November 15, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 15, 2019

Vol. 22  Number 43


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Colleagues:

This past week, I learned that pharmacies in the Bronx were either out of stock of opioids or on “back order.” This seemed hard to believe but one neurologist recounted his experience in trying to find a pharmacy carrying Percocet for his patient with severe paroxysms of sympathetic nerve pain. In exploring further, he had obtained a memo from a health organization suggesting that opioid manufacturers were loathe to ship supply to NY State because of the opioid excise tax recently enacted.

This particular organization suggested that the medications would be obtainable via a rather circuitous route via their own central distribution center.

This, of course, would be little help for this particular patient or for many who legitimately need narcotic analgesia. Despite the opioid crisis, pain relief is still a quality metric and pain is still the “fifth vital sign.” Measures in place, however well-intended, have put patients and physicians in a bind. Pain must be relieved but the relief is often difficult to obtain. And when the analgesics in question are out of reach, is it so hard to consider that patients might seek alternative means to relieve that pain?

Therefore never send to know for whom the bell tolls.
It tolls for thee.
John Donne

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

Arthur Fougner, MD
MSSNY President


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We Need Your Data
At November’s MSSNY Council meeting, Dr. Sana Block expressed concerns on behalf of physicians who are finding it difficult for patients to obtain medically needed prescriptions for pain.  He explained that pharmacies are not filling prescriptions for opioids when needed for patients with chronic pain.  Other Councilors stated that they have experienced difficulty for patients obtaining pain medications following surgery.  Anecdotal information is fine; but, to bring this to the attention of powers that might be able to address this problem, we need your data.

To help us help you, please download the MSSNY Hassle Factor Form.  Complete the form, letting us know if you have experienced difficulty in obtaining medically needed pain meds for you patients.

In Section C of the form, please indicate the name of the pharmacy.  If you have experienced problems with multiple pharmacies, please use multiple forms.  In addition, please identify the nature of the problem, such as the drug is out of stock; the pharmacy recommends a different drug, etc.  The completed form can be emailed to RxHassles@mssny.org or faxed to: 516-282-7093 or 516 282-7099 or 516-282-7098.


It’s Crunch Time – Please Make Sure Congress Adopts a Fair Solution to Surprise Medical Bills
 With just 6 weeks left in the year, Congress is continuing to have extensive discussions about 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 to this issue that protects patients’ access to needed care, and does not grant huge new powers to already market dominant insurers.  By clicking here, you can send a letter, and tweet at your legislators.

Please remind them of the successes of New York’s law.  In September, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.   According to a May Georgetown University report, there has not been any adverse premium impact attributable to our law.

At the same time, please remind them of the grave concerns that have been raised about insurance company friendly legislation (H.R.3630 Pallone/Walden, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.  When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not give them any more power.  Please contact your Senators and Representatives today!

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Physician Action on Key Health Care Legislation Needed
As of today, there were still 375 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just 6 weeks left in the year, the flurry of bill signings/vetoes has begun.  This week, MSSNY sent letters to the Governor in support of legislation to extend for 2 years the “nursing home exception” to mandatory e-prescribing (A.1034-A/S.4183) and to permit ophthalmologists to delegate administration of eye drops to assistants (S.4469-B/A.3822-D).

Physicians can quickly and easily send a letter to the Governor here on the following bills:

  • 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 Partial Prescription Fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • 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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NYeC: Shin-NY Reduced Healthcare Costs by Over $160 Million Annually
According to a recent preliminary analysis conducted by New York eHealth Collaborative (NYeC) use of the Statewide Health Information Network for New York (SHIN-NY) is reducing unnecessary healthcare spending in New York by $160-$195 million annually, which includes significant savings to Medicaid and Medicare.  To see NYEC’s white paper on this analysis click here.

The results of the analysis indicate that the savings are based on the current size and use of the network, using methodology developed by the Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for purposes with recent related federal proposals.

The report noted that, “The approximated savings and value are based and consistent with results of existing peer reviewed academic studies pointing to the value of using HIE generally. HIE has been associated with 50% reduction in rates of hospital readmission, 26% reduction in the rate of emergency department admissions, 35% reduction in the repeat of repeat imaging procedures and 10% lower 30-day readmission rate among Medicare fee-for-service beneficiaries”

The SHIN-NY is a statewide network that facilitates secure and confidential electronic sharing of patient data across the healthcare system to improve outcomes. It is comprised of and connects regional health information networks (RHIOs) that allow participating healthcare professionals, with patient consent, to quickly access and share comprehensive patient health information and medical records. Statewide, 100 percent of hospitals and over 100,000 healthcare professionals are connected to the SHIN-NY, which facilitates the exchange of health information (HIE) for patients across the state.

MSSNY representatives have been in regular communication with NYeC staff to work towards enhanced physician participation in their local RHIOs and the SHIN-NY.  They have touted HIT as a fundamental tool in positively impacting patient care and outcomes, but also have raised concerns that this technology, for many physicians, is not easily compatible with patient care delivery.  Physicians should be aware of programs such as the Data Exchange Incentive Program (DEIP) that helps subsidize the cost of connecting to your local RHIO.


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New York Is 1st State to Publicize Hospitals with C. Auris Cases
New York health officials on Nov. 13 published a list of healthcare organizations that have treated patients for the deadly fungus Candida auris, making it the first state to share this information with the public, reports The New York Times.

The list includes 64 hospitals, 103 long-term care homes, three hospice units and one long-term care hospital. It does not detail how many cases occurred at each organization.

The New York State DOH released the list in response to a rapid increase in C. auris cases. Health officials said the information is intended to boost transparency for consumers and motivate hospitals to stop C. auris from spreading further, according to NYT. The CDC has reported 836 cases of C. auris nationwide as of Aug. 31. Of these, 388 have occurred in New York.

To view the state’s full list of healthcare organizations reporting C. auris cases, click here. (Becker’s Hospital Review, Nov. 14)


Vaping Illness Leads to Lung Transplant at Henry Ford Health System
Henry Ford Health System this week announced that it performed what the health system believes is the first ever double-lung transplant for a patient with a vaping-related illness. Hassan Nemeh, who led the surgical team at Henry Ford, said the patient’s lungs were unlike anything he had seen in his 20-year career, noting that the 17-year-old patient’s lungs were scarred, rigid, inflamed, marked with dead spots. (New York Times, 11/12)


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Hospital Safety Grades
The Leapfrog Group last week released its Fall Leapfrog Hospital Safety Grades, giving about one-third of hospitals an “A,” but giving more than 40% of hospitals a “C” or lower. Leapfrog also published an infographic that looked at the rates of avoidable deaths at hospitals for each grade. (Source: HealthLeaders Media, 11/7)


CDC: Five Leading Causes of Death
U.S. residents living in rural areas of the country were more likely to die from preventable causes than those living in urban areas from 2010 to 2017, according to a CDC Morbidity and Mortality Weekly Report released last week. Overall, the researchers found heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke ranked as the five leading causes of death in the United States in 2017.


Survey Finds Many PCPs Don’t Discuss How Hair Care Can Be a Barrier to Exercise for Some Black Women
Findings published in the Journal of the American Board of Family Medicine suggests “primary care providers often don’t realize that hair care can be a barrier to regular exercise for some black women.” A survey of primary care physicians “found an overwhelming majority talk to their female African American patients about the importance of exercise. But three-quarters said they don’t talk with these patients about hair care, which can be a barrier to vigorous workouts.”


Families May Feel Better About End-Of-Life Care in ICU if Granted Simple Wishes
Researchers found in a small study that “families of dying patients may feel better about end-of-life care in the ICU if they are granted simple wishes, like letting the patient taste a favorite meal or use a blanket from home.” The findings were published in the Annals of Internal Medicine


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Hospital Price Transparency Rule Could Come Before Year’s End
CMS could release a rule by the end of 2019 on a proposal that hospitals disclose payer-specific negotiated rates, a White House adviser said. CMS is delaying action on the price transparency proposal, excluding it from the 2020 Medicare Outpatient Prospective Payment System final rule released Nov. 2.

The proposal, which CMS released July 29, includes provisions in a price transparency executive order signed this year by President Donald Trump. It would require hospitals to publish all “standard charges,” including the hospital’s gross charges and negotiated rates with payers for an item or service, online in a machine-readable format.

Under the rule, hospitals also would be required to publish the rates they negotiate with insurers for 300 services consumers are likely to shop for in a searchable and consumer-friendly manner. Hospitals that do not comply would be penalized.

The proposal builds on a current federal rule that requires hospitals to publish a list of their standard charges on the internet, but excludes negotiated rates with payers.

The American Hospital Association has come out against the proposal, saying it is “the wrong approach” and “would introduce confusion and fuel anticompetitive behavior among commercial health insurers.” Federal contends the proposal could significantly reduce healthcare costs. (Becker’s Hospital CFO Report Nov.11)


(E/M) Visit Frequently Asked Questions (FAQs) Physician Fee Schedule (PFS)
This document addresses Frequently Asked Questions (FAQs) regarding documentation and payment for evaluation and management (E/M) visits under the Medicare Physician Fee Schedule (PFS).

  1. What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?

The CY 2019 PFS final rule expanded current policy for office/outpatient E/M visits starting January 1, 2019 to provide that any part of the chief complaint (CC) or history that is recorded in the medical record by ancillary staff or the beneficiary does not need to be re-documented by the billing practitioner. Instead, when the information is already documented, the billing practitioner can review the information, update or supplement it as necessary, and indicate in the medical record that she or she has done so.

This is an optional approach for the billing practitioner, and applies to the chief complaint (CC) and any other part of the history (History of Present Illness (HPI), Past Family Social History (PFSH), or Review of Systems (ROS)) for new and established office/outpatient E/M visits.

To clarify terminology, we are using the term “history” broadly in the same way that the 1995 and 1997 E/M documentation guidelines use this term in describing the CC, ROS and PFSH as “components of history that can be listed separately or included in the description of HPI.” This policy does not address (and we believe never has addressed) who can independently take/perform histories or what part(s) of history they can take, but rather addresses who can document information included in a history and what supplemental documentation should be provided by the billing practitioner if someone else has already recorded the information in the medical record.


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Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line!
Revalidate before your due date to avoid a hold on your Medicare payments and deactivation of your Medicare billing privileges.

There are several ways to find your revalidation due date:

Generally, the due date will remain with the provider/supplier throughout subsequent revalidation cycles. So you will not have to wonder about the due date the next time you need to revalidate.

NOTE: Unsolicited applications received seven months prior to the revalidation due date will be returned to the provider.

Need assistance? Providers and suppliers can register for our provider enrollment webinars by either using the following links, Part A/Part B or by visiting the NGSMedicare.com website. The webinars below can be found under the Education Tab by selecting Webinars, Teleconference and Events.

  • Provider Enrollment Revalidation Overview
  • Getting Access to PECOS
  • Submitting Revalidation via PECOS Application
  • Submitting Revalidation via CMS-855A Paper Application for a Part A providers
  • Submitting Revalidation via CMS-855B Paper Application for a Part B providers
  • Submitting Revalidation via CMS-855I Paper Application for a Part B providers
  • Let’s Chat about Provider Enrollment Revalidation

PECOS: View and Manage Reassignments through Group Enrollment

Webinars

“When is the Flu not the Flu?” CME Webinar on November 20; Registration Now Open
Flu season is upon us, but there are myriad other illnesses that present similarly.  Be sure to brush up on these by signing up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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

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


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RENTAL/LEASING SPACE


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)

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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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: November 8, 2019 – Stop Digging

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 8, 2019

Vol. 22  Number 42


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Colleagues:

How did things ever get so far? This is the existential question confronting physicians every day. One of the key reasons why so many physicians report burnout or even depression is the feeling of a loss of professional autonomy. Sadly, the only group of professionals licensed to practice medicine have so little control in the way they actually practice. We are burdened by data entry, billing, coding, keeping up with new unfunded mandates, and all the while seeing their practices barely making payroll or even taking out second mortgages to keep their offices open. As said previously, it’s not about profitability anymore but about viability.

