Feb. 1, 2019 – Leg 2019: Strong at the Start

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


MSSNY eNews
February 1, 2019
Volume 22  Number 5

MSSNYPAC Seal

Colleagues:

Downhill Racer

Great news!  I finally was able to hit the slopes this season.  I spent the weekend in Lake Placid to meet with members from our 3rd and 4th districts at their Winter Meeting.  I’ve wanted to join them for many years, but circumstances conspired against us. Our MSSNY Vice Speaker Dr. Bill Latreille served as the congenial host and master of ceremonies.

Day One

Saturday morning began with reports by our 3rd and 4th District Counselors, Greg Pinto and Brian Murray.  They updated the assembly on county activities and the recent Council meeting.  We also had presentations from Moe Auster, our Government Affairs VP, and our MSSNYPAC Chair, Dr. Joe Sellers, on the changing political landscape, the many public health and professional issues under discussion and MSSNYs policies and perspectives. State Senator Betty Little discussed the significant changes in the State Capital, as well as key healthcare issues she is seeing in her district that covers the North Country. She affirmed my observations that we are in a very dynamic environment with regards to legislation and regulation.  She validated the observations of our Government Affairs staff and your leadership— that we are in a critical time of creating new relationships with our elected leaders and new regulators.

You have already seen rapid activity on a number of issues where the new legislature and Gov. Cuomo had consensus and campaigned to achieve.  It’s probably the ambience of Lake Placid, but I feel like we are in a slalom race to passage of the budget sometime around April 1. We need to keep our eyes and weight forward, lean into the gates, and watch for icy patches and cross the finish line on behalf of our citizens and our profession.  Make sure you are signed up as a PAL and join me in Albany for our Council meeting and State Legislative Day March 6. 

We had a number of other excellent presentations. Jim Dering, an attorney from Garfunkel Wild’s Albany office, gave a vitally relevant presentation on employment contracts. GW has great expertise in review and assistance with negotiations on behalf of physicians. They provide an excellent member benefit for contract review as part of their service to MSSNY members. Having negotiated a number of times on behalf of physician employees, GW provides a great value at a substantially lower cost than I have experienced in the past.

MLMIC

Michael Schoppman, President of MLMIC, updated the group on developments after the closing of the sale of MLMIC to Berkshire Hathaway. Over 95% of proceeds have been distributed. Remaining proceeds will be distributed after resolution of disputes. MLMIC has created an in house mediation system to assist policy holders who have had their distribution contested by other parties.  For more information, click here.

After an afternoon break, we met in the early evening to review potential resolutions for our MSSNY HOD April 11-13th. 

One area of concern is continued staffing and viability of small county medical societies.  We had a good discussion about potential opportunities for regionalization through our existing District model.  I related to the group that MSSNY is working on this through our Strategic Planning Committee and our Membership Committee and that MSSNY remains committed to assisting our county and District Societies as they work through these issues.

Covering All Bases

Our MSSNY President Elect, Dr. Art Fougner, and Vice President Bonnie Litvack and MSSNY legislative staff participated in the Legislative Breakfast hosted by New York County Psychiatric Society and the New York Council on Child and Adolescent Psychiatry. They met some of our new Senate members and visited with Senate Health Chair Gustavo Rivera and Assembly Health Committee Chair Richard Gottfried Sunday.

We have follow up meetings scheduled with a number of the new legislators.  We (MSSNY and you) need to engage all our legislators but particularly the new members in their districts and in Albany.  Please register and join me in Albany March 6th!

Medicinae membra movere!

Comments? comments@mssny.org; @mssnytweet; @TomMadejski

Thomas J. Madejski, MD
MSSNY President



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Capital Update

Physicians Urged To Oppose Further Dual Eligible Payment Cuts Proposed In State Budget
All physicians are urged to contact their state legislators to urge that they reject a proposal contained in the 2019-20 Executive Budget that would significantly cut the payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their “dually eligible” patients. You can send a letter in opposition here.

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, for practices that see a large number of dual eligible patients, this will have a profound impact.  For example, if a physician’s patient mix includes 500 such dual eligible patients, which could certainly be the case for many types of specialty physicians. That amounts to a decrease of over $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment.

In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care.

Inexplicably, in a time where there is a greater emphasis on assuring patients receive care in the most appropriate care settings, including community physician practices, these cuts could force patients to receive care in more expensive care settings.

Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the State Budget on the backs of dedicated community physicians seeking to deliver quality care to their patients.                       (AUSTER, AVELLA)



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Governor Proposes $175 Billion Budget For 2019-20; Many Items Of Impact To Medicine

As previously reported, Governor Andrew Cuomo has formally announced his proposed $175 Billion Budget for the FY 2019-20 Fiscal Year.

Some positive items in the Executive Budget include: 

  • Increase from 18-21 the legal age to purchase tobacco and e-cigarettes; Ban flavored liquids and sales in pharmacies (See MSSNY President Dr. Madejski’s statement of support here.
  • Regulate the practices of Pharmaceutical Benefit Managers (PBMs).
  • Assuring comprehensive health insurance coverage for those suffering from a mental health condition (MH, SUD or autism).
  • Prohibit pre-authorization for Medication-Assisted Treatment (MAT) to address opioid addiction.
  • Extension of the Excess Medical Malpractice Program for an additional policy year.
  • Reduce the current 9% interest rate on court judgments, which could have the effect of reducing liability premiums for physicians.
  • Create a statewide Maternal Mortality Board with necessary confidentiality protections. 

Some items of potentially significant concern include:

  • Cuts Medicaid payments for the deductibles of “dual eligible” patients, which could have a significant adverse impact for those physicians whose patient mix includes a substantial number of Medicare/Medicaid dual eligible patients. (see related article)
  • Legalize the sale of recreational marijuana to those 21 and over (see related article)
  • Expands the existing medical marijuana program to add additional health conditions which would be eligible for “Medical Cannabis”.
  • Permit Nurse Practitioners and licensed social workers to treat injured workers and be directly reimbursed under Workers Compensation without coordination with a physician.
  • Repeal “prescriber prevails” protections for prescriptions for Medicaid FFS patients that are not on the Medicaid formulary. 

Some items of Interest and Further Review Include:

  • Codify New York’s Health Insurance Exchange, and assure NY has continued coverage for pre-existing conditions, Essential Health Benefits and provide physician a clear method to appeal medications not included on insurers’ formulary
  • Expand health insurance coverage for IVF
  • Require ED physicians to check I-STOP database
  • Create a Commission on Universal Access to Health Care comprised of health policy and insurance experts to devise ways to achieve universal access to high quality, affordable health care.


MSSNY will be testifying at a Joint Senate-Assembly Budget Hearing examining these issues next Tuesday Feb. 5. (DIVISION OF GOVERNMENTAL AFFAIRS)


Assemblyman Gottfried Introduces Series of Health Insurance Reform Bills
This week Assembly Health Committee Chair Richard Gottfried reintroduced a number of important health insurance reform bills supported by MSSNY to better enable patients to receive the care they need and better enable physicians to be able to advocate on behalf of their patients to assure they receive the care they need.  These bills include:

  • A2393 – Gives independently practicing physicians the much-needed right to collectively negotiate with insurance companies on patient care issues in certain instances, under close state supervision.
  • A3038 (also carried by Senate Insurance Committee Chair Neil Breslin – S.2847) – Includes many provisions to improve the way that insurance companies operate by speeding up and improving prior authorization requirements and duration; ensuring that authorizations are being reviewed by qualified individuals, using evidence-based criteria; preventing harmful prescription drug formulary changes.
  • A3076 – Requires health insurer medical necessity decisions to be made by a NY licensed physician that is qualified to perform the procedure in question.
  • A2983 – Prohibits the inclusion of onerous clauses in contracts between physicians and HMOs, including those that reduce payment, impose inappropriate mandates on prescriptions and allow changes to prescriptions by those other than the prescribing physician or pharmacist with which they collaborate.
  • A2899 (also carried by Senate Health Chair Gustavo Rivera – S.873) – Prevents insurance companies from using extrapolation (except in certain circumstances) to unfairly assert and attempt to recoup purported overpayments.
  • A2799 – Ensures “prescriber prevails” protection for all prescriptions written for patients covered by Medicaid, giving physicians the final say in prescribing.      (AVELLA, AUSTER)

Senator Breslin Introduces Health Insurance Reform Bills
Senate Insurance Committee Chair Neil Breslin (D-Albany County) introduced this week two bills that are strongly supported by the physician-community to cut down on administrative hassles and to ensure that patients are able to receive the care that they need.

  • Senate Bill S2847, which is also carried by Assemblyman Gottfried (A.3038), would reduce prior authorization hassles by requiring health plan utilization review criteria to be evidence-based and peer reviewed; reducing the time frame for reviewing prior authorization requests from 3 business days to 48 hours (and to 24 hours for urgent situations); assuring that a prior authorization, once given, is enduring for the duration of the medication or treatment; prohibiting mid-year prescription formulary changes; and assuring that once a prior authorization is given, it cannot be withdrawn if eligibility is confirmed on the day of the service.
  • Senate Bill S2849, carried by Assembly Majority Leader Crystal People-Stokes (A.2969) would help to prevent harmful changes to drug formularies mid-year. Patients are not allowed to change insurance plans mid-year and often make selections with formularies in mind, so this bill would ensure that insurance companies are held to their end of the contract. (AVELLA, AUSTER)                    

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NYS Legislature Passes and Governor Signs In to Law the Reproductive Health Act
The New York State Legislature passed the Reproductive Health Act on January 22, 2019 and it was immediately signed into law by Governor Andrew Cuomo as Chapter 1, Laws of 2019.    Assembly Bill 21 and Senate Bill 240, sponsored by Assemblymember Deborah Glick and Senator Liz Krueger, amended the public health law by codifying the abortion procedure within New York State’s public health law and removing it from the penal law.  The bill passed the NYS Senate by a vote of 38-24 and the NYS Assembly by 95-49.  The law creates a statement of purpose and says that an abortion may be performed by a licensed, certified or authorized practitioner acting within their defined scope of practice under Title 8 of the Education Law. Under the new law, an abortion can be performed:

  1. a) within 24 weeks from the commencement of pregnancy;
  2. b) at any time, where there is an absence of fetal viability; or
  3. c) at any time, when necessary to protect the patient’s life or health.

MSSNY has a long standing policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.  Moving the abortion procedure from the State Penal law to the Public Health Law is consistent with this position.

The law does not expand the current scope of practices for health care providers.    It does, however, specify that health care practitioners can perform an abortion if it is otherwise enabled by their current scope of practice as defined under the NYS Education Law.  Nurse practitioners are allowed to perform a medicated abortion procedure already under their scope of practice.  However, Nurse Practitioners’ scope does not include “surgery” and cannot perform a surgical abortion.

The American College of Obstetricians and Gynecologists (ACOG), District II and the NYS Academy of Family Physicians (NYAFP) supported this measure.  MSSNY will be closely monitoring the implementation of the new law to assure health care practitioners are acting within their scope. (CLANCY)


Mental Health Association Joins Lists of Organizations Urging NYS Legislature to Consider Implications of Legalizing Recreational Marijuana
The Mental Health Association of New York State has joined the growing lists of organizations that is urging state officials to proceed cautiously as they consider proposals to legalize recreational marijuana.  The association listed several serious concerns about legalization, such as addiction and the impact marijuana can have on the neurological development of young people.   While the Medical Society has expressed support for efforts to remove the threat of criminal sanction for marijuana possession, it has also expressed concerns with efforts to legalize recreational marijuana use.  Additionally, Assembly Speaker Carl Heastie commented this week that marijuana legalization may not occur as part of the State Budget, noting the significant complications associated with enacting such a change.  The Medical Society is asking for the NYS Legislature to remove this provision from the budget proposal and are urging physicians to send a letter to the NY Legislature and to the governor through its Grassroots Action Center (GAC):  https://cqrcengage.com/mssny/app/write-a-letter?7&engagementId=495697                                        (CLANCY) 


Firearm Safety Measures Pass NYS Legislature; Awaiting Action by Governor

The NYS Legislature this week passed a package of bills that would help combat firearm violence.

  • 2451/A. 2689, sponsored by Senator Brian Kavanagh and Assemblymember JoAnne Simon, allows law enforcement officials, family and household members, and certain school officials to seek a court order requiring a person likely to harm themselves or others to surrender any firearms in their possession.
  • 2374/A.2690, sponsored by Senator Michael Gianaris and Assemblymember Amy Paulin, would establish an extension background check waiting period of up to 30 days.
  • 2248/A.2448, sponsored by Senator Luis Sepulveda and Assemblymember Patricia Fahy, would prohibit the possession of a device (bump stock) that accelerates the rate of fire of a firearm.

Also passed by the Legislature were S.101A/A.1715, sponsored by Senator Todd Kaminsky and Assemblymember Judy Griffin that prevents k-12 schools from authorizing anyone other than a security officer, a school resource officer or a law enforcement officer from carrying a firearm on school grounds.  Senator Shelley Mayer and Assemblymember Linda Rosenthal sponsored legislation (A.2685/S.2449) that directs the state police to devise regulations for gun buyback programs to ensure that such programs are operated consistently throughout the state.  Senator Anna Kaplan and Assemblymember Pamela Hunter sponsored legislation (S.2438/A.1213) which would require out of state applicants for gun permits to allow NY permitting authorities to review out-of-state mental health records.

All of these measures are now before Governor Cuomo for his action.

In March 2018, the MSSNY House of Delegates took action to support legislation that requires a waiting period and background checks prior to the purchase of all firearms, including the person-to-person transfer, internet sales, and interstate transactions for all firearms.  The MSSNY HOD also adopted policy to support legislation that blocks the sale of any device or modification, including but not limited to bump stocks, which convert a firearm into a weapon that mimics fully-automatic operation.  MSSNY supports legislation that would ban the sale and/or ownership of high-capacity magazines or clips and high-speed, high-destruction rounds. (MSSNY Policy 260.898 and Policy 260.899).

Furthermore, MSSNY has adopted a policy statement that states that gun violence in the United States is a public health crisis and supports federal efforts to reverse the ban that prohibits the Center for Disease Control from researching gun-related injuries, deaths, and suicides related to this violence.  In January 2019, the MSSNY Task Force on Firearm Safety also recommended that the Medical Society support the concept of “red flag” provisions.

In a press statement released by the NYS Legislature following the passage of the legislation, it contained a quote from Dr. Thomas Madejski, president of the Medical Society, that “Today’s gun safety package contains a number of important measures supported by the medical community.  Establishing ‘red flag’ laws, prohibiting the sale of so-called ‘bump stocks’ and extending the waiting period to purchase firearms are all common sense reforms that have been supported by MSSNY as ways to reduce the risk of firearms coming into the hands of those who present a risk to themselves or others.  We thank the Senate and Assembly leadership, as well as Governor Cuomo, for advancing these important measures.”                                                       (CLANCY)


Federal Regulators Propose Controls To Reduce Prescription Drug Costs, Create More Transparency
This week, HHS Secretary Alex Azar announced proposals to help lower prescription drug prices, reduce out-of-pocket costs for patients and bring about greater transparency in the pharmaceutical industry. The proposed rule would encourage drug manufacturers to pass discounts directly on to patients.

The proposed rule would exclude rebates on prescription drugs paid by manufacturers to PBMs and insurance companies from “safe harbor” protections under the Anti-Kickback Statute. Further, it would create a new “safe harbor” for discounts that are offered directly to patient, in addition to fixed fee service arrangements between manufacturers and PBMs.

