Doctors Are Against Unjustified High Cost of Prescriptions


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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

 

For Immediate Release
December 18, 2019 

DOCTORS ARE AGAINST UNJUSTIFIED HIGH COST OF PRESCRIPTIONS

Statement attributable to:
Art Fougner, MD

President, Medical Society of the State of New York

“We welcome Governor Cuomo’s announcement of a proposal to help to reduce the cost of some prescription medications for our patients, and look forward to reviewing further details regarding this proposal.  Patients in need of life-saving and health-maintaining medications, including insulin, must be able to receive them in a timely manner.  Furthermore, the Medical Society of the State of New York has long-standing policy supporting the investigation of sudden unjustified increases in the cost of prescription medications. We must continue to examine ways to ensure our patients are truly able to obtain the medications they need to lead a healthy life, including preventing inappropriate PBM or health insurer interference with patients receiving these needed medications.”

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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.

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

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MSSNYeNews: December 20, 2019 – Merry Grinchmas – Stupid Insurance Tricks

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
December 20, 2019

Vol. 22  Number 47


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Colleagues:

This is the last MSSNY Enews of the year. I was thinking of a holiday theme. Unfortunately, the Grinches of United Healthgroup have managed to drop a ton of coal in my stocking. So what has set me off? Well, this afternoon, I received a disturbing email about the Minnesota Miscreants. It seems that all claims are being systematically denied and requests for audits of medical records issued for each claim.

Procedures and visits are routinely downcoded. Remember, United just reported earnings for the third quarter of over 60 Billion Dollars. That’s roughly forty times the largest Powerball jackpot ever. In 2018, United CEO David Wichmann received total compensation of over $21 million. Let that all sink in for a moment. A man received a sum that would make even Midas jealous for denying claims for the care of folks whose only mistake was in paying premiums to his company.

We have been fighting this War on Doctors for many years. This year, much of my time has been occupied by the issue of unexpected Out of Network bills, dubbed Surprise Bills. Physicians are being portrayed by Health Policy wonks as “Greedy Doctors.” Yet the late Uwe Reinhardt offered that if you compared doctors to the talent pool from which they are recruited, physicians are woefully underpaid.

Moreover, about half of their revenue is absorbed by practice overhead. In addition, this doesn’t take into account college and medical school debt. Medicare payments for over twenty years have been essentially flat compared with the rising cost of living. But the doctors are greedy. Physicians account for, at most, 7.5% of total US healthcare spending. The doctors are greedy— really? Physicians contribute to local, state and federal economies both directly and indirectly by providing jobs, being consumers, and, oh yes, paying taxes. But hey, let’s pillory those greedy doctors.

I have spoken to Albany and NY’s Department of Financial Services has been alerted. However, they need data. So here’s my ask – send me as much information as possible about the insurer, the numbers of claims, what’s being denied, what info is being demanded, etc. The more specificity the better. Send it to me directly. I promise that I will collate the information and dispatch it to Albany if I have to walk it up myself.

We have fought these adversaries before – taking on Oxford and winning a class action suit, working with then Attorney General Cuomo to take down Ingenix. We have called them on their Stupid Insurance Tricks and won. To quote the late President George HW Bush, “This aggression will not stand.”

And to quote his son, President George W. Bush, “We will not waver; we will not tire; we will not falter; and we will not fail.”

And to you and yours, I, along with everyone at MSSNY, wish for you a Happy and a Merry. May the blessings of this holiday season last the whole year long.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


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MSSNY Together with Physicians Nationwide Raise Concerns with One-Sided Surprise Billing Proposal
With the passage of a 6-month federal Budget resolution this week by the US Congress that did not contain provisions to address “surprise” out of network medical bills, consideration of this issue will continue into 2020.  As consideration continues, physicians should continue to contact Senators Schumer and Gillibrand, as well as their US Representative, to urge for a balanced solution to protect patients from “surprise” out of network medical bills.  Physicians can send a letter here.

Last week, competing legislative proposals were advanced.  MSSNY, together with organized medicine, raised huge concerns with the insurance industry-friendly proposal advanced by Senator Alexander (R-TN) and Rep. Frank Pallone (D-NJ) that would provide health insurers with new incentives to drop physicians from their networks by enabling them to make payment for such surprise bills at the insurer-determined median in-network rate.  While an appeal arbitration mechanism would be available, it appears it would practically offer little recourse for a physician to be paid above benchmark payment.

MSSNY President Dr. Art Fougner issued a statement urging Congress to “go back to the drawing board”, noting that “the just announced Alexander-Pallone proposal Congress would hand market dominant health insurers a shiny new club to enable it to drop more physicians from their networks.”  The statement also praised “the many members of the NY delegation, including Rep. Morelle and Senator Schumer, for their efforts to assure the passage of a far more balanced approach that protects patients’ access to timely needed care.”

This week, Dr. Fougner also responded to an adverse article in Crains that cited statistics from New York union 32 BJ that had paid $10 million in out of network claims over the last 3 years.  Dr. Fougner’s response noted that: “Employer and union plans, such as 32BJ, should not be able to both have their cake and eat it too. They should not be able to both severely limit their physician/hospital networks and then complain about having to pay out of network claims when their insureds—our patients—inevitably need to be treated by an out of network physician due to an inadequate network.”

Separately, House Ways & Means Committee Chair Richard Neal (D-MA) and W&M Ranker Kevin Brady (R-TX) announced their own proposal to address surprise medical bills that, according to a press release “respects the private market dynamics between insurance plans and providers and first allows them to work out differences without interference. If the parties cannot come to agreement on their own, the agreement provides for a robust, impartial, and structured process to settle payment”.  However, no other information has been made available beyond this general description.


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Physician Action on Key Health Care Legislation Needed
As we approach the end of the year, several bills of strong interest to physicians and patients that passed the Legislature have been sent to the Governor for his consideration.  As noted below, please urge the Governor to sign TWO bills that would limit the power of health insurers and PBMs to limit patients’ access to needed prescription medications.   At the same time, please urge opposition to TWO bills that would expand already outrageously high liability costs facing physicians.

  • Protect against Insurer Mid-year formulary changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law.
  • Support Regulation of PBMs– This legislation would enable the State Department of Financial Services for the first time to oversee the practices of the PBM industry, and help to provide greater assurance that PBMs develop their prescription formularies fairly.  Please urge the Governor to sign this legislation into law.
  • Oppose Liability expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills.

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Physicians Ordering Home Care for Your Patients – Are You Aware of the Impact of the New Medicare PDGM Methodology?
Starting in 2020, Medicare is significant revising how it will pay for patient home care services through a new methodology known as the Patient-Driven Groupings Model (PDGM).

The PDGM is a new payment methodology for home care that relies more heavily on clinical characteristics and other patient data to classify home health services into more meaningful payment categories. It is part of CMS’ effort to shift Medicare payment away from volume-based payment towards value-based payment.   However, the new model could produce significant new documentation responsibilities for physicians.

In particular, the PDGM will break up the standard 60-day episode of care into one of two 30-day periods. That means 30-day periods will be implemented as a basis for payment vs. the 60-day periods used now. Each 30-day period is grouped into one of 12 clinical categories based on the patient’s main diagnosis. Moreover, the PDGM will increase the number of payment groupings and unique case-mix potential from 153 to 432. The current system allowed for 153 combinations, but with PDGM each 30-day period can be categorized into one of 432 case-mix groups.

The National Association for Home Care & Hospice (NAHC) has developed a suite of resources for physicians interested in learning more about the PDGM.  To read more about what physicians ordering home care services need to know about this program, please review here.