There’s an old saying – when you find yourself in a deep hole, stop digging. Going along to get along is no longer working. It’s time for a change – but how? Here’s one suggestion. Stop digging. It’s time to say, as Roberto Duran famously said, “No mas.” The decline in fortune did not start yesterday. This did not happen overnight. Therefore, the road back will not be a short one. But we must start. It will, for sure, be a long and arduous journey. But we must start. There will be bumps along the road but we must start. As the infamous Chairman put it, “A journey of a thousand miles begins with but a single step.”

So let’s take that single step. Get together. Get active. Support your fellow physicians. We need all the help we can get.

Stop digging.

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

Arthur Fougner, MD
MSSNY President

To all physicians who served in the United States Armed Forces,
 we salute you and thank you for your service!


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Congress Finalizes 2020 Medicare Payment Rule and 2021 E&M Changes with Potentially Significant Redistributive Effects
On November 1, 2019, CMS released its 2020 Medicare Revisions to Payment Policies under Physician Fee Schedule and Other Changes to Part B Payment Policies final rule.  For a brief summary from the American Medical Association as to the highlights of the nearly 2,500 page rule, click here.

Among the highlights:

  • The Medicare Physician Fee Schedule conversion factor will be $36.09 (CY 2019 conversion factor was $36.04), which reflects a budget neutrality adjustment for reductions in relative values for individual services in 2020.
  • Geographic Adjustment Factor (GAF) Increases. Each of the 5 New York Medicare payment locality will receive a slight GAF bump for 2020 and 2021, as follows
    • Manhattan +1.3% for 2020; +2.6% for 2021
    • NYC Suburbs/Long Island +1.5% for 2020; +2.9% for 2021
    • Poughkeepsie/Northern NYC Suburbs +1.7% for 2020; +3.4% for 2021
    • Queens +1.6% for 2020; +3.3% for 2021
    • Upstate NY +0.2% for 2020; +0.4% for 2021.
  • Effective January 1, 2021, CMS will adopt the CPT guidelines to report office visits based on either medical decision making or physician time. With CMS adopting the RUC work recommendations for the office visit codes, the work value increases represent $3 billion in redistributed spending, resulting in a 3% reduction in the conversion factor.   Moreover, CMS adopted the RUC physician time recommendations. Coupled with the work value increases and some modifications in direct practice costs, these changes lead to an additional $2 billion in redistributed spending, resulting in an additional 2% across-the-board reduction.
  • CMS departed from the RUC recommendations in two ways that further intensify the specialty redistribution impact. CMS will implement an add-on payment for office visits for primary care and patients with serious or complex conditions. This proposal redistributes an additional $2.6 billion, resulting in an additional 3% reduction to the Medicare conversion factor.

CMS states that although they have no specialty restrictions on reporting new code GPC1X, they assume that the following specialties will report this add-on code with 100% of their office visits, essentially making this a bonus payment for: family medicine, general practice, internal medicine, pediatrics, geriatrics, nurse practitioner, physician assistant, endocrinology, rheumatology, hematology/oncology, urology, neurology, obstetrics/gynecology, allergy/immunology, otolaryngology, interventional pain management, cardiology, nephrology, infectious disease, psychiatry, and pulmonary disease.

It is estimated that the add-on payment for GPCIX will be approximately $18 per visit.  Therefore, while each of these specialties are expected to see sizable increases in 2021, those expected to see sizable decreases as a result of E&M changes include: anesthesiology (-7%); cardiac surgery (-8%); colon & rectal surgery (-4%); emergency medicine (-7%); gastroenterology (-4%); general surgery (-4%);  neurosurgery (-6%); ophthalmology (-10%); plastic surgery (-5%); radiology (-8%); thoracic surgery (-7%) and vascular surgery (-5%)


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Council Notes — November 7, 2019
Nancy Nankivil, AMA Director of Practice Transformation, and Kyra Cappelucci, AMA Project Administrator, Practice Transformation, presented Practice Transformation Initiative: Solutions for Increasing Joy in Medicine. The AMA has partnered with the Physicians Foundation and several state medical societies to create a practice transformation framework to reduce physician burnout by furthering research focused on evidence-based interventions; collaborate and learn from health systems committed to assessing clinician satisfaction and its correlation to workflow design; and to foster a network or organizations implementing evidence-based solutions, sharing best practices and driving change to improve the joy in medicine.

Council approved the following:

  • MSSNY will become involved in the AMA/Physician Foundation’s Practice Transformation Initiative and will seek appropriate resources for this endeavor.
  • Approval of 2020 Legislative Program
  • MSSNY will file a FOIL request for all documents from the New York Department of Health regarding ZocDoc’s business model exempted from application of NYS Education 6530 laws.

ZocDoc changed its business model to charge practices a per-patient booking fee effective April 1, 2019. The NY DOH indicated that ZocDoc can move forward with the model despite concerns of violations with referral fees; some NY DOH emails regarding ZocDoc have been redacted in a Freedom of Information Law (FOIL) request.

  • MSSNY will seek legislation to create a physician-led healthcare cooperative in New York as one pathway for achieving legally permissible state supervised collective negotiation rights for physicians.
  • Strategies to Improve NYS Immunization Rates in Children: MSSNY will urge that New York State provide incentives to parents/guardians who vaccinate their children as a strategy to improve vaccine uptake in school-aged children and advocate that New York State develop programs to pay stipends to community health workers as a strategy to improve vaccine uptake in school-aged children.
  • Healthcare Cooperative Act: MSSNY will seek legislation to create a physician-led healthcare cooperative in New York as one pathway for achieving legally permissible state supervised collective negotiation rights for physicians.
  • Physician Owned Distributorships: MSSNY supports the concept of Physician Owned Distributorships (PODs), provided that they are operated consistently with generally accepted principles of physician ethical conduct (such as the AMA Code of Medical Ethics), including assuring that patients and other potential contractors are sufficiently notified of the physician’s financial interest in such POD.
  • Study of State and National Health Service Corps Needs: MSSNY will advocate for the expansion of the Doctors Across New York Physician Loan Repayment Program, support the development of State funded loan forgiveness and repayment programs for physicians, and advocate for scholarships/grants for medical students who plan to work in the state.
  • Manpower Assistance for Medical Students: MSSNY supports the concept of continuing federal manpower financial assistance, including grants and long term, low interest loans for medical students.
  • Patient-Driven Groupings Model (PDGM): MSSNY will work with the AMA to monitor implementation of the PDGM methodology to determine whether this new program will impose additional administrative burdens on physicians and/or impede patients from receiving needed home care services. Should it be determined that this new model is creating these issues, these concerns will be conveyed to CMS and Congress for remediation.

Complaints Re Pharmacies Not Honoring Scripts: WE NEED YOUR DATA
At yesterday’s MSSNY Council, Dr. Sana Block expressed concerns on behalf of physicians who are finding it difficult for patients to obtain medically needed prescriptions for pain.  He explained that pharmacies are not filling prescriptions for opioids when needed for patients with chronic pain.  Other Councilors stated that they have experienced difficulty for patients obtaining pain medications following surgery.  Anecdotal information is fine; but, to bring this to the attention of powers that might be able to address this problem, we need your data.  To help us help you, please download the MSSNY Hassle Factor Form. Complete the form, letting us know if you have experienced difficulty in obtaining medically needed pain meds for your patients.

In Section C of the form, please indicate the name of the pharmacy.  If you have experienced problems with multiple pharmacies, please use multiple forms.  In addition, please identify the nature of the problem, such as the drug is out of stock; the pharmacy recommends a different drug, etc.  The completed form can be emailed to comments@mssny.org or faxed to: 516-282-7093 or 516 282-7099 or 516-282-7098.


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Gov. Signs Law: Death Certificates to Specify Opioid-Involved Overdose
Following Governor Cuomo’s press release on November 5, 2019, the EDRS Team would like to reinforce the importance of complete and accurate Cause of Death data on all death certificates, including those deaths related to opioid overdose. See the Governor’s press release here. Capturing this data assists State and federal government agencies analyze and pinpoint community impacts and work toward combatting epidemics, such as the opioid crisis.

The EDRS Team would like to take this opportunity to let you know about the recently launched self-paced online course, Mastering the Cause of Death in the 21st Century, for physicians, medical examiners, coroners, and other medical certifiers. This course provides medical data providers with tips to get the best cause of death determination, including opioid related deaths. Participants may be eligible for AMA PRA credit for completing this course and its final assessment.

According to the state Department of Health’s Opioid Annual Data Report for 2018, the rate of opioid-overdose deaths in 2016 was 15.1 per 100,000 people, about three times higher than it was in 2010.

The new law takes effect immediately. Participants may register now by visiting  https://lms.udutu.com/LMSPortal/Account/LogOn?OrgCode=EDRS and using the organization code:  EDRS and select Create New Learner Account.  If you have additional questions related to the new drug specificity requirements or the EDRS implementation, call (518) 408-0243 or kira.cramer@health.ny.gov.  For more information on registration for the course, contact Zina Adams at zina.adams@health.ny.gov or 518-474-4317. Please see the flyer here.


MSSNY President Delivers Testimony to NY State Senate on Potential Harms of Electronic Cigarettes and Vaping
MSSNY President Dr. Arthur Fougner, MD, provided testimony to the New York State Senate public hearing held to examine the safety and potential harms of electronic cigarettes and vaping, especially among school-aged youth. (View full testimony here: 1Hr and 5 mins)

Dr. Fougner praised Governor Cuomo and the New York State Health Department for its emergency executive action to ban the sale of flavored e-cigarettes in the state (http://www.mssnyenews.org/press-releases/mssny-supports-call-to-ban-menthol-flavored-e-cigarettes/).  He also noted MSSNY’s long-standing support for legislation to ban flavored tobacco products, menthol and e-cigarettes and formally codify these provisions into law.

Specifically he noted that, “While evidence exists that adult smokers who completely substitute vaping for traditional smoking reduce their exposure to many of the toxic chemicals and carcinogens present in combustible tobacco cigarettes, e-cigarettes are not risk-free and are not approved by the Food and Drug Administration (FDA) as a quit-smoking aid. The bottom line is neither smoking nor vaping is safe, and people who do not smoke or vape should not begin to do so.” 

Dr. Fougner also urged strong caution regarding proposals to legalize the recreational use of marijuana since it appears from a number of sources that the vast majority of cases of vape-related lung illness are linked to the vaping of THC. Since the FDA has launched an ongoing investigation, he urged that “any proposed adult-use cannabis program, especially with a vaporizer product, be put on hold until completion of that investigation.”


Stolen Flash Drive: U of Rochester Med Center Pays $3M HIPAA Settlement
The University of Rochester Medical Center has agreed to pay $3 million to HHS’ Office for Civil Rights to settle potential HIPAA violations, according to a Nov. 5 news release. In 2013, URMC filed a data breach report with the OCR stating that an unencrypted flash drive had been stolen. Following the notice that patients’ protected health information could have been exposed, the OCR offered technical assistance to URMC.

Then in 2017, URMC disclosed that an unencrypted laptop had been stolen. An OCR investigation found URMC failed to conduct enterprise-wide risk analysis, implement security measures sufficient to reduce risk and vulnerabilities to a reasonable and appropriate level, utilize device and media controls, and employ a mechanism to encrypt and decrypt electronic protected health information.

“Because theft and loss are constant threats, failing to encrypt mobile devices needlessly puts patient health information at risk,” said Roger Severino, OCR director. “When covered entities are warned of their deficiencies, but fail to fix the problem, they will be held fully responsible.”

Along with paying the $3 million settlement, URMC will also undergo a corrective action plan, including two years of HIPAA-compliance monitoring.


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JAMA: People Turning To Social Media Platforms for STD Diagnosis
The Reddit community r/STDs “encourages its more than 10,000 members to share stories, concerns and questions about sexually transmitted diseases – and according to a study published Tuesday, they have increasingly done so.”

The study, published in the Journal of the American Medical Association, found that “the number of posts significantly increased over time, from just eight in 2010 to 3,375 in 2018.” Investigators “focused on a random sampling of 500 posts” and found over “half – 58 percent – asked the site’s members for a diagnosis,” while “nearly a third of those included photos of the apparent STD in question.”

