Thomas J. Madejski, MD
January 11, 2019
Volume 22 Number 2
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 email@example.com.
Thomas J. Madejski, MD
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 (firstname.lastname@example.org).
- 39-23 Democrat Majority
- 15 new Democrats
- 2 new Republicans
- 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)
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 email@example.com. (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.
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.
- 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.
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.
- 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.
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.)
- Measles Guidance for Providers(PDF)
- Health Alert: Measles Outbreak in New York City in Orthodox Jewish Community(PDF)
- Health Alert: Update on Measles Outbreak in New York City in the Orthodox Jewish Community(PDF)
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.
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 firstname.lastname@example.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.
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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.”
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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