At the November 7, 2019 meeting of the MSSNY Council, a resolution was adopted to monitor implementation of the PDGM “to determine whether this new program will impose additional administrative burdens on physicians certifying home care services for their patients, and/or whether it will impede patients from receiving needed home care services”.


First Long-Term Study of Health Impact of Vaping Points Way to Regulation of All Tobacco Products
On December 16, 2019, the first long-term study of e-cigarette use was published in the American Journal of Preventive Medicine. The results show conclusively that the use of e-cigarettes dramatically increases the risk of lung disease. It also found that dual use of combustible and electronic cigarettes increases risk beyond using either product alone. This information should be used immediately to inform tobacco regulation at the national, state and local levels. Unfettered access to these products is a public health threat.

The study did not conclude whether vaping is as dangerous as smoking combustible cigarettes, nor did it set out to do so. This question is largely irrelevant. Traditional cigarettes are the most dangerous consumer product in history, killing nearly half a million Americans each year. E-cigarettes need not be as dangerous to warrant strict regulations or sales bans.

A number of cities and states have already taken decisive action to curtail youth e-cigarette use by banning flavors or even overall sales. ASH believes that a flavor ban is a reasonable approach, provided it covers all flavors, including mint and menthol. Other studies have shown that the vast majority of youth e-cigarette users use flavored products. ASH also urges the Food and Drug Administration to re-open its efforts to reduce nicotine in all tobacco products to non-addictive levels.

As legislators consider how to address the e-cigarette epidemic, they should take a broad view of tobacco product sales. Addressing only e-cigarette sales can lead to inconsistent public health policy, for example: eliminating menthol e-cigarettes but leaving menthol cigarettes – which have killed millions – on the shelf.

The most comprehensive and defensible approach is to phase out the sale of all commercial tobacco products, as Beverly Hills, CA has done.


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Study: Adding Genetic Testing to Management of Patients with IBD May Help Determine Which Patients May Be At Greater Risk for Loss of Response
Healio (12/18) reports, “Adding genetic testing to the management of patients with inflammatory bowel disease [IBD] may present an opportunity to determine which patients are at greater risk for loss of response and help select the best therapies for each individual patient,” research indicated. In a presentation given at the Advances in Inflammatory Bowel Disease annual meeting, researchers discussed “the HLA-DQA15 allele and its ability to help predict loss of response.”

In a “study comprising more than 1,600 patients in Europe,” investigators “found that the presence of the allele was associated with a significant likelihood of loss of response due to antibody formation to both Remicade (infliximab, Janssen) and Humira (adalimumab, AbbVie),” with the “highest rate for loss of response…found among patients on infliximab monotherapy without an immunomodulator.”


Cold and Flu Rarely Strike at Same Time, Study Finds
People may be less likely to get the flu if they already have a common cold, according to a study published in Proceedings of the National Academy of Sciences.

For the study, researchers analyzed data on 44,230 respiratory illness samples from 36,157 patients in Glasgow, Scotland, between 2005 and 2013. Researchers tested each patient for 11 different virus groups.

Thirty-five percent of samples tested positive for a virus, and 8 percent were infected with more than one type of virus at the same time. Researchers also discovered an inhibitory interaction between flu and rhinoviruses, which are responsible for the common cold, at both an individual and population level.

“When there is a lot of flu in the population, there is little rhinovirus, and vice versa,” said study author Dr. Pablo Murcia, a researcher at the University of Glasgow Centre for Virus Research.

This trend may explain why cold and flu seasons peak at different times of the year on a cyclical basis. It also highlights the need for researchers to study viruses together like an ecosystem, rather than studying one at a time, Dr. Murcia said in a press release.


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Trump Administration Proposes New Rules to Increase Organ Transplants
The AP (12/17) reports the Trump Administration “proposed new rules Tuesday to increase organ transplants – steps to make it easier for the living to donate and to make sure that organs from the deceased don’t go to waste.” The article outlines the proposed rules that would increase potential reimbursement for donors and hold “organ procurement organizations” to higher standards.

The Hill (12/17, Sullivan) reports HHS “said that 20 people die each day while on the waitlist for a life-saving organ transplant, and that the new rules are intended to reduce that number and save lives.”

Health Exec (12/17, Baxter) also covers the story.


VA Discontinues Star Ratings System for Hospitals
The U.S. Department of Veteran Affairs has discontinued its star ratings system in an effort to improve transparency and allow veterans seeking healthcare to more easily compare VA and non-VA facilities.

The star ratings system, developed as an internal tool, enabled veterans to compare quality and performance at VA facilities.

However, the ratings did not “provide insight as to how our hospitals stack up against nearby non-VA facilities and are therefore of little value in helping veterans make informed healthcare decisions,” VA Secretary Robert Wilkie said in a news release.

Instead, each VA hospital’s website now features links to tools that will allow users to compare wait times, quality of medical care and patient experience ratings at facilities in their local area.

The VA will, however, continue to publicly release its Strategic Analytics for Improvement and Learning data that is used to internally manage hospital performance within the VA’s health system. Strategic Analytics for Improvement and Learning data assesses 60 quality metrics, overall efficiency and physician capacity.


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Study Suggests Eliminating H. Pylori Tied To 75 Percent Reduction In Gastric Carcinoma Risk
A recent research study indicates, “eliminating Helicobacter (H) pylori from a patient’s gastrointestinal tract could lead to a 75% reduction in risk of gastric carcinoma.” The retrospective study  https://www.gastrojournal.org/article/S0016-5085(19)41464-9/fulltextof over 370,000 veterans published in Gastroenterology “also found that racial and ethnic minorities, as well as smokers, were at significantly higher risk of gastric cancer after detection of H pylori.”


Hospitals Sue HHS to Block 2020 Medicare Drug-Rate Rule
Bloomberg Law (12/17) reports behind a paywall that hospitals across the US “are suing the Health and Human Services secretary in federal court in the District of Columbia to stop implementation of a 2020 rule governing the rate the agency will reimburse them for certain medications.” The challenged rule “reduces by nearly 30% Medicare reimbursements to certain public and not-for-profit hospitals for prescription drugs they purchase at a discounted price under the 340B program.” It “takes effect Jan. 1, 2020, and expands the facilities subject to the reduction to include off-campus provider-based departments.”


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WORKERS COMP

Information Re WC Deposition Fees for Depos Given on or/after October 2018
When a depo is ordered, the standard direction provides “A medical witness is entitled to a witness fee pursuant to Part 301 of Title 12 of the Official Compilation of Codes, Rules and Regulations of the State of New York. Within ten days of the completion of a witness’s deposition, the party responsible for such witness’s fee, if any, pursuant to the Workers’ Compensation Law and regulations, shall remit payment of the fee to the witness.  The fee is to be awarded in like manner as a witness fee, awarded for attendance at a hearing, irrespective of the location where the deposition takes place (including telephone and video testimony).  If the witness believes that the fee in excess of that set in Part 301 is warranted, such witness must submit a request to the Board within ten days of the deposition.  The Board will review such request and issue a subsequent decision concerning whether an additional fee is warranted.”

This standard language has been used by the WCB for many years.  When a claimant’s physician testifies, the fee must be paid within ten days.  If the doctor is not timely paid, the doctor should send a letter to the carrier, saying “I was deposed on X date, directing that I be paid within 10 days of my testimony. I have not been paid to date.  Please pay me within 10 days of this letter.”

If the carrier still does not pay within the demanded time frame, the doctor should send a letter to the Board, laying out the dates, saying “ I still have not been paid”, and attach the letter that was sent to the carrier.  The WC Board can issue an Administrative Determination directing payment of the standard fee under Regulation 301 (the Administrative Determination cannot provide for any requested extra fee— as the standard language above says, that has to be ordered by the WCLJ in the decision regarding the disputed issue for which testimony was taken).

