December 21, 2018 – Billion Dollar Baby

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
December 21, 2018
Volume 21  Number 46

MSSNYPAC Seal

Colleagues:

Governor Cuomo’s announcement this week “Let’s legalize the adult use of marijuana, once and for all” is a 180-degree turn from previous comments in early 2017. However, this “evolution” came as no surprise. In the summer, he set up a multi-agency task force to analyze the pros and cons of marijuana legalization, which then concluded the positives outweighed the negatives.   The Task Force members then went on the road to sell the idea. MSSNY and county medical society physician leaders testified at many of these meetings to state our support for marijuana decriminalization but also our strong concerns with the public health implications of the legalization of marijuana. The projected revenues the state would gain from legalization range $600M to $1.3B.  MSSNY has had meetings with the Governor’s office and key Assemblymembers to discuss how best to limit the potential significant adverse public health threats such as youth addiction and increased driving while intoxicated.

Vaping-the Next Epidemic

The U.S. Surgeon General Dr.  Jerome Adams, on Tuesday declared electronic cigarette use among America’s youth “an epidemic” and called for new restrictions on the products. The action comes a day after release of a Monitoring the Future report, which confirmed that teen vaping nearly doubled in 2018, with one in five high school seniors reporting current use of e-cigarettes. More than 3.6 million teens in the U.S. reported that they regularly used the vaping products. Recommendations in an advisory by Surgeon General Jerome Adams, MD, include banning vaping from establishments now covered by indoor smoke-free air policies, further restricting youth access to e-cigarettes in retail establishments, implementing new price policies, and banning marketing to youth.

The survey also found that many students believe they are vaping “just flavoring.” In fact, just about all brands include nicotine, and Juul, a popular, high-nicotine vaping product, that has particularly high levels of it. We all know that nicotine in any form is a tough chemical to give up.  It seems we haven’t learned much about the lure of “cool,” parent-unapproved chemicals in spite of our knowledge of addicting chemicals

Dr. Adams was joined by U.S. Health and Human Services Secretary Alex Azar and FDA Commissioner Scott Gottlieb, MD. The Monitoring the Future survey (sponsored by the National Institute on Drug Abuse) confirmed that the rise in youth e-cigarette use during 2017 and 2018 was the largest-ever single-year increase in use of a single substance ever recorded in the 43 years of the survey.

Sales of Juul increased by 600% in 2017 alone, making it the best-selling e-cigarette on the market. The e-cigarettes, which resemble USB flash drives, have high levels of nicotine — as much in a single cartridge as a pack of 20 regular cigarettes. “This is of particular concern for young people, because it could make it easier for them to initiate use of nicotine through these products and also could make it easier to progress to regular e-cigarette use and nicotine dependence,” Dr.  Adams noted.

In Tuesday’s New York Times, Jan Hoffman, in a column titled “How to Help Teenagers Quit Vaping,”   offered advice on how to get kids to quit vaping. His advice is good but I think most parents don’t even know their kids are doing it. It does not have the telltale smell of cigarette smoke.

County Health Officials Opposed to Legalization

The New York State Association of County Health Officials released a statement Tuesday outlining concerns about adverse health impacts from marijuana legalization. The association said it remains opposed to recreational marijuana legalization. But if it’s legalized, similar to MSSNY, the group called for safeguards and research as well as additional funding for local health departments for increases in workload.

The group is also opposed to e-cigarettes. According to the group, E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls to the U.S poison centers, increasing from 0.3% in September 2010 to 41.7% in February 2014. Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the initiation of smoking among adolescents and young adults. Marketing of e-cigarettes uses cartoons, promotes fruity tobacco flavors, and providers sponsorship of events such as concerts and sporting events, all forms of advertising and marketing designed to appeal to children and young adults.  For the above discussed reasons, both MSSNY and NYSACHO find it imperative to prohibit the advertisement of tobacco products and electronic cigarettes and NY State and therefore supports corresponding legislation.

MSSNY, working together with numerous public health advocacy organizations, is also calling on the Legislature to pass a law to create a statewide minimum age of 21 to purchase tobacco and e-cigarettes.  MSSNY also supports banning the use of flavored substances in vaped products.

Altria Nears a Deal to Take 35% Stake in Juul

According to the Wall Street Journal, Altria Group is nearing a deal to take a 35% stake in e-cigarette startup Juul Labs at a roughly $38 billion valuation, an investment that would make Juul one of the most valuable private companies.It would more than double what Juul was valued at just a few months ago, a sign of how quickly the startup has been growing and Altria’s desire to find growth outside its shrinking cigarette business.

While many groups have come together to alert the public to the health threats of nicotine, the developments around expanded use of e-cigarettes and marijuana show just how vigilant we need to continue to be.

Please share your suggestions or thoughts with me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


MLMIC Banner


eNews

New York Exchange Enrollment Continues to Rise
As talks of health care reform continue to swirl in Albany and across the country, enrollment in New York’s Health Insurance Exchange continues to accelerate.  Even with the federal removal of the individual coverage mandate – an act widely expected to lead to a decrease in enrollment – this year is actually outpacing last year in New York.

According to the NY State of Health, more than 1 million New Yorkers had enrolled in non-Medicaid coverage in the Exchange through December 15, representing an increase of about 83,000 people over last year. New York’s uninsured rate is currently under 6%, with about three-quarters of the uninsured eligible for subsidized coverage.  Specifically, there were 247,411 enrolled in a qualified health plan; 776,481 enrolled in the Essential Plan; 413,576 enrolled in Child Health Plus, and 3,283,564 enrolled in Medicaid.

This week, as part of his “First 100 Days” Address, Governor Cuomo proposed to codify into law both New York’s Exchange as well as its “pre-existing conditions” protects for consumers.  While New York currently has a law protecting patients from being denied coverage because of a pre-existing condition, this law is tied to the federal ACA provisions that were put in doubt as a result of last Friday’s federal District Court Judge’s ruling that the ACA is unconstitutional.

In response to Judge O’Connor’s ruling, Dr. Madejski was quoted in several papers, including Newsday, Westchester Journal News, and Buffalo Business First, stating “While the ACA has many flaws that we urge Congress to work to fix, among its strongest attributes are its mechanisms to enable the purchase of health insurance coverage for millions through a variety of subsidy programs.” Amongst those flaws is the need to require exchange plans to offer out of network coverage.

With health insurance coverage through the Exchange under discussion in 2019, MSSNY will continue to push for measures to ensure patients have access to comprehensive and varied health insurance options, including out of network coverage.


Exciting Sections Meeting: Young Physicians, Residents/Fellows, Medical Students. Saturday, February 9, 2019 at the Marriott Courtyard in Westbury and MSSNY HQ. Hear national leaders in medical toxicology and social media in medicine. Read all about it here.


Judge Reviewing CVS-Aetna Orders DOJ to Respond to Community Concerns
US District Court Judge Richard Leon this week ordered the US Department of Justice to respond to numerous comments filed to it raising concerns with the proposed mega merger between CVS and Aetna.  According to media reports, this development is expected to delay approval of the merger until at least Spring 2019.

