MSSNY eNews – April 26, 2019 – Standing Up for All Doctors

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

April 26, 2019

Vol. 22  Number 16




John Natale, MD, age 63, was a cardiothoracic and vascular surgeon who practiced in Arlington, IL. Dr. Natale says he made simple coding and billing mistakes. The government believes the doctor tried to rip off taxpayers.

In 2012, government prosecutors accused Dr. Natale of fraud for using CPT (current procedural terminology) codes that allegedly represented more complicated procedures than the surgical ones he performed.  Dr. Natale incorrectly stated that he had used a bifurcation or Y-graft in repairing an abdominal aortic aneurysm instead of a straight tube graft actually used. Government prosecutors accused Natale of fraud for using CPT codes that allegedly represented more complicated procedures than the surgical ones he performed.

Prison Sentence

Dr. Natale served a 10-month prison sentence after being convicted in U.S. district court of two counts of making false statements in connection with surgical codes submitted between August 2002 and October 2003. He was acquitted of two counts of Medicare fraud. When he was prosecuted, the MSSNY Council discussed the case at length and Councilors were shocked at the outcome of his trial and it was generally felt that CMS was using Dr. Natale as an example to warn all physicians that erroneous coding was a serious crime.

At this year’s 213th House of Delegates, Resolution 204, “Pardon Dr. Natale,” was adopted. The resolution asks that MSSNY petition President Trump to pardon Dr. Natale, offering some solace for the loss of his career and good name. The reference committee heard testimony that Dr. Natale was convicted and served a prison sentence, based on a coding error, despite having been cleared of the original charge of Medicare fraud in the matter. The AMA and MSSNY supported the overturning of his conviction several years ago, but did not prevail. Those who testified at the reference committee hearing felt strongly that Dr. Natale has been unfairly treated.

Just last week, I received the following note from Dr. Natale:

“Happy Easter to you, Art, and God bless you and your family.
I am working with Kirkland and Ellis in Washington D.C. (the same
lawyers that wrote my amicus brief to SCOTUS). I will send this
email to them. I am hoping for the best. I will keep you informed.
Again thanks for all your support.”

Then, a few days later, I found this in my inbox:

“Dr. Fougner, You’re always a light in a never ending terrible situation.
The leadership that you and the MSSNY provided over my father’s
government targeting was a relief at some of the lowest parts of
our lives. Our fight and resolve continues due to the strength and
kindness you and the MSSNY have provided to my father, our family,
and his community of support. Please express to the MSSNY board
and community our overwhelming gratitude we feel for this very
impactful measure your board has taken. We are proceeding
with this pardon, and when we are successful it will be larger
in part to you and the MSSNY. We should never forget the
medical profession is an easy & soft target, my father’s case
gives presence to future cases that should have all practitioners
fearful for their freedom, but his pardon will have large
implications and hopefully push the judicial system to think
twice on targeting doctors. I have been blessed to have you as
a supporter through much darkness and we look forward to
meeting you and MSSNY in person when we are successful.”

Kindest regards,
Michael Natale

Very proud son of Dr. John Natale

Honestly, I think the underlying story is the real story: All we have is each other.

What matters matters.

Arthur Fougner, MD
MSSNY President

Comments?; @mssnytweet; @sonodoc99


MLMIC Banner

Capital Update

Public Health and Patient Advocacy Groups Join Together to Urge Further limits on Exemptions For Immunizations
This week, the Medical Society of the State of New York, the American Academy of Pediatrics, NYSAAP, Chapter 1,2,3, the New York Chapter American College of Physicians Services, Inc.,  the New York Academy of Family Physicians and the NYS Association of County Health Officials met to work together to help enact A. 2371/S. 2984 which ensures that medical reasons are the only exception to vaccination requirements.  The legislation is sponsored by Assemblymember Jeffrey Dinowitz and Senator Brad Hoylman and is the Assembly and Senate Health Committees.  Also joining MSSNY in supporting this measure are Nurses Who Vaccinate and the Kimberly Coffey Foundation.  This week the number of measles cases rose to 695—and have exceeded the entire number of cases from 2018.   According to the CDC  “the high number of cases in 2019 is primarily the result of a few large outbreaks – one in Washington State and two large outbreaks in New York that started in late 2018. The outbreaks in New York City and New York State are among the largest and longest lasting since measles elimination in 2000.  The longer these outbreaks continue, the greater the chance measles will again get a sustained foothold in the United States.”  Physicians are encouraged to send a letter to their legislators urging support of Assembly Bill 2371 and Senate Bill 2984 by going to MSSNY Grassroots Action Center (GAC) Please Click Here   (CLANCY)