If this process is followed, the WCB can then identify recalcitrant carriers, and penalize them.  It is expected that this process could very quickly put an end to this practice, and more importantly, will get doctors paid timely.

For your ease in complying with the process, MSSNY has created these templates for your use.


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FDA Clears First Interoperable, Automated Insulin Dosing Controller
The FDA on Friday authorized the first interoperable, automated glycemic controller device. The Tandem Diabetes Care Control-IQ Technology adjusts insulin delivery to a patient with diabetes by connecting an insulin pump to a continuous glucose monitor.

Previous software to automate insulin delivery was approved as part of a single system. The Tandem Control-IQ technology, meanwhile, is designed to communicate with numerous compatible devices.

In a news release, an FDA official said that the authorization “help[s] ensure the safety and efficacy of innovative and customizable diabetes management systems that may help patients better tailor their treatments to their individual needs.” FDA news release


US Deaths from Alcohol-Related Liver Disease at Highest Levels since 1999
CDC data revealed that “U.S. deaths from alcohol-related liver disease (ALD) are at their highest levels since 1999 and have risen every year since 2006 in nearly every racial, ethnic and age group.” After analyzing “causes of death for people aged 25 and older in the two decades since 1997,” investigators “found that 2017 had the highest rates of death from ALD, at 13.1 per 100,000 deaths in men and 5.6 per 100,000 in women,” which “compares to 1999 ALD mortality rates of 10.6 per 100,000 in men and 3.3 per 100,000 in women.”

In particular, “mortality rates and recent increases in ALD diagnoses were…pronounced among middle-aged adults, Native Americans and non-Hispanic whites,” the study found. The findings were published online in the American Journal of Gastroenterology


Decline in US Life Expectancy
The decline in US life expectancy U.S. residents for decades had seen improvements in average life expectancy, but the trend reversed in 2014, according to a study published in JAMA. Researchers found that, since 2014, more U.S. residents have been dying at middle age from drug overdoses, diseases, obesity, suicide, and dozens of other causes.


New Drug Formulary FAQs
Now that the NY WC Formulary for new prescriptions has been in effect for almost two weeks, the Board has received some frequently asked questions and would like to make all stakeholders aware of them.

Please visit the Board’s Drug Formulary Overview webpage for:

  • An overview of the NY WC Formulary and the prior authorization process
  • The latest version of the NY WC Formulary: A Quick Guide and Video            overviews
  • A NY WC Formulary Dashboard Guide for Payers/TPAs
  1. Can a provider submit a prior authorization request via the Medical Portal for a non-formulary medication that is a continuation/refill of an existing prescription? 

Yes. The Board required that carriers provide prescribers with a list of their patients currently taking non-formulary medications by December 5, 2019. This requirement was put in place so that prescribers can immediately start either (a) switching their patients to formulary medications, or (b) submitting prior authorization requests in advance of the June 5, 2020, date.

  1. Should carriers process prior authorization requests for continuation/refill of medications submitted prior to June 5, 2020?

Yes. All prior authorization requests submitted via the Medical Portal (whether for new or continuation/refills) should be processed and reviewed.

Although refills/renewals of medications are not required to comply with the New York Workers’ Compensation Drug Formulary (NY WC Formulary) until June 5, 2020, if a prescriber submits a request via the Medical Portal, the carrier must process and review the request.

  1. What documentation is required from the prescriber to support a prior authorization request for the renewal/refill of a non-formulary medication?

The prescriber must provide the clinical rationale/justification for the use of the non-formulary medication.

  1. How should a prior authorization request for a refill/renewal of a non-formulary medication be processed by the carrier that is submitted prior to June 5, 2020?

If the prior authorization request provides appropriate clinical rationale/justification that would justify the use of the non-formulary medication, it may be approved for up to a one-year supply.  Said differently, if you were reviewing this on June 5, 2020, and would approve it, then approve it now for up to one year.

If the prior authorization request does not provide appropriate clinical rationale/justification for use of the non-formulary medication, then an approval (for up to a 30-day supply of the medication) should be granted. The reviewer should indicate that it is being approved as a refill/renewal for no more than a 30-day supply in anticipation that a subsequent request will be submitted with appropriate documentation to fully support the use of the non-formulary medication.

While a variance is not necessary for a refill/continuation of a medication, if an Attending Doctor’s Request for Approval of Variance and Carrier’s Response (Form MG-2) for a refill/continuation is submitted, the carrier should process the request using the current procedures until June 5, 2020, at which time all requests must go through the Medical Portal Prior Authorization process. Please be reminded that all requests for new medications must go through the Medical Portal Prior Authorization System effective December 5, 2019.

  1. I received a denial for a non-formulary request stating that the request was denied because the drug is not on the NY WC Formulary. Isn’t that what the non-formulary prior authorization requests are for, drugs not on the NY WC Formulary?

Yes, that is correct. If a drug is not on the NY WC Formulary, and the provider wishes to prescribe it, a non-formulary prior authorization request should be submitted using the electronic Prior Authorization System located on the Board’s Medical Portal.

If for any reason, the prescriber does not agree with the Level I or Level II denial or partial approval of their request, they should request the next level review.

  1. I requested oxycodone/acetaminophen 5mg/325mg for a patient that has been on it for five years. The patient is back to work, doing well, fully functional, but needs ongoing opioid medication for breakthrough pain. I requested prior authorization for a 365-day supply but received partial approval for a 30-day supply with the instruction that I need to wean the patient.  Is this an appropriate use of the prior authorization process?

The prior authorization request initiated by the provider was correct. The carrier’s advisory comment regarding weaning is not a direction to wean. A weaning direction can only come through the RFA-2OP process, which can only be ordered by a Workers’ Compensation Law Judge.

  1. If a medication (e.g., an opioid) is recommended per the Medical Treatment Guidelines, is it still necessary to get a prior authorization?

Opioids are considered formulary during Phase A only, and for a one-time seven-day supply only. Use of opioids outside of the Phase A one-time seven-day supply needs prior authorization. Documentation must support that the injured worker who requires long-term opioids demonstrates objective gains/maintenance of function with improved pain control consistent with the Non-Acute Pain Medical Treatment Guidelines recommendations.

  1. How many days’ supply of a formulary or non-formulary drug can I prescribe?

Phase A formulary drugs may be prescribed for up to a 30-day supply. Phase B formulary drugs may be prescribed for up to a 90-day supply.

When a prescriber submits a prior authorization request for a non-formulary medication, the request can be submitted and approved for up to a 365-day supply; however, the prescription can only be written for a maximum of a 90-day supply. If a prior authorization request for a 365-day supply is approved, the clinician can write the prescription for a 90-day supply with three refills.

Prior authorization requests for controlled substances (NYS CII – CV) can also be approved for up to a 365-day supply.  Prescribers would need to follow NYS Controlled Substances laws (e.g., NYS CIII – CV; 30-day supply with up to five refills, CIIs and benzodiazepines 30-day supply with zero refills). The 365-day supply prior authorization request could be approved, but multiple prescriptions would need to be written to encompass the 365 days.

For more information, visit the Drug Formulary Overview Page; General NY WC Formulary questions: WCBFormularyQuestions@wcb.ny.gov;

Technical support questions:

WCBCustomerSupport@wcb.ny.gov

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Program Year 2018 Open Payments Data Available for Review/Dispute through December 31, 2019
On June 28, 2019 the Centers for Medicare & Medicaid Services (CMS) published Program Year 2018 Open Payments data along with updated and newly submitted data from previous program years (2013-2017). Program Year 2018 data and newly submitted payment records are actively available for review and dispute through December 31, 2019. Learn more about reviewing and disputing public data.