Among the comments to the US DOJ is a letter from MSSNY President Dr. Thomas Madejski summarizing MSSNY’s extensive concerns with this merger among corporate behemoths. The DOJ letter also appended testimony provided by MSSNY Immediate Past President Dr. Charles Rothberg at an October NY Department of Financial Services hearing.

The letter also summarizes the extensive concerns that had been raised by NY DFS Superintendent Maria Vullo, the American Medical Association (AMA), the American Antitrust Institute and New York State Assembly Insurance Committee Chair Kevin Cahill.

Moreover, last week, the Pharmacists United for Truth and Transparency (PUTT) and the Pharmacists Society of the State of New York (PSSNY) jointly filed a motion asking Judge Leon to stop CVS and Aetna from further integration while the Court determines the merger’s harmful effects.

The US DOJ had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition.  The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger in late November with numerous conditions.

MSSNY’s letter to the DOJ highlighted that, even though the NY DFS had approved the acquisition, it did so highlighting several problems with the merger, including that the companies had not “provided any concrete analysis that the CVS/Aetna merger would result in specific reduced costs for New York consumers, or any business plan or study of asserted improved health outcomes to benefit New Yorkers.”

Moreover, MSSNY’s letter to the DOJ reiterated the extensive concerns articulated by the AMA.  Judge Leon’s concerns about the transaction included the strong opposition by the AMA, which had argued to the DOJ that it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options.  


Physician Compare 30-Day Preview Period Extended to 1/7
On November 30, CMS opened the 30-Day Preview Period for the 2016 performance information targeted to be publicly reported on Physician Compare starting in early 2019. The preview was scheduled to end on December 31 at 8pm ET. We are extending preview through Monday, January 7 at 8pm ET (5 PM PT).

For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at QPP@cms.hhs.gov.

If you have any questions about Physician Compare, public reporting, or the preview period, please contact us at PhysicianCompare@Westat.com.


NY Rx Card Banner


DFS Superintendent Vullo to Depart in February
New York Superintendent of Financial Services Maria Vullo announced this week that she would be stepping down from the position on February 1, 2019.  The many important activities engaged in by Superintendent Vullo include her close scrutiny and criticism of the defects of the many health care mega mergers such as the proposed Anthem acquisition of Cigna, and the proposed CVS acquisition of Aetna. In her statement announcing her departure she noted that “I am especially proud to have led DFS in cybersecurity, having promulgated a final regulation in March 2017 that is now the national standard for the protection of our nation’s financial markets.  I also am tremendously proud of our work to protect women’s rights in the face of federal assaults, by mandating insurance coverage of contraceptives and abortions without cost-sharing, providing essential coverage for women suffering from maternal depression, providing a special health care open enrollment period for victims of domestic violence, and implementing New York’s Paid Family Leave law.”


Assemblywoman Crystal Peoples-Stokes Named Majority Leader of NYS Assembly; Assembly Committee Chairs Mostly to Remain the Same
Assemblywoman Crystal Peoples-Stokes (D-Buffalo) was appointed by Assembly Speaker Carl Heastie to serve as the Assembly Majority Leader. The majority leader is responsible for the day-to-day operational duties of the Assembly chamber, including overseeing the floor during debates.  She will replace Joe Morelle, who just won election to Congress in his Rochester-area seat.

“Serving alongside Crystal Peoples-Stokes, I have had the opportunity to see firsthand how hard she works for the people of Buffalo and for families across our state,” Speaker Heastie, said. “Crystal is a trusted colleague who I have known for many years, and her experience and dedication to improving the lives of all New Yorkers is why I know she will make an ideal partner in leading the Assembly Majority. Crystal is widely respected by her colleagues and I am proud to appoint her as the next Majority Leader of the People’s House.”

Speaker Heastie also announced Assembly Committee Chairs for the 2019-2020 Session this week.  Many of the Chairs of Committees of strong interest to physicians and patients will remain the same.  The Assembly Health Committee Chair will continue to be Richard Gottfried.  The Insurance Committee Chair will continue to be Kevin Cahill.  The Higher Education Committee Chair will continue to be Deborah Glick.  The Assembly Judiciary Committee Chair will continue to be Jeffery Dinowitz.  The Codes Committee Chair will continue to be Joseph Lentol and the Ways and Means Committee will continue to be led by Helene Weinstein.   Assemblyman Marcos Crespo has been appointed chairman of the Committee on Labor, replacing Michele Titus.


Physicians File Class Action Suit Against ABIM
A class action lawsuit against the American Board of Internal Medicine (ABIM) was filed in a Pennsylvania federal court on December 6.  The plaintiffs include several physicians board certified in internal medicine who allege that the ABIM maintenance of certification (MOC)

requirements violate the federal anti-trust laws.  The physician plaintiffs allege that initially board certified internists have lost hospital privileges if they do not obtain MOC. It is also alleged that initially board certified internists have been removed from the list of “preferred physicians” by health insurers if they do not maintain MOC.  A similar action had been brought in an Illinois federal court by the American Association of Physicians and Surgeons (AAPS), but was dismissed on the basis that the complaint merely made general conclusions, and failed to provide sufficient specific details.



Garfunkel Ad


U.S. FDA Panel Votes for Prescribing Naloxone with Opioids
On Dec 18, an advisory panel to the U.S. Food and Drug Administration recommended prescribing the opioid overdose reversal drug, naloxone, with addictive painkillers.

The panel, which concluded a two-day discussion on ways to make the potentially life-saving drug readily available, voted 12-11 in favor of labeling changes for opioids that recommend co-prescribing the overdose antidote.


Surgeon General Declares E-Cigarettes a Youth Epidemic
The US Surgeon General on Tuesday declared electronic cigarette use among America’s youth “an epidemic” and called for new restrictions on the products.

The action comes a day after release of a Monitoring the Future report, which confirmed that teen vaping nearly doubled in 2018, with one in five high school seniors reporting current use of e-cigarettes. More than 3.6 million teens in the U.S. reported that they regularly used the vaping products.

Recommendations in an advisory by Surgeon General Jerome Adams, MD, include banning vaping from establishments now covered by indoor smoke-free air policies, further restricting youth access to e-cigarettes in retail establishments, implementing new price policies, and banning marketing to youth. In his advisory, the Surgeon General singled out the new generation of e-cigarettes that have e-liquid contained in a cartridge, such as the brand Juul, as posing a particular risk to youth.

He added that despite these risks, approximately two-thirds of Juul users between the ages of 15 and 24 in one survey did not know that Juul always contains nicotine. (See Dr. Madejski’s comments in the introduction.)


MSSNY Symposium Call for Abstracts; Open through 4:00 pm Tuesday, January 22, 2019
MSSNY member residents, fellows and medical students are invited to submit abstracts for consideration for the MSSNY Symposium, to be held April 12, 2019 at the Westchester Marriott in Tarrytown. Submissions will be accepted until 4:00 pm on Tuesday January 22, 2019. See complete guidelines at http://www.mssny.org/Documents/RFS/Guidelines_2019a.pdf.

Please contact sbennett@mssny.org with any questions.

If you’d like to help score abstracts, contact sbennett@mssny.org.


Dr. First Banner


3rd and 4th District Meeting Jan 25-27 at the Mirror Lake Inn in Lake Placid.


