programs for physicians at 11 different locations in the state during May and June. This program will provide:

  • Overview of the recent case law developments that impact the provision of healthcare
  • Strategies to safeguard the privacy of a patient’s medical information.
  • Strategies to protect Quality Assurance materials from discovery in a lawsuit
  • Steps that a physician should take to clarify his/her role as a consulting physician to improve patient care and reduce potential liability exposure
  • Review the information that the physician must disclose to the patient to establish true informed consent.

Click here to open the brochure regarding the 2017 Network Meetings. If you are interested in attending, please feel free to contact Ms. Diane Allen, MLMIC’s Risk Management Coordinator at 518-786-2741 or email: dallen@mlmic.com.

Registration Now Open for CME Webinar on Concussion in Pediatric and Adult Population
MSSNY will hold a Continuing Medical Education (CME) webinar on the “Current Concepts in Concussion for Pediatric & Adult Patients” on Wednesday, April 19, 2017 at 1 p.m. for all physicians and other health care providers.  Registration for the webinar is now open HERE A copy of the flyer can be found HERE

Faculty for the course will be John Anthony Pugh, MD, PhD, assistant professor of Neurology at Albany Medical Center (AMC), and Deborah Ilana Light, MD, primary care sports medicine and associate program director for the Sports Medicine Fellowship at Albany Medical Center.  Educational objectives are: 1) Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology; 2) Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol; 3) Describe methods for the primary and secondary prevention of concussion; 4) Identify patients who would benefit from referral to a concussion specialist.

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

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

USPSTF Releases Draft Guidelines on PSA Testing
The US Preventive Services Task Force (USPSTF) “has dropped its controversial opposition to routine screening for prostate cancer, and now says that men between the ages of 55 and 69 should discuss the test’s potential benefits and harms with their physicians “and make decisions based on their own ‘values and preferences.’” The group said in proposed new guidelines on April 11, “The decision about whether to be screened for prostate cancer should be an individual one.” The task force “continues to recommend that men 70 and older forgo screening altogether.”

The USPSTF’s 2012 advice against screening said there was little evidence that PSA screening was reducing deaths. Since that time, “PSA screening rates have declined by as much as 10%, and now less than one-third of US men get the tests.” Meanwhile, fewer men are being diagnosed with early-stage disease, when it is more treatable, while more are being diagnosed with more aggressive harder-to-treat cancer.

The draft prostate cancer recommendations announced online in JAMA, are open for public comment until May 8.

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

Physicians Still Disagree as to When to Recommend Mammograms
Research indicates “primary-care physicians and gynecologists continue recommending breast cancer screening for younger and older women despite changes to breast cancer screening guidelines.” Researchers found that “trust in different guidelines and a physician’s specialization affect their screening recommendations.” The findings were published in JAMA Internal Medicine http://bit.ly/2ojV8Ju. The US Preventive Services Task Force recommends biennial mammograms starting at 50 for all women.”

DFS: Insurers to Provide Coverage for Visits that Result in Marijuana Certification
New York State Department of Financial Services sent a letter issued on April 12, 2017 to remind insurers authorized in New York State that they must provide coverage for office visits for covered services, including those that result in medical marijuana certification, as long as the office visit wasn’t solely for the purpose of medical marijuana certification. 

Upcoming Veterans Health Care Training Program on Long Island: Includes CME Training for Primary Care Physicians
MSSNY, the New York State Psychiatric Association, and the National Association of Social Workers – New York State Chapter are hosting a two day conference on Long Island on Friday, May 5 and Saturday, May 6, 2017 at the Clarion Hotel & Conference Center, located at 3845 E Veterans Memorial Hwy, Ronkonkoma, NY 11779.

The conference will consist of interactive seminars and panel discussions focusing on the current and evolving healthcare needs of veterans. MSSNY will be conducting three CME accredited trainings for primary physicians and specialists, covering PTSD and TBI in returning veterans, suicide among returning veterans, and substance use disorders among returning veterans.

There is no cost, but separate registration is required for both the trainings and conference.

Click here to view a detailed schedule and register for the Veterans’ Mental Health Training Initiative

To register for each CME program, click on the program name below

PTSD and TBI in Returning Veterans
Friday, May 5, 1:15 p.m.
Faculty Presenter: Thomas Madjeski, MD
The educational Objectives for the PTSD program are:

1) Describe the symptoms of PTSD and TBI.
2) Describe the treatment modalities of PTSD and TBI.
3) Describe military culture & how to overcome unique barriers to treatment intrinsic to military culture 

Suicide among Returning Veterans
Friday, May 5, 2:30 p.m.
Faculty Presenter: Frank Dowling, MD
The educational Objectives for the Suicide program are:

1) Address the causes and warning signs of suicide and suicidal behavior among veterans.
2) Explore the best evidence-based diagnostic and treatment options available including psychotherapy and pharmacotherapy.
3) Identify barriers in military culture to identification and treatment and how to overcome them.