Bill Requiring Physicians to Discuss Risks of Prescribing Opioids on Senate Health Committee
Legislation which would require physicians and health practitioners who prescribe an opioid or other Schedule II Controlled Substance to discuss with patients’ the risks prior to being prescribed a CSII drug, is on the Senate Health Committee for action this Tuesday 4/30.  The measure, S. 4277, is sponsored by Senator Peter B. Harckham.  There is currently no Assembly same as. While the legistlation is well intended, it ignores the principle of informed consent—which essentially means that when a patient needs treatment, the physician gives the patient the information to make an informed decision. Additionally, this is duplicative of requirements that currently exist under the ISTOP law, whereby, after the physician prescribes the medication, the pharmacist is required to again inform the patient about the risks of taking a controlled substance. Moreover MSSNY is concerned that such requirements will further disincentive physicians from prescribing pain medications for patients who need them – already a growing concern. The Medical Society is opposed to this measure and encourages physicians to contact members of the Senate Health Committee to express their opposition.  Committee members are:  Senator Gustavo Rivera, Chair, Senators:  Patrick Gallivan, Robert Antonacci, Brian Benjamin, Alessandra Biaggi, David Carlucci, Brad Hoylman, Chris Jacobs, Todd Kaminsky, Betty Little, Jen Metzger, Velmanette Montgomery, Patty Ritchie, Julia Salazar, Toby Stavisky.  Members of the Senate can be reached at 518-455-2800.  (CLANCY)

CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain
The Center for Disease Control and Prevention (CDC) this week in a statement said that the authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain (Guideline) advise against misapplication of the guideline that can risk patient health and safety. The statement said, in part, that the “CDC commends efforts by healthcare providers and systems, quality improvement organizations, payers, and states to improve opioid prescribing and reduce opioid misuse and overdose. However, some policies and practices that cite the guideline are inconsistent with, and go beyond, its recommendations.  In the NEJM commentary, the authors outline examples of misapplication of the guideline, and highlight advice from the Guideline that is sometimes overlooked but is critical for safe and effective implementation of the recommendations.  The full text of CDC release of “CDC Advises Against Misapplication of the Guideline for Prescribing Opioids for Chronic Pain,” is available by Clicking Here.

The American Medical Association (AMA)’s Opioid Task Force Chair, Patrice Harris, MD, MA and President-Elect of the AMA, issued a statement that said in part, that “the CDC’s clarification underscores that patients with acute or chronic pain can benefit from taking prescription opioid analgesics at doses that may be greater than the guidelines or thresholds put forward by federal agencies, state governments, health insurance companies, pharmacy chains, pharmacy benefit managers and other advisory or regulatory bodies.”  A copy of that statement can be found here.

Last year, as part of the New York State budget, a provision was included that required a treatment plan for those on opioid therapy expected to last more than 90 days.  There was a recent letter that NYS Department of Health Bureau of Narcotics sent to physicians who prescribed controlled substances.  This letter stated that the treatment plan must follow generally accepted national professional or governmental guidelines, and shall include (but is not limited to) the documentation and discussion of the following clinical criteria within the medical record:

  • goals for pain management and functional improvement based on diagnosis, and a discussion on how opioid therapy would be tapered to lower dosages or tapered and discontinued if benefits do not outweigh risks;
  • an evaluation of risk factors for opioid-related harms.
  • Such documentation and discussion of the above clinical criteria shall be done, at a minimum, on an annual basis.