According to HHS, rebates currently amount to an average of 26-30% of a drug’s list price and this proposed rule would require these rebates be passed directly to patients (reflected in what they pay at pharmacies). The proposal would likely provide the greatest savings to seniors with high drug costs and is intended to encourage drug companies to compete for the lowest price and out-of-pocket cost for patients.  For more details, visit https://www.hhs.gov/sites/default/files/20190131-fact-sheet.pdf                                                                (AVELLA, AUSTER)


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Measles Outbreak in New York State Continues to Spread
Webinar Available at MSSNY CME Website

The measles outbreak in New York State continues to spread with at least 186 confirmed cases.  There have been 124 in Rockland County and 62 cases in Brooklyn with one suspected case currently being monitored.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.  This webinar has now been posted to the MSSNY CME website. Please check it out and keep yourself informed about the ongoing measles outbreak throughout New York State.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine here.                                                                                                                            (HOFFMAN, CLANCY)


“What’s Your Diagnosis? Psychological First Aid” Interactive CME Webinar
February 20, 2019 @ 7:30am – Registration now open

Be sure to register for the next Medical Matters webinar, What’s Your Diagnosis? Psychological First Aid.  This program will involve more interaction from participants.  You will be asked to answer questions about a case and discussion will follow.  Find out if you’re fully prepared to include psychological first aid during an emergency on February 20th at 7:30am.  Registration is open for this program here.  Faculty will be Craig Katz, MD, co-vice chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.

Educational Objectives:

  • Describe the basic tenets of psychological first aid (PFA)
  • Identify resources to assist patients during and after trauma
  • Describe a scenario and review questions and answers 

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. 


Registration Now Open for New Veterans Matters CME Webinars:
The Medical Society of the State of New York is proud to announce two NEW Veterans Matters webinars scheduled for February and March 2019. These webinars are: The Special Mental Health Needs of Women Veterans on Thursday, February 28th at 7:30am and Military Culture: Everything Physicians Need to Know About Veterans as Patients on March 14th at 7:30am.

Register here for The Special Mental Health Needs of Women Veterans, and here for Military Culture: Everything Physicians Need to Know About Veterans as Patients.

Veterans Matters: The Special Mental Health Needs of Women Veterans

When:  Thursday February 28, 2019 at 7:30am

Faculty: Malene Ingram, MD (Col., US Army Reserves)

Educational Objectives:

Review how the increased role of women in the military has impacted their mental health.

Describe mental health concerns unique to women veterans and how to identify and treat them.

Identify the barriers that women veterans face in getting the specific care they need

Veterans Matters: Military Culture: Everything Physicians Need to Know About Veterans as Patients 

Military Culture: Everything Physicians Need to Know About Veterans as Patients

When: Thursday, March 14 2019 at 7:30am

Faculty: Lt. Col Lance Allen Wang, & Marcelle Leis, CM Sgt (Ret)

Educational Objectives:

Describe the unique aspects of military culture and how they impact patients who are veterans.

Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality.

Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back into civilian life.

Additional information or assistance with registration may be obtained by contacting Sarah Humes at   shumes@mssny.org or (518) 465-8085

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 creditsä.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 



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For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
charring@mssny.org

 

 

eNews

 

MSSNY Statement re ZocDoc’s Amended Pricing Proposal

Last August, we advised the membership that MSSNY, together with its General Counsel, Garfunkel Wild, P.C., had been engaged in lengthy discussions with ZocDoc to better understand ZocDoc’s planned changes to its program. As a result of those meetings, ZocDoc postponed implementation of those pricing changes. ZocDoc recently announced that it is moving forward with its amended pricing proposal effective April 1, 2019.

Under the new pricing, physicians will pay a reduced annual licensing fee and a booking fee based on the physician’s specialty for each new patient making an appointment.

MSSNY is continuing to address the concerns of our members with regard to the proposed pricing methodology and will know more after a meeting, which will be scheduled shortly with Garfunkel Wild and ZocDoc.


SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
With nearly 40 newly elected legislators in Albany, the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships with this new Legislature to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure.
  • Reject unfair cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Reject burdensome mandates that interfere with patient care delivery.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.                                                                       (HARRING)

If you have any questions, please contact Carrie Harring: charring@mssny.org.



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Proposed VA Rules Allow More Vets to Seek Private Primary/Mental Healthcare
The New York Times (1/30) reports, “Veterans who live as little as a 30-minute drive from a Veterans Affairs health care facility will instead be able to choose private care, the most significant change in rules released Wednesday as part of the Trump administration’s effort to fix years-old problems with the health system.” This group of veterans “will be allowed to seek primary care and mental health services outside the department’s system.” At present, veterans are allowed to “use a private health care provider if they must travel 40 miles or more to a V.A. clinic.” The Times says using “commuting time rather than distance will greatly open the private sector to veterans in rural and high-traffic urban areas.”


CMS Unveils New Medicare Mobile App
CMS has unveiled a new Medicare information mobile app called “What’s Covered.” The objective is to “help beneficiaries understand what’s covered under Medicare, historically a source of much confusion.” CMS Administrator Seema Verma explained that the free app is part of the agency’s “‘eMedicare’ collection of tools, designed to help beneficiaries search and compare coverage and out-of-pocket costs online.”

“What’s Covered?” released on iOS and Android on January 28, aims to quickly bring such information to users’ mobile devices. The app now provides another solution—users can look up medical devices or services to find out how much Medicare covers and what they’ll have to pay. It also lets users browse preventative health services for which they are already eligible. 


Presentation in Social Media Ad2019 MSSNY Young Physicians Section Annual Meeting and Educational Symposium
Young Physicians, Residents/Fellows, Medical Students: Join us for two top CME* Programs by National Leaders in Medical Toxicology and Social Media in Medicine.

When: Saturday, February 9, 2019 at the Marriott Courtyard in Westbury and MSSNY HQ.

http://www.mssny.org/MSSNY/About_MSSNY/Member_Sections/Young_Physicians/Joint_Edu_Symposium_Welcome.aspx.

Leaders in medical toxicology and social media in medicine. CME* credits provided. We look forward to seeing you! Webex available (Contact sbennett@mssny.org)

*For each CME session

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

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.


Electric Scooters Cause Rash of Visits to Hospital EDs, Study Indicates

study published online in JAMA Network Open revealed that “more electric scooter riders showed up with injuries in the emergency” departments “of two hospitals on Los Angeles’ scooter-heavy Westside than either bicyclists or pedestrians.” Among the patients admitted “some 40.2 percent” had “head injuries,” and 31.7 percent had fractures. The Washington Post (1/25) reported, “Although California law required helmet use while operating electric scooters during the entire study period, only 4.4% of injured scooter riders were documented to be wearing a helmet” at the time of their accidents.


CDC: Nearly Two Percent of US High School Students Identify as Transgender

Nearly two percent of high school students in the United States identify as transgender, according to data published January 31 by the US Centers for Disease Control and Prevention” in the CDC’s Morbidity and Mortality Weekly Report. The data were derived from the “2017 Youth Risk Behavior Survey in 10 states and nine large urban school districts.” Reuters (1/24) reports that the CDC found that 35 percent of transgender students “said they had attempted suicide in the previous year, compared with about 7 percent of those who did not see themselves as transgender.”


 

Educational Sessions for Practitioners Interested Learning about Marijuana for Medical Purposes

In service educational programs are being offered by Curaleaf on cannabis use.  Both registered and un-registered practitioners are invited to these educational events. Light refreshments will be provided. Note: These programs have not been accredited by MSSNY.

To RSVP, contact Curaleaf Practitioner Liaison: Stacia Woodcock PharmD swoodcock@curaleaf.com

Practitioner In-Service: Medical Cannabis and Cancer

Date: February 13, 2019

Time: 6-8pm

Leaders: Curaleaf Pharmacists

Description: To help educate practitioners regarding how medical cannabis could benefit cancer patients.

Practitioner In-Service: CBD, Medical Cannabis, and the Illicit Market

Date: March 13, 2019

Time: 6-8pm

Leaders: Curaleaf Pharmacists

Description: To help educate practitioners on the difference between CBD, medical cannabis, and the cannabis obtained on the illicit market.

Practitioner In-Service: Medical Cannabis Journal Club

Date: April 17, 2019

Time: 6-8pm

Leaders: Curaleaf Pharmacists

Description: Reviewing and discussing several recent medical cannabis research papers, and discussing the potential influence on medical cannabis practice they represent.

Practitioner In-Service: Medical Cannabis and Women’s Health

Date: May 15, 2019

Time: 6-8pm

Led by Curaleaf Pharmacists

Description: To help educate practitioners on the use of medical cannabis as it applies to women’s health.

Practitioner In-Service: Medical Cannabis and the Opioid Crisis

Date: June 12, 2019

Time: 6-8pm

Led by Curaleaf Pharmacists

Description: To help educate practitioners on how medical cannabis can be used to reduce opioid usage and to treat opioid addiction.

Locations:

 

  1. Curaleaf Carle Place

255 Glen Cove Road

Carle Place NY 11514

CarlePlace@curaleaf.com1 (516) 534-2872

  1. Curaleaf Newburgh

8 North Plank Road

Newburgh NY 12550

Newburgh@curaleaf.com

  • (845) 762-0110
  1. Curaleaf Plattsburgh

345 Cornelia Street

Plattsburgh NY 12901

Plattsburgh@curaleaf.com

  • (518) 930-4340
  1. Curaleaf Queens

107-18 70th Road

Forest Hills NY 11375

Queens@curaleaf.com

1 (646) 968-2872

 

Joint Commission Pioneers in Quality eCQM Expert to Expert Webinar Series: ED-1 and ED-2 eCQMs

February 12, 2019 – 11 AM – 12 PM CT

Click here to register

If you cannot get the registration page to launch, please cut and paste this Event URL into your browser to register: https://goto.webcasts.com/starthere.jsp?ei=1228586&tp_key=5a5670b731

The Joint Commission and the Centers for Medicare & Medicaid Services (CMS) are committed to supporting hospitals on their journey towards electronic clinical quality measure (eCQM) adoption and transition to the new Clinical Quality Language (CQL) expression language for the 2019 eCQM reporting period. This series, offered in cooperation with and incorporating expert content from The Joint Commission, Centers for Medicare & Medicaid Services’ subcontractors Mathematica, Lantana, and ESAC, provides in-depth CQL coverage.

The February 12 session will address ED-1 and ED-2 eCQMs and will include a review of measure logic, common issues, and a question and answer session. At the end of this session, participants will be able to:

  • Apply concepts learned about the new Clinical Quality Language (CQL) expression language for the ED-1 and ED-2 eCQMs,
  • Identify common issues and questions regarding ED-1 and ED-2 eCQMs, and
  • Prepare to implement the CQL expression language for the 2019 eCQM reporting year (2020 data submission).

Space for each session is limited to 3000 lines; when all lines have been used, no additional participants can join. If your organization or colleagues use a meeting room and single conference line for this session, please read below about CE requirements. To claim continuing education credits, staff must register individually.

This webinar is approved for 1.0 Continuing Education Credit from: ACCME, ANCC, ACHE, California Board of Registered Nursing, IACET, and CJCP. CE/CME/CEU Credits available for live audio only; credits not offered for webinar replays. To claim credit, you must have:

  1. Individually registered for the webinar.
  2. Listened to the live webinar in its entirety. Only those listening live during the session will be eligible to receive credit.
  3. Completed a post-program evaluation/attestation. The program evaluation/attestation link will be sent to your registered email after the webinar.

Printable certificates will be sent via email 2 weeks after the session; all participant CE certificates will be sent at the same time.

A webinar recording and slides will be posted on the Expert to Expert Series landing page and the CMS’ eCQI Resource Center website within several weeks of each session.

Click here to register


 

 

 

 

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RENTAL/LEASING SPACE


5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464


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

Pediatrician BC, P/T
Seeking motivated, enthusiastic pediatrician for P/T position in solo practice in Long Island. Coverage will increase over time. Great opportunity for those seeking part time hours in an established practice.   Fax resume to 516-858-2389.


Physician 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, the insights of forward-thinking physicians like you are invaluable. 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


Avoid nuisance lawsuits!! Make sure your website is compliant with the Americans with Disabilities Act! We can do a free audit of your website and let you know if 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Jan. 25, 2019 – Are YOU for Single Payer?

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


MSSNY eNews
January 25, 2019
Volume 22  Number 4

MSSNYPAC Seal

Colleagues:

We’ve been getting reacquainted with snow and other forms of precipitation in Western New York this week. Water is essential to life, but like so many other substances there can be too much of a good thing, and excess can lead to significant problems.  Indeed, MSSNY and the New York State Academy of Family Physicians suffered from the consequences of Mother Nature’s intemperance.  Travel was challenging over the weekend and the NYAFP leadership thoughtfully curtailed the end of their Scientific Assembly meeting to allow safe travel for their members.

NYSAFP provided an excellent review of many clinical topics.  I provided an update on the changing legislative landscape within New York State.  Subsequently, NYSAFP President Marc Price and I had a fireside chat with the attendees to discuss various items of concern to our memberships.  NYSAFP and MSSNY are in policy agreement with the vast majority of issues.  Our organizations have had a long standing difference in support for a single payer healthcare system.  MSSNY has long standing policy against endorsement of single payer, but in 2017 directed our leadership to engage in discussions that would be beneficial to patients and physicians.  NYSAFP has had policy for single payer for a number of years. Both of us agree that the devil is in the details.  The New York Health Act continues to be modified by its primary sponsors, Assemblyman Richard Gottfried and Senator Gustavo Rivera.  Senator Rivera indicated to me earlier in the week at a public event that he planned on further refinement of the bill to address the concerns of his constituents.

Assemblyman Gottfried indicated earlier this week that he was attempting to address some of MSSNYs concerns based on discussions we had in the fall.  I emphasized to the assembled group the importance of continuing the dialogue to improve policy for our patients and members and to shape the healthcare environment for our patients and our practices.  There are a number of other items under serious discussion with the Governor and Legislature, including the legalization of some hydrophobic substances currently prohibited by law.  NYSAFP and MSSNY are in strong agreement with regards to equity in law enforcement, and high quality research regarding the risks and benefits and long term effects of a certain oily, herbal substance with psychotropic activity before further expansion of its availability.

You can make a difference!

I believe we are at one of those tipping points in our state and country.  We (MSSNY, NYSAFP, our other specialty societies, and you personally) have a professional duty to inform the discussions and decisions of our elected officials during their deliberations.  Join me in Albany March 6th as we meet our elected leaders to share our concerns and policy recommendations for the health and welfare of our patients and fellow citizens with the unique insight we have caring for individual patients and informed by the basic and clinical science we employ on a daily basis.

Your duty doesn’t stop there.  You also need to engage your representatives at home.  Our Physician Advocacy Liaison (PAL) program can help you get there

Some former members have voiced that our efforts are inconsequential, that NY is run by “ three men in a room.”  There may have been some truth to that in the past, but “the times they are a changing.”  The 2018 election has changed the dynamics substantially and as noted above we have substantial input into the discussion.  Our political leaders are now seek our thoughts on how to proceed with these difficult questions.  Our MSSNY Leaders and our excellent Government Affairs staff continue with ongoing discussions with Assembly and Senate leaders and the Governor’s Management Team.  We continue to seek other healthcare allies in our discussion.

You can empower our patients and our profession further with your help in Albany and at home. Remember together we really are stronger!

Excelsior

Comments? comments@mssny.org; @mssnytweet; @TomMadejski

Thomas J. Madejski, MD
MSSNY President



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SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
With nearly 40 newly elected legislators in Albany, the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships to ensure the physician community’s message is heard about policies that could impact patient care.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure.
  • Reject proposed unfair cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

A brief informal luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org. (HARRING)


Governor Proposes $175 Billion Budget for 2019-20; Many Items of Impact to Medicine
As reported last week, Governor Andrew Cuomo has formally announced his proposed $175 Billion Budget for the FY 2019-20 Fiscal Year that would close a $3 billion Budget deficit.