Physician Fee Schedule Final Rule: Understanding 3 Key Topics
Here are the answers to frequently asked questions::

Topic: E/M

Q: What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?
View the response here.

——————————————————————————————

Topic: QPP

Q: How does the MIPS payment adjustment apply to clinicians, especially those who may switch practices during the performance year?

A: Below are the general rules on how the payment adjustment is applied, which is different than the legacy programs.

  1. A MIPS eligible clinician (NPI) who bills to the same TIN in the payment year as they did during the performance period will be assessed the payment adjustment under that TIN/NPI combination according to the final score earned from data submitted/collected under that TIN
  2. A MIPS eligible clinician (NPI) who bills to a (new) TIN in the payment year that they did NOT bill to during the performance period will be assessed the payment adjustment under that (new) TIN/NPI combination based on the most advantageous final score attributed to that NPI under any TIN/NPI combination for the performance period.

———————————————————————————————-

Topic: Changes to MIPS Requirements

  1. Are there any changes to the data completeness requirements for the MIPS Quality performance category in 2019?
  2. No, the data completeness requirements are the same as in Year 2 (2018) even with the update to the submission terminology. Individual clinicians or groups submitting quality measure data on QCDR measures, MIPS CQMs, and eCQMs must submit data on at least 60% of the clinician or group’s patients that meet the measure’s denominator criteria, regardless of payer. Individual clinicians or groups submitting quality measure data on the Medicare Part B claims measures must submit data on at least 60% of the applicable Medicare Part B patients seen during the performance period.

Additionally, we have a fact sheet that provides additional information and scenarios on the MIPS payment adjustments.


American Board of Specialties on Continuing Board Certification: Vision for Future Commission Releases Report
The report, Draft Report for Public Comment which includes the Commission’s key findings and recommendations, will be posted on the Vision Initiative website for comment through Tuesday, January 15, 2019 at 10:00 p.m. EST.

We strongly encourage you to review the draft report and offer your comments by the January 15, 2019 deadline.

The American Board of Medical Specialties and its 24 Member Boards are committed to working with stakeholders to improve the continuing certification process so that it becomes a system that demonstrates the profession’s commitment to professional self-regulation, offers a consistent and clear understanding of what continuing certification means, and establishes a meaningful, relevant and valuable program that meets the highest standard of quality patient care. The Boards will seriously consider the Commission’s findings and recommendations once finalized, as they continue implementation of improvements and pilots currently underway.

Kristin Schleiter, JD
VP, Policy, Government Relations and Strategic Engagement
American Board of Medical Specialties
Direct 312-436-2686
Mobile 847-636-2779


AM Best Rates MLMIC A+
AM Best has assigned a Financial Strength Rating of A+ (Superior) and a Long-Term Issuer Credit Rating of “aa-” to MLMIC Insurance Company (MLMIC) (New York, NY). The outlook assigned to these Credit Ratings (ratings) is stable.

The ratings reflect MLMIC’s balance sheet strength, which AM Best categorizes as strongest, as well as its adequate operating performance, limited business profile and appropriate enterprise risk management. The ratings also benefit from the financial support provided by MLMIC’s direct parent company, National Indemnity Company, which is ultimately owned by Berkshire Hathaway Inc. [NYSE: BRK.A and BRK.B].

MLMIC’s risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR) is categorized as strongest and AM Best expects it to remain at a similar level in prospective years. The balance sheet strength assessment also considers the company’s track record of positive reserves development, as well as good financial flexibility provided by its publicly traded ultimate parent Berkshire Hathaway Inc.

MLMIC’s insurance portfolio is concentrated in the medical malpractice line of business. The company underwrites risks only within New York state, which represents one of the nation’s most challenging market environments. However, management has been able to operate successfully through underwriting cycles while maintaining MLMIC’s leading market position within New York.


Health Affairs: First Estimate of Physicians Telemedicine Use
The December issue of Health Affairs, using data from the AMA’s 2016 Physician Practice Benchmark Survey, provides the first nationally representative estimates of physicians’ use of telemedicine. In 2016, 15.4 percent of physicians worked in practices that used telemedicine for a wide spectrum of patient interactions, including e-visits as well as diagnoses made by radiologists who used telemedicine to store and forward data. In the same year, 11.2 percent of physicians worked in practices that used telemedicine for interactions between physicians and health care professionals. We found that in addition to specialty, larger practice size was an important correlate of telemedicine use. This suggests that despite regulatory and legislative changes to encourage the use of telemedicine, the financial burden of implementing it may be a continuing barrier for small practices.


Heart Group: Statins’ Benefits “Greatly Outweigh” Their Risks
For most patients who meet criteria for statin therapy, the benefits “greatly outweigh” the risks, according to a new scientific statement from the American Heart Association.

Here are some of the group’s conclusions, published in Arteriosclerosis, Thrombosis and Vascular Biology:

  • Statins prevent primary cardiovascular events in 5% of patients treated for 5 years (who achieve a 77-mg/dL reduction in LDL) and prevent secondary events in 10% of those treated.
  • Myopathy, including rhabdomyolysis, owing to statin use affects less than 0.1% of treated patients.
  • Severe liver toxicity occurs roughly 0.001% of the time.
  • Statins “modestly” increase the risk for diabetes, most often in patients with numerous other risk factors.

The absolute risks for additional adverse effects are listed in Table 7 of the document linked below.

AHA scientific statement in Arteriosclerosis, Thrombosis and Vascular Biology

AHA/ACC 10-year CV risk calculator


PAI Submits Comments in Response to Anti-Kickback Statute Request for Information (RFI
PAI submitted comments in response to the Anti-Kickback RFI, supporting the Department of Health and Human Services’ (HHS) efforts to modernize the Anti-Kickback Statute as well as the Beneficiary Inducement Civil Monetary Penalty Law (CMP). In its comments, PAI submitted several recommendations that would provide physicians relief from the antiquated aspects of these laws/regulation, including encouraging HHS to take the following key steps:

  • Establish clear exceptions to the Statute and CMP restrictions for payment models and demonstrations and other arrangements that promote physician-led initiatives to value-based care.
  • Allow physicians to align with other high-quality providers (clinical and non-clinical, including social support organizations) for greater coordinated care and a more holistic approach to patient care.
  • Encourage physician-patient relationships through greater patient incentives and rewards that promote and support the delivery of high-value, low-cost care and contribute towards greater coordinated care that improves outcomes.

More detailed recommendations include:

  • Permitting physicians and practices to enter into group purchasing arrangements for medical equipment and social support services on behalf of their patients.
  • Modernizing the statute to allow and provide for the infrastructure support and financial incentives necessary for value-based arrangements, for both providers and patients. The current exceptions, safe harbors, and waivers limited to certain models should be expanded to other APMs, demonstrations, and similar arrangements.
  • Strengthening physician-patient relationship by better alignment, including equipping physicians with tools that can be used to incentivize patient adherence to their care plans and help ensure medication adherence.
  • Allowing cost savings from rebates and negotiated discounts to be passed down from pharmacy benefit managers (PBMs) to patients and holding PMBs to stricter standards.
  • Creating additional safe harbors that allow physicians to establish arrangements with electronic health record vendors to further promote interoperability and health information exchange.
  • Clarifying the definitions of “value,” “risk,” and “market/market share” under the Statute and in their application to value-based payment arrangements.