The letter then goes on to note: “For an example of a generally accepted national governmental guideline for prescribing opioids for chronic pain from the Centers for Disease Control and Prevention (CDC), visit by Clicking Here

The CDC clarification says that the guideline does not support abrupt tapering or sudden discontinuation of opioids, nor does it suggest discontinuation of opioids already prescribed at higher dosages.       (CLANCY)     


Advocating to Improve Insurance Regulations – Take Action Now!
As we progress toward the end of session, it is vital that physicians let legislators know how they feel about a variety of insurance-related legislative measures that would impact physicians and their patients ‘ability to have coverage for the care they need. The following three bills would improve the way that insurance companies operate to allow for better and timelier treatment of patients in New York. Please take action by contacting your legislators and asking them to support these bills.

  • Collective negotiations: Negotiating with insurance companies is extremely difficult, especially when monolithic payers control a huge portion (or all) of the market in which you practice. The fact that Physicians are barred from advocating together with their colleagues is unfair, so we strongly support legislation introduced by Senator Rivera and Assemblymember Gottfried (S.3462/A.2393) that would allow physicians to collectively negotiate with insurance companies in certain situations. The bill is currently on the Assembly Health Committee’s agenda for Tuesday, 4/30 and is in the Senate Health Committee. Please urge your Assemblymember and Senator to join on as a co-sponsor  Here 
  • Mid-year formulary changes: Surprisingly, current law does not restrict insurance companies from making substantial changes to their prescription formularies mid-year. This is an egregious practice when you consider the fact that patients choose insurance plans based on the coverage presented to them – and they generally are not able to switch plans mid-year. Senator Breslin and Assemblymember Peoples-Stokes have introduced legislation (S.2849/A.2969) that would prevent mid-year formulary changes so that patients do not experience removal of a drug or changes in tiering. The bill is currently on the Senate Insurance Committee’s agenda for Monday, 4/29 and is in the Assembly Insurance Committee. Please urge your Assemblymember and Senator to join on as a co-sponsor  Here:
  • Prior authorizations: Prior authorizations continue to be a major roadblock to care and cause endless hassles for you and your staff. The burdens caused by excessive and often unjustified prior authorization requirements take away from the time that Physicians can spend with thei patients and lead to far too many hours being spent on paperwork. Senator Breslin and Assemblymember Gottfried have introduced an “omnibus bill” (S.2847/A.3038) that would help in reducing prior auth burdens, updating UR standards and patient protections for prescription drugs. The bill is currently in the Senate Health Committee and the Assembly Insurance Committee. Please urge your Assemblymember and Senator to join on as a co-sponsor Here   (AVELLA, AUSTER)

Advocacy Continues to be Needed Urging a “Go Slow” Approach on Legalizing Recreational Marijuana Use
While a proposal to legalize “recreational” or “adult use” marijuana was removed from consideration from the recently enacted State Budget, it remains under strong consideration on a “stand-alone” basis by the State Legislature with 8 weeks left to go in the 2019 Legislative Session. MSSNY continues to work with Parent-Teacher associations, school administration officials, county health officials, substance abuse providers, law enforcement and Smart Approaches to Marijuana (SAM) to raise concerns with these proposals.  MSSNY remains supportive of efforts to remove the threat of criminal sanction for marijuana use to address concerns related to selective enforcement of these laws, but remains very concerned regarding various adverse public health effects that have arisen in other states that have legalized recreational marijuana use.  Physicians are urged to continue to send a letter to their legislators urging a “go slow” approach Here     (AUSTER, CLANCY)                     

SED Grants Extension on Use of School Health Forms
The State Education Department (SED) has notified school districts that it has again delayed implementation of a new NYS School Health Examination Form.   In an April 16, 2019 letter to school superintendents and principals, SED instructed that schools accept any physician examination form from students for the 2019-2020 school year, regardless of the form used.  The Medical Society of the State of New York and the American Academy of Pediatrics, Chapters I, II, III, have been working with the SED and health officials on revisions to the school health form.   The new form was required by Commissioner’s Regulation 136.3 which became effective on July 1, 2018.   Physicians throughout the state have indicated that the new form was not compatible with the various electronic health record systems in use by physicians.  MSSNY, AAP and SED have been working collaboratively to make the form compatible to EHR.   A copy of SED’s letter to the school superintendents and principals can be found Here   (CLANCY)


NY Rx Card Banner

Workers Compensation Board Issues Updated Regulations to Implement Prescription Medication Formulary
The New York Workers’ Compensation Board (WCB) recently announced its 3rd revision of proposed regulations to implement a prescription drug formulary for injured workers’ medication needs.  To read the latest draft regulation, proposed formulary and summary documents, Click Here.