Review Now

Physician and teaching hospital review of the data is voluntary, but strongly encouraged. If you have not previously reviewed the Program Year 2018 data visit https://openpaymentsdata.cms.gov/ to review the publically available data. If you believe any records attributed to you are inaccurate or incorrect in any way you may initiate a dispute and work with the reporting entity to reach a resolution. CMS does not mediate disputes.

For more information on the review, dispute and correction process visit the Open Payments resource page at: https://www.cms.gov/OpenPayments/About/Resources.html.

·       Questions – Contact Live Help Desk

Submit questions to the Help Desk via email at openpayments@cms.hhs.gov or by calling  1-855-326-8366 (TTY Line: 1-844-649-2766), Monday through Friday, from 9:00 a.m. to 5:00 p.m. (ET), excluding Federal holidays. Visit the Resources page on the Open Payments website for many of the above resources.


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RENTAL/LEASING SPACE


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
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Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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PHYSICIAN OPPORTUNITIES

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                 Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                     Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


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: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


It’s Time! Put Patients Over Paperwork


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

 

For Immediate Release
December 16, 2019

It’s Time! Put Patients Over Paperwork

December 16, 2019, Westbury, NY—A physician’s time should be spent delivering care to their patients—not on the phone with insurance companies.

“The excessive time spent attempting to achieve prior authorizations has been well-documented as a significant factor in the increasing problem of physician ‘burnout,’ said Art Fougner, MD, president of the Medical Society of the State of New York. “ We must find ways to reduce the excessive hassles that keep physicians from spending time with their patients.”

The amount of time physicians need to manage bureaucratic hassles imposed by health insurers to ensure their patients obtain needed care and medications have become intolerable.  A recent Annals Of Internal Medicine study found that a physician spent two hours on administrative tasks for every hour spent with a patient.  A just conducted study by the Medical Society of the State of New York (MSSNY) found that 43% of responding physicians and their staffs spent more than 10 hours per week managing insurer prior authorization requests alone.

Remarkably, 22% of responding physicians indicated that they and their staff spent greater than 20 hours per week on these tasks!

These administrative roadblocks don’t just take time away from delivering care; they can adversely impact patients, as well.  The survey reported that 92% of physicians indicated that prior authorization requirements at least sometimes adversely impacted their patients’ health, and 48% indicated that they frequently did.

One particular time-waster is repeating prior authorization requests that were previously approved.  94% of responding physicians, and their staff, indicated that they had to repeat a prior authorization request for care or medication that was previously approved. 48% indicated that they often had to repeat previously obtained prior authorization requests.

Even where the Legislature takes action to remediate these problems and protect patients’ access to care, there is no guarantee that these problems will be fixed. For example, the New York State Legislature and Governor Cuomo worked together to enact a law in 2016 that established criteria to allow physicians to override a health insurer’s decision to subject patients to step therapy protocols when warranted by the patient’s individual circumstances.  However, the survey reported that half the respondents to the MSSNY survey said that health plans’ override process was, at the very least, “challenging”, while 28% found the override process to be “extremely difficult”.

Remarkably, over 30% were unable to ever override a health insurer step therapy medication protocol.

“We are hopeful the insurance industry can work with their network physicians and the medical associations who represent them towards addressing these hassles,” said Dr. Fougner.  “Moreover, legislation has been advanced by Assemblyman Richard Gottfried and Senator Neil Breslin (Assembly Bill 3038/Senate bill S.2847) that would reduce the frustrations associated with prior authorization requests, including ensuring they are clinically appropriate and preventing the need to repeat what has already been authorized.  This legislation sets forth a number of important steps to reduce these obstacles that get in the way of patients getting the care they need.”

Let’s truly put patients over paperwork!

# # #

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.

 

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

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MSSNYeNews – Surprise Bills – Deal or No Deal: December 13, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
December 13, 2019

Vol. 22  Number 46


MSSNYPAC Seal


Colleagues:

As the year slowly draws to a close, Congress is still wrestling with a fix for Surprise Medical Bills. Despite your pressure and persistence, some of the Committee Chairs still favor setting benchmark rates for out of network care based on insurers’ data for in network payments. Can you say WHAT? I knew you could.

This weekend, the story broke that there was a bipartisan deal in the works to resolve the issue. However, there was just one small problem – the purported deal was an early holiday gift to the insurance companies by setting the payment at the median in-network rate. Oh, they were throwing in a form of arbitration should doctor and insurer not agree, but this would be nothing close to NY’s. Moreover, physicians could only submit one claim every ninety days. Such a deal.

As often in DC, when rumors abound, others arise to take their place.  At this juncture, there is no deal. It is committee against committee and leader against leader. Your advocacy is working, folks. In June, insurers’ benchmarking was a done deal. Apparently, thanks to you, the deal has been slow cooking for so long that it’s not well done, it’s burnt to a crisp. But that’s today. There’s still some time before we can truly say benchmarking is dead for this session. While the bill we favor, based on elements of NY’s law, is also stalled, it’s clear that no bill is better than a bad bill. The backers of benchmarking want to get this done by Friday 13th (irony?) .Many in Congress would agree that it’s better to slow down and get it right. Therefore, it’s imperative that we keep the pressure on.

One easy way you can advocate on this issue is to go here. Just enter your information and send a note to your Representative and also to Senators Schumer and Gillibrand. Many of us have been active on social media as well, advocating for our patients and colleagues, so let’s keep it up.

Make no mistake; it could still be Merry Grinchmas.

For this session, it’s The Final Countdown.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


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MSSNY Together with Physicians Nationwide Raise Concerns with One-Sided Surprise Billing Proposal
Physicians are urged to continue to contact Senators Schumer and Gillibrand, as well as their US Representative, to urge that they continue to fight for a balanced solution to help protect patients from “surprise” out of network medical bills.  Physicians can send a letter here.

Competing legislative proposals were advanced this week. MSSNY, as well as the AMA, numerous state medical associations and national specialty societies raised huge concerns with the insurance industry-friendly proposal advanced by Senator Alexander (R-TN) and Rep. Frank Pallone (D-NJ) that would provide health insurers with new incentives to drop physicians from their networks by enabling them to make payment for such surprise bills at the insurer-determined median in-network rate.  While an appeal arbitration mechanism would be available, it would practically offer little recourse for a physician to be paid above the median in-network payment because it would not permit the consideration of regional charges for these services.

MSSNY President Dr. Art Fougner issued a statement urging Congress to “go back to the drawing board”, noting that “the just announced Alexander-Pallone proposal Congress would hand market dominant health insurers a shiny new club to enable it to drop more physicians from their networks, and make it even harder for physicians to negotiate fairly with these insurers”, it would also “make it harder for hospitals to have needed on/call specialty care in their emergency departments for patients in need of this critical care.”

The statement also praised “the many members of the NY delegation, including Rep. Morelle and Senator Schumer, for their efforts to assure the passage of a far more balanced approach that protects patients’ access to timely needed care.”

On Wednesday, House Ways & Means Committee Chair Richard Neal (D-MA) and W&M Ranker Kevin Brady (R-TX) announced their own proposal to address surprise medical bills that, according to a press release “respects the private market dynamics between insurance plans and providers and first allows them to work out differences without interference. If the parties cannot come to agreement on their own, the agreement provides for a robust, impartial, and structured process to settle payment”.  However, no other information has been made available beyond this general description.

While some have speculated that this issue could be punted into January, with Congress looking for revenue for a December 20 Budget extender bill, physicians must continue to advocate for a fair solution to this issue that will not adversely impact patient access to needed care.