CME WEBINARS

 “Public Health Preparedness 101” CME webinarJanuary 16, 2019 at 7:30am – Registration now open 

Are you prepared for a public health emergency?  And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here.  Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

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


Join MSSNY Banner


 

 


Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY STATEMENT IN RESPONSE TO JUDGE O’CONNOR’S ACA RULING


MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

December 17, 2018
For Immediate Release

MSSNY STATEMENT IN RESPONSE TO JUDGE O’CONNOR’S ACA RULING

Statement attributable to:
Thomas Madejski, MD
President, Medical Society of the State of New York

“Friday night’s Federal District Court ruling that the ACA is unconstitutional has the potential to wreak havoc with New York’s health care system, and our patients’ ability to obtain comprehensive health insurance coverage for the care they need.

While the ACA has many flaws that we urge Congress to continue to work to fix, among its strongest attributes are its mechanisms to enable the purchase of health insurance coverage for millions through a variety of subsidy programs.  These include expanded Medicaid coverage, tax credits and Basic Health plan coverage for those who earn too much to qualify for Medicaid.

Indeed, countless New Yorkers rely upon these mechanisms to obtain health insurance coverage that could be jeopardized if the court decision were to be upheld. Let’s work to make sure these important protections are maintained and enhanced.”

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

 

Media Contact:
Roseann Raia

Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516.488.6100 x 302
rraia@mssny.org

 

December 14, 2018 – Am. Bd. of Specialties Wants Your Opinion!

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
December 14, 2018
Volume 21  Number 45

MSSNYPAC Seal

Colleagues:

My wife Sandra and I were honored to be able to join the New York State Society of Anesthesiologists for their Annual PGA in Manhattan last weekend.  Congratulations to outgoing President Dr. David Bronheim upon completion of a successful year.  I look forward to working on a number of issues of mutual interest to MSSNY AND NYSSA with incoming president Dr. Vilma Joseph. Special thanks to Stuart Hayman and Dr. Rose Berkun for their hospitality and friendship.

NYSSA provides a robust educational program in conjunction with their PGA and I participated in a panel discussion about possible passage of single payer legislation in New York State and other potential health care financing changes.  Subsequent to that, I traveled to Washington, D.C., along with MSSNY Senior Vice President for Legislative Affairs Morris Auster to participate in a discussion convened by the AMA about the last Medicare financing reform.

Medicare and You

The federal Medicare program continues to be the major driver in physician payment in the United States.  Medicare policies (and experiments) often create care and payment changes in the commercial insurance market and in Medicaid.  Medicare payment seems to be perpetually in need of reform.  The last major change in Medicare financing occurred with the passage of MACRA in 2015. MACRA was in part an attempt to provide a solution to the ongoing problem of the Sustainable Growth Rate formula, a flawed calculation that failed to compensate physicians and others fairly, and created an ongoing crisis of potential cuts that could have crippled a physicians’ ability to provide care and maintain their practice.  MACRA traded the SGR solution for a new payment system that promised to control costs while providing higher value care.  MACRA provides a carrot of bonus payments for participation in quality activities through the MIPS program for smaller practices, or through the QPP program in a variety of forms.  Unfortunately due to budgetary constraints the bonuses occur in the context of a tournament.  The lower performers receive a stick in the form of payment reductions.  Part of the design assumed that a movement away from fee for service Medicare would improve quality and restrain cost increases.  Due to the cost of replacing the SGR, payment increases have been limited and, with the sequestration process affecting the Federal budget, inadequate for practices to keep pace with inflation, and in many cases a poor return on the investment in resources required to participate and attempt to improve care.  In fact, from 2001 to 2017 while Medicare payments to hospitals and skilled nursing facilities have increased approximately 50% (8% above inflation), Medicare physician payments adjusted for inflation dropped 36%! (6% increase minus a 42% increase in the CPI)

Incentives Are Wrong

MSSNY continues to work with our partners at the AMA, and other State and Specialty Medical Societies to improve the care of our patients, and enhance physician satisfaction and practice sustainability.  Improper payment incentives and inadequate payment systems harm patients, and retard the development of a healthcare system that improves societal health and patient outcomes.

There was a wide ranging and robust discussion about issues and opportunities to improve patient care by changing the existing Medicare payment system at the Washington meeting.  Some of the challenges we face include:

  • The overall fiscal situation of the United States:  In a country with an expanding national debt and budget deficits approaching 1 trillion dollars per year, adding additional funds to support practice sustainability will be very difficult.  Trying to redirect existing funds from other areas that have benefited from the increased value provided to the system by physicians’ activities will be politically challenging.
  • After the first 5 years of MACRA, there is a five-year freeze on the Medicare Part B conversion factor. It was anticipated that there would be further modifications to the payment system before this went into effect.  This obviously would exacerbate the inequity in update differential payment highlighted above.
  • Demonstrating to lawmakers and regulators what we believe to be true—the highest quality, and most cost effective care to a patient is provided by physicians in a non-institutional setting.
  • Creating flexibility for physicians to have a real choice as to participation in new payment models. While there is much excitement about value based care, there is limited data that demonstrates its preference to traditional fee for service Medicare.  Some specialties may be best served by preservation of a fee for service model.  One of the great difficulties in MACRA implementation is the difficulty to come up with alternate payment models for physicians to consider across the spectrum of specialties and types of practice.  A bias toward large group structure to be able to afford the management tools for population health needed in risk contracting will not work in many rural or urban settings with limited resources, geographic challenges etc.
  • Reducing the regulatory and documentation burden of practice, including assuring our EMRs are truly functional.  It’s lunacy to continue as is a system that has physicians spend two-thirds of their time on non-clinical activity to get paid and not get sued.  That’s a 21st Century cure that I’d like to see.

MSSNY, through our House of Delegates, Socio-Economic committees, Council and AMA delegation, will continue to consider, explore, and advocate for policies that improve the our patients’ lives and that of our physician members.  I’m always interested to hear policy thoughts and feedback from our members.

Please share your suggestions or thoughts with me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


MLMIC Banner


eNews

Measles Advisory Update – Webinar Available at MSSNY CME Website
The New York State Department of Health issued an update on Tuesday, December 11th to the Measles Health Advisory in New York State.  You can view the advisory here.  There have now been at least 130 confirmed cases in the downstate region.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” on Wednesday.  This webinar has now been posted to https://cme.mssny.org .  Please check it out and keep yourself informed about the ongoing measles outbreak in New York State. 

MSSNY Submits Comments to Department of Justice re CVS-Aetna
As reported last week, US District Court Judge Richard Leon has considering delaying the proposed mega merger between CVS and Aetna.   He has ordered a hearing for December 18 and told the companies to present arguments by December 14 to convince him why the acquisition should be permitted.

This week, MSSNY submitted comments to the US DOJ that included testimony MSSNY Immediate Past-President Dr. Charles Rothberg delivered at the October 18 NY DFS hearing examining this transaction, as well as summarizing the extensive concerns with this merger among corporate behemoths that had been raised by NY DFS Superintendent Maria Vullo, the American Medical Association, the American Antitrust Institute and New York State Assembly Insurance Committee Chair Kevin Cahill.