Comprehensive Workers Compensation reform legislation enacted by the State Legislature in 2017 directed the WCB to develop and implement a formulary.  The proposed regulation and formulary (By Clicking Here:) sets forth a listing of medications that may be prescribed for injured worker patient care needs without prior authorization during the first 30 days after the worker’s injury (Phase A), as well as a listing of medications that may be prescribed and dispensed, up to a 90- day supply, without obtaining Prior Authorization after 30 days following an accident or injury (Phase B).

The proposed regulation also notes that drugs listed as “Perioperative Formulary drugs” may be prescribed without Prior Authorization when prescribed four days before and four days after the patient goes into the hospital, clinic, or doctor’s office for surgery; with the day of surgery being day zero.  When prior authorization is needed for certain medications, the proposed rules require the carrier, employer, or PBM to approve, partially approve or deny a PA request within 4 calendar days of submission by the physician or other care provider.

The proposed regulation also sets forth that new prescriptions must be prescribed pursuant to the Formulary within 6 months of the effective date of the Formulary, and that refills and renewals must be prescribed pursuant to the Formulary within 12 months of the effective date of the Formulary.

Comments will be accepted by the WCB on the revised proposal until May 17.  (AUSTER)

Coalition of State Medical Societies Responds to CMS Report Describing Physician Participation In Medicare MIPS/APM Programs
This week MSSNY joined on to a letter to the Center for Medicare and Medicaid Services (CMS) along with 7 other state medical societies raising concerns with aspects of a CMS report (Click Here:) released in late March summarizing the results of physician and other care provider participation in the Medicare Quality Payment Program for 2017, effecting 2019 Medicare payments.

As reported in last week’s MSSNY e-news, according to CMS, a total of 1,057,824 “clinicians” were eligible for MIPS in 2017, of which 95% participated in the program and avoided a negative payment adjustment by receiving at least 3 points as their MIPS final score.    Physicians had a 94.2% overall participation rate, and non-physician clinicians had a 97.5% participation rate.  The report also noted that 81% of clinicians practicing in small practices participated with MIPS, and 94% of those practicing in a rural area participated with MIPS.

The medical societies’ letter raised concerns that the report failed to provide greater specificity as to the state by state results of small practice participation, as well as creating misimpressions by including within its definition of “participation” those practices unable to submit data due to being a designated disaster.  The report also raises concerns that “while the number of our states’ clinicians who did not participate appears relatively low, the fact that 15,238 of our clinicians would prefer to sit out of the QPP in 2017 and suffer a 4% payment penalty this year rather than hassle with participation is significant to us and bad for medicine”.  Moreover, because some of the mitigating factors no longer exist, the societies noted that “we foresee future outcomes in our states in which potentially thousands more receive the payment penalty. We believe there is an urgent need for CMS to prioritize QPP improvements to ensure broad physician participation.”

Other highlights of the CMS report include:

  • Of the over 1,000,000 clinicians that participated in QPP, 54% received their final score based on participation as part of a group; 12% of received their final score based on individual participation; and 34%  received final scores based on participating in the QPP through an Advanced Payment Model (APM).
  • Bonuses: 71% overall received positive adjustments ranging from +0.28% to +1.88%; 22% received bonuses of up to +0.2%; and 2% received no positive or negative adjustment.
  • Of the over 340,000 clinicians who participated in the APM track, the overwhelming majority participated via the Medicare Shared Savings Program (as an Accountable Care Organization).
  • Of those who successfully participated, 74.3% reported data for a full 12 months, and another 24.9% reported data for 90 days to 12 months.  With regard to small practices, 44.5% reported for the full 12 months, and 53.9% reported data for 90 days to 12 months.
  • The most frequent quality measures reported were: 1) controlling high blood pressure 2) screening for tobacco use and cessation 3) Breast Cancer screening 4) pneumococcal vaccine and 5) encouraging use of aspirin or other anti-platelet
  • The most frequent Quality Improvement measures reported were 1) Having 24/7 access to a patient’s medical record 2) Use of decision support and standardized treatment protocols 3) Patient Centered Medical Home attestation 4) Engaging with patients through patient portal and 5) Collection of data and follow up regarding patient experience.      (AUSTER)