Medscape reports investigators conclude, “requests for crowd-diagnoses were frequent, with most receiving a reply within hours, and many of these requests were for second opinions after obtaining an original diagnosis from a health care professional.”


Workers Comp

Workers’ Compensation Formulary
The NYS Workers Compensation Board Drug Formulary (NY WC Formulary) becomes effective in four weeks (12/5/19) for new prescriptions.

Training materials related to the NY WC Formulary, as well as an updated version of the NY WC Formulary (effective 11/5/19), can be found on our webpage:

Drug Formulary Overview

Information and resources related to the Board’s Medical Portal, which is used to access the prior authorization system, could be found on the Medical Portal Overview webpage. For more information or assistance Visit http://www.wcb.ny.gov/content/ebiz/drugformulary; General Formulary questions:

Subscribe for email notifications at http://www.wcb.ny.gov/notify


 

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CDC

CDC: Preventing Adverse Childhood Experiences Can Reduce Chronic Disease Experiencing traumatic things as a child puts you at risk for lifelong health effects, according to a body of research. The CDC’s new report confirms this, finding that Americans who had experienced adverse childhood experiences or ACEs, were at higher risk of dying from five of the top 10 leading causes of death.

And those who’d been through more bad experiences — such as abuse or neglect, witnessing violence at home or growing up in a family with mental health or substance abuse problems — were at an even higher risk. According to the agency, women and minorities—like African Americans, American Indians, and Alaskan Natives—were more likely to experience four or more kinds of harm while they were kids. The conclusions were drawn from surveys taken by adults between 2015 and 2017.


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Webinars

How to Maximize Success & Maintain Full Control & Ownership of Your Practice
MSSNY invites you to tune in on Tuesday, November 12 from 7PM-8PM for a webinar featuring Roy Bejarano, Co-Founder & CEO of Scale Physician Group, and Andrew Blustein, Partner/Director and Vice Chair of Garfunkel Wild, P.C. Scale Physician Group provides expert non-clinical advisory and management services to independent and private equity owned physician groups, empowering physician leaders to build modern healthcare delivery platforms that yield better results.

Roy will share the lessons and best practices learned from his experience working with over 1,200 physicians across the country. Andrew will introduce Roy and facilitate a Q&A session following the presentation. Special thanks to Garfunkel Wild, P.C., who serves as MSSNY’s General Counsel, for bringing us this program. Access the flyer here.


“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Flu season is upon us, but there are myriad other illnesses that present similarly.  Be sure to brush up on these by signing up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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

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


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MSSNY President-Elect Dr. Bonnie Litvack Delivers Testimony to NY Senate on Veterans Mental Health
President-Elect Dr. Bonnie Litvack, MD provided testimony to the New York State Senate Committee on Mental Health and Developmental Disabilities at its public hearing to examine veterans’ mental health.

Dr. Litvack spoke about MSSNY’s “Veterans Matters” educational program which is a part of the Veterans Mental Health Training Initiative (VMHTI) that is funded through an appropriation in the New York State budget.  She noted that the program seeks to insure our veterans can receive the care they need and deserve in New York State. She thanked the committee for their foresight in fighting for continued funding for the program.

Dr. Litvack highlighted that roughly 1.64 million troops were deployed in Operation Enduring Freedom and Iraqi Freedom and had prolonged exposure to combat which took a toll on veterans psychologically.  Additionally she noted that “11% of New York State veterans began serving after 9/11 and this group in New York State is expected to reach 22% by 2025”. Dr. Litvack quoted a 2010 RAND survey on NYS veterans which found that 22% of post 9/11 veterans have a probable mental health diagnosis, 16% screened positive for depression and PTSD.

Dr. Litvack spoke briefly about the VMHTI program which looks to educate the community and healthcare providers on veteran specific mental health issues which includes; PTSD, depression, suicide, traumatic brain injury. Dr. Litvack emphasized the importance of asking individuals whether or not they are veterans in order to help them connect to various organizations that can help them. Dr. Litvack concluded by stating that the program is both timely and critical, emphasizing that the healthcare community needs to be educated on the importance of mental health as it relates to veterans.

MSSNY faculty have participated in numerous presentations at institutions and county medical society meetings all across the State of New York.  Please contact Mhoffman@mssny.org if you would like to have a presentation at your hospital or next county medical Society meeting.

Dr. Litvak at State Senate

MSSNY President-Elect Dr. Bonnie Litvack testified this week before the Senate Mental Health Committee regarding MSSNY’s Veterans mental health training initiative

 

Classified

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)

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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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Revisions to Payment Policies under Physician Fee Schedule and Other Changes to Part B Payment Policies Final Rule

On November 1, 2019, the Centers for Medicare and Medicaid Services (CMS) released the CY 2020 Revisions to Payment Policies under Physician Fee Schedule and Other Changes to Part B Payment Policies final rule.

The AMA is continuing to review the rule and will work with our colleagues in the federation to further analyze these policies in the coming weeks. Attached is a summary of some of the policies CMS finalized in the rule.

Please see an AMA summary of these Medicare payment rules here.

 

MSSNY President Delivers Testimony to NY State Senate on Potential Harms of Electronic Cigarettes and Vaping


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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
November 4, 2019 

MSSNY President Delivers Testimony to NY State Senate on Potential Harms of Electronic Cigarettes and Vaping

November 4, 2019, Westbury, NY— MSSNY President Dr. Arthur Fougner, MD, today delivered testimony to the New York State Senate examining the safety and potential harms of electronic cigarettes and vaping, especially among school-aged youth.

In particular, he praised Governor Cuomo and the New York State Health Department for its emergency executive action to ban the sale of flavored e-cigarettes in the state (http://www.mssnyenews.org/press-releases/mssny-supports-call-to-ban-menthol-flavored-e-cigarettes/).   He also noted MSSNY’s long-standing support for legislation, such as that sponsored by Senator Brad Hoylman and Assemblymember Linda Rosenthal, to formally codify these provisions into law.  This legislation will take on even greater importance if the Governor’s action is not upheld by the courts. 

Specifically he noted that “While evidence exists that adult smokers who completely substitute vaping for traditional smoking reduce their exposure to many of the toxic chemicals and carcinogens present in combustible tobacco cigarettes, e-cigarettes are not risk-free and are not approved by the Food and Drug Administration (FDA) as a quit-smoking aid. The bottom line is neither smoking nor vaping is safe, and people who do not smoke or vape should not begin to do so.”

Dr. Fougner also urged strong caution regarding proposals to legalize the recreational use of marijuana since it appears from a number of sources that the vast majority of cases of vape-related lung illness are linked to the vaping of THC. According to the NYS Department of Health we know that those individuals who have developed some of the cases of EVALI were patients who only vaped black market marijuana which had been laced with Vitamin E acetate.  Since the FDA has launched an ongoing investigation, he urged that “any proposed adult-use cannabis program, especially with a vaporizer product, be put on hold until completion of that investigation.”

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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: November 1, 2019 – Medicine’s Popeye Moment

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 1, 2019

Vol. 22  Number 41


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Colleagues:

Do you recall the days when physicians dictated every manner in which Medicine was practiced?

I do. Today, those days seem just a lovely dream – like Disney World in the rear view. It feels as if every new day brings some new aggravation. EHRs, Billing, Coding, RVUs, MOC, I-STOP occupy a larger portion of a physician’s day than does family dinner. Each year brings with it the promise of a new unfunded mandate. Patient care was once the physician’s raison d’etre. Now, it’s an inconvenient truth.

Physicians are always the good guys, the nice guys, the ones who, when reimbursements are cut, are reduced to plaintively requesting, as Oliver Twist once did, “Please sir, I want some more.“ Medicine is the only US enterprise that regularly receives a cost of living decrease. I’ve said it before— that everyone thrives on the indulgence of physicians’ good will.

If you’re older like me, you’ll remember that moment in every Popeye cartoon when our Sailor, finally at his limit, reached for his spinach, exclaiming, “That’s all I can stand ‘cause I can’t stand no more.”

Physicians are notorious whiners, which usually results in our not being winners. So if you want to start winning, I’ll make one suggestion. Your Medical Society’s annual Lobby Day is March 4, 2020. It’s time to take that passion to Albany. Let those that would make laws affecting your practice, your family and your patients hear your voices, your concerns, your angst.

Or would you rather just settle into Kubler-Ross’ Acceptance and simply shuffle off to watch the sunset?

Your call.

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

Arthur Fougner, MD
MSSNY President


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NYCMS Testifies at Legislative Single Payor Hearing
On October 23, New York County Medical Society Past-President and MSSNY Legislative Committee member Dr. Scot Glasberg testified at a Bronx NYS Assembly-Senate Health Committees hearing examining proposals to create a single payor system in New York State. To view Dr. Glasberg’s testimony and Q&A with Committee Chairs Richard Gottfried and Gustavo Rivera, click here and scroll to the 1:25 mark.

While MSSNY and NYCMS continue to support a multi-payor health insurance system and oppose a single payor system, both MSSNY and NYCMS have engaged with legislators to highlight the positives of such legislation but also the many areas of concern effecting patient care delivery with moving to such a system.  During the hearing, Assemblyman Gottfried praised NYCMS and MSSNY 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.  During the hearing Q&A, Dr. Glasberg highlighted that, even with the changes to the legislation, deep concerns still remain including with the ambiguity of the bill’s patient care payment standard, as well as the risk of steep cuts that could be needed to address Budget constraints.

There have been multiple hearings around the State examining the single payor issue, with the testimony overwhelmingly in favor of legislation.  Earlier this year, MSSNY President Dr. Art Fougner testified at an Albany hearing on this issue (click here and here.)
Dr. Fougner’s testimony noted that while there are aspects of a single payor system that are appealing, such as the potential for administrative simplification, MSSNY remains concerned that the good intentions of the sponsors of this proposal may not be how the NY Health system will ultimately operate, particularly when they must respond to situations where anticipated tax revenues do not meet spending projections.

He also noted that continued promotion and expansion of the varied programs to provide health insurance coverage for New York’s uninsured and underinsured is MSSNY’s preferred approach. This legislation will be a major source of discussion during the upcoming 2020 Legislative Session.


Bill Enacted to Provide Greater Clarity to Medical Record Disbursement When Physicians Retire
The Governor this week signed into law a bill (S.5367/A.2349) that sets forth procedures to follow when a physician or other health care practitioner ceases delivering patient care in New York State. The goal of the legislation is to address the often-asked question of where patient records should be sent when a physician or other care provider retires from medical practice or moves to another state.

Specifically, the legislation requires the practitioner, at least 30 days prior to ending their practice, to make a good faith effort to notify the practice’s “current patients” of the impending closure and of the patient’s right to request their patient information or medical records be sent to the health care provider, facility, or practitioner of their choice or returned to the patient.  It also clarifies that the provisions of the bill do not apply to situations where a physician’s practice is acquired or merged with another entity, and the physician continues to deliver care to their patients.

It also notes that the bill does not affect the application of other relevant statutes regarding medical record retention such as provisions that set forth the time periods that physicians are required to retain patient medical records, and provisions that require physicians to provide copies of medical records to other medical practitioners in response to a patient request.

However, MSSNY pointed out to the Governor’s office that the bill does contain an ambiguity in that, as written, it could be interpreted to require retiring health care practitioners to provide patients with the original medical records rather than providing copies of the medical records.  That would be in conflict with the laws noted above instructing physicians to provide patients with copies of medical records and retaining the original records.  MSSNY will work with the New York State Department of Health to assure there is clear guidance to physicians as to how this is to be applied.


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Physician Action Needed on Health Bills to be Considered by Governor
As of today, there were still nearly 500 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just a few months left in the year, the flurry of bill signings/vetoes has begun.