Some positive items in the Executive Budget include: 

  • Increase from 18-21 the legal age to purchase tobacco and e-cigarettes; Ban flavored liquids and sales in pharmacies (See Dr. Madejski’s statement of support here.
  • Regulate the practices of Pharmaceutical Benefit Managers (PBMs).
  • Assuring comprehensive health insurance coverage for those suffering from a mental health condition (MH, SUD or autism).
  • Prohibit pre-authorization for Medication-Assisted Treatment (MAT) to address opioid addiction.
  • Extension of the Excess Medical Malpractice Program for an additional policy year.
  • Reduce the current 9% interest rate on court judgments, which could have the effect of reducing liability premiums for physicians.
  • Require Medicaid to cover services under the National Diabetes Prevention Programs for individuals diagnosed with prediabetes.
  • Create a statewide Maternal Mortality Board with necessary confidentiality protections.

Some items of potentially significant concern include:

  • Cuts Medicaid payments for the deductibles of “dual eligible” patients, which could have a significant adverse impact for those physicians whose patient mix includes a substantial number of Medicare/Medicaid dual eligible patients. Send a letter to your legislator here.
  • Legalize the sale of recreational marijuana to those 21 and over.
  • Expands the existing medical marijuana program to add additional health conditions which would be eligible for “Medical Cannabis”.
  • Permit Nurse Practitioners and licensed social workers to treat injured workers and be directly reimbursed under Workers Compensation without coordination with a physician.
  • Repeal “prescriber prevails” protections for prescriptions for Medicaid FFS patients that are not on the Medicaid formulary. 

Some items of Interest and Further Review Include:

  • Codify New York’s Health Insurance Exchange, and assure NY has continued coverage for pre-existing conditions, Essential Health Benefits and provide physician a clear method to appeal medications not included on insurers’ formulary
  • Expand health insurance coverage for IVF;
  • Require ED physicians to check I-STOP database;
  • Create a Commission on Universal Access to Health Care comprised of health policy and insurance experts to devise ways to achieve universal access to high quality, affordable health care;

Staff is continuing to pore through the thousands of pages of Executive Budget legislation and will provide further detailed updates.                                                                          (DIVISION OF GOVERNMENTAL AFFAIRS)


Governor Proposes “The Cannabis Act” To Legalize Use of Recreational Marijuana
Governor Andrew Cuomo proposed in his New York State Budget legislation a comprehensive component that would provide for the legalization of recreational marijuana.  Contained within the legislation is the existing program on medical marijuana.  The Medical Society is asking for the NYS Legislature to remove this provision form the budget proposal and are asking physicians to send a letter to the NY Legislature and to the governor through its Grassroots Action Center (GAC):

The bill’s components are as follows:

  • “The Cannabis Act” stated purpose– “It is hereby declared as a policy of the state of New York that it is necessary to properly regulate and control the cultivation, processing, manufacture, wholesale and retail production, distribution, transportation and sale of cannabis, cannabis-related products, medical cannabis and help cannabis within the state of New York, for the purposes of fostering and promoting temperance in their consumption, to properly protect the public health, safety and welfare, and to promote social equality.”
  • Creates an Office of Cannabis Management — The plan calls for creation of a new state agency called the Office of Cannabis Management. It will be run by an executive director and be a division of the state’s Alcoholic Beverage Control office. The executive director can place limitations on the number of licenses, regulate potency and the types of marijuana products to be sold.  Office will have the ability to halt all cultivation and sales “at any time of public emergency.”
  • The director will work with other agencies, including the agriculture department, to develop rules governing the safe production of marijuana plants, including devising restrictions on pesticide use. The office is also charged with developing rules to prevent people under 21 from obtaining marijuana.  The recreational program will be the three-tiered grow/distribute/sell approach.   This is significantly different than the existing medical marijuana program which is a “vertically integrated” system in which one company does all three things.
  • Local Authority — The proposal permits both individual counties and cities with more than 100,000 residents to opt out – and therefore not permit cultivation or retail pot facilities in their jurisdictions – if their governing body adopts an ordinance, law or resolution to “completely prohibit the establishment or operation” of any of the -licensed entities.
  • Tax projections– Administration projections are for $300 million a year coming from three separate taxes on the marijuana supply chain, including 22 percent of sales and excise taxes. No revenues are expected this year and $83 million next year is expected in tax receipts.
  • Location of stores– Selling marijuana without a license is prohibited. Stores must be located at street level, be or a public thoroughfare, or on an arcade or “sub-surface thoroughfare leading to a railroad terminal.’’   They must be certain distances away from schools and houses of worship.
  • Penalties—Unlawful possession of cannabis $150 fine. Possession of under 21 and less than one-half of one ounce fine is not more than $100. Fine for smoking marijuana in a public place is $150. Possession of more than one ounce of cannabis would be a $125 fine, and more than 2 ounces would result in a fine of $125 per additional ounce possessed above two ounces.  Criminal sale less than one ounce would be a $250 fine or 2x the value of the sale; Criminal sale of more than one ounce would be a $500 fine or 2x the value of the sale; Criminal sale of 4 ounces would be $1,000 fine or 2x the value of the sale.
  • It would also be unlawful to take any adverse employment action against an employee based on conduct allowed. Employers would be permitted to “take adverse employment action” against workers “for the possession or use of intoxicating substances during work hours.”
  • Creates the NYS Cannabis Revenue Fund—monies collected for the administration of the program, data gathering, monitoring and reporting, the governor’s traffic safety committee, small business development and loans, substance abuse, harm reduction and mental health treatment and prevention, public health education and intervention, research on cannabis uses and applications, program evaluation and improvements and any other identified purpose recommended by the executive director and approved by the budget director.
  • Advertising – The bill authorizes the office to promulgate rules prohibiting advertising that is deception; promotes overconsumption; depicts consummation by children; is designed in any way to appeal to children or minors; within 200 feet of a school, playground, child care center, public park or library; in a public transit or station; in publicly owned or operate property and makes medical claims or promotes adult-use cannabis for a medical or wellness purpose. It also allows the office to determine marking, branding, packaging, labeling, location of cannabis retailers and advertised that are aim at young people.

Medical Marijuana

  • Removes the medical marijuana program out of DOH and into the Office of Cannabis Management.
  • Allows anyone who is authorized to prescribe controlled substances in New York to certify patients.
  • Reduces from 3 hours to 2 hours course work requirements.
  • Expands list of conditions to include: Alzheimer’s, muscular dystrophy, dystonia, rheumatoid arthritis, autism, and any condition authorized as part of a cannabis research license.   It authorizes the executive director to add additional conditions to the list.
  • Authorizes the executive director to set the per dose price.
  • Allows certified patients, over 21, to cultivate up to four plants at home.
  • Allows for research studies.
  • Creates the Medical Cannabis Trust Fund—25% of monies shall be transferred to the counties where cannabis is manufactured; 22% shall be transferred to the counties in which cannabis was dispensed and allocated in proportion to the gross sales; 5% to OASAS; 5% to criminal justice services for a program of discretionary grants to state and local law enforcement agencies.

While MSSNY has supported marijuana de-criminalization, the broad reach of this proposed program is of significant concern.  With many articles detailing the teen vaping epidemic, MSSNY is concerned with similar dynamics taking hold with marijuana legalization.  (CLANCY, AUSTER)


NYS Legislature Passes and Governor Signs in to Law the Reproductive Health Act
The New York State Legislature passed the Reproductive Health Act on January 22, 2019 and it was immediately signed into law by Governor Andrew Cuomo as Chapter 1, Laws of 2019.    Assembly Bill 21 and Senate Bill 240, sponsored by Assemblymember Deborah Glick and Senator Liz Krueger, amended the public health law by codifying the abortion procedure within New York State’s public health law and removing it from the penal law.  The bill passed the NYS Senate by a vote of 38-24 and the NYS Assembly by 95-49.  The law creates a statement of purpose and says that an abortion may be performed a licensed, certified or authorized practitioner acting within their defined scope of practice under Title 8 of the Education Law.   Under the law, an abortion can be performed within 24 weeks from the commencement of pregnancy, an absence of fetal viability or at any time when necessary to protect a patient’s life or health. 

MSSNY has policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.   Moving the abortion procedure from the penal law to the public health law is consistent with this position.   The law does not expand the current scope of practices for health care providers.    It does, however, specify that health care practitioners can perform an abortion if it otherwise enabled by their current scope of practice as defined under the NYS Education Law.  Nurse practitioners are allowed to perform a medicated abortion procedure already under their scope of practice.  Nurse practitioners scope does not include “surgery” and cannot perform a surgical abortion.  The American College of Obstetricians and Gynecologists (ACOG), District II and the NYS Academy of Family Physicians (NYAFP) supported this measure.  (CLANCY) 


Comprehensive Contraception Coverage Act Passed by NYS Legislature; Awaits Governor Action
“The Contraceptive Equity Act” has passed the NYS Legislature.    Assembly Bill 585-A/Senate Bill 659-A, sponsored by Assemblymember Kevin Cahill and Senator Julia Salazar, requires health insurance policies to include coverage of all FDA-approved contraceptive drugs, devices and productions.  The bill also requires insurance coverage for emergency contraception when prescribed or when lawfully provided over the counter and allows for dispensing of up to twelve months of contraception.  The bill would also require coverage of voluntary sterilization procedures for women and men and would require coverage for patient education and counseling about contraception.

The bill would also require that any follow-up care related to the covered contraceptives including management of side-effects, counseling and device insertion and removal be covered.  The legislation also importantly contains a “prescriber prevails” provision.  MSSNY has policy that supports allowing greater access to emergency contraception and supports insurance coverage for contraceptive drugs and devices.  The bill was also supported by COG and NYAFP. (CLANCY)


Conversion Therapy Bill Signed Into Law By Gov. Cuomo; MSSNY Participates In Bill Signing Ceremony
On Friday, January 25, 2019, Governor Andrew Cuomo signed legislation that would prohibit a mental health professional from engaging in sexual orientation change efforts with a patient under 18 years of age.  A. 576/S. 1046, sponsored by Assemblymember Deborah Glick and Senator Brad Hoylman, provides that any sexual orientation change efforts attempted on a patient under 18 years of age by a licensed mental health professional shall be considered unprofessional conduct and shall subject the provider to discipline by the provider’s licensing entity.   Frank Dowling, MD, MSSNY Secretary, participated in the bill signing ceremony.  The Medical Society of the State of New York has supported this measure and it has been part of our legislative program for several years. (CLANCY)


Firearm Safety Package Moving in NYS Legislature
The New York State Legislature will be considering a series of firearm safety measures next week. Senate Bill 2448, sponsored by Senator Luis Sepulveda, would prohibit the possession, manufacture and transport of rapid-fire modification devices which are commonly referred to as a “bump stock” mechanism.  This legislation is on the Senate Codes Committee for its consideration on Monday.  Its companion measure, A.2684, sponsored by Assemblywoman Patricia Fahy is also on the Assembly Codes Committee.   Senate Bill 2374/A.2690 sponsored by Senator Michael Gianaris and Assemblymember Amy Paulin, would establish a waiting period before a firearm, shotgun or rifle can be sold or transferred.  The bill requires either the National Instant Criminal Background Check System (NICS) or its successor to issue a “proceed” response to the licensee or a 30 day waiting period to expire.  The measure is on the Senate and Assembly Codes Committee for action.

At its 2018 House of Delegates, the Medical Society of the State of New York enacted policy that  supports legislation that blocks the sale of any device or modification, not limited to bump stocks, that functionally converts a firearm into a weapon that mimics fully-automatic operations.   MSSNY also supports legislation that requires a waiting period and background checks prior to the purchase of firearms, including person-to-person transfers, internet sales and interstate transactions. Also coming before the Senate Judiciary Committee is S.2451, sponsored by Senator Brian Kavanagh.   Its companion measure Assembly bill 2689, sponsored by Assemblymember JoAnne Simon, is on the Assembly Codes Committee.

This bill, commonly referred to as a “red flag” law, would establish an Extreme Risk Protection Order (ERPO) which is an order of protection prohibiting certain persons from purchasing, possessing or attempting to purchase or possess a firearm, rifle or shotgun.  Under the measure, a police officer, a family or household member, a school administrator or his/her designee, can request a court-issued order of protection when it is believed that a person has threatened or committed an act of violence towards themselves or others, or situations where an order of protection has been violated, or where there is a pending charge or conviction for an offense involving the use of a weapon.  The bill provides grounds for the request and surrendering of the firearm.  MSSNY’s Taskforce on Firearm Safety recently recommended, and the MSSNY Council agreed, that MSSNY support the concept of “red flag” provisions.              (CLANCY)


Empire Center Forum Examines Implication of Proposed New York Health Act
This week the Empire Center for Public Policy held a widely attended seminar in Albany at which legislators and industry experts discussed the provisions and ramifications of the New York Health Act (NYHA), as well as possible alternatives for achieving universal health care.  NYHA bill sponsors Senator Gustavo Rivera and Assemblyman Richard Gottfried presented their case for a single-payer system, including the articulation of their goal to assure coverage for the currently uninsured and underinsured by re-directing the enormous amount of health care dollars that currently goes toward administrative spending. 

In response, representatives of HANYS and the NYS Conference of Blues Plans raised significant concerns with the legislation, including possible ERISA pre-emption and the elimination of employer-funded insurance as an option for patients.  They also noted that, while the goals of expanded coverage are agreed to by many, the “devil is in the details” regarding how such a program would be constructed and implemented.  Assemblyman Gottfried and Senator Rivera indicated a revised NYHA bill would be introduced soon, including provisions to clarify that pre-authorization requirements for needed care would be no more burdensome that what is currently imposed by Medicare (a concern raised by MSSNY).

The Empire Center’s health policy director Bill Hammond noted that the NYHA would require a significant tax increase which could be greater than $139 billion (plus long term care) suggested by a recent Rand study. Hammond also presented information outlining how New Yorkers would be affected financially.   Hammond also noted that, while many people would pay less for health insurance, many from across financial strata, would pay more. In fact, Hammond noted that many of those that would pay more would be low- and middle-income individuals and families.

The second panel, moderated by Hammond, was comprised of Eric Linzer, CEO of the NY Health Plan Association, Michael Sparer, professor and Chair of Health Policy at Columbia University, and Michael Capaldo, a board member of the NYS Association of Health Underwriters.

Sparer advocated for allowing individuals to buy into government programs like Medicaid, the Essential Plan and CHP in order to assist the un- and underinsured in achieving more affordable coverage. He also noted the great difficulties that the federal government’s unwillingness to provide waivers would present. Linzer noted his support for state subsidies for those who qualify for little to no subsidies (ie, 400-600% FPL) in order to expand affordable coverage and help to stabilize the risk pool. He also discussed focusing on transparency within the pharmaceutical industry.  Capaldo advocated to expand the use of New York’s All Payer Database so that individuals can better shop for care. He also proposed innovating network coverage, such as permitting members to go to a non-participating provider if they are cheaper than a participating provider, and possibly allowing the member to share in the savings.  (AVELLA, AUSTER, HARRING)



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Measles Outbreak in New York State Continues to Spread
Webinar Available at MSSNY CME Website

The measles outbreak in New York State continues to spread with at least 177 confirmed cases.  In Rockland County, there have been 18 new cases in January, 2019, after a drop in cases in December.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.  This webinar has now been posted to the MSSNY CME website. Please check it out and keep yourself informed about the ongoing measles outbreak throughout New York State.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine here.            (HOFFMAN, CLANCY)


“What’s Your Diagnosis? Psychological First Aid” Interactive CME Webinar February 20, 2019 @ 7:30am – Registration Now Open

MSSNY’s next Medical Matters webinar is entitled What’s Your Diagnosis? Psychological First Aid.  This is a newly formatted interactive program that is more immersive for participants.  You will be asked to answer questions about a case and discussion will follow.  Find out if you’re fully prepared to include psychological first aid during a public emergency on February 20th at 7:30am.  Registration is open for this program here.  Faculty will be Craig Katz, MD, co-vice chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.