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 approximately 622 (390 in New York City, and 200 in Rockland, 20 in Orange, 10 in Westchester and 2 in Sullivan counties) confirmed cases as of April 24.  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 growing 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)

Registration Now Open for Veterans Matters CME Webinar on April 30th
Register now for MSSNY’s next Veterans Matters webinar on April 30th at 7:30am. This webinar is entitled Suicide in Veterans.  Register for this program Here .
Veterans Matters: Suicide in Veterans
When: Thursday April 30, 2019 at 7:30am – Register Here
Faculty: Jack McIntyre, MD
Educational Objectives:

Address the causes and warning signs of suicide and suicidal behavior among veterans
Explore evidence-based diagnostic, intervention and treatment options
Identify barriers to identification and treatment in military culture and methods to overcome them

Additional information or assistance with registration can be obtained by contacting Melissa Hoffman at 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.  (HOFFMAN, CLANCY)

Registration Now Open for Medical Matters Webinar on May 15, 2019 @ 7:30am
The Importance of Resilience After a DisasterRegister here:

The Medical Society of the State of New York will host its final Medical Matters webinar of 2019, The Importance of Resilience After a Disaster on May 15th @ 7:30am.  Encouraging post traumatic growth is an essential part of recovery from any type of disaster.  Learn more about how best to encourage resilience behaviors in patients.

Faculty: Craig Katz, MD

Educational Objectives:

Define resilience and post traumatic growth

Describe how best to measure resilience and post traumatic growth

Explore resilience behaviors and how to encourage them in your patients

Additional information or assistance with registration can be obtained by contacting Melissa Hoffman at 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.  Physician should only claim credit commensurate with the extent of their participation in the activity.

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


NYC DOHMH Issue Health Advisory on Measles
The New York City Department of Health and Mental Hygiene (DOHMH) released a health advisory related to the current measles outbreak which now totals almost 400. While most cases have been in the Orthodox Jewish communities of Williamsburg, a small number have occurred outside of this area. The advisory includes recommendations about vaccinations and proof of immunity, and provides specific guidance for individuals residing in the four zip codes in Williamsburg impacted by the Order of the Commissioner.

The Medical Society of the State of New York has created a just-in-time Medical Matters online course entitled “The Continued Public Health Threat of Measles 2018”.  This free CME program is on the MSSNY CME website. If you are new to the website, please follow the steps to create an account.  For those who have been on the site, please log in to your account.  Please contact Melissa Hoffman at if there are any questions about the CME site.  


Rockland County Renews State Of Emergency Despite Court Order
Rockland County renewed its state of emergency order, despite it being struck down by a judge earlier this month, as the state’s worst measles outbreak in a generation continues, officials said Thursday afternoon. Under the renewed state of emergency, which is extended to May 25, 16 schools are forbidden from allowing students to attend class until they are vaccinated or provide a legal exemption. The order affects 331 students, according to county officials. Rockland County has 200 reported cases of measles as of April 25, up from 186 last week, and brings New York’s total to more than 600 reported cases.

The county’s numbers make up about 29 percent of the country’s measles cases, despite Rockland County representing 0.1 percent of the population, according to the state of emergency order.


NY Primary Care Doctors in PCMH Rose by 35% from 2018-2018
The number of primary care providers in New York State adopting a high-performing, health care delivery model known as the patient-centered medical home (PCMH) rose by more than 35 percent between May 2017 and May 2018, a dramatic increase in the rate of growth over prior years, according to a United Hospital Fund report released on April 18. Over the past eight years the number of clinicians working in PCMH practices has increased at an average rate of roughly 15 percent a year, from 3,400 clinicians in 2011 to more than 9,000 at the end of May 2018. The recent growth coincides with the Delivery System Reform Incentive Payment (DSRIP) program, the state’s Medicaid reform initiative, in which all or most of a patient’s health care needs are coordinated through a primary care physician. The report, Patient-Centered Medical Homes in New York, 2018 Update: Drivers of Growth and Challenges for the Future, is part of a series UHF has produced since 2011 tracking the adoption of the PCMH model across New York State. New York State continues to lead the nation in the adoption of the medical home model, accounting for 15 percent of the nation’s NCQA-recognized PCMH clinicians.