Physicians can quickly and easily send a letter to the Governor here on the following:

  • Support Ending 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 https://p2a.co/jPbHbaC
  • Support Partial prescription fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking https://p2a.co/YRf6CsU
  • 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 https://p2a.co/HPhmZqB

High Rate of Thyroid Cancer in New York is on Staten Island
The rate of thyroid cancer on Staten Island is 67% higher than other boroughs and 69% higher than rates across the rest of the state, according to data released by the state health department this month. Thyroid cancer is the most common cancer among women aged 20-34 in New York State and on Staten Island, and it is also the most common cancer among women aged 35-39 on Staten Island. The state could not determine why the rate is higher for Staten Island residents than other New Yorkers, and ruled out exposure from the terror attacks on the World Trade Center and its aftermath. The summary found that the number of responders — mostly men — made up a small portion of the population and could not explain the elevation in thyroid cancer among women. Other environmental tests proved inconclusive or not significant to the uptick in thyroid cancer rates. (Politico, Oct. 30)


Medicare Fraud Could Mean More Deaths/Hospitalizations
A retrospective study finds that patients who receive care from physicians who commit Medicare fraud or patient abuse have a higher rate of mortality and hospitalization than those who are treated by doctors without those records. Looking at data from more than 8,200 patients who were treated by those who would turn out to have been defrauding Medicare or engaging in other harmful behavior, researchers found that these patients had between a 13%-23% higher risk of dying during the study follow-up period than those who were not treated by physicians who engaged in risky behavior. Patients treated by those found to be engaging in some kind of illegal activity also had between 11%-30% higher rates of emergency hospitalizations. In addition to the financial savings to Medicare, identifying perpetrators could also improve patients’ health, the authors suggest. (STATMorning Rounds News Oct. 29


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Legislation Will Provide $100M for ED Suicide Prevention
Reps. Eliot Engel and Gus Bilirakis on Monday introduced legislation to curb the country’s rising suicide rate. The law would allocate $100 million in federal funding over a five-year period to emergency departments to help identify and treat individuals at a high risk of suicide.

The money would be earmarked for training emergency department clinicians to identify high-risk individuals and developing programs to coordinate care and follow-up services, Engel’s office said. It also would go toward supporting the recruitment and retention of behavioral health professionals who specialize in treating those experiencing suicidal ideation and the development of telehealth and other approaches.

Suicide rates in New York have increased by about 30% since 2000, Engel, a Democrat who represents New York’s 16th congressional district, encompassing parts of the Bronx and Westchester County, said in a statement. The legislation created with Bilirakis, a Republican from Florida, would “leverage the skills of nurses and emergency department professionals who are trained in identifying and treating at-risk individuals to help end this crisis and save lives.”

Suicide is the 10th leading cause of death in the country and was responsible for about 47,000 deaths in 2017, according to the Centers for Disease Control and Prevention. Suicides and suicide attempts cost the country about $70 billion per year in lifetime medical and work-loss costs. — Health Pulse Oct.29


New York’s MRT 1115 Waiver: Downstate & Upstate Public Comment Day
The Department of Health (DOH) recently held two public comment days—one in NYC and one in Syracuse – regarding its application to the federal government to extend until 2024 the existing DSRIP waiver.  You can view the webcast of both Public Comment Days here.

Phil Alotta from DOH gave a grief summary of the 1115 Waiver as well as the concept paper that was submitted for the DSRIP waiver extension. The 1115 waiver is designed to permit New York to use a managed care delivery system to deliver benefits to Medicaid recipients, create efficiencies in the Medicaid program, and enable the extension of coverage to certain individuals who would otherwise be without health insurance.

Greg Allen from DOH highlighted that potentially preventable admissions (PPA) were reduced by 21%, potentially preventable readmissions (PPR) were reduced by 17% and PPR/PPA costs per member were reduced by 14%.   Mr. Allen also highlighted future DSRIP goals which include; the expansion of medication-assisted treatment into primary care and emergency department settings, partnerships with the justice system, primary care and behavioral health integration and addressing social determinants of health through community partnerships.

Additionally, he emphasized the need to expand practices to high need areas and populations that includes an effort in reducing maternal mortality, bettering children’s population health and focusing on long-term care reform. He emphasized the departments need for continued improvements and investments in workforce flexibility, addressing the opioid epidemic and having interim access insurance fund.  He added that these efforts must be seen through a multi-payer lens and by continuing New York’s investment in the Social Determinant of Health (SDH) Networks as well as aligning performance based measures with value-based payment models.

The vast majority of public comments came from individuals representing different Community Based Organizations (CBO’s) who voiced their support for DSRIP and also urged the department to invest more in the social determinates of health as improving children’s behavioral health and developing a better infrastructure for CBO’s when working with DSRIP.  While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as physician practices, MSSNY and many other groups have raised concerns that there is still insufficient funding being made available to physicians and other community care providers who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.



Symposium on Woman's Health Ad Banner


In New York, Oral HPV Fairly Common in Sexually Active Adolescent Girls
Oral human papillomavirus (HPV) is not uncommon among sexually active adolescent females, and the vaccine appears to be protective, suggests a JAMA Network Open study.

Nearly 1300 sexually active females aged 13 to 21 in New York City had oral samples tested for HPV at baseline. Roughly 6% tested positive for oral HPV. Nearly 2% were positive for oncogenic types, while 0.2% had types included in the quadrivalent vaccine. Risk for oral HPV decreased with increasing time since their first sexual experience, “potentially reflecting the highlight transient nature of HPV infection,” the authors write.

Patients who received at least one dose of the vaccine had an 80% lower risk for oral HPV types included in the quadrivalent vaccine, relative to unvaccinated participants, although the authors note that few patients were unvaccinated. In addition, the presence of cervical HPV was associated with oral HPV.

The authors conclude: “This study’s findings suggest that … HPV vaccination is associated with a significant decrease in detection of HPV types in the oral cavity.”

Commentators say the results are similar to what is observed in adult patients.

JAMA Network Open article
JAMA Network Open commentary
Background: NEJM Journal Watch Women’s Health coverage of evidence of herd immunity against oral HPV (NEJM Journal Watch subscription required)


TO: New York State Residents, Fellows, and Medical Students
MSSNY Announces the 15th Resident/Fellow/Medical Student Poster Symposium 

When:    Friday, April 24, 2020
Where:   Westchester Marriott
Tarrytown, New York
Time:      1:30 pm – 4:00 pm

Click here for detailed guidelinesDeadline for abstract submission is 4:00 pm, Monday, February 3, 2020. We welcome your participation. Participants must be MSSNY members, and membership is free for first-time resident/fellow members, and for all medical students.  Join online.


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Research Suggests Gender Discrimination Contributes to Burnout Among Female Surgical Residents, Physicians
A study published in the New England Journal of Medicine indicates “sexual harassment, gender discrimination and verbal abuse are contributing to high rates of burnout among female physicians.” A survey study of over 7,400 surgical residents, 40 percent of which were female, showed “approximately 42% of female surgical residents reported burnout, compared to 36% of male surgical residents.”

Reuters (10/28) reports in a separate study of 26 primary care physicians, nurse practitioners, and clinical directors in a rural part of California, researchers found “women and minority health professionals are sometimes driven out of rural communities by the discrimination and harassment from colleagues.” The interview-based study showed “many of the healthcare professionals who were female, nonwhite and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment and hostility from their colleagues.” The findings were published in JAMA Network Open.


Former JUUL Exec Claims Company Knowingly Sold Tainted Nicotine Pods
The New York Times (10/30) reports Siddharth Breja, the former senior vice president for global finance at JUUL Labs, has filed a federal lawsuit claiming the company knowingly “sold at least one million contaminated mint-flavored nicotine pods – and refused to recall them when told about the problem.” Breja “claims he was fired on March 21 in retaliation for whistle-blowing and objecting to the shipment of the contaminated and expired pods and other illegal and unsafe conduct.”

The Washington Post (10/30) reports the lawsuit “comes as Juul announced the layoffs of 500 employees, among them a handful of executives, including chief financial officer Tim Danaher.”

On its website, NBC News (10/30) reports Breja claims JUUL CEO Kevin Burns once said, “Half our customers are drunk and vaping,” in response to concerns that customers would notice the poor quality of the tainted pods. Breja also said the company has a culture of “disregard for the law, public safety, and public health.”


Docs Laud E/M Proposal, Blast Pay Cuts in Physician Fee Schedule Rule
As the comment period for the proposed 2020 Medicare Physician Fee Schedule rule drew to a close on Friday night, CMS received over 30,000 comments, including letters from major industry groups commending the agency for proposing to do away with a policy that would collapse evaluation and management (E/M) payment rates.

CMS decided in the 2019 Medicare Physician Fee Schedule final rule to consolidate E/M levels 2 through 5 into a single payment rate by 2021 to reduce the administrative burden associated with Medicare documentation requirements. Facing staunch industry criticism, the federal agency proposed earlier this year to walk back on the policy, which many industry groups are now praising. “CMS recognized that its earlier plan for E/M visits would have disrupted care patterns and may have created other unintended consequences. Having the separate codes helps acknowledge the difference in resources in treating patients with more complex care needs,” the American Medical Group Association’s (AMGA) president and CEO Jerry Penso, MD, MBA, said in a statement.

Finalizing the proposal to keep separate E/M payment rates would also avert unintended consequences, such as forcing “medical practices to reduce their Medicare patient volume or limit the medical issues addressed during one office visit due to lower reimbursement rates for more complex visits,” MGMA stated in its comments. ( RevCycle Intelligence, September 30, 2019)


Heavy Soda Consumption Associated with Hip Fracture after Menopause
Older women who drink more soda may be more likely to suffer hip fractures than their counterparts who consume little to no soda,” researchers concluded after examining “data on soda consumption, bone health and fractures for more than 70,000 women who were 69 years old on average.” The findings were published online in the journal Menopause.


“When is the Flu not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am.  This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar herePlease click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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

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


Classified

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
_______________________________________


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


NYS Corrections Logo

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)

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Council November 7, 2019

AGENDA
MSSNY Council Meeting
Thursday, November 7, 2019, 9:00 a.m.
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590

A.  Call to Order and Roll Call

B.  APPROVAL of the Council Minutes of September 19, 2019

C.  New Business (All Action & Informational Items)

    1. President’s Report
      a.  Presidential Appointments to the 2020 Nominating Committee
                 (For Council Approval)
            b. New Eighth District Councilor, Mark Jajkowski, MD (For Council Approval)

2.  Board of Trustees Report – Dr. Sam Unterricht will present the report (handout)

3.  Secretary’s Report – Dr. Frank Dowling will present the report

4.  MLMIC Update  –  Dr. John Lombardo will present a verbal report

5.  AMA Delegation Report – Dr. John Kennedy will present a verbal report

6.  MSSNYPAC Report – Dr. Thomas Lee will present the report (handout)

7.  MESF Update – Dr. Thomas Madejski (nothing to report at this time)

8.  County Federation Report – Dr. Aaron Kumar will present the report

9. Commissioners/Councilors (Action Items – (For Council Approval)
    Commissioner of Governmental Relations, Fregery Pinto, MS, Commissioner
1. Legislative & Physician Advocacy Committee, Paul A. Pipia, MD, Chair
(For Council Approval)

a. 2020 Legislative Program
b. Resolution 70 – Physician Fees and Single Payer
c. Resolution 72 – Healthcare Cooperative Act
d. Resolution 117 – Parental Alienation Syndrome in Custody Cases
e. Resolution 122 – Physician-Owned Distributorships
f. Resolution 201 – Study of State and National Health Service
 Corp Needs

2.  Long-Term Care Subcommittee Resolution (For Council Approval)
     a. Patient-Driven Groupings Model (PDGM)

3. Commissioner of Science & Public Health, Joshua Cohen, MD, Commissioner

  a. Committee on Infectious Diseases
  Resolution 166 – Strategies to Improve NYS Immunizations Rates in Children
Presented by Dr. Cohen/Dr. Fogarty/ Pat Clancy (For Council Approval)

b. Quality Improvement and Patient Safety Committee & Physician Wellness and Resiliency Committee
    Joint Resolution Supporting MSSNY Involvement in AMA’s Practice Transformation
Presented by Dr. Charles Rothberg, Co-Chair, Physician Wellness Committee
(For Council Approval)

10.  Presentation – Physician Wellness
Presented by:
Ms.  Nancy Nankivil, Director, AMA’s Practice Transformation
Ms. Kyra Cappelucci, Project Administrator, Practice Transformation at
American Medical Association