Educational Objectives:

  • Describe the basic tenets of psychological first aid (PFA)
  • Identify resources to assist patients during and after trauma
  • Describe a scenario and review questions and answers

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. (HOFFMAN, CLANCY)


For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
charring@mssny.org

eNews

New York’s Capital Region Reports Boost in Crucial NIH Funding Last Year
The Albany (NY) Times Union (1/17, Mendoza) reports the Albany, New York area “saw a significant jump in funding for biotech research last year from the National Institutes of Health,” according to the Albany-based Center for Economic Growth. The center found that the NIH “directed $62 million in funding to 20 institutions across an eight-county area,” a sum that “is the most the area has received from the NIH since 2013.” According to the article, “More than half of the Capital Region’s federal life sciences research and development funding comes from the National Institutes of Health,” an infusion that researchers regard as critical to scientific institutions.


JAMA Observational Study on Pharma Marketing v. Opioid Overdose
An observational study published in JAMA Network Open analyzes the link between how much money pharmaceutical companies spend marketing to doctors and opioid overdose death rates a year later. The companies spent nearly $40 million to market their medications to U.S. doctors between 2013 and 2015.

The researchers who conducted the JAMA study looked at more than 2,000 counties across the United States to see whether overdose death rates changed in the year after doctors in the area received payments and/or marketing material from opioid manufacturers. The counties that got more marketing attention did later experience higher overdose death rates.

The study authors point out that prescription opioids account for about 40 percent of all overdose deaths and, more importantly, are the first opioid a person typically encounters. While most overdose deaths are related to illicitly obtained opioids, mainly heroin and fentanyl, the authors say using prescription opioids first may lead to OD deaths from any type of opioid. Although the study did not prove causation, it does show that pharmaceutical companies and doctors may play an unexpected role in the opioid epidemic, and it raises questions about how the U.S. health care system could more effectively address the opioid crisis.

Sourced from: JAMA Network Open


Free Buprenorphine Waiver Training in Albany Feb 22
When:  Fri Feb 22 12-5
Where: Desmond Hotel, Albany

The PCSS-MAT Half-and-Half Medication Assisted Treatment (MAT) waiver training course provides an overview of the FDA-approved medication—buprenorphine—prescribed for the treatment of opioid use disorder (OUD). This course provides the required 8-hour training to prescribe buprenorphine for the treatment of OUD. The course provides an overview of prevention, identification, and treatment of substance use disorders emphasizing OUD.

Tuition: Free

More information/ to register: www.nyacp.org


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USAF Looking for Medical School Applicants, Med Students, Fellows and Residents

The NY USAF office handles applications for the Office of the Surgeon General’s following programs:

1. Medical Corps Health Professions Scholarships Program
(Up to 100% Tuition & Fees Scholarship for 4 years, with $2,330/month Stipend,   $20K Sign-up bonus, and materials reimbursement quarterly)
     a. Undergraduates and graduates applying to medical school
     b. Current medical school students
     c. Students already enrolled in early assurance programs at the undergrad or       graduate levels
2. Medical Corps Health Professions Financial Assistance Program 
(Earn up to an additional $73K per PGY on top of what their residency program is already paying)
    a. Final year medical school students playing in the match cycle
    b. Final year medical school students already matched
    C. Current Residents
    d. Current Fellows
3. Direct Accessions of BE/BC Physicians
(Initial Sign-on bonuses from $250-400K depending on specialty + competitive pay    and unmatched benefits)
           a. Final year residents and fellows
           b. Practicing Physicians seeking a change, challenge, or privilege to serve
           c. Any ‘a’ or ‘b’ candidate wanting to gain additional training, licensing, and experience as an Aerospace Medicine Doctor (a.k.a. Flight Surgery or Flight Medicine)
           d. A pathway to highly specialized and elite physician programs and teams like Special Operations Surgical Teams (SOST), Critical Care Assessment Teams (CCAT), Ground Surgical Teams (GST), Center for Sustainment of Trauma and Readiness Skills (CSTARS)  and many, many, more growth and career broadening pathways.

MSSNY Past President and Family Physician Ralph Schlossman, MD Died Jan. 17
Dr. SchlossmanMSSNY Past President Ralph Schlossman, MD, 88, died at his home surrounded by his wife of 64 years, Ruth, family and friends on January 17, 2019. Interment was on, January 20 at Mount Hebron Cemetery.

He graduated from New York University School of Medicine in 1955 and joined the Medical Society of the County of Queens in January 27, 1959. Dr. Schlossman became President of Medical Society of the County of Queens in 1970-1971 and President of Medical Society of the State of New York in 1998-1999. He was MSSNY Councilor from 1984-1992. He was elected to the Board of Trustees in 2000 and served on it until 2005 and he was Chair of the Board from 2004-2005. Dr. Schlossman received the Medical Society of the State of New York’s most prestigious award, the Henry I. Feinberg Award for leadership.

Dr. Schlossman served in the United States Air Force from 1956-1958 and was Chief Flight Surgeon 31st Tactical Fighter Wing and Commander of 31st Tactical Hospital. He was proud of his service in the U.S. Air Force, becoming the flight surgeon of a wing of the first generation of supersonic fighter bombers and one of the first physicians to fly faster than the speed of sound.

Dr. Schlossman and his wife Ruth have three children Andrew, Wendy and Marcie. The Family requests contributions may be made to Hadassah or Wounded Warriors Project.


Workers Compensation New Medical Fee Schedule
The new Medical Fee Schedule will be effective for services provided on or after April 1, 2019. The Board adopted the use of ICD-10 October 1, 2015, as previously announced in Subject Number 046-785 Chair Announces Adoption of ICD-10. Therefore, effective April 1, 2019, the Board will require full compliance with ICD-10.

The Workers’ Compensation Medical Fee Schedule is published by Optum Insight. Copies may be obtained by mail, telephone, or online.

By telephone: Call (800) 464-3649, option 1.

Online: Go to www.optum360coding.com, keyword New York, or https://www.optum360coding.com/Product/40508/. 


Erie County Medical Society Physicians Meet with Local Legislative Delegation
On January 4, 2019, physician leaders of the Medical Society of the County of Erie (MSCE) met with several key local legislators representing Western New York in Albany and Washington.  Participating Senators and Assembly Members included Senator Patrick Gallivan, Ranking Member of the Senate Health Committee on Health, and Assembly Members Angelo Morinello, Michael Norris and Monica Wallace.  Also participating were top staff from Senator Michael Ranzenhofer, Senator Tim Kennedy, US Representative Chris Collins and US Representative Brian Higgins.

In anticipation of the 2019 legislative session, two important topics were discussed – physician concerns with proposals to legalize recreational marijuana (proposed in the Governor’s Executive Budget) and legislation to create a statewide single-payer insurance program.

MSCE representatives included: Drs. Robert Armstrong, Secretary/Treasurer MSCE; Rose Berkun, Chair Legislative Committee MSCE (and MSSNY Legislative Committee Vice-Chair); Gale Burstein, Erie County Health Commissioner and Chair of Public Health Committee MSCE; John Gillespie, President MSCE; Kenneth Eckhert III, President-Elect MSCE; Gordon Tussing, Chair Practice Management Committee MSCE; Willie Underwood, Immediate Past President MSCE; Joseph McCarthy, Esq., MSCE Counsel and Jennifer Scharf, Esq., Co-Chair Health Law Committee MSCE.

Have you had a local meeting with your legislators on key legislative issues impacting physicians and their patients?  Please share with us to include in future issues of the MSSNY e-news.


Cost of Insulin for Treating T1D Nearly Doubled Over Five-Year Period
Reuters (1/22)reports, “The cost of insulin for treating type 1 diabetes [T1D] in the United States nearly doubled over a five-year period,” researchers found in “a report due to be released on Tuesday by the nonprofit Health Care Cost Institute (HCCI).” The report revealed that an individual with T1D “incurred annual insulin costs of $5,705, on average, in 2016,” compared to an “average cost” of “$2,864 per patient in 2012.” According to Reuters, these numbers “represent the combined amount paid by a patient and their health plan for the medicine and do not reflect rebates paid at a later date.”


What’s Changed for 2019 E&M Services?
For those of you who bill Medicare for Evaluation and Management and some telehealth services, you will need to know what has changed based on the 2019 Final Rule for Medicare.  You or your staff should review the changes through the following link:
What’s Changed as a Result of CMS Final Rule 2019


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MSSNY eNews: Positive Budget Items!

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


MSSNY eNews
January 18, 2019
Volume 22  Number 3

MSSNYPAC Seal

Colleagues:

Where does the time go?  After a brief holiday and New Year’s break, your MSSNY team is back at it again.  Former MSSNY President Malcolm Reid, MSSNY VP of Governmental Affairs Moe Auster and I attended the State Advocacy Summit sponsored by the American Medical Association this past weekend.

The meeting’s focus is on policy issues that the States are likely to encounter in the near future.  State Medical Society officers meet with content experts on a wide range of topics, and officers from other State and Specialty Societies compare notes and work on solutions to improve the health of our patients and our communities. Topics included further coverage expansions for the uninsured; the ongoing opioid crisis; consolidation in the healthcare sector.  Liability reform efforts centered on early communication and resolution of medical injuries outside of the traditional tort system. Two resources are PEARL Process for Early Assessment and Resolution of Loss from Stanford and MACRMI from the Massachusetts Alliance for Communication and Resolution following Medical Injury (MACRMI).

Monday, I met with a friend and colleague, Dr. Tom Hughes, medical director of a large physician organization to discuss how MSSNY and the County Societies in his area could work with the physicians and other providers in his organization on physician wellness.  We hope to work together to create some novel programming and resources to reduce stressors, improve patient care, and return more joy to the practice of medicine for our physicians and their healthcare teams. Our Committee on Physician Wellness has developed a number of resources that may be useful to you personally, or to a colleague who may need help. We had a general discussion about the changing nature of healthcare delivery and physician leadership needed to improve outcomes, for both patients and their caregivers.

Dr. Hughes and I agreed that there is a window of opportunity for physicians to increase or re-establish leadership in patient care, physician practice, and healthcare financing.  There is emerging data that the best performing systems are physician led.  Unfortunately with the relative size and financial clout of other sectors, amplified by consolidation after consolidation within and across industries, the window may be closing rapidly.

Honored to Be Honored

On Tuesday, I was honored to represent MSSNY at a City & State event recognizing the “Top Healthcare Power 50” in New York State. Opening remarks were provided by CVS’ EVP and General Counsel Tom Moriarty; Ken Raske, CEO of Greater NY New York Hospital Association.  The CVS chair spoke about how CVS was going to work to transform healthcare through their pharmacies in conjunction with pharmacists and non-physician practitioners.  Mr.  Raske spoke about the substantial progress made in treating cancer throughout New York State, and the many advancements in care that have occurred driven by the healthcare systems of NY. Treatment innovations are still largely, but less exclusively driven by physicians. The evolution of healthcare financing and financial power within that system has moved away from physicians to health systems, Big Pharma, retailers, and the Insurance industry (JP Morgan, Berkshire Hathaway, and Amazon anyone?).

That’s where we (MSSNY and you) come in.  Physicians are the natural leaders of improvement in healthcare because of their duty to do their best for their patients.  MSSNY provides a venue and mechanism for physicians to come together and develop solutions.  Through our combined efforts we can make the world a better place for our patients, our communities, and our profession.

Non ministrari sed ministrare

Please send me your thoughts at comments@mssny.org. 

Thomas J. Madejski, MD
MSSNY President


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Capital Update

SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
With nearly 40 newly elected legislators in Albany, the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships with this new Legislature to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana and creating a single payor health insurance structure.
  • Reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Reject burdensome mandates that interfere with patient care delivery.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.
  • Reject inappropriate scope of practice expansions of non-physician practitioners.
  • Prevent big-box, store-owned medical clinics that will negatively impact community primary care delivery.

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.  (HARRING)


Governor Proposes $175 Billion Budget for 2019-20
This week, Governor Andrew Cuomo formally announced his proposed $175 Billion Budget for the FY 2019-20 Fiscal Year that would close a $3 billion Budget deficit.  The Budget contains $1.3 Billion in revenue actions, including a 5 year extension of the surcharge on high earners.

Some positive items include: 

  • Increase from 18-21 the legal age to purchase tobacco and e-cigarettes; Ban flavored liquids and sales in pharmacies (See MSSNY President Dr. Tohmas Madejski’s statement of support here.
  • Regulate the practices of Pharmaceutical Benefit Managers (PBMs)
  • Assuring comprehensive health insurance coverage for those suffering from a mental health condition (MH, SUD or autism)
  • Prohibit pre-authorization for Medication-Assisted Treatment (MAT) to address opioid addiction
  • Extension of the Excess Medical Malpractice Program for an additional policy year;
  • Reduce the current 9% interest rate on court judgments
  • Require Medicaid to cover services under the National Diabetes Prevention Programs for individuals diagnosed with prediabetes.
  • Expand health insurance coverage for IVF;
  • Create a statewide Maternal Mortality Board with necessary confidentiality protections 

Some items of potentially significant concern include:

  • Legalize the sale of recreational marijuana to those 21 and over (see below summary). The Governor would create an Office of Cannabis Management to oversee program.  Municipalities would be able to opt out of sales in their local jurisdictions.  The program is expected to generate $300 million in annual revenue.
  • Create a new “Medical Cannabis” program for patients who have a “serious health condition.”
  • Permit PAs, NPs, social workers, acupuncturists and licensed social workers to treat injured workers under Workers Compensation.
  • Repeal “prescriber prevails” protections for prescriptions for Medicaid FFS patients for medications that are not on the Medicaid formulary.
  • Eliminate Medicaid coverage for deductibles of “dual eligible’ patients

Some items of Interest and further review Include:

  • Codify New York’s Health Insurance Exchange, and assure NY has continued coverage for pre-existing conditions,

Essential Health Benefits and easy way to appeal medications not included on insurers’ formulary.

  • Require ED physicians to check I-STOP database;
  • Launch a comprehensive education and training program to reduce implicit racial bias in health care facilities Statewide;
  • Launch an uterine fibroid and endometriosis research and public outreach campaign
  • Encourage more prescribers to become designated buprenorphine prescribers by directing OASAS, OMH and DOH to oversee implementation of statewide learning collaborative;
  • Make $5 million available to regional perinatal centers and other health care providers to expand their telehealth capabilities in rural communities;
  • Create a Commission on Universal Access to Health Care comprised of health policy and insurance experts to devise ways to achieve universal access to high quality, affordable health care.