Governor Signs Bill Into Law to Reduce Some Prior Authorization Hassles
This week Governor Cuomo signed into law legislation (S.5328, Breslin/A.2880, Hunter) that would reduce the need to obtain prior authorization from a health insurer when a prior authorization for a related procedure has already been obtained from that insurer.  MSSNY supported this legislation and sent a letter to the Governor’s Counsel urging that this measure be signed into law.

This legislation would help to provide additional needed clarity to existing law to prevent patient inconvenience and unnecessary administrative hassles.  It would ensure that if a physician providing a treatment to a patient for which a prior authorization (PA) has already been received determines that providing an additional or related service or procedure is “immediately necessary as part of such treatment”  and would not be “medically advisable to interrupt the provision of care to the patient” in order to obtain a PA, then the insurer shall not deny the claim, except under limited circumstances.

Specific patient scenarios this legislation seeks to address include when a patient receiving chemotherapy needs to quickly receive treatment for related health issues, such as nausea, low platelet count or allergic reactions, without the need for the physician to request an additional PA from the insurance company.   We were also been made aware of several instances from the New York State Society of Orthopedic Surgeons where additional necessary health care services performed for a patient in the context of providing previously authorized arthroscopic surgery have been denied for lack of prior authorization and/or submission of different CPT codes.

The law takes effect in March.


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MSSNY Participates in Efforts to Assure Enforcement of NY’s “Step Therapy”
MSSNY Governmental Affairs staff this week participated in a roundtable discussion of patient and provider advocacy organizations to discuss issues related to the implementation of New York’s groundbreaking Step Therapy Reform law.  Adopted by the State Legislature and Governor Cuomo in 2016, it was fully implemented in January 2018.

The goal of the law is to ensure that patients have timely access to the most effective medications to treat or manage their particular condition, by assuring physicians have clearly defined criteria to quickly override a health insurer’s step therapy protocol with a minimum of hassle.  The law also requires health insurers to use evidence-based and peer reviewed clinical criteria in establishing a step therapy protocol.

A recent MSSNY survey reported that many physicians were unaware of the law’s protections.  Moreover, many other physicians reported that health plans’ step therapy override process was “challenging” or “extremely difficult”.

MSSNY has a dedicated webpage to help physicians better understand this important law and how they can effectively override these step therapy protocols when warranted by patient circumstances.  It is noteworthy that, according to DFS data, in 2018 there were only 13 attempted external appeals of a health insurer’s denial of a step therapy override request.

The group also discussed potential next steps to ensure that the law is working as intended, including arranging meetings with state regulators. MSSNY Governmental Affairs staff will continue to actively participate in efforts to ensure the law is being implemented as it was intended when it was enacted.


MSSNY Calls Upon Legislature and Governor to Prohibit the Sale of Flavored Nicotine and Tobacco Products
The Medical Society of the State of New York, working with close to 50 medical and public health organizations, called upon leadership in the New York State Legislature and the Governor to enact policies that would prohibit the sale of flavored nicotine products in e-cigarettes and tobacco products, such as cigarillos and chewing tobacco.

In December, MSSNY began meeting with members of the Governor’s staff and with key Assembly and Senator staff asking for enactment of policy either within the 2020 New York State Budget or early 2020 passage of two bills that would accomplish these important public health goals.  Assembly Bill 47A/Senate Bill 428A, sponsored by Assemblywoman Linda Rosenthal and Senator Brad Hoylman, would prohibit the sale and distributions of all flavored e-liquid, including menthol, for use in e-cigarettes.

Equally important, is Assembly Bill 8808/Senate Bill 6809, sponsored by Assemblywoman Rodneyse Bichotte and Senator Brad Hoylman, which would prohibit the sale and distribution of flavored tobacco products and accessories.  The Medical Society is urging physicians to send letters of support on these two bills to their legislators and to the Governor by going to MSSNY Grassroots Action Center (GAC) here.


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NYS Public Health and Planning Council Approve Continuation of Emergency Regulations on E-cigarettes
The Public Health and Health Planning Council’s Committee on Codes, Regulations and Legislation met on Thursday to continue emergency regulations that included requiring signage warning against the dangers of illegal products and the prohibition on the sale of electronic liquids with characterizing flavors.  The first proposal would require entities to post signage about the dangers of vaping illegal e-cigarettes liquid products. The second proposal would prohibit any individual or entity to possess, manufacture, distribute sell or offer to sell any e-liquid flavor product.

New York State Department of Health Deputy Commissioner Brad Hutton explained that the department was seeking approval from the committee to adopt the proposal to make the signage permanent. It would require retailers to post warning signs on their products.  Mr. Hutton noted that the committee had previously approved the emergency regulation prohibiting flavoring in September. Due to the court recently issuing a restraining order in preventing the department and local health departments from enforcing the ban the emergency regulation will expire December 15. Thus, the department seeks the committee’s approval to have the emergency regulation renewed for another 90 days in the same form as previously approved.


MSSNY Raises Concern to SED with Overbroad Practice Affidavit Form
MSSNY has reached out to top staff to the New York State Education Department (SED) to raise concerns with a problematic new affidavit form required to be completed when a physician practice notifies SED of its proposed formation or a practice name change.  For more information about this development, please see this “alert” prepared by MSSNY’s General Counsel, Garfunkel Wild.

Specifically, SED is requiring that new professional practice entities submit an affidavit when applying for Certificates of Authority to operate in New York State, or for professional practice entity name changes. The affidavit requires that a licensed professional who is either an owner or an authorized shareholder attest to whether the professional practice entity has any “relationship, ownership interest, affiliation or association with any other business and/or professional practice entity.” If there is such a connection, the licensed professional must name the affiliated/associated entity, state the nature of relationship, and attest that the relationship is fully compliant with all applicable rules and regulations of the New York Education Law and Business Corporation Law.

In addition to the confusion this generates, and the breadth of information being requested, there are concerns with the risk of significant penalties because of a component of the affidavit that states, “I understand that any misrepresentation or any false or misleading information in, or connection with, my application may be cause for denial, professional discipline or criminal prosecution.”

SED staff has indicated that revisions to the affidavit form are likely to be made.


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DFS Advises NY Insurers to Provide Vaping Cessation Coverage
The Department of Financial Services has issued a circular letter advising New York insurers to provide coverage for vaping cessation treatment that uses methods recommended for smoking cessation, including screening, behavioral interventions and federally approved pharmacotherapy for adults, as well as behavioral interventions for children and adolescents. Go here.


Transgender New Yorkers Less Likely to Receive HIV Treatment, PrEP
The city health department attributed the lack of HIV-negative transgender New Yorkers receiving care to misinformation circulating online, an official said at a joint hearing of City Council committees today.

Pre-exposure prophylaxis, or PrEP, is a medicine that reduces the risk of getting HIV through sex by 90 percent. It is often a free or low-cost medicine for insured people, while the uninsured will qualify for a new federal program; uninsured New Yorkers can receive PrEP through the city health department and other city services like NYC Health + Hospitals, Dr. Demetre Daskalakis, the city’s deputy health commissioner for disease control, told lawmakers on the health and hospitals committees.

“I’ve heard from a lot of our PrEP programs [that] we don’t have a lot of trans people,” Daskalakis said. “We think there is some misinformation about how PrEP interacts with hormones.”

He said he has seen advertisements falsely state the drugs interact with each other, as well as inaccurate information circulating online. Transgender individuals, regardless of status, are still less likely to receive HIV-related care.

HIV diagnoses in most groups declined in 2018, though transgender people and New Yorkers with a history of injection drug use are receiving care at lower rates, the city health department announced last month. (Politico 12/9)


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Flu is Prevalent in New York State, Health Officials Say
New York officials have declared that the flu is ‘prevalent’ in the state.” The state Department of Health said that as of Nov. 30, “there have been 3,158 laboratory-confirmed cases, 691 hospitalizations and one child death.” New York officials have declared that the flu is “prevalent” in the state.