D. Reports of Officers (Verbal Reports)

1. Office of the President – Arthur C. Fougner, MD
2. Office of the President-Elect – Bonnie L. Litvack, MD
3. Office of the Vice-President – Joseph R. Sellers, MD
4. Office of the Treasurer – Mark J. Adams, MD – Financial Statement for the
period 1/1/19 to 9/30/19 (For Council Approval)
5. Office of the Speaker – William R. Latreille, Jr., MD

E.  Reports of Councilors (Informational)

  1. Kings & Richmond Report – Adolph B. Meyer, MD
  2. Manhattan & Bronx Report – Joshua M. Cohen, MD
    ACTION ITEM – Investigation of Impact of ZocDoc’s
    Business Practice on Violation of Public Accommodation Laws
    (For Council Approval)
  3. Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
  5. Suffolk County Report – Linda S. Efferen, MD
  6. Third District Branch Report – Brian P. Murray, MD
  7. Fourth District Branch Report – Gregory Pinto, MD
  8. Fifth District Branch Report – Howard H. Huang, MD
  9. Sixth District Branch Report – Robert A. Hesson, MD
  10. Seventh District Branch Report – Janine L. Fogarty, MD
  11. Eighth District Branch Report – Edward Kelly Bartels, MD
  12. Ninth District Branch Report  – Thomas T. Lee, MD
  13. Medical Student Section Report – Peter Joo
  14. Organized Medical Staff Section – Stephen F. Coccaro, MD
    (no report submitted)
  15. Resident & Fellow Section Report – Catherine E. Steger, DO
    (no report submitted)
  16. Young Physician Section Report – L. Carlos Zapata, MD
    (no report submitted)

F. Commissioners (Informational Items)
1.   Commissioner of Communications, Maria A. Basile, MD, MBA
      Report from the Division of Communications

2.    Commissioner of Continuing Medical Education, Mark J. Adams, MD
       Report from the Office of CME

3. Commissioner of Governmental Relations, Gregory Pinto, MD
   a. HIT Committee Minutes, October 3, 2019
b. Long Term Care Minutes, September 26, 2019
c. Quality Improvement & Patient Safety Minutes,
September 25, 2019

 4. Commissioner of Membership, Parag H. Mehta, M
           PowerPoint Presentation – “Harnessing the Science of Persuasion” (handout)

 5. Commissioner of Science & Public Health, Joshua M. Cohen, MD
a.  Addiction and Psychiatric Medicine Minutes, October 4, 2019
b.  Bioethics Minutes, September 27, 2019
c.  End of Life Care Minutes, September 13, 2019
d.  Heart, Lung & Cancer Minutes, October 16, 2019
e.  Infectious Diseases Minutes, October 17, 2019
f.   Preventive Medicine & Family Health Minutes, October 10, 2019
g.  Physician Wellness & Resilience Minutes, October 18, 2019

   6. Commissioner of Socio Medical Economics, Howard H. Huang, MD
          (No written report submitted)

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

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

I. Report of the Alliance, Helena Mirza, Co-President
    Alliance Report

J. Other Information/Announcements

  1. Firearms Safety Letter to Michael Dowling, Northwell
  2. Surprise Bill Sign-On Letters
  3. Prior Authorization(PA) Sign-On Letter
  4. American Board of Internal Medicine Letter
  5. Physician Wellness Letter to Commissioner Zucker
  6. Scope of Practice Sign-on Letter
  7. 2020 PFS Final Rule Summary

K. Adjournment

 

 

 

 

MSSNYeNews: October 25, 2019 – Surprises

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 25, 2019

Vol. 22  Number 40


MSSNYPAC Seal


Colleagues:

It’s not the surprise that matters, it’s how you react to it.
Innocent Mwatsikesimbe, Author

This week’s epistle concerns two unrelated surprises. The first is a new law about the performance of pelvic examinations under anesthesia (see story below). For years, one way medical students learned to perform this necessary skill was in the operating room immediately prior to surgery. Concerns were raised (and rightly so) by women who later learned of this unwanted “surprise,” no matter how clinical it might have been. In 2011 (reaffirmed in 2017), ACOG released a Committee Opinion that explicitly states: 

Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery.

Still, sporadic reports indicated that this practice was ongoing which then prompted legislative action. Hospital legal teams are now huddling to draft appropriate consent language. In the meantime, the best way to deal with this (as always) is simply to discuss the matter with your patient ahead of time, eliminating any surprise.

Surprise Bills

As for the second surprise, Surprise Bills are still the subject of furious debate in Congress. Because of your efforts and those of medical societies across the country, the prospect of handing over to insurers, the power to set the benchmark for all fees is no longer a done deal. In fact, the House Bill HR 3630, which would do just that, has but 3 cosponsors while HR 3502, which resembles New York’s law, has 100. Of course, this fight is far from over as the insurers are waging their fight on many fronts. One thing you can do is go here to send a letter to your members of Congress. I urge everyone to do so as this issue is critical to all physicians.

So are these two surprises really unrelated? Perhaps in a way, they are not. There are indeed wheels within wheels. Individually, we may not be able to exert sufficient pressure but together, with everyone’s hand on the needle, we may move it sufficiently to achieve the desired end.

Once again, I leave you with Benjamin Franklin:

We must indeed all hang together or, most assuredly, we shall all hang separately.

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

Arthur Fougner, MD
MSSNY President


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Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still nearly 500 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just a few months left in the year, the flurry of bill signings/vetoes has begun.

Physicians can quickly and easily send a letter to the Governor here on the following:

  • Support ending 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 here.
  • Support partial prescription fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • 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 here.

New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
As recently reported, Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. The law was designed to respond to reports of medical students being asked to perform such exams, without express patient consent, as part of their medical training in teaching hospitals.

Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

  • the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
  • the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has  already given oral or written consent; or
  • the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

It would also make violation of such provision an element of physician misconduct. Several other states have passed similar laws expressly banning this practice without clinical justification.  MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.  The American College of Obstetricians & Gynecologists have issued an ethical opinionthat “Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery”. The law takes effect on April 4, 2020.


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Physicians Welcome to Provide Public Comments on DSRIP at 10/30  in Syracuse Public Forum
Next Wednesday, October 30, the New York State Department of Health (NYSDOH) will be holding a Public Comment forum for New York’s 1115 waiver  at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.   A similar forum was held today in New York City.

The open comment period for both forums will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Specifically, the NYS Health Department is seeking from the federal government a continuation of DSRIP for the 1-year balance of the 1115 waiver ending on March 31, 2021 and to extend an additional 3 years from April 2021 to March 31, 2024.   Click Here to view the Amendment Proposal.

Background on the DSRIP Program

The roughly $6 billion Delivery System Reform Incentive Payment (DSRIP) program provides incentives for Medicaid providers to create and sustain an integrated, high-performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving  the quality of care, improving the health of populations and reducing costs.

The DSRIP program promotes community-level collaboration and aims to reduce avoidable hospital use by 25% over the 5-year demonstration period. A total of 25 Performing Provider System (PPS) were established in different regions of the State to implement innovative projects across three domains: system transformation, clinical improvement and population health improvement (New York’s Prevention Agenda).

While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as community physician practices, some have raised concerns that not enough funding has been made available to physicians who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.


NYDOH to Offer Free Coaching, Nicotine Replacement Therapy to Vapers
The New York State DOH has announced new services for e-cigarette users seeking help to stop vaping, including free quit-coaching and nicotine replacement therapy through the New York State Smokers’ Quitline. The quitline is available for New Yorkers of all ages, including adolescents.

The DOH added the service to the quitline to address the growing need to help users of e-cigarettes break their dependence on vaping. The New York “Department of Health announced Monday that it has expanded services available through the New York State Smokers’ Quitline in response to a nationwide outbreak of vaping illnesses that has killed 33 people and hospitalized nearly 1,500 more. Those interested can contact the quitline by calling 1-866-NY-QUITS (1-866-697-8487) any day of the week beginning at 9 a.m. A specially trained quit coach will assess users of e-cigarettes for type of product, frequency of inhalation, and dependence.

Based on the assessment, a user may be eligible to receive complimentary patches, gum, lozenges or a combination of these products. Quit coaches also will help users develop a personalized quit-plan and guide them to consult their health care professionals and health insurance plans for additional stop-smoking medication and support.

Similar to the eligibility guidelines for cigarette users, users of e-cigarettes who qualify for the quitline’s free NRT will receive a starter kit with a minimum two-week supply and can receive up to two kits per year – the second after 90 days from the first shipment. More information about eligibility is available online at www.nysmokefree.com.


 

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It’s Tomorrow: New York Will Accept Vaping Devices on Drug Take Back Day
New Yorkers will be able dispose of their vaping devices and cartridges at more than 200 locations across the state as part of National Prescription Drug Take Back Day for the first time on Saturday, Gov. Andrew Cuomo announced this morning.

With nearly 150 vaping-related lung illnesses reported in the state, New York will partner with the Drug Enforcement Administration to collect e-cigarette devices and cartridges in addition to prescription drugs and other medications.

New Yorkers can dispose of medications and vaping devices at 223 locations across the state. More than 400 health care facilities will also dispose of their unused and expired medications as part of the national Take Back Day.


Study: How Physicians’ Belief in Treatment Effectiveness Can Impact Patients
The NPR (10/21, Vaughn) “Shots” reports that a study shows “that patients can pick up on subtle facial cues from doctors that reveal the doctor’s belief in how effective a treatment will be,” which “can have a real impact on the patient’s treatment outcome.” The article adds, “Researchers randomly assigned undergraduate students to play the role of a patient or a doctor.”

The study “found that during the administering of the pain stimulus, the doctor group showed measurably less pain expression in their faces when they believed that the patient actors had been given a cream that provided actual pain relief.” Within “trials where the doctor group believed the cream was effective, patients reported that they found the doctors more empathetic.” The results were published in Nature Human Behavior.


CMS Sanctions UnitedHealthcare Plan: 3 Things to Know
One of UnitedHealthcare’s Medicare Advantage plans will face enrollment restrictions for 2020 due to compliance issues.

Three things to know:
1. CMS sanctioned the UnitedHealthcare plan because for the third year in a row, the plan did not adhere to a rule requiring it to have a medical loss ratio of at least 85 percent. A medical loss ratio measures how much of an insurer’s revenue goes toward medical claims versus overhead costs.
2. UnitedHealthcare said despite added benefits, the plan fell out of compliance because of a federal legislation reducing the health insurer’s tax liability for 2018.
3. Enrollment for the affected plan will be suspended for the 2020 contract year. The health plan is sold in nine states to less than 1 percent of UnitedHealthcare’s Medicare Advantage members. Becker’s Hospital News Payer Issues (October 15)


Could Your Practice Use Some Professional Help?
MSSNY’s IMG Subcommittee, through its Clearinghouse Opportunities Program, is looking for physicians who can offer IMG candidates meaningful experiences that will help them become familiar with the US healthcare system and prepare for residency training. Many IMG candidates have previous experience in their own countries as faculty members, practicing physicians or researchers, and they need a way to stay involved in health care as they wait for residency training opportunities. Others have recently graduated from medical school abroad.

IMGs who are ECFMG certified may be asked to assist with computer work, data collection, shadowing you while you treat your patients, help with research and special projects, and assist in any non-clinical activities in physician’s offices. Physicians in any specialty who have a position to offer are encouraged to contact MSSNY. Please send a brief description of the work with which you could use help, your requirements and any compensation that may be available, to Ruzanna Arsenian (rarsenian@mssny.org). 



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Pro Publica: Doctor Payments from the Drug Industry
Sunshine laws may seem stringent, but doctors continue to benefit from the biopharma industry. A ProPublica investigation has found more than 700 doctors who have earned at least $1 million from drug makers or medical device companies over the past five years alone. Another 2,500 made at least $500,000.

The ProPublica analysis found that Xarelto, a blood thinner made by Janssen, generated the most payments to doctors — with $29.2 million dropped in 2016 alone.