Staff is continuing to pore through the thousands of pages of Executive Budget legislation and will provide further detailed updates. (DIVISION OF GOVERNMENTAL AFFAIRS)


Governor Proposes “The Cannabis Act” to Legalize Use of Recreational Marijuana
Governor Andrew Cuomo proposed in his New York State Budget legislation that would provide for the legalization of recreational marijuana.  Contained within the legislation is the existing program on medical marijuana.  The bill’s components are as follows:

    • “The Cannabis Act” stated purpose– “It is hereby declared as a policy of the state of New York that it is necessary to properly regulate and control the cultivation, processing, manufacture, wholesale and retail production, distribution, transportation and sale of cannabis, cannabis-related products, medical cannabis and help cannabis within the state of New York, for the purposes of fostering and promoting temperance in their consumption, to properly protect the public health, safety and welfare, and to promote social equality.”
    • Creates an Office of Cannabis Management — The plan calls for creation of a new state agency called the Office of Cannabis Management. It will be run by an executive director and be a division of the state’s Alcoholic Beverage Control office. The executive director can place limitations on the number of licenses, regulate potency and the types of marijuana products to be sold.  Office will have the ability to halt all cultivation and sales “at any time of public emergency.”
    • The director will work with other agencies, including the agriculture department, to develop rules governing the safe production of marijuana plants, including devising restrictions on pesticide use. The office is also charged with developing rules to prevent people under 21 from obtaining marijuana.  The recreational program will be the three-tiered grow/distribute/sell approach.   This is significantly different than the existing medical marijuana program which is a “vertically integrated” system in which one company does all three things.
    • Local Authority — The proposal permits both individual counties and cities with more than 100,000 residents to opt out – and therefore not permit cultivation or retail pot facilities in their jurisdictions – if their governing body adopts an ordinance, law or resolution to “completely prohibit the establishment or operation” of any of the -licensed entities.
    • Tax projections– Administration projections are for $300 million a year coming from three separate taxes on the marijuana supply chain, including 22 percent of sales and excise taxes. No revenues are expected this year and $83 million next year is expected in tax receipts.
    • Location of stores—Selling marijuana without a licenses is prohibited. Stores must be located at street level, be or a public thoroughfare, or on an arcade or “sub-surface thoroughfare leading to a railroad terminal.’’   They must be certain distances away from schools and houses of worship.
    • Penalties—Unlawful possession of cannabis $150 fine. Possession of under 21 and less than one-half of one ounce fine is not more than $100. Fine for smoking marijuana in a public place is $150. Possession of more than one ounce of cannabis would be a $125 fine, and more than 2 ounces would result in a fine of $125 per additional ounce possessed above two ounces.  Criminal sale less than one ounce would be a $250 fine or 2x the value of the sale; Criminal sale of more than one ounce would be a $500 fine or 2x the value of the sale; Criminal sale of 4 ounces would be $1,000 fine or 2x the value of the sale.
    • It would also be unlawful to take any adverse employment action against an employee based on conduct allowed. Employers would be permitted to “take adverse employment action” against workers “for the possession or use of intoxicating substances during work hours.”
    • Creates the NYS Cannabis Revenue Fund—monies collected for the administration of the program, data gathering, monitoring and reporting, the governor’s traffic safety committee, small business development and loans, substance abuse, harm reduction and mental health treatment and prevention, public health education and intervention, research on cannabis uses and applications, program evaluation and improvements and any other identified purpose recommended by the executive director and approved by the budget director.
    • Advertising – The bill authorizes the office to promulgate rules prohibiting advertising that is deception; promotes overconsumption; depicts consummation by children; is designed in any way to appeal to children or minors; within 200 feet of a school, playground, child care center, public park or library; in a public transit or station; in publicly owned or operate property and makes medical claims or promotes adult-use cannabis for a medical or wellness purpose.  It also allows the office to determine marking, branding, packaging, labeling, location of cannabis retailers and advertised that are aim at young people.

    Medical Marijuana

    • Removes the medical marijuana program out of DOH and into the Office of Cannabis Management.
    • Allows anyone who is authorized to prescribe controlled substances in New York to certify patients.
    • Reduces from 3 hours to 2 hours course work requirements.
    • Expands list of conditions to include: Alzheimer’s, muscular dystrophy, dystonia, rheumatoid arthritis, autism, and any condition authorized as part of a cannabis research license.   It authorizes the executive director to add additional conditions to the list.
    • Authorizes the executive director to set the per dose price.
    • Allows certified patients, over 21, to cultivate up to four plants at home.
    • Allows for research studies.
    • Creates the Medical Cannabis Trust Fund—25% of monies shall be transferred to the counties where cannabis is manufactured; 22% shall be transferred to the counties in which cannabis was dispensed and allocated in proportion to the gross sales; 5% to OASAS; 5% to criminal justice services for a program of discretionary grants to state and local law enforcement agencies.

    While MSSNY has supported marijuana de-criminalization, the broad reach of this proposed program is of significant concern.  With many articles detailing the teen vaping epidemic, MSSNY is concerned with similar dynamics taking hold with marijuana legalization. (CLANCY, AUSTER)


    NY Rx Card Banner


    Important Health Care Access Legislation Re-introduced
    With session barely a week old, a flurry of legislation both old and new has been introduced. Of particular importance for MSSNY members are bills introduced by Senator Gustavo Rivera, the new Chair of the Senate Health Committee, that MSSNY supports and will advocate towards enactment this session:

    • 1800/A.1165 – Extends confidentiality protections for testimony provided by physicians at a peer review committee who may become a party to an action regarding the topics that were discussed at such peer review meeting. This would greatly improve the peer-review process by encouraging physicians to submit information without fear of misuse in subsequent legal proceedings. Assembly Health Committee Chair Richard Gottfried has re-introduced the “same-as” bill in the Assembly.
    • 873 – Prohibits the use of extrapolation by health insurers to determine amounts overpaid apart from a few exceptions.
    • 1796 – Clarifies liability protections for organizations that establish committees to assist physicians thought to be suffering from addiction or mental illness (like MSSNY’s Committee for Physicians Health). This is vital to ensuring that physicians can receive the help that they need to continue practice and to remain available to the patients in their communities.
    • 1794 – Assures “prescriber prevails” protections for physicians prescribing certain medications to patients covered under Medicaid managed care.
    • S.467 – More closely aligns NYS regulations with federal Stark Law. Currently the state does not allow “Stark” exceptions recognized under the federal law, including for assisting physicians in implementing costly electronic medical record systems.   This legislation would prevent future inappropriate inconsistencies by ensuring that any arrangement permitted under the federal law will also be permitted under the State law.         (AVELLA, AUSTER)

    Conversion Therapy Passes NY State Legislature; Governor Expected to Sign Measure
    Legislation that would prohibit a mental health profession from engaging in sexual orientation changed efforts with a patient under 18 years of age, passed both houses of the NY State Legislature.

    A. 576/S. 1046, sponsored by Assemblymember Deborah Glick and Senator Brad Hoylman, would provide that any sexual orientation change efforts attempted on a patient under 18 years of age by a licensed mental health professional shall be considered unprofessional conduct and shall subject the provider to discipline by the provider’s licensing entity.

    The measure is expected to be sent to the governor’s office for his consideration; and the governor is expected to sign the bill.  The Medical Society of the State of New York, as well as several other specialty societies, supports this measure and it has been part of MSSNY’s legislative program for several years. (CLANCY)


    NYS Legislature Expected to Act on the Reproductive Health Act on January 22, 2019
    The New York State Legislature is expected to vote on the Reproductive Health Act on January 22, 2019—the 46th Anniversary after the US Supreme Court issued Roe v. Wade.   Assembly Bill 21 and Senate Bill 240, sponsored by Assemblymember Deborah Glick and Senator Liz Krueger, amends the public health law by placing the abortion procedure within New York State’s public health law.  The abortion procedure is currently under the penal law.  The bill is pending on the Assembly calendar and passed through the Assembly Health and Codes Committees.

    The bill creates a statement of purpose and says that an abortion may be performed a licensed, certified or authorized practitioner acting within their defined scope of practice under Title 8 of the Education Law.   Under the bill’s provisions an abortion can be performed within 24 weeks from the commencement of pregnancy, an absence of fetal viability or at any time when necessary to protect a patient’s life or health.  MSSNY has policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.    Moving the abortion procedure from the penal law to the public health law is consistent with this position.                                                                        (CLANCY)


    Comprehensive Contraception Coverage Act Moving in NYS Legislature
    “The Contraceptive Equity Act” has moved through the Assembly Insurance and Codes Committee and is currently on the Assembly Calendar.   It is anticipated that this measure will be voted on next week.

    Assembly Bill 585-A/Senate Bill 659-A, sponsored by Assembymember Kevin Cahill and Senator Julia Salazar, would require health insurance policies to include coverage of all FDA-approved contraceptive drugs, devices and productions.  The bill also requires insurance coverage for emergency contraception when prescribed or when lawfully provided over the counter and allows for dispensing of up to twelve months of contraception.

    The bill would also require coverage of voluntary sterilization procedures for women and men and would require coverage for patient education and counseling about contraception.  The bill would also require that any follow-up care related to the covered contraceptives including management of side-effects, counseling and device insertion and removal be covered.  The legislation also contains a prescriber prevails provision.  MSSNY has policy that supports allowing greater access to emergency contraception and supports insurance coverage for contraceptive drugs and devices. (CLANCY)


    Measles Outbreak in New York State Continues to Spread
    Webinar Available at MSSNY CME Website

    The measles outbreak in New York State continues to spread with at least 177 confirmed cases.  In Rockland County, there have been 18 new cases in January, 2019, after a drop in cases in December.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.  This webinar has now been posted to the MSSNY CME website. Please check it out and keep yourself informed about the ongoing measles outbreak throughout New York State.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine here.      (HOFFMAN, CLANCY)


    “What’s Your Diagnosis? Psychological First Aid” Interactive CME webinar
    February 20, 2019 @ 7:30am – Registration now open

    Be sure to register for the next Medical Matters webinar, What’s Your Diagnosis? Psychological First Aid.  This program will involve more interaction from participants.  You will be asked to answer questions about a case and discussion will follow.  Find out if you’re fully prepared to include psychological first aid during an emergency on February 20th at 7:30am.  Registration is open for this program here.  Faculty will be Craig Katz, MD, co-vice chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.

    Educational Objectives:

    • Describe the basic tenets of psychological first aid (PFA)
    • Identify resources to assist patients during and after trauma
    • Describe a scenario and review questions and answers

    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. (HOFFMAN, CLANCY)


    Physician’s Electronic Emergency Preparedness Toolkit Updated
    Be sure to check out MSSNY’s newly updated Physician’s Electronic Emergency Preparedness Toolkit at the MSSNY CME website.  This essential toolkit is set up in four modules and provides participants with a total of 15 free CME credits.  Each module offers a comprehensive selection of resources on everything from legal protections and best practices to go-bag and office checklists.

    MSSNY designed this resource to assist medical professionals in becoming fully prepared and ready for the next public health emergency.  MSSNY has also created a new podcast to accompany the updated toolkit, be sure to listen to it here.  (HOFFMAN, CLANCY)


    Substance Use Disorders in Veterans
    LIVE CME Seminar in Rochester February 6, 2019 at 7:30am

    The Medical Society of the State of New York and the Monroe County Medical Society will host a live Veterans Matters CME seminar entitled Substance Use Disorders in Veterans on Wednesday February 6th at 7:30am at the Monroe County Medical Society, 137 Allens Creek Rd, Suite 100, Rochester, NY  14618.

    Reservations can be made by contacting Ronaele King at rking@mcm.org or (585) 473-7573.  The faculty will be John McIntyre, MD and the educational objectives are:

    • Define Substance Use Disorders (SUDs), symptoms, warning signs, comorbidities
    • Explore evidence-based intervention and treatment options for SUDs among veterans
    • Identify barriers to diagnosis and treatment and methods to overcome them

    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 of these live activities 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.                                  (HOFFMAN, CLANCY)


    For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

    pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
    charring@mssny.org

    eNews

    NY WC Board Adds New, Free Tool for State-Of-The-Art Virtual Hearings
    This week, New York State Workers’ Compensation Board Chair Clarissa M. Rodriguez announced the Board has launched a new tool that makes it even easier for injured workers, attorneys and other participants to attend workers’ compensation hearings remotely. The Board’s virtual hearings, a first-in-the-nation initiative, give injured workers a way to move the claim process forward without having to travel many miles for a hearing that may last only minutes, which is especially beneficial depending on the extent of their injuries.

    The Board is now offering an app that may further improve the user experience for those attending virtual hearings. The WCB VHC app is free in the iOS App Store and does not require users to install any additional software on their mobile device. It employs a simple interface that guides the user from sign on, to the virtual waiting room, and finally to the video hearing once a Judge calls the case.

    In addition to added convenience for injured workers, the new app may be particularly helpful for attorneys and licensed representatives who attend hearings regularly because it saves sign-on profile information, allowing users to log in faster. Users can also remove a hearing from their schedule if information was entered incorrectly or if they are no longer appearing for a case.

    Parties using the app can still use other apps or features on their mobile devices while waiting for their hearing to be called. A notification will automatically alert them when it’s time to join a hearing, even if they’re in another app or their screen is off. Virtual hearings are entirely optional though, and parties can always choose to attend in-person if they prefer.

    Virtual hearings were first tested in the Capital District Office in Menands in November 2017, and are now available at all Board locations except Newburgh and Allegany. More information on virtual hearings and the new virtual hearings app, including instructional videos and other training materials, is at www.wcb.ny.gov/virtual-hearings. To access the app in the iOS App Store, visit bit.ly/VHCApp.


    Memorial Sloan Kettering Bars Top Executives from Pharma Boards
    After several conflict-of-interest scandals, Memorial Sloan Kettering Cancer Center in New York City will bar top executives from serving on corporate boards of drug and healthcare companies that pay them, according to The New York Times (1/11/19).

    Hospital officials said the executive board also finalized a series of reforms designed to limit the way its top executives and researchers could profit from their work at Memorial Sloan.

    The policy changes, announced by hospital executives Jan. 11, come as the nonprofit cancer center works to contain the fallout from several conflict-of-interest scandals.

    In September 2018, José Baselga, MD, PhD, medical oncologist, physician-in-chief and CMO of Memorial Sloan, resigned from his position after reports surfaced that he failed to disclose significant financial ties to the drug industry and other healthcare companies in more than 100 research articles. Following Dr. Baselga’s resignation, the cancer center’s partnership with Paige.AI also came under fire. The AI startup was founded by three insiders at Memorial Sloan, which subsequently granted the company an exclusive deal, presenting a possible conflict of interest.

    In October, as more reports surfaced about board memberships held by Memorial Sloan officials, Craig Thompson, the hospital’s CEO, resigned from Merck’s board. The drugmaker had paid him about $300,000 for his service in 2017.

    The policy change is just one of the steps the cancer center said it will take to overhaul its corporate relationships and conflict-of-interest policies. The hospital board on Jan. 11 also formalized a policy that prohibits board members from investing in startup companies that Memorial Sloan helped to found. In addition, it prevents hospital employees from accepting personal compensation, equity stakes or stock options from corporate boards.
    Read the full report here.


    74% of Primary Care Physicians Report Their Patients Affected by Shutdown
    Despite Federal assurances that critical elements of the US healthcare system remain intact during the government shutdown, the majority of US healthcare clinicians say their patients have been negatively affected by the shutdown.

    Fifty-eight percent of US clinicians surveyed—including primary care physicians (PCPs), registered nurses (RNs), and physician assistants (PAs)—report that the patient population they treat has been affected by the shutdown. Physician reports of patient impact were even higher, with 74% of physicians stating that patients have been affected, compared to PAs (55%) and RNs (51%). Over a third of respondents (35%) reported that a notable portion of their patients have been affected, while 23% reported that at least a few patients have been affected.

    Stress over limited finances and loss of their benefits was the top concern for patients, with nearly half of healthcare clinician respondents observing this in their patients, and 25% reporting it as their top frustration.

    Healthcare professionals (HCPs) working in impoverished areas noted immediate impact of income loss. “Given the area I live in, many of our patients are no longer receiving checks, which means they have to choose between food or medication, which for those with families is an easy decision,” said a physician in Virginia. Few organizations have contingency plans in case the shutdown persists.