This declaration initiates a state regulation that will require healthcare professionals who are not vaccinated for influenza to wear masks in areas where patients are present.

“Getting vaccinated remains the best way for all New Yorkers to protect against the flu, and it is vital for caregivers who come in contact with patients to get vaccinated to help prevent the spread of flu,” State Health Commissioner Howard Zucker said.

As of Nov. 30 there have been 3,158 laboratory-confirmed cases, 691 hospitalizations and one child death, according to the state Department of Health.

NYS FLU TRACKER
https://nyshc.health.ny.gov/web/nyapd/new-york-state-flu-tracker


First Time: More Women than Men Enrolled in Medical School
Women comprise the majority of enrolled U.S. medical students for the first time, according to 2019 data released December 11 by the AAMC (Association of American Medical Colleges). This progress builds on the milestone reached in 2017, when, for the first time, women comprised the majority of first-year medical students.

The proportion of women students has been rising over recent years, from 46.9% in 2015 to 49.5% in 2018. In 2019, women comprise 50.5% of all medical school students.

The number of applicants to medical schools rose by 1.1% from 2018 to 2019, to a record 53,371, and the number of matriculants (new enrollees) grew by 1.1%, to 21,869. Across applicants and matriculants, the number of women increased while the number of men declined.

The 2019 data also show that the nation’s medical schools continue to make modest gains in attracting and enrolling more racially and ethnically diverse classes, although these groups remain underrepresented in the overall physician workforce.

  • Applicants who are Hispanic, Latino, or of Spanish origin increased 5.1%, to 5,858, and matriculants from this group grew 6.3%, to 2,466.
  • The number of black or African American applicants rose 0.6%, to 5,193, and matriculants increased by 3.2%, to 1,916. Among black or African American men, applicants and matriculants increased 0.5%, and the total enrollment of black or African American men rose 3.7%, to 3,189.
  • American Indian or Alaska Native applicants grew by 4.8%, to 586, and matriculants rose 5.5%, to 230. Data tables are available here* (Dec. 11 American Assocation of Medical Colleges)

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First Time: More Americans Dying at Home Rather than in Hospitals
In 2017, 29.8 % of deaths by natural causes occurred in compared to 30.7 percent at home, according to research reported on Wednesday in the New England Journal of Medicine. That marks the first time in 50 years that a plurality of Americans were dying at home according to The New York Times.


Low-Dose Aspirin May Fail To Lower Dementia Risk Among Adults with T2D
HELIO reported, “Japanese adults with [T2D] assigned a long-term low-dose aspirin regimen did not lower their risk for dementia vs. similar adults who did not routinely take aspirin,” investigators concluded in a “post hoc analysis of the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes trial.” The findings of the 2,536-participant study were published online in Diabetes Care.


MEDICARE/MEDICAID

The New Medicare Beneficiary Identifier (MBI)
Effective 1/1/2020, the new Medicare Number, commonly referred to as the MBI, will be required for all Medicare inquiries and transactions. If you would like to learn more about the MBI, we have a section of our website with all the information you need to comply with the CMS initiative.
1. Select “Claims & Appeals” then select “Medicare Beneficiary Identifier (MBI).” Or
2. Click on the MBI scrolling banner on our home page. OR
3. Select “Learn About MBI” on our home page.
Avoid your claims being rejected. Use the MBI today.


Members Only: Year-End Car Deals You Won’t Want to Miss


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Most HICN Claims Reject – Regardless of Date Service
Use Medicare Beneficiary Identifiers (MBIs) now to avoid claim and eligibility transaction rejects. Starting January 1, 2020, regardless of the date of service on the Medicare transaction, most Social Security Number – based Health Insurance Claim Number (HICN) Medicare transactions will reject with a few exceptions.

If you do not use MBIs on claims after January 1, you will get:

  • Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber)
  • Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submission/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”

Thank you for transitioning to MBIs during the 21-month transition period, protecting your patients from identity theft.

  • You are currently submitting 87% of claims with MBIs.
  • If your patient doesn’t have their new card, give them the Get Your New Medicare Card flyer in English or Spanish.
  • Get MBIs through the MAC portals (sign up (PDF) now and after the transition period. You can also find the MBI on the remittance advice.

See the MLN Matters Article (PDF) for more information on getting and using MBIs.

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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                 Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                     Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


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: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY Urges Congress to Go Back to Drawing Board on Surprise Bill Legislation


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

 

For Immediate Release
December 10, 2019

 

MSSNY URGES CONGRESS TO GO BACK TO DRAWING BOARD ON
SURPRISE BILL LEGISLATION

 

Statement attributable to:
Art Fougner, MD
President, Medical Society of the State of New York

“The billion dollar health insurance industry must have been really good this year to have been given this holiday gift from Representative Pallone and Senator Alexander.

Physicians across New York and across the country agree with the goals of legislation to protect patients from surprise out of network medical bills. However, with the just announced Alexander-Pallone proposal Congress would hand market dominant health insurers a shiny new club to enable it to drop more physicians from their networks, and make it even harder for physicians to negotiate fairly with these insurers. It would also make it harder for hospitals to have needed on/call specialty care in their emergency departments for patients in need of this critical care.

The proposal fails to provide the balance that New York’s acclaimed surprise billing law achieved, which protected patients from these bills while fairly balancing the interests of insurers and physicians. New York’s law has saved consumers hundreds of millions of dollars and has not had any adverse impact on the NY health insurance premiums.

We thank the many members of the NY delegation, including Rep. Morelle and Senator Schumer, for their efforts to assure the passage of a far more balanced approach that protects patient’s access to timely needed care.

Bottom line – Congress needs to go back to the drawing board.”

# # #

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.

 

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

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MSSNYeNews: December 6, 2019 – Progressive or Regressive

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
December 6, 2019

Vol. 22  Number 45


MSSNYPAC Seal


Colleagues:

NY State faces a significant budget deficit as 2020 approaches. Assembly Speaker Heastie knows it. Senate Leader Stewart Cousins knows it. Governor Cuomo knows it. This promises to be a Dickensian winter of discontent. Our Medical Society stands as it has always stood – ready to help.

One contentious area has been medical liability. Our governor at his birthday event announced that NY is the most progressive state in the country as he recounted a litany of accomplishments. However, what he failed to mention is that in the arena of medical liability, NY is the most regressive state in the country. NY pays out annually more than the next two highest states put together. NY’s liability environment is so toxic that in the 1980’s, in order to keep physicians’ practicing, NY began providing an excess layer of malpractice insurance.

Our state government perennially rails against waste, fraud, and abuse in the Medicaid system. Yet Albany refuses to address the obvious waste, fraud and abuse that is our medical liability system. By enacting even modest reforms, hundreds of millions of hard-earned taxpayer dollars could be reclaimed by the Medicaid system by disincentivizing the defensive practices that do nothing to enhance patient care.

Albany wants to fight climate change yet continues to drop lumps of coal into New Yorkers’ stockings every year. I say we embrace climate change – let’s change Albany’s medical liability climate once and for all.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


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It’s Crunch Time – Please Make Sure Congress Doesn’t Let the Insurance Industry Write the  “Surprise Bill” Solution
As Congress reaches a critical juncture about whether to act on legislation to address “surprise” out of network medical bills, it is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution that protects patients’ access to needed care, and does not grant huge new powers to the health insurance industry.  By clicking here, you can send a letter, and tweet at your legislators.