Of the top 20 drugs with the most annual spending on doctors from 2014 to 2018, six made the list in each of the years: Invokana to treat type 2 diabetes, the blood thinners Xarelto and Eliquis, the antipsychotic Latuda, the immunosuppressive drug Humira and the multiple sclerosis drug Aubagio. Another three drugs were on the list for four years: Victoza to treat type 2 diabetes, psoriasis treatment Otezla and the cholesterol-lowering drug Repatha. (Research funding and royalties are not included.)

Xarelto topped the list in spending for four years, totaling more than $123 million in payments from 2014 to 2018. In March, its makers, Johnson & Johnson and Bayer AG, agreed to pay $775 million to settle about 25,000 lawsuits claiming that the companies had failed to warn patients that Xarelto could cause fatal bleeding.


CDC Report: Teen Suicide Rate Spikes
A new CDC report shows suicide rates among youths and young adults ages 10 to 24 spiked over a decade, outpacing the suicide rate of other age groups and ending years of relative stability. Yet, researchers say they are not sure what is driving the jump in suicide rates among youth and young adults.


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TO: New York State Residents and Fellows
MSSNY Announces the 15th Resident/Fellow/Medical Student Poster Symposium 

When:    Friday, April 24, 2020
Where:   Westchester Marriott
Tarrytown, New York
Time:      1:30 pm – 4:00 pm

Click here for detailed guidelines. Deadline for abstract submission is 4:00 pm, Monday, February 3, 2020. We welcome your participation. Participants must be MSSNY members, and membership is free for first-time resident/fellow members. Join online.


Still Time for NY Ambulatory Clinics to participate in the AHRQ Safety Program!
Beginning in December 2019, this program combines evidence-based guidance with strategies to address the attitudes, beliefs, and culture that often pose challenges to improving antibiotic prescribing.

Participation in this AHRQ program will help clinics meet the Centers for Medicare and Medicaid Services Merit-based Incentive Payment System (MIPS) requirements and can demonstrate compliance with the new Joint Commission Ambulatory Antimicrobial Stewardship Standard as many of the concepts are similar.

Continuing education credits including Maintenance of Certification (MOC) for ABIM, ABP, and ABFM will be offered at no charge for participants. 

Benefits of participating include:

  • Reduce unnecessary antibiotic use and increase appropriate antibiotic use

       Enhance teamwork and communication around diagnosis and treatment of infections and antibiotic prescribing in your practice
       Improve patient safety and safety culture

  • Improve workflow, especially during the busy cold and flu season
  • Maintain and improve patient and family satisfaction

Eligible Clinics
Clinics that care for children and/or adults and are:

       Primary care clinics
       Urgent care clinics
       Student health clinics
       Community-based health clinics (e.g., Federally Qualified Health Centers or FQHCs)
       Outpatient specialty clinics that provide primary care (e.g., OB/GYN)

How Can I Learn More?
Attend an Informational Webinar (all times listed are Eastern Time):

October 30 1 p.m.
November 5 at 2 p.m.
November 14 at 2 p.m.
November 26 at noon
December 2 at 2 p.m.

Visit https://safetyprogram4antibioticstewardship.org/ or email antibioticsafety@norc.org.

This program is funded and guided by the Agency for Healthcare Research and Quality and led by Johns Hopkins Medicine and NORC at the University of Chicago.


CME

“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? on November 20 at 7:30am. This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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

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


Register Now for Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm

The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2 from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432.  Please click here to register.  To view the program flyer, please click here.

Program schedule:

7:30—8:20 am:           Registration and Breakfast

8:20—8:30am:            Welcome and Opening Remarks

8:30—9:30am:            Health Matters for Women: Endometriosis *
 Faculty: Lisa Eng, DO

9:30—10:30am:         Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am:       Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm:       Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

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

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

**The Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.

The Academy of Medicine of Queens County designates EACH of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä.  Physicians should only claim credit commensurate with the extent of their participation in the activity.


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RENTAL/LEASING SPACE


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.
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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


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)
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)
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)

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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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Connecticut, New Jersey and New York Medical Societies Commend Governors’ Efforts to Address “Cross-Border” Issues Relating to Cannabis, But Concerns Remain About Legalization of Marijuana Use


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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

Connecticut, New Jersey and New York Medical Societies Commend Governors’ Efforts to Address “Cross-Border” Issues Relating to Cannabis, But Concerns Remain About Legalization of Marijuana Use

October 17, 2019, Westbury, NY—Following is a joint statement from the presidents of the Connecticut, New Jersey and New York Medical Societies:

“We commend the regional approach that the Governors of Connecticut, New Jersey, and New York are seeking to address ‘cross-border” issues relating to cannabis purchase and use.

However, our medical societies continue to have serious concerns with proposals to legalize the purchase of recreational or so-called “adult use” marijuana given the public health challenges that have arisen in other states that have legalized the purchase of marijuana for non-medical purposes.

These concerns have grown in recent weeks given the significant number of cases of pulmonary illness relating to the use of vaping devices, which have included many instances where cannabis was being vaped.

Important steps were taken this year in New York State to greatly reduce the threat of criminal sanction based upon possession of small amounts of marijuana, including expunging previous convictions for low-level possession offenses.  We believe that similar “decriminalization” measures should be pursued in other states, and a review taken as to whether these laws are achieving their intended goals.  Most importantly, we urge Congress and the President to work together to pass legislation to re-schedule marijuana under the Controlled Substances Act. Then, necessary research as to the health benefits and health risks of marijuana could begin.”

Art Fougner, MD
President, Medical Society of the State of New York

Marc Levine, MD
President, Medical Society of New Jersey

Bollepalli Subbarao, MD
President, 
Connecticut State Medical Society

# # #

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: October 18, 2019 – Foul Turns Fair

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 18, 2019

Vol. 22  Number 39


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Colleagues:

October marks the tenth anniversary of the establishment of FAIR Health. Among other things, FAIR Health holds the database of physicians’ charges. It wasn’t always that way. When the managed care networks were first set up, many physicians did not join the plans and were Out of Network. Were an insured to see one of these physicians, if their plan had an Out of Network provision, that physician would be paid according to the plan’s formula based on Usual and Customary Fee. The most widely consulted database for usual and customary was held and run by a company called Ingenix. Basically, all the insurers relied on Ingenix data for their payment determinations. However, it turned out there was a problem. Ingenix was a wholly owned subsidiary of United Healthcare – soon to be United Health Group.

Our Medical Society began an action that didn’t go far but attracted attention. Soon, then Attorney General Andrew Cuomo became interested and he began investigating how exactly insurers and Ingenix determined these out of network payments. Cuomo’s staff found the flies in that ointment.

A NY Times editorial from 2008 noted that the insurers’ ingenious Ingenix solution was an invitation for abuse since the insurers had a strong financial interest in keeping the payments to physicians low. Eventually, Attorney General Cuomo filed suit, thus joining Medical Societies in their actions against the insurers. When Ingenix was unable to demonstrate even that their figures were accurate, it was game over and United agreed to pay $50 Million that was used to set up a new database – FAIR Health.

Oh, but don’t shed a tear for Ingenix. It is still around – you know it as OPTUM.

And so it goes.

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

Arthur Fougner, MD
MSSNY President



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Please Continue the Fight for a Fair Federal Solution to Surprise Medical Bills
Please continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair federal legislative solution to the issue of surprise medical bills.  By clicking here, you can send a letter, make a tweet and make a phone call to your elected officials. It only takes a few minutes and contains all of the details necessary to get our point across.

Recently, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.

While MSSNY together with physician groups across the country are working diligently to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of legislation that emulates New York’s successful model, such as H.R.3502, sponsored by Representatives Ruiz and Roe.   This week, the number of co-sponsors for this legislation reached 100, including 13 members of New York’s Congressional delegation (Clarke, Higgins, King, Lowey, Meng, S. Maloney, Morelle, Nadler, Rice, Rose, Stefanik Suozzi, and Velasquez).

At the same time, grave concerns have been raised about the alternative being pushed by insurance companies (H.R.3630, sponsored by Representative Pallone, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.  When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.   

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not give them any more power.  Please contact your Senators and Representatives today!


Patient Medical Debt Protection Act Introduced
Comprehensive legislation (A.8639/S.6757 – was recently introduced in New York that would place significant new restrictions on the billing of patients for outstanding medical bills.  The legislation would also expand New York’s “surprise bill” law to address circumstances where a patient receives a bill from an out of network physician due to incorrect information regarding that physician’s participation status.

MSSNY, together with representatives for several specialty societies, have met with key legislative staff to have a further understanding of the legislation, including raising significant concerns with a component of the legislation that would require a consolidated bill for the services of hospitals and physicians for hospital-based care.  We noted that the requirement to go through the hospital would substantially increase the circumstance where a physician is unpaid or underpaid for medical care delivered, since the physician bill will very often be a fraction of the hospital bill.   The legislation is also unclear as to how such hospital based care would be billed to an insurance company when the patient has health insurance coverage.  A major source of the problem facing patients, we noted, is the increasing number of health plans offering coverage with enormous deductibles, which necessitates legislative action to increase coverage options to reduce this huge financial burden for patients.

Please remain alert for further updates on this legislation.


Contact Your Members of Congress to Prevent a Medicare Conversion Factor Freeze
As Congress works towards a year end healthcare package, we are calling on Congress to stand with America’s physicians and patients by urging Congress to implement positive payment adjustments to the grossly inadequate Medicare fee schedule.  Click here to send a letter to Senators Schumer and Gillibrand, as well as your congressional representative.

For years, physicians were faced with an uncertain environment as Medicare’s deeply flawed Sustainable Growth Rate (SGR) formula constantly threatened devastating cuts that would deeply impact the access to care for millions of patients. The Medicare Access and CHIP Reauthorization Act (MACRA) got rid of the SGR and provided modest increases for a few years, but physicians are now facing a pay freeze for the next six years.

According to the Consumer Price Index, economy-wide inflation increased 43 percent or 2.1 percent on average. However, adjusting for inflation in practice costs, Medicare physician pay has declined by 19 percent between 2001 and 2018.  Based on these statistics it is clear that American physicians cannot continue to provide quality care to Medicare patients under the current payment system therefore;

We are urging Congress to:

  • Implement positive payment adjustments for physicians to replace the payment freeze over the next six years.
  • Extend the Advanced APM bonus payments for an additional six years.
  • Implement additional technical improvements to the MACRA MIPS program to reduce the hassles inherent in complying with the program.

These improvements will have an immediate impact and help protect physician practices from accruing additional penalties as they transition over to the MIPS and APM programs.


Albany Policy Forum Examines New York’s Enormous Medicaid Budget
This week the Empire Center for Public Policy held a policy forum: ‘Medicaid Migraine: Retaking control of New York’s Surging Health-Care Costs’ on Wednesday at the Albany Institute of History and Art. The forum, which was comprised of a panel of individuals from various organization which included Rose Duhan, President and CEO of Community Health Association of New York State, James Lytle, Partner, Manatt, Phelps & Phillips, Lara Kassel, Coordinator at Medicaid Matters and Harold Iselin, Managing Shareholder at Greenberg Traurig.

Rose Duhan, President and CEO, Community Health Care Associations of New York State: highlighted the disparity between the amount that is spent on Medicaid verses the overall amount spent on public health in New York State. She spoke about the need to focus on the social determents of health and investing in existing social services infrastructure to improve patients’ outcomes. She noted that the social aspects of health which includes access to food, housing and racism all drive healthcare costs and although cannot be solved in a single budget cycle require investment over the long term.

James Lytle, Partner, Manatt, Phelps & Phillips: noted that it shouldn’t be a surprise that Medicaid continues to have a cost-discipline issue. He noted that while New York is a compassionate state that avoids having to cut spending on programs, though nearly 1/5 of spending on health-care is wasted.  With regard to the global cap, he noted the cap doesn’t cut costs; it simply counts them and is a barometer to show how much has been spent thus far.  He also noted that long term care is the biggest driver of Medicaid spending due to an aging population with less family and community-based resources being available to them.  Moreover, many stakeholders will be impacted if sudden big changes are made.

Lara Kassel, Coordinator of Medicaid Matters New York: emphasized on the need for policy makers to look at Medicaid from the perspective of the consumer; those who are directly benefitting from the program. She added that their perspective comes from the advocacy and highlighted the importance of looking at their organization as an equal partner when it comes to budget-making.