    Only 15% of respondents report that their organization is considering a contingency plan if the shutdown continues—such as offering continued medical care to meet patient needs even if the patient is unable to pay for them or offering payment plans. Of those 85% of respondents from organizations without contingency plans, the majority—76%—said they have not yet discussed these plans. Nine percent said that their organizations have not dealt with enough adverse outcomes yet to incentivize planning. The data are from InCrowd, pioneer of the real-time market intelligence platform for the life sciences, and were sourced Friday, January 11, 2019.


    Garfunkel Ad


    Sacklers Directed Purdue Efforts to Mislead Public about Pain Medication
    The New York Times (1/15) reports that documents in a court filing by the Massachusetts Attorney General against Purdue Pharma indicate that “members of the Sackler family, which owns the company that makes OxyContin [oxycodone hydrochloride], directed years of efforts to mislead doctors and patients about the dangers of the powerful opioid” pain medication.

    The filing contends that Richard Sackler, company president at the time, “urged that sales representatives advise doctors to prescribe the highest dosage of the powerful opioid…because it was the most profitable.” Additionally, the court filing “asserts that Sackler family members were aware that Purdue Pharma repeatedly failed to alert authorities to scores of reports the company had received that OxyContin was being abused and sold on the street.”


    Physicians Angered by California’s Investigations into Opioid Deaths
    The Los Angeles Times (1/17) reports “the Medical Board of California has launched investigations into doctors who prescribed opioids to patients who suffered fatal overdoses, in some cases months or even years later.” The effort is angering “physicians in California and beyond, in part because the doctors being investigated did not necessarily write the prescriptions that led to a death.” So far, “regulators have formally accused at least 23 doctors of negligent prescribing, and more cases are expected.”


    Dr. Ira Udell to Receive Lifetime Achievement Award from Northwell LIJ Feb. 9
    A Lifetime Achievement Award will be presented to Ira Udell, MD at the Annual Black Tie Gala on February 9, 2019. Dr. Udell’s membership in the LIJ family began in 1974 as a rotating medical intern. After completing his ophthalmology residency at Long Island Jewish Medical Center in 1979, he served two years as a cornea fellow at Harvard Medical School’s Massachusetts Eye and Ear Infirmary.

    Dr. Udell returned to Long Island Jewish as a cornea specialist, joining the full-time Department of Ophthalmology faculty in 1981. In 1993, Dr. Udell was asked to serve as acting Chairman of the LIJ Department of Ophthalmology. This was the beginning of twenty-five years of service in a number of chairman roles, culminating as Chairman of the Departments of Ophthalmology at Long Island Jewish Medical Center and North Shore University Hospital until December 2017. 

    Dr. Udell is currently the Arlene and Arthur Levine Professor and Chairman of Ophthalmology at the Zucker Hofstra-Northwell School of Medicine. He has been Chief of the Cornea Service since 1981. Dr. Udell is an Honor Award, Senior Honor Award, Distinguished Service Award, and Life Achievement Award recipient of the American Academy of Ophthalmology (AAO).

    He was a member of the American Academy of Ophthalmology Re-credentialing and Ophthalmic Technology Assessment Committees. He has served in the past as New York State Counselor to the American Academy of Ophthalmology, Director at Large of the Contact Lens Association of Ophthalmology (CLAO), CLAO ERF Board of Directors, past President of the Long Island Ophthalmologic Society and President of the New York State Ophthalmologic Society.

    Dr. Udell has been involved in training more than 130 residents during the course of his tenure at LIJ and Northwell. His research interests, which he has extensively lectured on and published, include corneal transplantation, endothelial keratoplasty, ocular infections, allergy and ocular surface disorders. Currently Dr. Udell serves on the Steering Committee for the National Eye Institute Zoster Eye Disease Study (ZEDS). If you would like to attend, contact Jessica York to make your reservation $125 per person at 718.470.8708 or jbimby@northwell.edu.


     

    Classified

    RENTAL/LEASING SPACE


    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

    Pediatrician BC, P/T
    Seeking motivated, enthusiastic pediatrician for P/T position in solo practice in Long Island. Coverage will increase over time. Great opportunity for those seeking part time hours in an established practice.   Fax resume to 516-858-2389.


    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


    Avoid nuisance lawsuits!! Make sure your website is compliant with the Americans with Disabilities Act! We can do a free audit of your website and let you know if 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 ON TOBACCO PURCHASE AGE


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

 

January 15, 2019
For Immediate Release

MSSNY STATEMENT ON TOBACCO PURCHASE AGE

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

“New York’s physician community thanks Governor Cuomo for advancing legislation in his forthcoming executive budget proposal to raise the cigarette and e-cigarette purchase age to 21.  The Medical Society of the State of New York has long advocated for increasing the purchase age for tobacco products.  This proposal is a response to the disconcerting rapid rise we have seen in teen use of e-cigarettes.  Moreover,  a  2015 Institute of Medicine report indicated that raising the cigarette purchase age to 21 will have substantially positive impact on public health by reducing the number of adolescents and young adults who start smoking.  MSSNY has joined with other patient advocacy groups supporting efforts to raise the purchase age to 21.  We look forward to working with the legislature to help enact this important proposal into law.”

# # #

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

 

Council – January 24, 2019

AGENDA
MSSNY Council Meeting
Thursday, January 24, 2019 9:00 a.m.
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590

A. Call to Order and Roll Call

B. APPROVAL of the Minutes of November 1, 2018

C. New Business (All Informational/Action Items)
1. President’s Report:

a. Letter to the United States Department of Justice regarding CVS-Aetna
b. Testimony of Charles Rothberg, MD regarding the Proposed CVS Acquisition of Aetna
c. Honoring Dr. Sheldon Putterman with a plaque for his many years of dedication to the CME Committees & Subcommittees
d. MSSNY Task Force on Firearm Safety Action Item (FOR COUNCIL APPROVAL)
To be presented by Dr. Latreille & Dr. Dowling
e. Medicinal & Recreational Marijuana Memorandum
f. MSSNY Committees Goals Document
g. Governor’s Budget Proposal
h. Dr. Madejski’s Letter – Maintenance of Certification (MOC) requirements for continuing board certification

ADJOURNMENT OF COUNCIL
Action Item – For Council Approval

Approval of the Empire State Medical, Scientific & Educational Foundation, Inc. Election of Directors

RECONVENE COUNCIL

 

  1. Board of Trustees Report – Dr. Robert Hughes will present the report (handout)
  1. Secretary’s Report – Dr. Frank Dowling will present the report
  1. MLMIC Update –  Donald Fager will present the report  (verbal)
  1. AMA Delegation Report – Dr. John Kennedy will present the report
  1. MSSNYPAC Report – Joseph Sellers will present the report (handout)
  1. MESF Update – Mr. Thomas Donoghue will present the report (handout)
  1. CME Update – Mark Adams will present the report & the following action item:
    CME Report and Action Item Resolution 2018-169 Partnership on Continuing Medical Education

D. Reports of Officers

  1. Office of the President – Thomas J. Madejski, MD
  2. Office of the President-Elect – Arthur C. Fougner, MD
  3. Office of the Vice President – Bonnie L. Litvack, MD
  4. Office of the Treasurer – Joseph R. Sellers, MD Financial Statement for the period 1/01/18 to 12/31/18
  5. Office of the Secretary – Frank G. Dowling, MD
  6. Office of the Speaker – Kira A. Geraci-Ciradullo, MD

E. Reports of Councilors (Informational Items)

  1. Kings & Richmond Report – Parag H. Mehta, MD
  2. Manhattan & Bronx Report – Joshua M. Cohen, MD
  3. Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
  5. Suffolk County Report – Maria A. Basile, MD
  6. Third District Branch Report – Brian P. Murray, MD
        No written report submitted
  7. Fourth District Branch Report – Gregory Pinto, MD
  8. Fifth District Branch Report –Howard H. Huang, MD
  9. Sixth District Branch Report – Robert A. Hesson, MD
        No written report submitted
  10. Seventh District Branch Report – Janine L. Fogarty, MD
  11. Eighth District Branch Report – Edward Kelly Bartels, MD
  12. Ninth District Branch Report –  Thomas T. Lee, MD
  13. Medical Student Section Report – Breyen Coffin
  14. Organized Medical Staff Section – Stephen F. Coccaro, MD
  15. Resident & Fellow Section Report – Justin Fuehrer, DO
  16. Young Physician Section Report – L. Carlos Zapata, MD
          No written report submitted

F. Commissioners (Informational Items)

  1. Commissioner of Communications, Maria A. Basile, MD, MBA
              a. Report from the Division of Communications
  2. Commissioner of Governmental Relations, Gregory Pinto, MD
       a. Report from the Division of Governmental Affairs
  1. Commissioner of Membership, Parag H. Mehta, MD
        a. Committee on Membership Action Items 

    Appendix 1:
    Resolution 2019-1 would establish that physicians who participate as members through agreements with their groups or institutions are active members.
    COMMITTEE RECOMMENDATION:
    The Membership Committee recommends that the Council approve Resolution 2019-1, Group and Institutional Membership, for submission to the House of Delegates by MSSNY President Thomas Madejski, MD.
    (FOR COUNCIL APPROVAL)
    Appendix 2:
    Resolution 2019-2 states that at the conclusion of a three-year term for any pilot project, the Council and Board of Trustees shall determine if a pilot should be ended, or continued as an approved alternative membership option for interested county medical societies, and report on its action to the House.
    COMMITTEE RECOMMENDATION:
    The Membership Committee recommends that the Council approve Resolution 2019-2, Pilot Membership Projects, for submission to the House of Delegates by MSSNY President Thomas Madejski, MD.
    (FOR COUNCIL APPROVAL)
    Sponsorship Agreements:
    COMMITTEE RECOMMENDATION:
    The Membership Committee recommends that the Council approve the creation of a Sponsorship Agreement initiative as outlined in the committee’s report.
    (FOR COUNCIL APPROVAL)
  1. Commissioner of Science & Public Health, Joshua M. Cohen, MD
    a. Addiction and Psychiatric Medicine Committee Minutes, 10/19/2018
    bBio Ethics Committee Minutes, 11/2/2018
    c.  Committee on Health Care Disparities Minutes10/26/18 and 10/30/18
        d. Heart, Lung Committee Minutes 10/17/18
        e. Infectious Diseases Committee Minutes, 10/25/18
         f. Preventive Medicine and Family Health Committee Minutes, 10/18/18

5. Commissioner of Socio Medical Economics, Howard H. Huang, MD
       a. Interspecialty Committee Minutes, November 8, 2018

G. Report of the Executive Vice President, Philip Schuh, CPA, MS
1. Membership Dues Revenue Schedule
2. Group Institutional Dues Comparison Report

H. Report of the General Counsel, Garfunkel Wild, P.C. , Barry Cepelewicz, MD
     No written report submitted

I. Report of the Alliance, Valerie Semeran, Co-President
     1. Alliance Report
         No written report submitted

J. Other Information/Announcements

  1. 2017-2018 ABMS Board Certification Report (handout)
  2. Maternal Mortality Letter
  3. PAI Scorecard 2019 Quality Payment Program (QPP) Finalized Policies
  4. PAI Key Changes 2019 QPP Participation

K. Adjournment

MSSNY eNews: County Health Officials v. Marijuana

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


MSSNY eNews
January 11, 2019
Volume 22  Number 2

MSSNYPAC Seal

Colleagues:

MSSNY members are familiar with my strong concerns regarding legalization of recreational marijuana and potential severe consequences with regards to expanded use on our fellow citizens individually, and as a society. There are a number of financial considerations that continue to push for expansion of marijuana use.  Potential tax revenues are enticing. A 2018 state report estimates state and local taxes to range from $248 million – with a 7 percent tax – to $678 million if New York were to enact a 15 percent tax.  Big Tobacco is salivating about becoming Big Marijuana with the acquisition of commercial marijuana growers in other states, and obtaining novel delivery systems for a new potentially addictive substance.

This week I welcome the statement of the New York State Association of County Health Officials’ (NYSCHO) that MSSNY signed onto earlier in the week: “County Health Officials serve as the first line of defense in our communities, and they have seen up close the devastation associated with the abuse of legalized prescription opioid medications. While the addictive risk of opioids is different than marijuana, we are very concerned that the legalization of marijuana will similarly result in unintended, harmful consequences for countless New Yorkers.’’

“Roughly 60% of New Yorkers favor it by one recent measure. However, lawmakers would be wise to consider what voters have consistently indicated as far more important to them — their health. In the most recent election, in New York and nationally, poll after poll found that voters by far were most concerned about their health1. It was the leading voter issue in the 2018 cycle2.”

As public health officials,“NYSACHO members are focused on the concrete, local level considerations associated with legalized recreational marijuana. The experience of other states shows that legalizing recreational marijuana could likely adversely impact the health of a great many New Yorkers. Therefore, a great many questions must be answered before proceeding.’’ Among them:

  • How will we protect motorists from drivers under the influence of marijuana? What will be the impairment standard, and how will it be enforced?
  • New York has proven itself as one of the most aggressive anti-smoking states in the nation, establishing the Clean Indoor Air Act and spending tens of millions of dollars in tobacco settlement revenue to curtail smoking. How is legalizing the smoking of marijuana (the most widely used means of ingestion) consistent with both the spirit and technical implementation that act?
  • Marijuana potency is widely and wildly variable. Many varieties induce a debilitative loss of mental and physical capability. How will potency be measured, tested and enforced?
  • Research has substantiated that marijuana use significantly increases the likelihood of addiction to other drugs. What resources will be made available to address the care needs of a new class of persons living with drug addiction?
  • What resources will be made available to support public information campaigns that better ensure New Yorkers fully understand these and other potential health impacts?

“Proceeding swiftly, without building in essential protections and providing resources necessary to mitigate the impact of legal marijuana, could come back to haunt lawmakers with the onset of another preventable public health crisis caused by the use of a legal drug.

…“we implore lawmakers to proceed thoughtfully to address the concerns we and others have expressed.”

Additionally, the New York State Sherrifs‘ Association voiced similar and related concerns.

MSSNY believes our representatives should focus on criminal  justice reform and expansion of research on the efficacy and safety of medicinal marijuana before creating a new population of damaged individuals with potential for lifelong consequences similar to the consequences of expanded opiate useage that we continue to struggle with currently and, for those harmed by exposure to a poorly studied substance with psychotropic effects, many years into the future.

MSSNY is proud to stand with the New York State Association of County Health Officials, and the New York State Association of Sherrifs in support of the health and safety of all New Yorkers.

Now is the Time to Engage with Your Local Legislators to Let Them Know of Your Perspective on This Issue

Suus bonus et amicis


1. Kaiser Health Tracking Poll, January 2018: HuffPost: Midterm elections  March 23 – 26, 2018; Gallup’s Midterm Election Benchmark poll, Oct.15-28; Pew Research, A look at voters’ views ahead of the 2018 midterms, November 1, 20182. ABC News 2018 exit polling; NBC News exit polling; CBS News exit polling


Please send me your additional thoughts at comments@mssny.org. 

Thomas J. Madejski, MD
MSSNY President


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Capital Update

Gov. Cuomo to Present Budget on Tuesday, January 15
Governor Cuomo has announced he will present his 2019-2020 Executive Budget this coming Tuesday, January 15th.  He will deliver his State of the State and budget address at 2:00 in Albany.