The US Department of Justice (DOJ) had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition.  The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger in late November with numerous conditions.

While DFS’ conditional approval agreement addressed to some degree some of the concerns raised by MSSNY over the last year, MSSNY President Dr. Thomas Madejski issued a statement noting that physicians remained very concerned about the adverse impact to the health care delivery system in New York given the enormous reach of this transaction.

MSSNY’s letter to the DOJ highlighted that, even though the NY DFS had approved the acquisition, it did so highlighting several problems with the merger, including that the companies had not “provided any concrete analysis that the CVS/Aetna merger would result in specific reduced costs for New York consumers, or any business plan or study of asserted improved health outcomes to benefit New Yorkers.”

Moreover, MSSNY’s letter to the DOJ reiterated the extensive concerns articulated by the AMA.  Judge Leon’s concerns about the transaction included the strong opposition by the AMA, which had argued to the DOJ that it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options. 

Advocacy Alert – Please Urge Governor to Sign Bill Requiring Greater Transparency of Insurer Compliance with Mental Health & SUD Parity Laws
Physicians are urged to send a letter to the Governor requesting that he sign into law legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the NY Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.   A letter can be sent from here.

MSSNY, working together with the New York State Psychiatric Association and other specialty societies, had strongly supported this legislation as it passed the Legislature nearly unanimously.   The bill was delivered to the Governor on December 11, which means he has until December 22 to act. 

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS (https://dfs.ny.gov/consumer/health/cg_health_2018.pdf).

Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws.


NY Rx Card Banner


NY DFS Approves Cigna-Express Script Merger with Several Conditions
The New York Department of Financial Services (DFS) announced late Thursday that it had approved the purchase by Cigna of PBM Express Scripts.  MSSNY had submitted to DFS a letter detailing its concerns with this transaction in connection with the hearing that had been scheduled by DFS for last Friday, December 7, but the hearing was postponed after only one other group had requested to testify.

As noted in the last week’s e-news, MSSNY’s letter urged DFS to place meaningful “guardrails…to ensure that our patients’ ability to receive the care or medication they need from the physician or pharmacy of their choice is not disrupted or made more burdensome.” Concerns included: the anticompetitive effects of a health insurer purchasing a PBM when that PBM continues to provide services to other health insurance companies; the lack of a regulatory structure in New York regarding the actions of PBMs; and the risk of even more burdensome prior authorization requirements.

While MSSNY is still reviewing the final Opinion and Decision, at first glance, many of the conditions of approval appear similar to those that were required by DFS as part of its approval of the CVS acquisition of Aetna, including:

  • Prohibiting increased health insurance rates to pay for the cost of the acquisition;
  • Prohibiting dividends to be paid by Cigna without the express prior approval of DFS for 3 years;
  • Prohibiting preferential PBM pricing of Express Scripts to any Cigna-affiliated health insurer, to better ensure insurance competitors can continue to fairly purchase PBM services from Caremark;
  • Limiting changes to Cigna’s healthcare provider networks for 3 years, including maintaining access to non-chain New York pharmacies;
  • Contributing $20 million to New York State, to support health insurance education and enrollment activities and strengthen New York health care transformation activities, which may include payments to the New York State Health Care Transformation Fund
  • Requiring an independent third-party audit to assess whether Cigna employees have accessed Confidential Information from Express Scripts in violation of firewall policies; and

Furthermore, the decision contained a requirement that the parties “agree to take no action to oppose legislation” to directly regulate PBMs in New York State.

Nevertheless, physicians remain concerned with the increasing consolidation in the health care system.  MSSNY’s letter to DFS expressing concerns with this transaction, as well as its letter to the US DOJ regarding the CVS purchase of Aetna (see related article) noted that “the efficiencies that are promoted and marketed to supposedly occur are hardly ever borne out after these transactions are consummated.  Inevitably, these mergers create market dynamics that almost always result in further administrative burdens placed on physicians seeking to assure their patients receive the care or medication they need.

MSSNY Addiction & Psychiatric Medicine Committee Paper: Medicine and Marijuana
The Medical Society of the State of New York convened its members on the Addiction and Psychiatric Medicine Committee, the Bioethics Committee and its Health Disparities Committee for comments on the possibility that New York State government may seek legalization of recreational marijuana.  Comments were also expressed by committee members on the existing marijuana program for medicinal purposes.    

American Board of Specialties on Continuing Board Certification: Vision for Future Commission Releases Report
The report, Draft Report for Public Comment which includes the Commission’s key findings and recommendations, will be posted on the Vision Initiative website for comment through Tuesday, January 15, 2019 at 10:00 p.m. EST.

We strongly encourage you to review the draft report and offer your comments by the January 15, 2019 deadline.

The American Board of Medical Specialties and its 24 Member Boards are committed to working with stakeholders to improve the continuing certification process so that it becomes a system that demonstrates the profession’s commitment to professional self-regulation, offers a consistent and clear understanding of what continuing certification means, and establishes a meaningful, relevant and valuable program that meets the highest standard of quality patient care. The Boards will seriously consider the Commission’s findings and recommendations once finalized, as they continue implementation of improvements and pilots currently underway.

Kristin Schleiter, JD
VP, Policy, Government Relations and Strategic Engagement
American Board of Medical Specialties
Direct 312-436-2686
Mobile 847-636-2779 

DFS Fines Aetna and Oscar More Than $2.5 Million For Violations Of Insurance Law
NY Department of Financial Services (DFS) Superintendent Maria Vullo announced this week DFS had imposed fines against Aetna and Oscar totaling more than $2.5 million for violations of New York Insurance Law.  According to the DFS press release, Aetna will pay a civil penalty of $1.95 million for violations including the failure to make prospective determinations, including pre-authorizations, and failure to acknowledge and respond to members’ complaints within required timeframes.  Oscar Insurance Corp. will pay a civil penalty of $576,950 for violations including the failure to adhere to deadlines for utilization reviews and failure to include detailed explanations of adverse determination notices.

Regarding Aetna, a DFS market conduct examination found that from 2012 through 2015, Aetna failed to comply with a number of consumer/provider protections, including: completing pre-authorizations determinations within three business days of receipt of all necessary information; Responding to members’ complaints within the required time frames; sending initial adverse determination letters to the insured and providers within 30 days; and making an appeal determination within 60 days of all necessary information to conduct an appeal.

Under the consent order, Aetna will review and revise all of its procedures related to utilization review, appeals, grievances and complaints to ensure that timely determinations and notifications are given to insureds, providers, and other recipients.  Moreover, Aetna will reprocess all preventive care claims where cost sharing was inappropriately applied and make overdue payments, including interest; and reprocess all claims that were inappropriately denied, and make overdue payments, including interest.

Regarding Oscar, a DFS market conduct examination found that from 2013 through 2015, Oscar failed to comply with a number consumer/provider protections, including: failing to make a determination for prospective utilization reviews within three business days; Failing to make a determination for concurrent utilization reviews within one business day; and failing to include an accurate and detailed explanation of the clinical rationale for the denials in the adverse determination notices;

Under the consent order, Oscar Insurance will be: revising EOB statements to include the appropriate forfeiture language; revising adverse determination notices to include a detailed explanation of the clinical rationale for denials; and reviewing and revising all procedures, related to utilization review to assure that timely determinations are made.