PCMH is a patient-centric model of care that strengthens relationships between patients and their clinical teams, focusing on improving the health of the population served by the practice. It is especially valuable for treating people with multiple chronic conditions, who generate a disproportionate share of U.S. health care costs.

Primary care practices that have adopted the PCMH model are also struggling with a rapidly changing, and challenging health care landscape. The emergence of, telemedicine, convenient care (e.g., retail clinics and urgent care centers), and concierge medicine, among other innovations, threatens to make it more difficult for PCMH practices to thrive. The report offers suggestions that could make medical homes better able to compete, including: improving access by expanding hours; focusing on prevention and health education; helping patients negotiate the health system during and after acute episodes and hospitalization; and helping patients with multiple chronic diseases better manage their conditions.

MSSNYPAC Welcomes New Co-Chairs And Members

With the transition of Dr. Joseph R. Sellers, MD into the role of MSSNY Vice President, Dr. Arthur Fougner, MSSNY President, has seated two new Co-Chairs with the appointment of Dr. Thomas T Lee, MD, Neurosurgeon of Westchester County and Dr. Rose Berkun, MD Anesthesiologist of Erie County.  Each Chair brings their own strengths, vast experience in fundraising, astute political awareness, and great love for their profession.   Additional appointments to the MSSNYPAC Executive Committee are: Dr. Malcolm Reid, MD, MPP Physical Medicine & Rehabilitation of New York County, Dr. Inderpal Chhabra, MD Internal Medicine of Nassau County, Dr. Michael A. Pisacano, MD, Ophthalmologist of Bronx County, Janine L. Fogarty, MD Radiologist of Monroe County, Yongsoo Joo as Medical Student Representative.  See the full committee list.

All leaders of MSSNYPAC extend their deep gratitude to the hundreds of MSSNYPAC donors in New York State who continue to support the great work MSSNYPAC has helped New York physicians to achieve on behalf of our patients.  MSSNYPAC is a powerful tool essential to amplify the voice of physicians, helping to expand the opportunities for meaningful dialogue with key health care policymakers, and build strong relationships that last.

Become a supporter today Thank you.

Garfunkel Ad

NYState of Health Providing Grants for Multi-Specialty Groups to Use Open Notes
NYSHealth has supported the spread of OpenNotes in hospital systems throughout New York State, providing patients with access to the visit notes written by their doctors, nurses, or other clinicians. Now, they are eager to spread the program to other health care settings, such as multispecialty group practices and federally qualified health centers. Through a new Request for Proposals, we will provide grants of up to $100,000 in support of the adoption or spread of OpenNotes in non-hospital settings. Proposals are due Thursday, May 2nd.

Telemedicine Tied to More Antibiotics for Kids
Telemedicine may be leading to the overprescribing of antibiotics to sniffling children, a new study suggests. The study was published Monday in the journal Pediatrics. Children with cold symptoms seen via telemedicine visits were far more likely to be prescribed antibiotics than those who went to a doctor’s office or clinic, researchers found. And a higher proportion of those prescriptions disregarded medical guidelines, raising the risk they could cause side effects or contribute to the rise of antibiotic-resistant germs.

“I understand the desire for care that’s more convenient and timely,” said the study’s lead author, Dr. Kristin Ray of the University of Pittsburgh. “But we want to make sure that we don’t sacrifice quality or safety or effectiveness in the process.” Ray and her colleagues looked at more than 340,000 insured children who had acute respiratory illness medical visits in 2015 and 2016.

Children received prescriptions for antibiotics more than half the time during telemedicine visits, compared with 42% at urgent care clinics and 31% at doctors’ offices.