This week U.S. Rep Joe Morelle (D-Rochester) authored an op-ed in The Hill that made the case for federal legislation to address surprise medical bills based on New York’s model using an independent dispute resolution mechanism, and in opposition to an approach that would base payment on an insurer-determined median in-network payment.

Also this week, MSSNY sent a letter to the Congressional delegation to address some of the inaccurate statements about the impact of New York’s law. In particular, we highlighted that the New York DFS has commented on multiple occasions that there has been no adverse premium impact of New York’s surprise bill law.  In the May report from Georgetown University analyzing New York’s law, it was noted that “state regulators report that there has not been, as yet, an indication of an inflationary effect in insurers’ annual premium rate filings.”.

Moreover, in a webinar hosted by Yale University professor Zach Cooper with NYDFS staff, it was noted that New York’s law “at least in the first years, was helping to save money”, and that it has “never been raised by any of the plans…as any significant cost driver in making premiums go up.”

It is clear why.  The balance in New York’s law results in a dynamic where the dispute resolution is rarely used.  From 2015 to 2018, there were just over 2,500 decisions, as compared to the over 7 million visits to New York emergency departments each year.   A recent DFS report found that the law saved consumers over $400 million and reduced out-of-network billing by 34%.

Even the health insurance industry has praised New York’s approach.  In a recent statement in support of legislation to extend New York’s law to out of network hospitals, the New York Health Plan Association (which includes representatives of the largest insurance companies in the country) commented that “The existing Independent Dispute Resolution process has worked well to ensure reimbursements for emergency services are fair and reasonable while holding individuals harmless.

Large market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not let Congress make this worse.  Please contact your Senators and Representatives today!


Listen to this Podcast to Hear Why You Need to Be in Albany on March 4
Please plan to be in Albany on March 4, 2020 for Physician Advocacy Day to hear from key health care policy leaders and to meet with your local legislators!  To register, click here.

Want to learn more about why you should come to the State Capitol.  Listen here to a 15-minute podcast featuring Suffolk County Medical Society President Dr. Richard Schoor, Suffolk County Medical Society Executive Director Dr. Aaron Kumar, and MSSNY Senior Vice-President Moe Auster discussing the importance of physician advocacy, including participating in the Albany Lobby Day.


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Dutchess County Medical Society Physician Leader Praises Goal, Raises Concerns at Legislative Single Payor Hearing
On November 25, Poughkeepsie orthopedic surgeon and Dutchess County Medical Society Past President Dr. William Barrick delivered testimony to New York State Senate and Assembly Health Committee members at a Kingston hearing examining a proposal to create a single payor health care system in New York State.  Dr. Barrick’s testimony at the hearing can be viewed here, at the 7:32 mark.

Dr. Barrick’s testimony praised the goals of the New York Health Act legislation to reduce insurance hassles and expand coverage while also raising the significant challenges inherent in implementing such a massive system.  At one point, his testimony elicited a comment from Senate Health Committee Chair Gustavo Rivera regarding what the fee schedule of this system would likely be if this legislation were to be enacted, to which Senator Rivera characterized as “above Medicare”.

Dr. Barrick’s comments regarding possible prior authorization requirements prompted Assembly Health Committee Chair Richard Gottfried to praise MSSNY and the New York County Medical Society for engaging in a constructive dialogue, including highlighting specific areas of concern in the far-reaching proposal.  As a result, changes were made to the legislation including limiting prior authorization requirements and providing stronger collective negotiation rights for physicians. Dr. Barrick also raised the importance of liability reform as an essential component if legislation were enacted to create a single payor system.

MSSNY President Dr. Art Fougner previously testified at a May hearing in Albany, and New York County Medical Society Past-President Dr. Scot Glasberg testified at a Bronx hearing on this topic.


Data Exchange Incentive Program (DEIP) Step-By-Step
The Data Exchange Incentive Program (DEIP) offers a one-time incentive to help providers offset the cost of connecting to the SHIN-NY via a Qualified Entity (QE). Click here to view a  DEIP step-by-step document that will help physicians know what to expect regarding the DEIP process and timeline.


Hospital Groups Sue HHS to Block Price Transparency Rule
Four organizations representing hospitals and health systems across the nation sued HHS Dec. 4, challenging a final rule that requires hospitals to disclose the rates they negotiate with insurers beginning in 2021.

The American Hospital Association, the Association of American Medical Colleges, the Children’s Hospital Association, and the Federation of American Hospitals filed the lawsuit in the U.S. District Court for the District of Columbia. The groups argue that HHS lacks statutory authority to require public disclosure of individually negotiated rates between commercial insurers and hospitals. The lawsuit further alleges that the rule violates the First Amendment because it requires “highly confidential” negotiated rates to be disclosed.

“America’s hospitals and health systems stand with patients and are dedicated to ensuring they have the information needed to make informed health care decisions, including what their expected out-of-pocket costs will be,” Rick Pollack, president and CEO of the AHA, said in a press release. “Instead of giving patients relevant information about costs, this rule will lead to widespread confusion and even more consolidation in the commercial health insurance industry. We stand ready to work with CMS and other stakeholders to advance real solutions for patients.”

Under the final rule, issued Nov. 15, hospitals will be required to disclose the standard charges, including payer-specific negotiated rates, for all items and services. Hospitals that fail to publish the negotiated rates online could be fined up to $300 a day.
(Becker’s Hospital Review, 12/5)


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FDA Raises New CBD Concerns
FDA in a Consumer Update revised last week raised new safety concerns about products containing cannabidiol (CBD), particularly CBD-containing foods. In addition, FDA last week sent warning letters to 15 Companies that the Agency said are illegally marketing CBD Products.


HHS Moves to Provide HIV Prevention Drug to the Uninsured
HHS today launched a program to provide HIV prevention or PrEP drugs to an estimated 200,000 uninsured people at risk of HIV.

Officials intend to use Truvada that will be donated by Gilead Sciences in an annual arrangement through 2030. HHS Secretary Alex Azar said the department will cover the costs of dispensing the treatment through next March. After that, CVS, Rite Aid and Walgreens will donate pharmacy dispensing services.

The announcement comes nearly a year after President Donald Trump in his State of the Union address vowed to eliminate domestic HIV transmissions by 2030.

HHS has requested $291 million from Congress to support Trump’s plan. Both the House and Senate have committed to the HIV strategy, and Azar said officials are working to wrap funding into a short-term spending patch if fiscal 2020 appropriations measures aren’t finalized.

“We do need this money to get this moving,” Azar said.


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Deaths from Alcohol-Related Liver Disease at Highest Levels Since 1999
According to Reuters (11/29), CDC data revealed that “U.S. deaths from alcohol-related liver disease (ALD) are at their highest levels since 1999 and have risen every year since 2006 in nearly every racial, ethnic and age group.”

After analyzing “causes of death for people aged 25 and older in the two decades since 1997,” investigators “found that 2017 had the highest rates of death from ALD, at 13.1 per 100,000 deaths in men and 5.6 per 100,000 in women,” which “compares to 1999 ALD mortality rates of 10.6 per 100,000 in men and 3.3 per 100,000 in women.” In particular, “mortality rates and recent increases in ALD diagnoses were…pronounced among middle-aged adults, Native Americans and non-Hispanic whites,” the study found. The findings were published online in the American Journal of Gastroenterology.


Health Foundation of Western/Central NY’s Health Leadership Program
The Health Foundation for Western and Central New York is now accepting applications from leaders in western and central New York who are interested in participating in Cohort 10 of the Health Leadership Fellows Program. The Fellows program is designed for executives and leaders from health-related non-profit organizations, safety net organizations and public agencies that address the needs of older adults and young children impacted by poverty.