A copy of the Aetna consent order can be found here.

A copy of the Oscar Insurance Company consent order can be found here.


Garfunkel Ad


Millions Expected To Drop Health Coverage in 2019 with Repeal of ACA Penalty
Kaiser Health News piece predicts that millions of Americans are likely to drop their health insurance for next year now that the ACA’s penalty for not having coverage has been eliminated. The Congressional Budget Office predicted that “the repeal of the penalty would move 4 million people to drop their health insurance next year – or not buy it in the first place – and 13 million in 2027.” The article says some consumers “who from the start hated the Affordable Care Act, or Obamacare as it is often called, will drop their coverage as a political statement,” while others will do so because of affordability.


Dr. First Banner


NY Hospitals Reach Settlement, Agree To Stop Improper Billing of Rape Survivors
A group of New York hospitals has agreed to pay restitution to rape survivors and revise billing procedures as part of a legal settlement, state Attorney General Barbara Underwood announced Nov. 29.

The settlement resolves allegations that the hospitals illegally billed at least 200 forensic exams to rape survivors, ranging from $46 to $3,000 each, according to Ms. Underwood.

Hospitals are Brookdale University Hospital Medical Center in Brooklyn; Montefiore Nyack (N.Y.) Hospital; New York Presbyterian/Brooklyn Methodist Hospital; New York-Presbyterian/Columbia University Irving Medical Center; Staten Island-based Richmond University Medical Center; and Bronx-based St. Barnabas Hospital. Columbia University, which employs physicians, is also included.

The hospitals have agreed to pay restitution to rape survivors, in addition to costs, and implement written policies to prevent rape survivors from receiving bills for their rape exams. The settlements follow an investigation of billing practices for forensic rape examinations at Brooklyn Hospital Medical Center. Ms. Underwood said the investigation resulted in an agreement with the hospital, and her office initiated a statewide investigation of billing practices for rape exams at other facilities.

New York law requires that hospitals bill rape exams to the state Office of Victim Services directly, unless the sexual assault survivor voluntarily decides to assign the costs to a private health plan. (Becker’s Hospital Review 11/30)

Free Dinner Symposium for Physicians in Independent Practice
To address the needs of physicians in independent practice, PrescRXptive Communications and E Central Medical Management are co-sponsoring the third annual Toolkit for Independence: Tips and Techniques for a Successful Medical Practice, a complimentary dinner symposium packed with insights to help independent medical practices thrive. The event will be held on Thursday, January 10, from 5:30 – 9:30 p.m. at Jewel Restaurant in Melville.

The symposium is free for physicians and office managers who are accompanied by a physician. The evening includes a cocktail hour and sit-down dinner. There are limited seats available. For additional information, call 631-606-0525. To register, visit http://toolkit-for-independence.eventbrite.com/. 

2019 ACPH Call for Abstracts Now Open through March 29, 2019
Showcase your work at the American Conference on Physician Health (ACPH)! The conference, which is being hosted by the American Medical Association, Mayo Clinic and Stanford University School of Medicine, is being held September 19-21, 2019 at the Sheraton Charlotte Hotel/Le Meridien in Charlotte, NC. Authors are invited to submit abstracts for consideration as part of the 2019 ACPH. Submissions will be accepted from December 10, 2018 to March 29, 2019.

Submit your abstract in one of two categories:

  • Research: submitted as either a poster or oral presentation
  • Workshop: submitted as an interactive session

*research and non-research workshops considered

Be sure to visit the conference website physician-wellbeing-conference.org to review important details in our “Call for Abstracts” section, as well as the instructions for submitting abstracts. Submissions for all abstracts must be made electronically via the abstract submission form, information available at the ACPH 2019 Call for Abstracts website. Please contact us at physicianhealth@ama-assn.org with any questions or requests.

CME WEBINARS

“Public Health Preparedness 101” CME webinar
January 16, 2019 at 7:30am – Registration now open

Are you prepared for a public health emergency?  And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here.  Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

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


Join MSSNY Banner

DISABILITY

What Should Clinicians Know About Disability?
Approximately 1 in 5 adults reports a disability, and health care professionals play distinctive roles in defining disabilities and treating individuals with them. Better care for the great diversity of people with disabilities “requires better engagement with and reflection upon the rich and complex meaning of disability,” writes Joel Michael Reynolds, The Hastings Center’s Rice Family Fellow in Bioethics and the Humanities, in the AMA Journal of Ethics. Reynolds outlines a set of recommendations and duties clinicians have when encountering patients with disabilities, including the responsibility to recognize the authority of these people as experts about their own experiences. Read the article.


CMS

QPP Tip: Avoiding 2020 MIPS Payment Adjustment – The Minimum to Report
The “test” and “partial” participation options that were available for the CY 2017 MIPS participation period are no longer available for the CY 2018 MIPS participation period. To avoid the 2020 MIPS payment adjustment, based on 2018 MIPS participation, physicians will need a minimum of 15 points across all four MIPS categories – quality, improvement activities, promoting interoperability, and cost. Potential ways to achieve the minimum 15 points include:

  • 100 percent score in improvement activities category – reporting medium/high weight activities to achieve a total of 40 points
  • Achieving 18 points out of a total of 60 points (if reporting 6 measures) for the quality category
    • Reporting six measures for at least 60 percent of applicable patients
    • Earning the maximum 10 points for a high-performance score for at least two measures, which have benchmarks and are not “topped out” measures
  • Reporting the ACI base score measures and either:
    • Reporting at least one quality measure for at least 60 percent of applicable patients
    • Reporting one improvement activity
    • Receiving a small practice bonus
    • Receiving a complex patient bonus of at least three points


For additional information, please see Step 5 of the Navigating the QPP Resource  available on PAI’s MACRA QPP Resource Center.

 


Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day or by month. Price is negotiable. Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

58th Street room1 58th Street room2 58th Street room3


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


December 7, 2018 – Marijuana: Right or Wrong?

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
December 7, 2018
Volume 21  Number 44

MSSNYPAC Seal

Colleagues:

There is significant public pressure to permit the recreational use of marijuana.

Given the new political makeup of the New York State Legislature come January, it is a distinct possibility that legislation to legalize its use will be a high priority.  Particularly given that many of the states surrounding New York—Vermont, Massachusetts, Connecticut, and New Jersey— not to mention the entire country of Canada, have acted or are soon to act to legalize its use.

We have shared with many our support for eliminating the threat of criminal sanction for marijuana use, but also concern with its outright legalization, citing statistics from other jurisdictions such as Colorado where legalization has occurred.

We have had meetings throughout the fall with top staff to the Governor, the New York State Health Department and with key legislators.  We have engaged allies such as the NYS Association of County of Health Officials.  We have testified at several regional forums.  And we have engaged with the media regarding our concerns, including the Buffalo News and Syracuse Post-Standard.

What Are Our Concerns?