Substance Use Disorders Among Returning Veterans
Saturday, May 6, 10:45 a.m.
Faculty Presenter: Adolph Meyer, MD
The educational objectives for the Substance Use Disorders program are:

1) Explain substance use disorders (SUDs), symptoms, warning signs, comorbidities
2) Explore treatment options for veterans including evidence-based practices in psychotherapy and pharmacotherapy
3) Identify barriers to identification and treatment, including those unique to military culture, and how to overcome them

The presentation is part of Veterans Mental Health Training Initiative, which is supported by a grant provided by the New York State Legislature and administered through the New York State Office of Mental Health.

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

Further information or for assistance in registering for these programs, contact Greg Elperin at gelperin@mssny.org.

Trans-Fat Ban Linked to Reduction in New York’s CVD Admissions
Banning the use of trans-fatty acids in some New York counties coincided with a decline in admission rates for cardiovascular disease, JAMA Cardiology reports.

Researchers compared admission rates for the composite of myocardial infarction and stroke between New York counties implementing the ban in its eateries versus those that did not. The restricting counties showed an additional 6% drop in admissions relative to non-restricting counties after adjustment for an already-declining trend across the state. The difference became significant 3 years after implementation of the bans and benefitted men and women equally.

Of note, in 2015, the FDA mandated that food manufacturers remove partially hydrogenated oils from their products by mid-2018.

JAMA Cardiology article

Dietary & Lifestyle Strategies in Cardiovascular Risk Reduction – Half Day!

Friday, May 12, 2017, 8:00 AM – 1:30 PM

To Register and for more information, click here.

  • Diet and lifestyle are crucial components in the development and progression of cardiovascular disease (CVD), but are underemphasized in the educational training of most health care providers. This course will review the evidence for diet and cardiovascular disease including recent guidelines, analyses and controversies while providing practical counseling advice for assessing and implementing change to patients’ diets and lifestyle patterns. The evidence for dietary supplements will be reviewed as well as the evidence for exercise and how to appropriately and safely prescribe an exercise regimen for the prevention and treatment of cardiovascular disease. Attendees will learn specific time- efficient strategies to assess patients’ diet, use technology and motivational strategies for greater patient engagement and convey basic dietary advice within the time constraints of an office visit.

The NYU Post-Graduate Medical School designates this live activity for a maximum of 5.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. ​


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Physician Opportunities

Internist Needed Mon.-Fri. for Psychiatric Inpt in Queens
Internist needed for Full time general medical care of psychiatric inpatients.  Creedmoor Psychiatric Center is in Queens, and convenient to NYC, Nassau/Suffolk and near major transportation.  We are a small well organized Medical Department looking for another member.  Our physicians enjoy their work- life balance. Please contact: alan.diner@omh.ny.gov or call 718-264-4046

Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next generation of primary care. If the fusion of health care and technology inspires you, please apply here.

Ophthalmologist Part Time
Ophthalmologist needed to work at multiple nursing homes in all 5 boros except Staten Island. Part time or full-time position available.  Generous salary and incentives.Ttech provided. Opportunity to perform surgery, but not required. Please email cv to privacyssw@gmail.com

Multiple Physician Positions with DOHMH Office of School Health
Office of School Health is the largest program of the New York City Department of Health and Mental Hygiene (DOHMH). This bureau is responsible for managing the health issues and promoting the well-being of the over 1.3 million children and adolescents enrolled in New York City’s 1700 school buildings.

Positions with the Office of School Health (OSH) combine clinical skills and public health training. OSH focuses on child health, asthma prevention, obesity and nutrition, vision screening, dental care, mental health, reproductive health, and childhood disability. We collaborate with various city and community based agencies to provide social and academic services to address the needs of all New York City school children, especially those facing the most significant social, economic, and health challenges.

The Office of School Health is currently undergoing expansion. There is an immediate need for physicians with an expertise in pediatric, adolescent, or family medicine, with the capacity to utilize primary care skills set through a public health lens. OSH is also  interested in public health and preventive medicine graduates with programmatic, analytic, and social medicine skills.

The NYC DOHMH is reaching out to identify candidates for this recruitment. We are enlisting your help to nominate medical professionals who are committed to contributing their talents to improve health and academic outcomes in our schools. Please consider applying for these positions or passing these opportunities on to talented physicians among your own personal networks.

Attached are the American Academy of Pediatrics position statements on the role of the School Physician as well as the job description and recruitment flyers:

  • Adolescent School Health Physician, Family and Child Health/SH Reproductive/City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to:https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 277208
  • Field Doctor, Bureau of School Health/SH Medical (pre-K-8 Programs or High School) City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to:https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 265869
  • Supervising Medical Doctor,Bureau of School Health/SH Reproductive Health, City Medical Specialist, Level: 02/Part-time (35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ Job ID:  277026

Please list in your cover letter how you heard about this position (including name of the professional association, website, or individual who referred you). If you have questions, please contact Caroline Volel, MD, MPH at OSH@health.nyc.gov.