Applications can be submitted online here.

The deadline to apply for the Health Leadership Fellows Program is Friday, April 3, 2020. Interviews will be held throughout the spring, and the program will begin in November 2020. For those interested in learning more about the program, the Health Foundation will hold the following informational webinar sessions. Log-in information for the webinars will be posted on the Fellows web page at a later date.

  • February 13, 2020 at 2 pm
  • March 10, 2020 at 11 am

More than 300 leaders in western and central New York have graduated from Health Leadership Fellows since the program began. Taking what they have learned from the expert faculty, residential sessions, leadership assessments and coaching sessions, fellows have used new information, relationships and ideas to improve health care for people in our regions.

Questions? Visit the Health Leadership Fellows page on our site, check out our FAQ sheet or email Fellows Program Director Nancy Blaschak at nblaschak@hfwcny.org.


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California Surgeon: Prison Time for Role in $580M Billing Fraud
An orthopedic surgeon was sentenced to 30 months in federal prison Nov. 22 for his role in a healthcare fraud scheme that resulted in the submission of more than $580 million in fraudulent claims, mostly to California’s worker compensation system, according to the Department of Justice.

Daniel Capen, MD, was sentenced more than a year after pleading guilty to conspiracy to commit honest services fraud and soliciting and receiving kickbacks for healthcare referrals. He was one of 17 defendants charged in relation to the government’s investigation into kickbacks physicians received for patient referrals for spinal surgeries performed at Pacific Hospital in Long Beach, Calif.

Dr. Capen received at least $5 million in kickbacks for referring surgeries to Pacific Hospital and for referring services to organizations affiliated with the hospital. He allegedly accounted for $142 million of Pacific Hospital’s claims to insurers between 1998 and 2013, according to the Justice Department.

In addition to the prison term, Dr. Capen was ordered to forfeit $5 million to the federal government and pay a $500,000 fine. Becker’s Hospital. Review

Subject: Continuous Recruitment for NYS DUR Board Membership


Fed Legislation: States Must Maintain a DUR program and Establish a DUR Board The NYS Medicaid DUR Board provides recommendations to the Department of Health associated with establishing clinical standards for Medicaid’s pharmacy program. The composition of the DUR Board can be found on pages 1 & 2 of the Bylaws: https://www.health.ny.gov/health_care/medicaid/program/dur/docs/bylaws.pdf

Responsibilities of the DURB include:

  • The establishment and implementation of medical standards and criteria for the retrospective and prospective DUR program.
  • The development, selection, application, and assessment of educational interventions for physicians, pharmacists and recipients that improve care.
  • The collaboration with managed care organizations to address drug utilization concerns and to implement consistent management strategies across the fee-for-service and managed care pharmacy benefits.
  • The review of therapeutic classes subject to the Preferred Drug Program.

CVs associated with interest in becoming a DUR Board member are accepted continuously and can be submitted to the DUR Board mailbox at dur@health.ny.gov. If no vacancies exist, CVs will be kept on file for consideration once a position becomes available. Questions on membership and candidacy can be directed to the DUR Board Member Liaison, Robert Sheehan, at dur@health.ny.gov or 518-486-3209.

For more information about the NYS Medicaid DUR Board please visit: https://www.health.ny.gov/health_care/medicaid/program/dur/


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WORKERS COMP

Important News About WC Authorization/Re-Registration

Back in November 2017, MSSNY notified members that the WCB was updating its directory in 2018 and all WC authorized physicians had to re-register –

New Health Care Provider Registration Coming Soon

The Workers’ Compensation Board (Board) has initiated a registration process to update and maintain a current list of medical providers who are authorized to treat injured workers. The goal of this process is to enable an injured worker to easily and accurately identify Board-authorized medical providers.

Registering

You will be notified in November when registration opens for Board-authorized medical providers. Authorized providers are asked to register with the Board and update their office address(es) and contact information by January 15, 2018. This registration process will be an ongoing initiative every two to three years.

Medical providers who have not registered by January 15, 2018 will:

  • be removed from the public directory of Board authorized providers, and
  • become ineligible for the Board’s disputed bill process.

Creating an Account in the New York State Health Commerce System (HCS)

The Board will use the existing New York State Health Commerce System (HCS) for this registration process. For the initial registration and for future updates to your practice information, you will need to have an HCS account. If you don’t already have one, you can view directions to create an account on the New York State Department of Health website.

Q. If a WC physician did not re-register with the WCB to update the physician directory, what happened?
A. The physician was dropped from the directory of authorized WC physicians.

Q. What will occur moving forward?
A. Anyone who did not re-register with the WCB since 2018 will be dropped from WC authorization on or about 1/1/20. If a WC authorized physician doesn’t register by 1/30/20 their authorization status will be terminated.

Q. What if a physician wants to keep his/her WC authorization status?
A. Please have the doctors complete the registration process, click the link provided:
http://www.wcb.ny.gov/content/main/hcpp/Health_Provider_Registration_Instructions.pdf

Back in November 2017, MSSNY notified members that the WCB was updating its directory in 2018 and all WC authorized physicians had to re-register –


CME

MSSNY Podcast: DPT Vaccine
According to the CDC Provisional Pertussis Surveillance Report, there were 345 confirmed cases of pertussis in New York State in 2018.  There is currently a case in Montgomery County, and in October 2019 Jefferson County had an outbreak.  If pertussis is present in a community, it is possible for fully vaccinated people of any age the contract this highly contagious disease.  Be sure to learn more by listening to MSSNY’s podcast on the Tetanus, Diphtheria & Pertussis vaccine here.

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RENTAL/LEASING SPACE


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
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Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                 Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                     Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

NYS Corrections Personnel Ad

Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


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: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY Ready to Work with Governor and Legislature on Medicaid Budget Gap


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

 

For Immediate Release
December 3, 2019

MSSNY Ready to Work with Governor and Legislature on Medicaid Budget Gap

Need to Work Towards Proposals to Rein in System Costs that Also Protect Patients’ Ability to Receive Timely and Quality Care

Comprehensive Medical Liability Reform IS Healthcare Reform

December 3, 2019, Westbury, NY— Physicians across the state of New York stand ready to work with the Governor and the Legislature to address our enormous Medicaid Budget gap.  However, we must be careful to make sure steps are not taken to further impair patient access to care by creating additional incentives for physicians NOT to participate in New York’s Medicaid program.

A recent Kaiser Family Foundation Report demonstrates that New York remains having one of the lowest Medicaid to Medicare physician payment ratios in the country.

“We suggest one reform from the original Medicaid Redesign Team be revisited,” said Art Fougner, MD, president of the Medical Society of the State of New York.  “NY should enact comprehensive medical liability reform.  New York’s physicians and hospitals continue to incur, by far, the highest liability costs in the country, far surpassing more populous states such as California and Texas.”

In fact, a recent report by  Leverage Rx showed that in 2018, New York once again had the highest cumulative medical liability payouts of any state in the country, 85% more than the state with the second highest amount (Pennsylvania); the highest per capita liability payment; and, 22% more than the second highest state (Pennsylvania).

“Medical liability reform is an essential component of efforts to reduce unnecessary healthcare spending. Defensive practices increase healthcare costs without improving outcomes,” said Dr. Fougner.  “While estimates vary as to the extent of these costs, multiple studies demonstrate many physicians feel compelled to perform low-value additional tests, consults and procedures in order to defend against a possible future lawsuit. More than budget neutral, medical liability reform would result in real budget dollar savings. In short, liability reform is healthcare reform.”

The Medical Society of the State of New York stands ready to work with all parties to work towards responsible proposals to rein in system costs that also protect our patients’ ability to receive timely and quality care.

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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.

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

 

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