And most recently, through the hard work of MSSNY’s Addiction and Psychiatric Medicine, the Preventive Medicine and Family Health Committee, and the Committee to Eliminate Health Disparities, we developed a paper that sets forth our continuing concerns with legalizing recreational marijuana, but also sets forth several recommendations that we believe are absolutely essential if the Legislature acts to legalize it.  Our recommendations are many, but some ideas include:

  • Prohibiting the sale of any type of marijuana products to anyone younger than 25 years of age;
  • Prohibiting the sale of any type of marijuana products to pregnant and post-partum women;
  • Prohibiting the sale of any flavored type of marijuana;
  • Limiting the amount of marijuana an individual may obtain to ensure that there is no “marijuana shopping” to obtain large amounts for resale
  • Developing an electronic system to prevent individuals collecting large amounts of marijuana from multiple sources
  • Prohibiting use in public areas similar to tobacco legislation
  • Establishing a public awareness campaign similar to the tobacco program that would highlight the risks of marijuana to discourage vulnerable populations, youth, individuals with a history of addiction and mental illness from using marijuana
  • Prohibiting marketing and advertising to youth, (similar to the tobacco control program) ;
  • Requiring child proof packaging with information about poisoning and overdose; and
  • Limiting marijuana product sales to state-operated entities; and
  • Assuring a portion of the revenues  should support establishment of addiction treatment and rehabilitation of substance use disorder programs 

Given the substantial amount of revenue New York State could achieve through permitting the sale of recreational use marijuana, we anticipate seeing a proposal in the state budget.

Now is the time to engage with your local legislators to let them know of your perspective on this issue. We understand that physicians may have diverging perspectives on the merits of legalization of marijuana.  Indeed, the physicians on MSSNY’s committees had diverging perspectives.  But they all agreed regardless of these perspectives that the state must place strong guardrails around any legalization proposal to prevent against harm to the public that could occur.

Stay tuned for further details.

Please share your suggestions or thoughts with me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


MLMIC Banner


eNews

New York City Council Passes Resolution in Support of Single Payer Legislation
The conversation regarding single payer legislation in New York continued on Thursday as Assembly Health Committee Chair Richard Gottfried and others testified before the New York City Council, which was considering (and ultimately adopted) a resolution in support of the far-reaching proposal . During his testimony, Assemblyman Gottfried noted that new iteration of the plan would include long-term care and would be financed by mostly by higher earners via a “broad-based progressively graduate taxes,” adding at least $159 billion to the state’s tax rolls each year. In addition to a payroll tax (80% paid by employers), he referenced an additional tax on capital gains and dividends.

Assemblyman Gottfried also noted that the bill would “make sure doctors, hospitals and other providers are paid fairly – and today, most of the time, they are not.” He explained, “…the legislation explicitly requires that provider payments be reasonable, related to the cost of providing the care, and assure an adequate supply of the care.  No coverage today has that guarantee.” Gottfried believes that savings will be garnered via elimination or reduction in bureaucracy and administrative burdens and asserts that physician payments will not decrease.

The Greater New York Hospital Association testified at the hearing to express its strong concerns, citing a lack of federal funding, escalating taxes and potential reductions in payment to hospitals, stating “There are huge obstacles in the way…and we do not believe these obstacles can be overcome.” Municipal unions also discussed their concerns about the proposal, even as Assemblyman Gottfried assured union leaders that concessions would be made addressing their concerns.

Also, it was reported this week that enrollment through the NYS Exchange is up this year for 2019 coverage, despite Congress’ elimination of the individual mandate.  According to its press release, more than 930,000 consumers had enrolled in coverage in a Qualified plan or the Essential Plan, including 51,000 new consumers. 

MSSNY Urges DFS to Reject Cigna-Express Scripts Transaction
Noting that “physicians are extremely worried about the adverse impact to patient care as a result of the increasing consolidation in the health care industry” MSSNY President Dr. Thomas Madejski this week urged the New York Department of Financial Services (DFS) to reject the proposed acquisition of Express Scripts by Cigna. In particular, he noted that the merger of behemoths in health care seldom occurs in a vacuum – It almost always prompts “copycats” to counteract the enormous bargaining leverage the newly merged entity will have.

If the transaction is to be approved, Dr. Madejski urged DFS to place meaningful “guardrails…to ensure that our patients’ ability to receive the care or medication they need from the physician or pharmacy of their choice is not disrupted or made more burdensome.”

The letter was sent in conjunction with a public hearing scheduled by DFS Superintendent Maria Vullo for Friday, December 7 examining this proposed transaction. The hearing has been rescheduled for January 10, 2019. Among the concerns raised by Dr. Madejski in his comment letter to the Superintendent included:

  • The anticompetitive effects of a health insurer purchasing a Pharmaceutical Benefits Manager (PBM) when that PBM continues to provide services to other health insurance companies. The concern is that the accumulation of power across the health insurer and PBM industries will disadvantage New York’s several regional health insurance companies thereby potentially reducing health insurer competition in many regions of the State;
  • The combined entity will leverage its significant new market power to impose even more burdensome prior authorization hassles for physicians and their staff that already unduly interfere with patient care delivery, at a time when New York physicians spend an inordinate amount of time on receiving prior authorizations.
  • The lack of a regulatory structure in New York regarding the actions of PBMs.

The letter also urged that, if the transaction is to be approved, Cigna should be required to reduce prior authorization burdens, support efforts to regulate PBMs, and to contribute towards enhancing the ability of the DFS to investigate health insurer violations of New York’s extensive managed care laws.

US Federal Judge Puts the Brakes on CVS-Aetna
As reported in numerous media sites, US District Court Judge Richard Leon has considered delaying the proposed mega merger between CVS and Aetna. He has ordered a hearing for December 18 and told the companies to present arguments by December 14 to convince him why the acquisition should be permitted.  

The US Department of Justice (DOJ) had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition. The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger last week with numerous conditions.

While DFS’ conditional approval agreement addressed to some degree some of the concerns raised by MSSNY over the last year, MSSNY President Dr. Thomas Madejski issued a statement noting that physicians remained very concerned about the adverse impact to the health care delivery system in New York given the enormous reach of this transaction.

Judge Leon’s stated concerns included the strong opposition by the American Medical Association, which last summer submitted extensive documentation to the DOJ urging it to reject the merger, arguing it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options. “Given that I have to decide, based on what I expect to be well-informed and thoughtful public commentary — I specifically already mentioned the American Medical Association’s lengthy concerns that they have put in writing previously,” Judge Leon said.

Prior to approving the merger with conditions, New York DFS Superintendent Maria Vullo had stated publicly her very significant concerns about the scope of this transaction on health care delivery.

The numerous articles on this issue have also noted that it is unclear if Judge Leon has the power to reject the merger, or simply question whether the conditions are satisfactory to meet antitrust concerns.

MSSNY has been discussing with AMA antitrust experts the possible next steps that could be taken to prevent this merger from being advanced.  Given the fluidity of this situation, please remain alert for further updates.


NY Rx Card Banner


DOH Brings Stakeholders Together to Set Parameters for Midwife Led Birthing Centers
MSSNY, together with the American College of Obstetricians & Gynecologists (ACOG) – District 2, have been participating in an ongoing series of discussions among several stakeholders organized by the NYS Department of Health seeking to establish regulations permitting midwife-led birthing centers (MBC) in New York.  Legislation permitting these centers was signed into law by Governor Cuomo in 2016 but implementing regulations have not yet been completed.   Other participants in these discussions include associations representing hospitals, midwives, and birth centers.