You can watch the Governor’s address by live webcast on the Governor’s website:  https://www.governor.ny.gov/


2019 Legislative Session Commences
The 2019 legislative session officially began this week with new party control of the New York State Senate, an all-Democrat controlled Legislature and executive and an influx of new names in the Capitol. Democrats hold a sizeable 106-43 majority in the Assembly and a 39-23 majority in Senate.  On the first day of session (January 9), Andrea Stewart-Cousins (D-Westchester County) was sworn in as the new Majority Leader of the Senate.   Assemblyman Carl Heastie (D-Bronx) was re-elected Speaker of the NYS Assembly while Assemblywoman Crystal People-Stokes (D-Buffalo) was named Assembly Majority Leader. Committee chairs have been assigned, with the following notable changes in Senate leadership: Health (Gustavo Rivera); Insurance (Neil Breslin); Mental Health (David Carlucci); Consumer Protection (Kevin Thomas); Aging (Rachel May); and Social Services (Roxanne Persaud). Issues with likely immediate legislative action include reproductive health and voting reforms, issues that have overwhelmingly passed the Assembly in previous sessions but not the Senate.

With so many new assemblymembers and senators, and new faces in powerful positions, it is incumbent upon physicians to take the time to develop or further solidify existing relationships with their local elected officials, educating them about the issues affecting physicians and how to ensure that they are able to provide the best care for the people of New York.  Physicians are encouraged to join MSSNY’s Physician Advocacy Liaison (PAL) Network, to help make grassroots contacts with local legislators more defined and ongoing basis.  Click here to join or contact Carrie Harring (charring@mssny.org).

Legislative breakdown:

  • Senate
    • 39-23 Democrat Majority
    • 15 new Democrats
    • 2 new Republicans
  • Assembly
      • 106-43 Democrat Majority (plus one Independent)
      • 13 new Democrats

    • 9 new Republicans                                                                        (DIVISION OF GOVERNMENTAL AFFAIRS)

State of State and Budget Proposal Announced
Governor Cuomo has announced that his budget proposal will be unveiled during his State of the State address next Tuesday, January 15. Cuomo has asserted that he plans to include in the budget many of the agenda items that he discussed at his December State of the State preview, including codification of the insurance exchange and pre-existing condition protections rights, increased access to contraception, legalization of marijuana, and constitutional protections for abortion rights, amongst others. “Anything that’s not done, we will try to get wrapped up in the budget,” the governor said on WAMC. “I think we have an historic 100 days here, and a great opportunity.

We just have to get it done.” Legislators have come out of the gate with an ambitious agenda, promising to act swiftly and effectively to pass progressive legislation that they have long championed, so it remains to be seen what will pass ahead of the budget and what changes will be contained within the budget. The budget is due on April 1.                                          (AVELLA)


Conversion Therapy Prohibition Bill Moving in NYS Legislature
Legislation that would prohibit a mental health profession from engaging in sexual orientation changed efforts with a patient under 18 years of age, is moving in both houses of the NY State Legislature.   A. 576/S. 1046, sponsored by Assemblymember Deborah Glick and Senator Brad Hoylman, has been placed on the agenda of the Committee on Higher Education in both houses.  This measure would provide that any sexual orientation change efforts attempted on a patient under 18 years of age by a licensed mental health professional shall be considered unprofessional conduct and shall subject the provider to discipline by the provider’s licensing entity.

The Medical Society of the State of New York supports this measure. The American School Counselor Associations, the American Academy of Pediatrics, the National Association of Social Workers, the American Counseling Association Governing Council, the American Psychoanalytic Association, the American Academy of Child and Adolescent Psychiatry, and the Pan American Health Organization have all concluded that the risks of conversion therapy are too great.          (CLANCY)


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NYS Legislature Expected to Act on the Reproductive Health Act in January; On Assembly Health Committee Agenda
The New York State Legislature is expected to quickly take action on the Reproductive Health Act and it is anticipated that a vote will be held on January 22, 2019—the 46th Anniversary after the US Supreme Court issued Roe v. Wade This landmark decision held that a woman has a fundamental right to make medical decisions about the course of a pregnancy.  Assembly Bill 21 and Senate Bill 240, sponsored by Assemblymember Deborah Glick and Senator Liz Krueger, would amend the public health law by placing the abortion procedure within New York State’s public health law.  The abortion procedure is currently under the penal law.

The measure is on the Assembly Health Committee for its consideration next week.  The bill creates a statement of purpose and says that an abortion may be performed a licensed, certified or authorized practitioner under Title 8 of the Education Law.   Under the bill’s provisions an abortion can be performed within 24 weeks from the commencement of pregnancy, an absence of fetal viability or at any time when necessary to protect a patient’s life or health.  MSSNY has policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.   Moving the abortion procedure from the penal law to the public health law is consistent with this position.                   (CLANCY)


Passage of Comprehensive Contraception Coverage Act a Priority with NYS Legislature
Passage of legislation, entitled “The Contraceptive Equity Act” is a priority in both houses of the NYS Legislature in 2019.   Assembly Bill 585/Senate Bill 659, sponsored by Assemby member Kevin Cahill and Senator Julia Salazar, would require health insurance policies to include coverage of all FDA-approved contraceptive drugs, devices and productions.  The bill would also require insurance coverage of voluntary sterilization procedures, contraceptive education and counseling, and related follow-up procedures. The bill would also prohibit insurance companies from imposing an cost-sharing requirements. The bill also defines “emergency contraception” and “prescriber” and would allow a registered professional nurse to administer or dispense emergency contraception to a patient. It also allows a pharmacist to dispense emergency contraception to be self-administered by the patient.

The measure would authorize a licensed midwife to prescribe and order a non-patient specific regimen of emergency contraception to be dispensed or administered by a nurse or pharmacist.  The bill builds upon the 2002 Women’s Health and Wellness Act, passed by the NY Legislature, which required insurance plans to cover contraceptive prescriptions. (CLANCY)


MSSNY President Urges Caution on Single Payor Proposals
With the discussion of single payor legislation heating up in Albany, MSSNY President Dr. Thomas Madejski’s op-ed on the topic appeared in the January 1, 2019 edition of the Albany Times-Union.

Dr. Madejski noted that “One of the most appealing aspects of the NYHA is the potential to reduce administrative burdens associated with delivering patient care. Physicians increasingly report difficulties with challenging insurer-imposed prior authorizations that lead to unnecessary delays in patients receiving needed care. And physician burnout arising from these administrative burdens is a very real and pervasive issue.  However, there is concern among many physicians that budget pressures could force state bureaucrats implementing a single-payer system to impose even more burdensome prior authorization requirements.

Furthermore, many physicians are concerned that these same budget pressures could create enormous pressure to constrain payments for care at a time when physicians already face immense overhead costs that exceed those in any other state.”  He went on to note that “Failure to adequately address the many questions with transitioning to a single-payer system may not be in the best interest of New Yorkers. We must make sure that, in our efforts to address the current barriers patients face in receiving care, we do not impose new ones.”                                                                                                  (AUSTER)


SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
On January 9th, the New York State Legislature welcomed nearly 40 new members in Albany – the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships with this new Legislature to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reduce excessive health insurer prior authorization hassles that delay patient care
  • Reduce the high cost of medical liability insurance through comprehensive reforms
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders
  • Reject inappropriate scope of practice expansions of non-physician practioners
  • Prevent big-box, store-owned medical clinics that will negatively impact community primary care delivery
  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana and creating a single payor health insurance structure.

A brief luncheon to which members of each house are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives. If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.  (HARRING) 


Workers Compensation Board Finalizes Fee Schedule Increases to Take Effect April 1
As reported in last week’s MSSNY e-news, The New York Workers Compensation Board has finalized regulations providing for an overall 5% increase in the medical fee schedule for care to injured workers that will be applicable April 1, 2019.  For more information, click here.

Moreover, the WCB finalized regulations to increase the physician deposition and hearing testimony fee from $400 to $450, also effective April 1 for more information, click here.

The WCB also clarified that payment of such witness fees shall be paid by the carrier within ten days of the testimony, and suggest physicians who have not been paid within that time frame contact the WCB for enforcement.

Certainly, this a positive step forward, but there are concerns with some aspects of the changes.  For example, the WCB decided to implement changes in reimbursement for electrodiagnostic testing that had been opposed by MSSNY, certain specialty societies and many physicians.  As is noted in the WCB Summary of Public Comment:

“The Board received comments objecting to the change in CPT codes resulting in reductions in reimbursement for EMG studies and EDX testing. Needle EMG tests have received proportionate increases. Surface EMGs are not recommended under the Medical Treatment Guidelines and therefore have no fee associated. Fees for NCV reflect changes to the CPT codes themselves, as created by the American Medical Association, and the method for billing, and will be reimbursed at 200% of the Medicare level, so no change has been made.”

On the other hand, the Board decided to not implement a change to Physical Medicine Ground Rule 2 that MSSNY had opposed.  Here, the Summary of Public Comment stated:

“The Board received many comments disagreeing with physical medicine Ground Rule 2 – specifically, the 12 sessions/180-day limitation. In response, the Board has decided not to implement this change, so Ground Rule 2 will read as it did previously: “Physical medicine services in excess of 12 treatments or after 45 days from the first treatment, require documentation that includes physician certification of medical necessity for continued treatment, progress notes, and treatment plans. This documentation should be submitted to the insurance carrier as part of the claim.”

While the changes are a positive step forward to better assure access to care for injured workers, these modest increases are the first positive updates in over two decades.  During this same time, the costs of running a medical practice increased well over 30% (as measured by the Medicare Economic Index).  As a result, MSSNY will continue to press the case for further increases to better assure there remains a comprehensive network of physicians to provide needed care for injured worker patients.
(AUSTER)


Mayor DeBlasio introduces “NYC Care” plan for uninsured
NYC Mayor Bill DeBlasio recently unveiled his plan to provide care to uninsured and to boost usage of primary care in order to increase access to comprehensive and preventive care and to cut down on unnecessary usage of more expensive care at emergency departments. While the plan, which will be named “NYC Care”, was described by DeBlasio as an expansion amounting to “Universal Health Care,” it in reality will work to foster greater awareness of a set of benefits that are already available, yet underused. NYC Care does not provide insurance to individuals, but instead provides access for residents to the city’s public Health + Hospital system’s hospitals and primary care clinics. The plan seeks to help the uninsured – including undocumented immigrants – and to create better health outcomes without the expense of revising or creating a new health insurance system.

A key part of the plan will be providing cards to those without coverage to encourage care and to improve awareness of its availability. Services will be priced on a sliding scale; those who cannot afford to pay will receive free care. DeBlasio’s quoted price tag is $100 million to extend care to some 600,000 people who currently lack coverage and the hope is to contain costs by diverting individuals from emergency care and by managing and preventing long-term issues with primary care. (AVELLA)

For more information, please Click here.


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.
(HOFFMAN, CLANCY)


What’s Your Diagnosis? Psychological First Aid Interactive CME webinar February 20, 2019 @ 7:30am – Registration now open
Psychological first aid is an essential component of emergency preparedness.  Find out if you’re fully prepared in MSSNY’s upcoming interactive Medical Matters webinar on February 20th at 7:30am.  You will be presented with a case study and asked questions about treatment during the webinar.  Registration is open for this program.  Faculty will be Craig Katz, MD, co-vice chair of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response committee.

Educational Objectives:

  • Describe the basic tenets of psychological first aid (PFA)
  • Identify resources to assist patients during and after trauma
  • Describe a scenario and review questions and answers

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. (HOFFMAN, CLANCY)


Measles Outbreak in New York State Worst in Recent History Webinar Available at MSSNY CME Website
The measles outbreak in New York State has now become the worst in recent history with at least 167 confirmed cases.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December.  This webinar has now been posted to our web site please click here.  Please check it out and keep yourself informed about the ongoing measles outbreak in New York State.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine here.


For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
charring@mssny.org
eNews

State Legislature Should Create Peer Support System for Physician
MSSNY President Tom Madejski, MD, wrote in an opinion piece for the Rochester (NY) Democrat & Chronicle (1/4) that “being a physician is an extremely gratifying job. However, the unrelenting demands placed on physicians are contributing to a serious burnout problem.” Madejski argued that the state legislature should create a peer-support system to address physician burnout “to assure that patients’ continued access to their physicians is not jeopardized.”


New York Seeing Worst Measles Outbreak in Decades
New York State is dealing with a measles outbreak “called the largest in the state’s recent history, and it’s occurring at a time when there have been spikes in measles cases globally.” Since the outbreak began last fall, “measles has been diagnosed in at least 112 people across Rockland and Orange counties and at least 55 in New York City, according to numbers provided by the New York State and city health departments on Tuesday.”

Health officials attribute this year’s outbreak to a “combination of anti-vaccine propaganda combined with a lack of enforcement of school requirements that parents must vaccinate their children for contagious, spreadable diseases.” I would say this is the largest measles outbreak that New York state has had in recent history,” said Dr. Howard Zucker, the state commissioner of health. “If you go back many decades ago when we weren’t vaccinating, of course there were probably more outbreaks, but in my memory, I don’t know of a measles outbreak that was this significant,” he said. “We have immunized 13,000 children since this outbreak has begun.”

The outbreak, which emerged after some children were infected on a visit to Israel in September, has particularly affected Orthodox Jewish communities, according to the New York City Health Department. In New York City alone as of Tuesday, “we have 55 cases confirmed in Brooklyn,” said Dr. Jane Zucker, assistant commissioner for the Bureau of Immunization at the NYC Health Department. She is of no relation to Dr. Howard Zucker.

The largest outbreak in New York City had 58 cases in 2013, she said. Now, “I’m certainly hoping that there are no further cases and we won’t exceed that 58, but we’re still in the middle of the outbreak.”

(Please view MSSNY’s Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” on our web site please click here.)

https://www1.nyc.gov/site/doh/health/health-topics/measles.page


If You Have an Opinion about MOC, Speak Now
The ABMS Visions for the Future Commission released its report on principles for continuous professional development and MOC in December.  The period for public comment closes January 15.


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Young Physicians, Residents/Fellows, Medical Students Meet Feb.9 in Westbury
Join us for two top CME* programs by national leaders in medical toxicology and social media in medicine. Saturday, February 9, 2019 at the Marriott Courtyard in Westbury and MSSNY HQ. Read more here.

Webex available (contact sbennett@mssny.org)

*For each CME session

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

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’s Member Perks Program and Enjoy $4,500 in Savings!
MSSNY  Member Benefit!  Our new Abenity App provides members with exclusive perks and over $4,500 in savings on everything from pizza, the zoo, movie tickets, theme parks, hotels, and car rentals!

Popular Features Include:

  • Nearby Offers: Use show and save mobile coupons to quickly access savings on the go.
  • eTickets On Demand: Save up to 40% with no hidden fees.
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  • Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!

REGISTER & LOG IN: Click on the following link: http://mssny.abenity.com and then create a unique user name and password

FOUR TIPS TO GET YOU STARTED

    1. Mobile Apps: For quick access to savings on the go and to receive proactive Perk Alerts of nearby offers, download our app for iPhone, Android, and Windows phones at http://mssny.abenity.com/perks/about.
    2. Quick Tour: Slide through our top features at http://mssny.abenity.com/perks/about
    3. Monthly Emails: Subscribe to our newsletters and be the first to know about new discounts and giveaways at http://mssny.abenity.com/perks/profile

  1. Connect: Register for free giveaways, get the inside scoop and share your savings stories on Facebook, Twitter, or Instagram using #LifeHasPerksSPREAD THE WORD

Overdose Deaths: Women Aged 30 To 64 Increased 260% from 1999 to 2017
A new report from the Centers for Disease Control and Prevention published Jan. 11 in the Morbidity and Mortality Weekly Report “reveals that drug overdose deaths among females aged 30 to 64 have skyrocketed in recent years.” The website reports that “deaths from drug overdoses increased by 260 percent among women aged 30 to 64 between 1999 and 2017.” In addition, “the rate of drug overdose deaths from opioids increased by an enormous 492 percent among women aged 30 to 64,” investigators revealed


Teens Turning To Vaping Rehab
NBC Nightly News (1/8) reported that vaping is “so addictive that some teens are now turning to rehab.” Dr. Sharon Levy of Boston Children’s Hospital was shown saying, “They’re getting very high nicotine levels in their bloodstream, and that’s causing them problems with things like paying attention and focusing. And that’s really new.” She added, “We’re seeing more mental health and psychiatric problems that are happening immediately.”