Harold Iselin, Managing Shareholder at Greenberg Traurig: noted that the global cap has been a useful tool that has added predictability to budgeting. He spoke about the three main drivers of Medicaid costs; Enrollment, Health-Care Costs and Special Programs. Regarding enrollment, he noted that it is a good sign and having an increase in enrollment is a good thing.  In relation to utilization costs, he noted that overall it has been a successful outcome, adding that it has not spiked even in terms of long-term care.  When it comes to unit costs however, he highlighted three major drivers; minimum wage, pharmacy costs and hospital costs. In terms of minimum wage he noted that it was originally supposed to be outside of the global cap but was added into it later on.  In relation to pharmacy costs, he noted that as new treatments were introduced namely the Hep-C treatment, costs went up. He added that though physician costs have stayed flat overall, there must be more investment into primary care. He concluded by mentioning that you cannot look at the global cap without looking at the general fund and state funding in general.


MSSNY, CT, and NJ Medical Societies Commend Governors’ Efforts to Address “Cross-Border” Issues Relating to Cannabis; Concerns Remain About Legalization of Marijuana Use

On October 17, MSSNY released the following joint statement to the press:

“We commend the regional approach that the Governors of Connecticut, New Jersey, and New York are seeking to take to address ‘cross-border” issues relating to cannabis purchase and use.

However, our medical societies continue to have serious concerns with proposals to legalize the purchase of recreational or so-called “adult use” marijuana given the public health challenges that have arisen in other states that have legalized the purchase of marijuana for non-medical purposes.

These concerns have grown in recent weeks given the significant number of cases of pulmonary illness relating to the use of vaping devices, which have included many instances where cannabis was being vaped.

Important steps were taken this year in New York State to greatly reduce the threat of criminal sanction based upon possession of small amounts of marijuana, including expunging previous convictions for low-level possession offenses.  We believe that similar “decriminalization” measures should be pursued in other states, and a review taken as to whether these laws are achieving their intended goals.  Most importantly, we urge Congress and the President to work together to pass legislation to re-schedule marijuana under the Controlled Substances Act. Then, necessary research as to the health benefits and health risks of marijuana could begin.”

Art Fougner, MD
President, Medical Society of the State of New York
Marc Levine, MD
President, Medical Society of New Jersey
Bollepalli Subbarao, MD
President,
Connecticut State Medical Society


Montefiore Plans to Close Mount Vernon Hospital
Montefiore Health System plans to close its Mount Vernon hospital and invest $41 million to build an emergency department and ambulatory care center, officials said Tuesday. Upon completion of the 40,000-square-foot health care complex, the 121-bed hospital will close. Montefiore expects construction to be completed by the end of next year. It still must receive state Department of Health approval for the project. The hospital will be replaced by the emergency department and medical offices for primary and specialty care.

Montefiore Health System, which has its flagship hospital in the Bronx, has expanded rapidly in the Hudson Valley. It has taken over management of hospitals in Cornwall, New Rochelle, Nyack, Newburgh, and White Plains. It is negotiating to add St. John’s Riverside Hospital in Yonkers. Services at the new center will include primary care, mental health care, specialty care, pediatrics, chronic disease management, wound care and imaging services. Its emergency department will include equipment for cardiac diagnosis and monitoring as well as an X-ray machine and CT scanner.


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Weill Cornell Medicine Eliminates Medical Ed Debt for Qualifying Students
A transformative new scholarship program established by Weill Cornell Medicine will eliminate medical education debt for all students who qualify for financial aid, the institution announced today. A lead gift from The Starr Foundation, directed by Weill Cornell Medicine Overseer Maurice R. Greenberg, in partnership with gifts from Joan and Board of Overseers Chairman Emeritus Sanford I. Weill and the Weill Family Foundation have made this longstanding goal possible. Learn more.


HHS: Physicians Guide to be More Cautious When Tapering Patients Off Opioids
HHS “published a guide https://bit.ly/2VB5Eej” instructing physicians to be more cautious in tapering patients off opioids in response to reports of some physicians cutting patients off from opioids too fast or “in some cases even dismissing patients from their practice.”

The new guide states that doctors “should never abandon” pain patients, and warns of risks including “acute withdrawal, pain exacerbation, anxiety, depression, suicidal ideation, self-harm, ruptured trust, and patients seeking opioids from high-risk sources.” It says that opioid doses are typically reduced by between 5 and 20 percent a week, but that slower tapers are often better tolerated, partly because they are less likely to trigger withdrawal symptoms.

The guide also lays out reasons to consider tapering patients off opioids, stressing that the benefits of staying on the drugs need to outweigh the risks. Those risks are substantial, including addiction and overdose, but many chronic pain patients and their doctors say they have been able to stay on high doses of opioids and function competently. (NY Times, 10/17)

As of October 8, the CDC confirmed 28 deaths associated with the use of e-cigarettes, or vaping, and 1,299 lung injury cases.


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WORKERS COMP

Workers Comp Webinars for Medical Providers
The Board is hosting webinars to provide training on the Drug Formulary and prescription prior authorization process. These are being offered at different times so you can choose one that best fits your schedule. Visit the Board’s website to register for one of the sessions listed below.

October 22, 8:30 a.m. – 9:30 a.m.
October 24, 4:30 p.m. – 5:30 p.m.
October 29, 8:30 a.m. – 9:30 a.m.

More Information

For more information, visit wcb.ny.gov/content/ebiz/drugformulary/
General Formulary questions: WCBFormularyQuestions@wcb.ny.gov
Technical support questions: WCBCustomerSupport@wcb.ny.gov
Subscribe for email notifications



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Case Count for Vaping-Related Lung Injury Up
CDC yesterday said as of Oct. 15, the number of people sickened from a lung illness linked to vaping and e-cigarettes rose to 1,479 cases. So far, 33 people have died from the illness—which officials are now calling EVALI, short for “e-cigarette or vaping product use associated lung injury”—and additional deaths are being investigated.

Only Alaska among the 50 states and the District of Columbia has yet to see a case. Deaths confirmed as part of the outbreak total 26.Moreover, it is reported that the CDC will shortly step up its surveillance efforts on “vaping illness” in a novel way.  The agency will request that doctors seeing patients with suspected respiratory infection ask about their use of vaping products.

An updated guidance will “advise physicians on how to diagnose and manage patients who may have both a lung infection and a vaping injury,” the news service reported.

Physicians suspecting a patient has vaping-related lung damage are asked to get a detailed history of substances used and obtain the actual products for testing, if possible, as well as to report the case to local or state health departments.

The CDC said it still had no clear idea of what is causing the vaping-related illnesses. The general profile for victims has not changed either: most are young men and the majority used THC e-liquid products.


Amazon Pays for Employees to Travel to California for Cancer Care
Amazon is aiming to control healthcare spending by paying to send employees to California to receive cancer care, according to The Wall Street Journal. Seattle-based Amazon will cover travel expenses for employees diagnosed with cancer who see physicians at Duarte, Calif.-based City of Hope.

More than 380,000 of Amazon’s workers and families are eligible for the benefit, which can be used for any cancer diagnosis, according to the report. Dene Sparrman, Amazon’s director of global benefits, told The Wall Street Journal the benefit is designed to lower healthcare spending and increase employees’ choices. “Instead of waiting for patients to get the wrong care first, then reaching out to the expert, this model is designed so that the patient has access to expertise as early as possible to help ensure the correct care is delivered first,” she told The Wall Street Journal. The new benefit also enables Amazon workers to meet with City of Hope physicians by videoconference, when allowed by state regulations, according to the report. (October 15, WSJ)


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WEBINARS/CME/SYMPOSIUMS

When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? On November 20 at 7:30am. This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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

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


Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm
The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2nd from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432.  Please click here to register. To view the flyer, please click here.

Program schedule:

7:30—8:20 am:           Registration and Breakfast

8:20—8:30am:            Welcome and Opening Remarks

8:30—9:30am:            Health Matters for Women: Endometriosis *
 Faculty: Lisa Eng, DO

9:30—10:30am:         Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am:       Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm:       Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

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

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

**The Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.  

The Academy of Medicine of Queens County designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä.  Physicians should only claim credit commensurate with the extent of their participation in the activity.

Classified

RENTAL/LEASING SPACE



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

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 eNews: October 11, 2019 – R-E-S-P-E-C-T

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 11, 2019

Vol. 22  Number 38


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Colleagues:

The term “provider” has bothered me for a long time. And it should bother you as well.  ACP President Dr. Robert McLean posted Defining our identity does not include the ‘P word’ for his September President’s message. The central theme is a reminder that the practice of Medicine is a profession.  Physicians have a unique relationship with patients that is considerably more than the “Cable Guy” who comes to install your TV service. Dr. McClean writes:

… Such a fundamentally unique and sacrosanct relationship as that between patient and physician is not merely “providing” a health service. And that is why the term “health care provider” is so inappropriate. The patient-physician relationship does not consist of simple transactions where we provide and patients consume. That marketplace terminology implies that health care can be conceptualized as just another commodity.

The primacy of this relationship has been eroded with the commoditization of aspects of the health care delivery system. 

Dr. McClean is not the only physician upset by “provider creep.” Washington pediatrician, Dr. Niran Al-Agba goes one step further, writing in the Kitsap Sun: The sneaky cynicism of calling your doctor a ‘provider’. She traces the history of provider as a pejorative back to 1930’s Germany:

… According to Dr. Saenger, who wrote Jewish Pediatricians in Nazi Germany: Victims of Persecution, “the 1937 issue of the Reichs Medizinal Kalender, a directory of doctors, the remaining Jewish doctors in Germany were stigmatized by a colon placed before their names. Their medical licenses were revoked in 1938. They could no longer call themselves ‘Arzt’ or ‘doctor.’ They were degraded to the term ‘Behandler’ or freely translated, ‘provider.’  

She continues:

Insulting any person on the basis of their race, ethnicity or gender is morally wrong. Using the word “provider” to describe a physician is and will always be insulting, personally and professionally; it is demeaning and devalues the education and degree conferred upon every physician. Why are physicians forced to suffer repeated use of this derogatory professional insult? And why have physicians as one professional body not risen up in anger at this injustice? 

While I would not equate those who call physicians “the P word” with the Third Reich, people should realize that Provider is insulting and demeans our noble profession.

Dr. McClean concludes:

And by the way, this terminology issue was raised through the ACP Board of Governors way back in 2008. Hence, it has been ACP policy since 2009 to eliminate use of the term “provider” and “prescriber” in lieu of “physician” in all publications and communications. Pass it on. 

I would add that this has been MSSNY policy since 2011:

Professionalism in Terminology 207.956

The leadership and staff of the Medical Society of the State of New York shall not in written or spoken word, use the term “provider” in referring to physicians

With that, I give you the inimitable Aretha Franklin.

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

Arthur Fougner, MD
MSSNY President



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eNews

DFS Proposes Regulation to Ensure Patients Have More Detailed Notice of New York’s Surprise Bill Law
New York Department of Financial Services (DFS) Superintendent Linda Lacewell announced this week a proposed regulation to assure patients that receive a claim for the services from a non-participating physician or a non-participating referred healthcare provider receive notice from their health plan and non-par treating physician about the protections of New York “surprise bill” law.  This action follows a recent report of a Long Island patient on “CBS This Morning” who received surprise bills totaling hundreds of thousands of dollars that weren’t covered by his healthcare plan.

“We are taking this action to strengthen the law so that New Yorkers have all the information they need to avoid surprise medical bills,” said Superintendent Lacewell. “After hearing about − and resolving – a recent issue, we know that if it could happen to one consumer; it could happen to others.”

The proposed regulation would require health plans that receive a claim for the services of a non-participating physician or a non-participating referred healthcare provider that could result in a surprise bill to provide additional notice to the insured consumer.

The notice would advise that the insured consumer may receive a surprise bill based on the claim and would include a description of surprise bills and the New York Out-of-Network Law’s Independent Dispute Resolution (IDR) process for surprise bills, as well as instructions on how to submit a dispute, a copy of an assignment of benefits form, and the healthcare plan’s designated addresses for submitting the form. The notice would be included on or with the explanation of benefits.