The researchers also found that in looking at telemedicine doctors’ decisions about whether to prescribe or not prescribe antibiotics, 4 out of 10 failed to meet medical guidelines on matching treatment to diagnosis. That mainly had to do with doctors prescribing bacteria-fighting drugs to treat viral illnesses, such as colds and flus, that are unaffected by antibiotics. In comparison, 3 out of 10 urgent care clinic decisions were inappropriate, and about 2 out of 10 doctors’ office decisions were. The researchers also found telemedicine physicians appeared to be ignoring other guidelines. For example, doctors are supposed to take a throat swab and run a lab test before diagnosing strep throat. But that rarely happened in telemedicine visits, Ray said.

A large recent study on antibiotic prescribing patterns for adults found little difference between telemedicine and office visits. But there has been little study of the issue in children. The American Academy of Pediatrics, which publishes the journal, encourages parents not to use such direct-to-consumer programs. Academy officials say limited physical examinations and lack of access to patient records can harm care. (AP)

Federal Judge Will Enjoin Family-Planning Physician Gag Rule
U.S. District Judge Michael J. McShane said yesterday that he plans to issue a temporary injunction against the Trump administration’s gag rule dictating what physicians can and cannot say about family planning to their patients in the Title X program. The AMA is the lead plaintiff in the lawsuit to stop the rule, which was set to take effect May 3.

Erie County: NFL Champ Vance Johnson Keynote “How a Doctor Saved My Life

Wednesday, May 1@ Shea’s Seneca

Erie County Medical Society’s 198th Annual Meeting and Installation of Officers will feature Vance Johnson, retired NFL wide receiver Superbowl Champion, as keynote speaker, to tell  “How A Doctor Saved My Life” will be held Wednesday, May 1, 2019 at 5:45 PM – location is The Historic Shea’s Seneca, 2188 Seneca St., Buffalo. Tickets are available at $110 per person – contact Emily McMullen at 716-852-1810.

Services for Dr. Anthony Santomauro on Saturday, May 11 in Amherst, NY
Services for retired surgeon Anthony Santomauro, a MSSNY member since 1963, will be held on Saturday, May 11, 2019 at 10:00 AM at the University at Buffalo Newman Center, 495 Skinnersville Road, Amherst, NY 14228.


Open Payments Data Available for Review
Pre-publication Review and dispute for the Program Year 2018 Open Payments data publication began on April 1, 2019 and will end on May 15, 2019. The Centers for Medicare & Medicaid Services (CMS) will publish the Open Payments Program Year 2018 data and updates to the previous program years’ data in June 2019.

Physician and teaching hospital review of the data is voluntary, but strongly encouraged. Please keep in mind the following:

  • Records eligible for review and dispute: all records submitted during the submission period of the current calendar year, including newly edited, submitted, and re-attested records from previous calendar years. For detailed information refer to the Physician and Teaching Hospital Review and Dispute Tutorial
  • Disputes must be initiated by May 15, 2019 in order to be reflected in the June 2019 data publication. For more information on review and dispute timing and publication refer to the Review and Dispute Timing and Data Publication Quick Reference Guide.
  • CMS does not meditate or facilitate disputes. Physicians and teaching hospitals should work directly with reporting entities to resolve disputes.
  • Registration in the Open Payments system is required in order to participate in review and dispute activities.

Registration Details
If you have never registered with Open Payments before:

Make sure you have your National Provider Identifier (NPI) number and State License Number (SLN). Initial registration is a two-step process:

  1. Register in the CMS Enterprise Identity Management System (EIDM);
  2. Register in the Open Payments system

For users who have previously registered:  Users that have registered during previous program years do not need to re-register.

Please note:  If the account has not been accessed within the last 60 days the account will have been locked due to inactivity. To unlock an account go to the CMS Enterprise Portal, enter your user ID and correctly answer all challenge questions to gain access to your account. You will be prompted to create a new password.

If the account has not been accessed for 180 days or more, the account will be deactivated. To reinstate the account contact the Open Payments Help Desk at 1-855-326-8366; (TTY line: 1-844-649-2766) 

For more information about the registration process, visit the physician and teaching hospital registration page on the Open Payments website. Need help or have questions? Contact the Open Payments Help Desk at or call 1-855-326-8366 (TTY Line: 1-844-649-2766). The Help Desk is available Monday through Friday, from 8:30 a.m. to 7:30 p.m. (ET).