NBC focuses on 15-year-old male, whose $150-a-week vaping habit transformed him from “a straight-A student to an F student” and eventually caused a seizure. In another story on its website, NBC News (1/8,) reports that this male, who “was hooked in a way that doctors never noticed before with regular cigarettes,” had become “what the Food and Drug Administration and the Surgeon General call an epidemic of e-cigarette use. And, as with most teens who are taking up the habit, it was the slender, easy-to-conceal Juul device that really got him hooked.”


Dr. First Banner


Bellevue Launch Program for PTs to Transition to Plant-Based Diets
 Modern Healthcare (1/5) reported that in light of recent studies on the health benefits of plant-based diets, “NYC Health & Hospitals/Bellevue was motivated in November 2017 to develop the Plant-based Lifestyle Medicine Program, which offers patients with chronic diseases support services to transition to and stick with eating vegetarian.” The program will officially launch Jan. 16 with over 300 patients enrolled.


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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.



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

Pediatrician BC, P/T
Seeking motivated, enthusiastic pediatrician for P/T position in solo practice in Long Island. Coverage will increase over time. Great opportunity for those seeking part time hours in an established practice.   Fax resume to 516-858-2389.


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


 


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 eNews: Visions, Myopia, or Delusions?

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


MSSNY eNews
January 4, 2019
Volume 22  Number 1

MSSNYPAC Seal

Colleagues:

I hope you, your families, friends, and patients have a happy and healthy New Year.  I want to bring to your attention recent developments in the current controversy of Maintenance of Certification (MOC).

The ABMS Visions for the Future Commission released its report on principles for continuous professional development and MOC in December.  The period for public comment closes January 15.

One of the principle duties of a learned profession is self-regulation of professional duties and standards.  The nature of that regulation has evolved over the years from the profession itself to a more complicated structure to provide regulation with input from multiple stakeholders outside the profession to ensure service to the public.  Part of that evolution resulted in the establishment of Certification Boards as professional knowledge and practice became more and more specialized.

Medicine continues to debate and discuss how to best maintain and improve practice standards and the Specialty Boards have been important advocates for higher practice standards.  The dilemma for the boards and the profession is how best to move continuing professional development forward, while minimizing the burden to the profession.  Clearly, one size does not fit all, and there has been variable acceptance of maintenance of certification requirements across the specialties within the ABMS.  I was able to provide some testimony to the Visions Commission this past March, and MSSNY is reviewing the report and preparing comments.  I encourage you to review the report and send us your thoughts for inclusion in our response here.

I think most of us agree that competition is good, and can help to improve performance and satisfaction when applied to many different situations.  To that end, a group led by Dr. Paul Tierstein, a cardiologist from the Scripps Clinic in California, created the National Board of Physicians and Surgeons as an alternative for MOC, in response to some of the criticisms of the present ABMS sponsored program with regards to cost, relevance and burden of participation both in time and on physician wellness.  There have also been some concerns regarding the actions of some of specific specialty boards’ activities.  Those concerns have resulted in at least one class action lawsuit against one of the constituent specialties within the ABMS

MSSNY is committed to advocating for our patients, the betterment of public health, maintaining high standards of practice, and the well-being of the physicians of New York State.

Finding the balance that maintains and raises practice standards and patient care, while not paradoxically worsening care and reducing time spent with patients due to overly burdensome requirements is the key. Please send me your additional thoughts at comments@mssny.org. 

Quod oculus non videre mente id quod non habet

Thomas J. Madejski, MD
MSSNY President


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eNews

SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
On January 9, the New York State Legislature will welcome nearly 40 new members in Albany – the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, as well as strengthen existing relationships with this new Legislature to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 6th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click HERE to register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reduce excessive health insurer prior authorization hassles that delay patient care
  • Reduce the high cost of medical liability insurance through comprehensive reforms
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders
  • Reject inappropriate scope of practice expansions of non-physician practitioners
  • Prevent big-box, store-owned medical clinics that will negatively impact community primary care delivery
  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana and creating a single payor health insurance structure.

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. County Medical Societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org. (HARRING)


MSSNY President Urges Caution on Single Payor Proposals
With the discussion of single payor legislation heating up in Albany, MSSNY President Dr. Thomas Madejski’s op-ed on the topic appeared in the January 1, 2019 edition of the Albany Times-Union.

Dr. Madejski noted that “One of the most appealing aspects of the NYHA is the potential to reduce administrative burdens associated with delivering patient care. Physicians increasingly report difficulties with challenging insurer-imposed prior authorizations that lead to unnecessary delays in patients receiving needed care. And physician burnout arising from these administrative burdens is a very real and pervasive issue.  However, there is concern among many physicians that budget pressures could force state bureaucrats implementing a single-payer system to impose even more burdensome prior authorization requirements. Furthermore, many physicians are concerned that these same budget pressures could create enormous pressure to constrain payments for care at a time when physicians already face immense overhead costs that exceed those in any other state.”

He went on to note that “Failure to adequately address the many questions with transitioning to a single-payer system may not be in the best interest of New Yorkers. We must make sure that, in our efforts to address the current barriers patients face in receiving care, we do not impose new ones.” (AUSTER)


President Approves Bill to Provide Funding for States to Prevent Maternal Deaths
President Donald Trump has signed into law legislation, the “Preventing Maternal Deaths Act”, to provide millions of dollars in funding to states to establish maternal mortality committees.  The bill had been passed by the US Congress in early December.   The purpose of such committees are to investigate pregnancy-related deaths and use the findings to prevent others.

In the United States, the maternal mortality rate is 26.4 deaths per 100,000 (about 700 per year). That rate increased 250% between 1987 and 2014, according to the Centers for Disease Control and Prevention (CDC). The CDC estimates that 60% of the deaths are preventable.  The maternal death rate is more than three times higher for African American women than white women in the United States, according to the CDC.

MSSNY working together with the American College of Obstetricians & Gynecologists – District II have supported legislation in the 2018 Legislative Session to establish a Maternal Mortality Review Board in New York.  The MMRB would be comprised of a multidisciplinary team of medical experts tasked with reviewing data on maternal deaths, identifying the root causes of the these events, and disseminating evidence-based best practices to prevent them in the future. The board’s primary focus will be on quality improvement rather than punishment, reviewing outcomes of care, conducting peer reviews, and collaborating on process improvements.  As a necessary component to achieving this mission, the bill contains broad confidentiality protections to the board’s proceedings to allow for open and honest dialogue and review.  However, some are advocating that the confidentiality provisions be minimized, which could seriously undermine the quality improvement goals of the MMRB.  MSSNY will again work with ACOG in 2019 to achieve passage of a MMRB in New York.


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Gov. Signs Measure to Increase Transparency of Mental Health Parity Compliance
Just before the close of 2018, Governor Cuomo signed into law legislation establishing the Mental Health and Substance Use Parity Report Act, a measure that MSSNY strongly supported in conjunction with the New York State Psychiatric Association and other patient advocacy groups. With its adoption, the NY Department of Financial Services (DFS) will be required to collect key data points and elements from health insurers in order to analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.

We thank the hundreds of physicians who took the time to contact the Governor to urge that he sign the bill into law.  MSSNY’s letter to the Governor noted that “In light of the growing opioid epidemic, it is vitally important that the state and various public stakeholders have a resource that would help those individuals make informed choices with respect to the choice of health plan.   Moreover, the responsibility to provide such information will incentivize insurers to follow the laws that are intended to assure that patients have coverage for the care they need.”

Timothy’s Law, which works to ensure New Yorkers have access to care and treatment for mental illness and substance abuse disorders, was passed in 2006 and made permanent in 2009. This law mandated a number of provisions aimed at improving access to mental health and substance abuse care, including coverage of a variety of relevant services for children and employees of large employers and premiums and cost sharing for mental health services that are equivalent to those for physical health services. However, investigations by the New York Attorney General’s office have identified numerous instances of noncompliance, including evidence of elevated levels of denials for mental health services. This necessitated proactive evaluation of insurers and health plans to ensure compliance and provide New Yorkers with the information they need to get the best possible care.

The data collected this law will be used by the DFS to ensure compliance with Timothy’s Law and to prepare an annual Mental Health Parity report as part of the annual comprehensive DFS Consumer Guide to Health Insurance.  In a letter of support to Governor Cuomo, the American Medical Association noted that the bill “will provide important data to better compare requirements for accessing benefits that are applied to mental health and substance use disorder treatment and coverage as compared with those applied to medical/surgical benefits. The compliance report, particularly if made available to key stakeholders and open for public inspection to patient advocates, will help regulators and others identify where appropriate oversight and enforcement are necessary.” (AVELLA, AUSTER, CLANCY)


Workers Comp Board Finalizes Fee Schedule Increases to Take Effect April 1
The New York Workers Compensation Board finalized regulations providing an overall 5% increase in the medical fee schedule for care to injured workers that will be applicable April 1, 2019.  For more information, click here.

Moreover, the WCB finalized regulations to increase the physician deposition and hearing testimony fee from $400 to $450, also effective April 1.   The WCB also clarified that payment of such witness fees shall be paid by the carrier within 10 days of the testimony, and suggest physicians who have not been paid within that time frame contact the WCB for enforcement.

There are concerns with some aspects of the changes.  For example, the WCB decided to implement changes in reimbursement for electro-diagnostic testing that had been opposed by MSSNY, certain specialty societies and many physicians.  As is noted in the WCB Summary of Public Comment:

“The Board received comments objecting to the change in CPT codes resulting in reductions in reimbursement for EMG studies and EDX testing. Needle EMG tests have received proportionate increases. Surface EMGs are not recommended under the Medical Treatment Guidelines and therefore have no fee associated. Fees for NCV reflect changes to the CPT codes themselves, as created by the American Medical Association, and the method for billing, and will be reimbursed at 200% of the Medicare level, so no change has been made.”

It should also be noted that with regard to the proposed changes to physical medicine Ground Rule 2, the Summary of Public Comment stated:

“The Board received many comments disagreeing with physical medicine Ground Rule 2 – specifically, the 12 sessions/180-day limitation. In response, the Board has decided not to implement this change, so Ground Rule 2 will read as it did previously: “Physical medicine services in excess of 12 treatments or after 45 days from the first treatment, require documentation that includes physician certification of medical necessity for continued treatment, progress notes, and treatment plans. This documentation should be submitted to the insurance carrier as part of the claim.”

MSSNY will continue to push for further increases in the WC fee schedule.  While the changes are a positive step forward to better assure access to care for injured workers, these modest increases are the first positive updates in over 2 decades.  During this same time, the costs of running a medical practice increased well over 30% (as measured by the Medicare Economic Index). (AUSTER)


Six Cases of Acute Flaccid Myelitis Confirmed in New York
The Albany (NY) Times Union (12/28) reported CDC officials have confirmed six cases of acute flaccid myelitis in New York, three of which were “in New York City and three more outside the five boroughs.” Nationwide, the CDC received 336 reports of suspected AFM this year and confirmed 182 of them in 39 states as of Dec. 21. As in previous years, an uptick in cases was observed around August and peaked in September.

The increase in cases also appears to be following a biennial pattern, with 120 cases confirmed in 2014, followed by just 22 in 2015, then 149 in 2016, 35 in 2017, and now 182 in 2018.


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Lake Erie College of Osteopathic Medicine Expands to Elmira
Buffalo (NY) Business First (1/3) reports hospitals in western New York are hoping that the new Lake Erie College of Osteopathic Medicine (LECOM) campus in Elmira may bring more physicians to the area. The article explains that LECOM is based in Erie, Pennsylvania with other locations in that state as well as Florida, but LECOM is now “investing nearly $20 million in a new facility on the Elmira College campus for a medical school program.” The new location in Elmira is scheduled to open in 2020 and “will start with 120 osteopathic medical students annually, growing to 480 after four years.”


JAMA Oncology: Over 7% of Cancers in US Attributable To Excess Body Weight
The findings were published in JAMA Oncology report that a study indicates “more than seven percent of cancer cases in the United States are attributable to excess body weight.” Investigators “found that from 2011 to 2015, among people 30 and older, 4.7 percent of cancers in men and 9.6 percent of those in women were attributable to excess weight – some 37,670 cancers in men, and 74,690 in women every year.”


Study: Casts Doubt on Omega-3 for Primary Cardiovascular Disease
Many people without known cardiovascular (CV) disease take omega-3 (ω-3) fatty acid supplements (“fish oil”) to prevent adverse CV events. However, recent studies cast doubt on this practice.

In the VITAL study, about 26,000 people (mean age, 67) without CV disease were randomized to 1-g capsules of fish oil (eicosapentaenoic acid plus docosahexaenoic acid) or placebo. During mean follow-up of 5.3 years, risks for the primary endpoint (nonfatal myocardial infarction [MI], stroke, or CV-related death) and all-cause death were similar in the two groups. Although the incidence of MI was significantly lower in the ω-3 group than in the placebo group, the absolute difference was small: 1.1% vs. 1.5% during 5 years of treatment and N Engl J Med 2018 Nov 10; [e-pub]).

In the ASCEND trial, more than 15,000 people (mean age, 63) with diabetes but without CV disease were randomized to 1-g fish-oil capsules (eicosapentaenoic acid plus docosahexaenoic acid) or placebo. During mean follow-up of 7.4 years, risks for the primary endpoint (nonfatal MI, stroke, transient ischemic attack, or CV-related death) or all-cause death were similar in the two groups (NEJM JW Gen Med Oct 1 2018 and N Engl J Med 2018; 379:1540).

A meta-analysis of 10 randomized trials (78,000 total patients) showed no significant differences between ω-3 recipients and controls in risks for coronary heart disease–related death, nonfatal MI, any coronary heart disease event, or major adverse CV events overall. Subgroup analyses among participants with known coronary heart disease or diabetes yielded similar findings (JAMA Cardiol 2018; 3:225).

The two new randomized trials do not support the use of ω-3 fatty acid supplements for preventing adverse CV events in patients with no history of CV disease. Although the meta-analysis showed no evidence of benefit for secondary prevention, a recently published trial (REDUCE-IT) showed that a different ω-3, icosapent ethyl, lowered risk for adverse CV events in patients with established CV disease and elevated triglycerides; those results are summarized elsewhere.


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FREE CME PROGRAMS

Be sure to check out all of MSSNY’s Medical Matters and Emergency Preparedness FREE CME Programs
An individual in New York was recently diagnosed with Brucellosis from raw milk. Did you know that MSSNY offers an Emergency Preparedness CME program on Brucellosis, Glanders, Melioidosis and Tularemia?  Additionally, MSSNY has posted the recent Medical Matters webinar on Measles which continues to spread throughout the state. 

All of MSSNY’s timely and relevant CME programs are available at https://cme.mssny.org.  Please note that you will need to create an account there if you haven’t already.

Additional information or assistance with the website may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.


“Public Health Preparedness 101” CME webinar January 16, 2019 at 7:30am – Registration now open
The American Medical Association Code of Medical Ethics opinion 8.3 states that: “With respect to disaster, whether natural or manmade, individual physicians should take appropriate advance measures, including acquiring and maintaining appropriate knowledge and skills to ensure they are able to provide medical services when needed.”

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. 


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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

Pediatrician BC, P/T
Seeking motivated, enthusiastic pediatrician for P/T position in solo practice in Long Island. Coverage will increase over time. Great opportunity for those seeking part time hours in an established practice.   Fax resume to 516-858-2389.


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