Additionally, the proposed regulation requires health plans that determine that services billed by a healthcare provider as emergency services are not emergency services to notify the consumer that the consumers may receive a surprise bill for such services and that consumers may be protected from any such surprise bill.  The notice would include the healthcare plan’s contact information as well.  If a health plan receives an assignment of benefits form and determines that a disputed bill is not a surprise bill, they would be required to notify the consumer in writing of the procedures for filing a grievance or appeal and provide information on how to file a complaint with DFS.

It is also important to note that the proposed regulation would require non-participating physicians who bill consumers for emergency services or a surprise bill to inform the consumer of the IDR process, along with providing the claim form and assignment of benefits form which non-participating physicians already must send with surprise bills.

Click here to view a full copy of the proposed amendment, which will be published in the October 23, 2019 State Register and subject to a 30-day notice and public comment period.


MSSNY President, Dr. Fougner, Comments in Crain’s re Surprise-Billing Amendment Proposes More Requirements for Insurers and Physician
Dr. Arthur Fougner, president of the Medical Society of the State of New York, said that the society is “supportive of efforts to assure patients are notified by insurers of the limitations of their coverage, and the protections available to them under our surprise bill law,” in a statement provided to Crain’s. “We are continuing to review the new proposal and will seek to provide feedback to DFS regarding the contents of the proposed disclosure form.”


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Urge the Governor to Support Formulary Protection Legislation!
MSSNY joined AARP and over thirty various health and consumer organizations in sending a letter to urge Governor Andrew Cuomo to approve S.2849/A.2969 that would protect health plan members from increases in out-of-pocket prescription drug costs in the middle of a contract year.

In a press release by AARP, Dr. Arthur Fougner, President of MSSNY said: “MSSNY strongly urges that this formulary protection bill be signed into law as it would provide significant protection from the adverse consequences many patients face as a result of non-medical switching of prescription drugs. If a treatment is working, it should not be changed due to financial constraints. In medicine as in sports, you don’t change a winning game; it’s unreasonable to force patients to change a successful course of treatment for any reason other than medical need.”

MSSNY encourages physicians, as well as their families, friends and other sympathetic individuals to send these letters to their lawmakers.

Protect your patient’s prescriptions! Urge the governor to sign formulary protection bill into law by clicking here.

Click Here to view the full letter!


Medical Society Raises Concerns About Trump’s Order on Medicare
Although the Medical Society of the State of New York supports the goal of President Donald Trump’s executive order on Medicare, it is concerned with several policy directions the order advances, according to a statement issued Tuesday by Dr. Art Fougner, president of the society.

“In particular, we are concerned with the apparent goal to expand the Medicare managed-care program, which likely could include efforts to disincentivize continued or new enrollment in the Medicare fee-for-service program,” Fougner said. “This is especially problematic in light of multiple instances in recent years where Medicare managed-care plans dropped huge numbers of physicians from their Medicare Advantage networks. This, in turn, significantly reduces care options for our patients.”

The society also takes issue with proposals to expand “already cumbersome Medicare value-based payment programs,” Fougner said. Specifically, many smaller physician practices have reported challenges with the Medicare Merit-based Incentive Payment System, such as burnout from spending more time on health-tech systems than on treating patients “to meet well-intended but often overreaching value programs.”

Additionally, Fougner said that some proposals in the order seem to focus on expanding the scope of other types of health practitioners. The combined care of a team headed by a physician is what is best for patients, he said.

Trump’s executive order states that it is focused on empowering patients to “select and access the right care, at the right time, in the right place, from the right provider.” Another focus is to help the fiscal sustainability of the Medicare program through alternative payment methodologies linked to value, increased choice and lower regulatory burdens for providers.

Dr. Fougner said, “We look forward to working with medical associations across the country to work with the administration toward preserving and strengthening the Medicare program so that our seniors continue to have timely access to the quality care they need and deserve.” (Crain’s Health Pulse Oct 8)


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Physicians – Beware of Fake Letters Claiming to be from NYS Board for Medicine
Please should be aware that the New York State Board for Medicine has advised of a scam where physicians have received a bogus letter claiming to be from the “NY State Education Department, Office of the Professions” indicating that their license has been suspended for “Illegal Drug Trafficking Under Section 33(c) of The Aviation Drug Trafficking Control Act of 1984”.

The Board for Medicine has advised MSSNY that, should any physician receive such a letter, that they be aware that they would not receive such a letter from the NYS Board for Medicine or NYSED.


New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

  • the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
  • the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has already given oral or written consent; or
  • the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

Several other states have passed similar laws expressly banning this practice without clinical justification. MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.


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Bronx Teen Is First to Die in New York from Vaping
A teenager from The Bronx became the first New Yorker to die from vaping last week, state officials said Tuesday. The 17-year-old boy treated at Montefiore Hospital is among nearly two dozen people across the nation whose deaths have been linked to the use of electronic cigarettes, officials said.

“Parents have to know, young people have to know: You are playing with your life when you play with this stuff,” Gov. Andrew Cuomo said at an unrelated news conference at his Manhattan office.

The boy was first treated for a “vaping-associated respiratory illness” early last month and was hospitalized again in late September before his Oct. 4 death, according to the Democratic governor’s office. The teen’s death was reported Tuesday to the state Department of Health, which is investigating the case, officials said.

The boy may be the 20th person in the United States to die from a vaping-related illness amid an outbreak of lung ailments linked to the habit.

The U.S. Centers for Disease Control and Prevention had confirmed 18 vaping deaths in 15 states as of Oct. 1, and another was reported in Massachusetts on Monday.

Some 110 people across the Empire State — including 21 in New York City — have come down with serious lung illnesses after using at least one vape product, according to the state health department. Officials have attributed most of those cases to black-market cannabis vape devices rather than nicotine-based e-cigarettes sold in stores.

The spate of sicknesses nonetheless spurred state authorities to ban flavored e-cigarettes, but a pending lawsuit blocked the measure from taking effect last week.


Poll: New Yorkers Back Ban on E-Cigs
A majority of New Yorkers support Gov. Andrew Cuomo’s emergency ban on flavored e-cigarettes and think vaping is a serious public health problem, according to a poll published Monday.

The Siena College Research Institute found that 78% of the more than 800 New Yorkers surveyed believe e-cigarette use and vaping represent either a very serious or somewhat serious public health problem. Nearly two-thirds (61%) of New Yorkers support banning flavored e-cigarettes, and 52% support banning the sale of all e-cigarette and vaping devices.

The poll found that 12% of New Yorkers vape on a regular basis.

The poll—which has a margin of error of 4.3 percentage points—was conducted between Sept. 22 and Oct. 1. That means the final results came in two days before a state court temporarily blocked Cuomo’s prohibition on flavored e-cigarettes in response to a lawsuit from the industry.

Health Commissioner Howard Zucker vowed after the court’s decision that the state will use “every tool at our disposal to address this crisis.” More than 1,000 people have been diagnosed with vaping-related illnesses in the U.S., with 18 reported deaths, according to data from the U.S. Centers for Disease Control and Prevention.


 

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Physicians Welcome to Provide Public Comments on DSRIP at 10/25 NYC and 10/30 Syracuse Public Forums
The New York State Department of Health (NYSDOH) will be holding Public Comment Days for New York’s 1115 waiver program on:

  • October 25th 2019 at Baruch College, 55 Lexington Ave. (Corner of 24th St. & Lexington Ave.), Room 14–220 (14thFloor), New York, NY 10010.
  • October 30th 2019 at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.

The open comment period for both forums will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Specifically, the NYS Health Department is seeking from the federal government a continuation of DSRIP for the 1-year balance of the 1115 waiver ending on March 31, 2021 and to extend an additional 3 years from April 2021 to March 31, 2024.   Click Here to view the Amendment Proposal.

Background on the DSRIP Program

The roughly $6 billion Delivery System Reform Incentive Payment (DSRIP) program provides incentives for Medicaid providers to create and sustain an integrated, high-performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving the quality of care, improving the health of populations and reducing costs.

The DSRIP program promotes community-level collaboration and aims to reduce avoidable hospital use by 25% over the 5-year demonstration period. A total of 25 Performing Provider System (PPS) were established in different regions of the State to implement innovative projects across three domains: system transformation, clinical improvement and population health improvement (New York’s Prevention Agenda).

While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as community physician practices, some have raised concerns that not enough funding has been made available to physicians who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.


Hassle Factor Form Now in Easy-to-Use PDF Format
MSSNY’s Hassle Factor Form has been updated.  The updated PDF version of the form can be found at the following this link.

Anyone can access the form by clicking on the drop-down box of RESOURCES from the MSSNY home page – www.mssny.org.  Then, scroll down to Payer Relations (SME).  Now, scroll to Hassle Factor Form and click.  This is a more user friendly form.

The County Medical Societies can send it to their members and add it to their websites.  The PDF version can be used by the county medical societies to gather data/information from the membership for interacting with DFS.



Doctor Sues Kaiser Permanente over Opioid-Related Patient Satisfaction Scores
An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

Eryn Alpert, MD, worked at Kaiser Permanente from 2012 to December 2017, when she was fired. The lawsuit alleges her dismissal stemmed from her failure to accept patient satisfaction scoring tools. It alleges these tools were structured to incentivize physicians to prescribe opioids, even when medically unnecessary. The lawsuit said this pressure was greater in the emergency department, where patients often went seeking prescriptions and would leave poor reviews if they didn’t receive them, according to the report.

In the lawsuit, Dr. Alpert alleges her resistance to prescribing unnecessary opioids created a high standard deviation in her patient scores, which in turn prevented her from gaining shareholder status three years in a row, according to the report.


CME

“Influenza 2019-2020” CME Webinar on October 16; Registration Now Open
Are you prepared for flu season?
The first of MSSNY’s 2020 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2019-2020” on Wednesday, October 16, 2019 at 7:30 a.m.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

  • Educational objectives are:
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
  • Describe clinical and laboratory diagnostic features and treatment specific to each flu season
  • Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated

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

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

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


“When Is the Flu Not the Flu?” CME Webinar on November 20 at 7:30am; Registration Now Open
.  This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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

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


Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm
The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2nd from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432.  Please click here to register.

Program schedule:

7:30—8:20 am:           Registration and Breakfast

8:20—8:30am:            Welcome and Opening Remarks

8:30—9:30am:            Health Matters for Women: Endometriosis *
 Faculty: Lisa Eng, DO

9:30—10:30am:         Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am:       Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm:       Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

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

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

**The Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.  

The Academy of Medicine of Queens County designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä.  Physicians should only claim credit commensurate with the extent of their participation in the activity. 


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CMS

HHS Issues Opioid Tapering Guidance for Clinicians
The Department of Health and Human Services today released a guide to help clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain. Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the guide reviews issues to consider when changing a patient’s chronic pain therapy. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction,” said Adm. Brett Giroir, M.D., HHS assistant secretary for health.


NGS Notice : Errors Causing Incorrect Part A and Part B Claim Denials
Date Reported: 10/9/2019
Status: Open
Provider Type(s) Impacted: Part A, Part B, HH+H
Description of Issue

National Government Services (NGS), along with all Medicare Administrative Contractors (MACs), is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. NGS is informing providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. This is causing claims to incorrectly deny based on invalid beneficiary entitlement.
National Government Services Action

NGS is actively pursuing a solution to this issue which will be shared with providers as soon as possible.
Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.
Proposed Resolution/Fix Date TBD


Seal of Italian Medical SocietyCalling All Physicians of Italian Heritage: Join Morgagni Medical Society
The Morgagni Medical society of New York is comprised of physicians of Italian heritage, who meet for social, educational and professional meetings in NYC quarterly. It is a nonprofit 501c3 organization, and sponsors a medical school scholarship in conjunction with the Columbus Citizen’s Foundation. Interesting people and speakers, exceptional dinners, opera night, exclusive club and venue events.

Members can march with their families in the NYC Columbus day parade. New members, both of Italian descent as well as Italophiles, have a great opportunity to share culture and profession. Check out www.Morgagnimedicalsociety.com, email Morgagni.society@gmail.com for information and join today!


Classified

RENTAL/LEASING SPACE



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

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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