Join Primary Care First Model Options Informational Sessions
CMSInnovation Center recently announced the CMS Primary Cares Initiative that will provide primary care practices and other providers with five new payment model options, two of which are under the Primary Care First path.

The Primary Care First payment model options will test whether financial risk and performance-based payments that reward primary care practitioners and other clinicians for easily-understood, actionable outcomes will reduce total Medicare expenditures, preserve, or enhance quality of care, and improve patient health outcomes. Primary Care First also includes a payment model option that provides higher payments to practices that specialize in care for high need patients, including those with complex, chronic needs and seriously ill populations (SIP).

Please attend one of our upcoming informational sessions to learn more about Primary Care First. During the one-hour event, you’ll hear from senior leaders and the team behind Primary Care First about the model aims, requirements, benefits of participation, and application next steps.

For your convenience, we will offer multiple informational sessions. Session information and registration links are included below:

Informational Session 1: Tuesday, April 30th at 12 PM EDT
Register to attend

Informational Session 2: Tuesday, April 30th at 3 PM EDT
Register to attend

Informational Session 3: Thursday, May 16th at 12 PM EDT
Register to attend

Informational Session 4: Thursday, May 16th at 3 PM EDT
Register to attend

Feel free to forward this invitation to colleagues who may be interested in learning more about the Primary Care First Model. Reference materials will also be available for download during the event.

For additional information about Primary Care First, please visit the model website at




Bronx Physician’s Office for Sale or Lease
Fully equipped physician’s office for sale or lease. Features three exam rooms, lab room, reception area and waiting room, computer and storage rooms. Bronx location near Einstein Hospital and subway. Call 914-882 3797/

Park Avenue Medical Office for Sale
On Park Ave, for sale is a large medical office, in a beautiful full service co-op with two entrances, one of which is an impressive doorman in lobby entrance.The office has high ceilings, easily adaptable to any specialty and priced to sell. Three good size rooms easily converted to five exams, plus consult, bathroom, reception and large waiting room. Outstanding location. A must see. View floorplan Call Jeff Tanenbaum,  646-234-2226 or email for showings and more information.

Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing:

Office Rental 30 Central Park South.
Two fully equipped exam, two certified operating, bathrooms and consultation room.  Shared secretarial and waiting rooms. Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time.

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:


Multi-Specialty Medical Office Looking To Bring On More Doctors
New York Medicine Doctors Center is a multi-specialty Medical Agency networking some of the best medical professionals and specialists in the New York Tri-State area. Our offices currently serve both Manhattan and Queens, providing a variety of advanced technological on site testing, imaging, and services for the most rapid results.

We are actively looking to bring on board an array of Doctors specializing in Primary Care, Gynecology, Gastroenterology, ENT, Urology, Podiatry, and Dermatology.

As we continue to broaden our medical services in both locations, we also provide individualized on-boarding contracts with health benefits, tailored in-house marketing and advertising, practice management assistance, and in house team of administration dedicated in serving any and all concerns whether it be credentialing or equipment related tasks.

If you are interested in joining our growing network, please do not hesitate to contact us

at 718-360-9550 or 212-931-8533. Our direct email is

Primary Contact: Oksana

Seeking Executive Director of the Onondaga County Medical Society
 An exciting opportunity for the right person to provide leadership for physicians Salary: Commensurate with experience Job Description: Direct day-to-day operations of the Onondaga County Medical Society Some evening meetings, travel required. RequirementsExperience with leading political advocacy; political sophistication. Must know how to interface with government officials. Good networking and communication skills. Conversant with budgets and finance. Excellent media relations skills, including electronic, social media, and written communications. Familiar with medical issues and comfortable discussing them. Education: BA/BS required.  MPH or MBA desirable. We expect innovation and project initiation. The Executive Director will receive a contract that increases remuneration commensurate with membership growth. Application Instructions: Please direct your application to: Dr. Brian Johnson,

Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail:  Fax: (1-516) 833-4760 Equal Oppty Employer M/F

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 or those seeking part time hours in an established practice. Fax resume to 516-858-2389.