The DOH staff  have sought to clarify a number of questions in developing the implementing regulations including: the definition of which expectant mothers are “a patient at low risk”; the required level of review by the State to establishing a MBC including whether it should require a certificate of need (CON);  the scope of collaborative agreements between midwives and OB-GYNs; the scope of transfer agreements between MBCs and area hospitals; and whether, as argued forcefully by ACOG, there should be a required agreement of an MBC to a regional perinatal center (RPC) to assure that the best interests of expectant mothers and their babies are met. 

Medicare Rights Center: “45.1% of Online Provider Directories Inaccurate”
In 2017’s audit report, CMS found that 45.1% of provider directory locations listed in online directories were inaccurate. In the early 2018 report, 52.20% of the provider directory locations listed had at least one inaccuracy. Now, the third such report shows that 48.74% of the provider directory locations listed had at least one inaccuracy. The types of inaccuracies remain the same: the provider was not at the location listed; the phone number was incorrect; or the provider was not accepting new patients when the directory indicated they were.

These inaccuracies put people with Medicare in a difficult position. Not having access to accurate directories when they are making decisions about their Medicare options can lead to beneficiaries choosing MA plans based on illusory networks. Coupled with CMS’ current campaign that blatantly favors MA over Original Medicare, risks are mounting that people will mistakenly enroll in an MA plan that is not right for them. Once enrolled, they may find that they are reaching out to doctors that are unreachable, not in the areas they expected, not accepting new patients, or perhaps not part of the network at all. There’s even a chance that people with Medicare could suffer from lack of access to care by choosing a network without providers that are accessible or genuinely accepting new patients.

In the 2017 report, CMS announced they had sent 31 Notices of Non-Compliance, 18 Warning Letters, and 3 Warning Letters with a Request for a Business Plan. In the early 2018 report, they announced 23 Notices of Non-Compliance, 19 Warning Letters, and 12 Warning Letters with a Request for a Business Plan. In this latest report, 18 Notices of Non-Compliance, 15 Warning Letters, and 7 Warning Letters with a Request for a Business Plan were sent.

Earlier this year, CMS reiterated previous warnings that “[monetary penalties] and other enforcement actions may be imposed,” but this has not happened…” (Medicare Rights Center)

CVS: New Script Benefit for Employer-Sponsored Insurance Plans in 2019
CVS Health Corp announced as of the beginning of 2019 a new prescription benefit option for employer-sponsored plans that will ensure clients receive all rebates and discounts paid by drugmakers. The new plan, called “guaranteed net cost,” may serve to counter criticism of pharmacy benefit managers (PBMs), often the beneficiaries of rebates paid by pharmaceutical companies. Forbes (12/5) reports, “In August, CVS grabbed headlines when it disclosed that it has historically retained 2% of rebates negotiated with drug makers, which this year translates to 3% of the company’s annual earnings per share, or about $300 million.” The move by CVS echoes a growing trend among PBMs generally to increase transparency on drug pricing for consumers.


Garfunkel Ad


Millions Expected To Drop Health Coverage in 2019 with Repeal of ACA Penalty
Kaiser Health News piece predicts that millions of Americans are likely to drop their health insurance for next year now that the ACA’s penalty for not having coverage has been eliminated https://khn.org/news/without-obamacare-penalty-think-itll-be-nice-to-drop-your-plan-better-think-twice/ The Congressional Budget Office predicted that “the repeal of the penalty would move 4 million people to drop their health insurance next year – or not buy it in the first place – and 13 million in 2027.” The article says some consumers “who from the start hated the Affordable Care Act, or Obamacare as it is often called, will drop their coverage as a political statement,” while others will do so because of affordability.


Dr. First Banner


CME WEBINARS

The Continued Public Health Threat of Measles: 2018 CME Webinar
December 12, 2018 at 7:30am – Registration now open

In response to the recent and expanding measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 roster.  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 program here.

Educational Objectives:

  • Increase physician’s awareness of the role of measles as a re-emerging infection.
  • Discuss strategies to improve vaccination rates.
  • Explore herd immunity and the role it plays in recent measles outbreaks.

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

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


Join MSSNY Banner

Residents, Fellows, Students

SAVE THE DATE: MSSNY SECTIONS ANNUAL MEETING: YPS, RESIDENTS, FELLOWS, AND STUDENTS
The Meeting will be held on Saturday, February 9, 2019 at the Marriott Courtyard in Westbury, with YPS and RFS business meetings held at MSSNY headquarters down the street. Presentations will be given on Opiates and Social Medial. More to follow!


New York Medicaid

2019 Meaningful Use – NY Medicaid EHR Incentive Program
The Centers for Medicare & Medicaid Services recently published rulemaking impacting the NY Medicaid EHR Incentive Program and aligning it with the Merit-based Incentive Payment System (MIPS). 2019 meaningful use requirements for all eligible professionals include:

  • 2015 Edition Certified EHR Technology
  • Stage 3 objectives and measures
  • Minimum 90-day EHR reporting
  • 6 clinical quality measures (CQMs), including one outcome or high priority measure
  • Full calendar year CQM reporting

The thresholds for Stage 3 Objective 6 Coordination of Care measures 1 and 2 will not increase. These measures will remain at more than 5% for 2019 meaningful use and the remainder of the program.

The eCQI Resource Center has posted the 2019 CQMs. These align with MIPS, so eligible professionals may be able to participate in both the NY Medicaid EHR Incentive Program and MIPS.

Questions? Resources about meaningful use, including tip sheets, webinars, and frequently asked questions are available at https://health.ny.gov/ehr. For additional assistance, please contact program support at 1-877-646-5410 or hit@health.ny.gov.


CMS

CMS Cuts Payments to 11,000 Nursing Homes, Cites Readmission Rates
Medicare is modifying one year’s worth of payments to 14,959 skilled nursing facilities based on readmission rates, according to a Kaiser Health News report. Nearly 11,000 nursing homes will face penalties, while nearly 4,000 others will receive bonuses, the report states.

The payments factor in how often nursing home residents are rehospitalized within 30 days of leaving. They aim to reduce preventable hospital admissions of residents and dissuade nursing homes from discharging patients too quickly, according to the report.

Nursing homes will receive the bonuses and penalties during the fiscal year that began Oct. 1 and ends Sept. 30, 2019. The bonus for best-performing nursing homes is 1.6 percent more per Medicare patient, and the worst-performing nursing homes will see a penalty of nearly 2 percent of each payment.

The incentive payments, which do not apply for patients covered by private Medicare Advantage, are part of CMS’ Skilled Nursing Facility Value-Based Purchasing Program. To determine the payments, Medicare factored in performance on the program’s hospital readmissions measure during calendar year 2017 and examined improvement made since calendar year 2015.

Scores for individual nursing facilities nationwide are available here. (Becker’s Hospital Review  Dec 3)


Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day or by month. Price is negotiable. Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

58th Street room1 58th Street room2 58th Street room3


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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