January 18, 2019

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


MSSNY eNews
January 18, 2019
Volume 22  Number 3

MSSNYPAC Seal

Colleagues:

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

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

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

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

Honored to Be Honored

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

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

Non ministrari sed ministrare

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

Thomas J. Madejski, MD
MSSNY President


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Capital Update

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

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

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

Join us to urge your legislators to:

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

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

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


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

Some positive items include: 

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

Some items of potentially significant concern include:

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

Some items of Interest and further review Include:

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

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

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

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


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

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

    Medical Marijuana

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

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


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

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

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

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

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


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

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


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

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

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


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

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


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

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

    Educational Objectives:

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

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

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


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

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


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

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

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

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

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

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


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

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

    eNews

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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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


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

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


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


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

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

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

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

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


     

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    RENTAL/LEASING SPACE


    Rare Find — Great Office Share
    Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


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MSSNY STATEMENT ON TOBACCO PURCHASE AGE


MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

January 15, 2019
For Immediate Release

MSSNY STATEMENT ON TOBACCO PURCHASE AGE

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

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

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

 

Media Contact:
Roseann Raia

Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516.488.6100 x 302
rraia@mssny.org

 

Council – January 24, 2019

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

A. Call to Order and Roll Call

B. APPROVAL of the Minutes of November 1, 2018

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

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

ADJOURNMENT OF COUNCIL
Action Item – For Council Approval

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

RECONVENE COUNCIL

 

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

D. Reports of Officers

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

E. Reports of Councilors (Informational Items)

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

F. Commissioners (Informational Items)

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

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

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

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

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

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

J. Other Information/Announcements

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

K. Adjournment

County Health Officials v. Marijuana

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


MSSNY eNews
January 11, 2019
Volume 22  Number 2

MSSNYPAC Seal

Colleagues:

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

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

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

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

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

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

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

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

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

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

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

Suus bonus et amicis


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


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

Thomas J. Madejski, MD
MSSNY President


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Capital Update

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

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


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

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

Legislative breakdown:

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

    • 9 new Republicans                                                                        (DIVISION OF GOVERNMENTAL AFFAIRS)

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

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


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

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


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

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


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

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


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

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

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


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

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

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

Join us to urge your legislators to:

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

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


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

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

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

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

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

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

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

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


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

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

For more information, please Click here.


Public Health Preparedness 101, CME Webinar January 16, 2019 at 7:30am – Registration now open
Are you prepared for a public health emergency?  And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here.  Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

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


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

Educational Objectives:

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

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

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


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


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

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

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


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

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

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

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

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

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


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


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

Webex available (contact sbennett@mssny.org)

*For each CME session

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

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


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

Popular Features Include:

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

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

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

FOUR TIPS TO GET YOU STARTED

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

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

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


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

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


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


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RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.



Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

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


Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


 


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Visions, Myopia, or Delusions?

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


MSSNY eNews
January 4, 2019
Volume 22  Number 1

MSSNYPAC Seal

Colleagues:

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

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

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

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

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

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

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

Quod oculus non videre mente id quod non habet

Thomas J. Madejski, MD
MSSNY President


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eNews

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

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

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

Join us to urge your legislators to:

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

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

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


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

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

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


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

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

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


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

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

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

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


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

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

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

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

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

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

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


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

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


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


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


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

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

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

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

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


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FREE CME PROGRAMS

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

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

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


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

Are you prepared for a public health emergency? And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here. Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

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


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RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

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


Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


December 21, 2018 – Billion Dollar Baby

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


MSSNY eNews
December 21, 2018
Volume 21  Number 46

MSSNYPAC Seal

Colleagues:

Governor Cuomo’s announcement this week “Let’s legalize the adult use of marijuana, once and for all” is a 180-degree turn from previous comments in early 2017. However, this “evolution” came as no surprise. In the summer, he set up a multi-agency task force to analyze the pros and cons of marijuana legalization, which then concluded the positives outweighed the negatives.   The Task Force members then went on the road to sell the idea. MSSNY and county medical society physician leaders testified at many of these meetings to state our support for marijuana decriminalization but also our strong concerns with the public health implications of the legalization of marijuana. The projected revenues the state would gain from legalization range $600M to $1.3B.  MSSNY has had meetings with the Governor’s office and key Assemblymembers to discuss how best to limit the potential significant adverse public health threats such as youth addiction and increased driving while intoxicated.

Vaping-the Next Epidemic

The U.S. Surgeon General Dr.  Jerome Adams, on Tuesday declared electronic cigarette use among America’s youth “an epidemic” and called for new restrictions on the products. The action comes a day after release of a Monitoring the Future report, which confirmed that teen vaping nearly doubled in 2018, with one in five high school seniors reporting current use of e-cigarettes. More than 3.6 million teens in the U.S. reported that they regularly used the vaping products. Recommendations in an advisory by Surgeon General Jerome Adams, MD, include banning vaping from establishments now covered by indoor smoke-free air policies, further restricting youth access to e-cigarettes in retail establishments, implementing new price policies, and banning marketing to youth.

The survey also found that many students believe they are vaping “just flavoring.” In fact, just about all brands include nicotine, and Juul, a popular, high-nicotine vaping product, that has particularly high levels of it. We all know that nicotine in any form is a tough chemical to give up.  It seems we haven’t learned much about the lure of “cool,” parent-unapproved chemicals in spite of our knowledge of addicting chemicals

Dr. Adams was joined by U.S. Health and Human Services Secretary Alex Azar and FDA Commissioner Scott Gottlieb, MD. The Monitoring the Future survey (sponsored by the National Institute on Drug Abuse) confirmed that the rise in youth e-cigarette use during 2017 and 2018 was the largest-ever single-year increase in use of a single substance ever recorded in the 43 years of the survey.

Sales of Juul increased by 600% in 2017 alone, making it the best-selling e-cigarette on the market. The e-cigarettes, which resemble USB flash drives, have high levels of nicotine — as much in a single cartridge as a pack of 20 regular cigarettes. “This is of particular concern for young people, because it could make it easier for them to initiate use of nicotine through these products and also could make it easier to progress to regular e-cigarette use and nicotine dependence,” Dr.  Adams noted.

In Tuesday’s New York Times, Jan Hoffman, in a column titled “How to Help Teenagers Quit Vaping,”   offered advice on how to get kids to quit vaping. His advice is good but I think most parents don’t even know their kids are doing it. It does not have the telltale smell of cigarette smoke.

County Health Officials Opposed to Legalization

The New York State Association of County Health Officials released a statement Tuesday outlining concerns about adverse health impacts from marijuana legalization. The association said it remains opposed to recreational marijuana legalization. But if it’s legalized, similar to MSSNY, the group called for safeguards and research as well as additional funding for local health departments for increases in workload.

The group is also opposed to e-cigarettes. According to the group, E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls to the U.S poison centers, increasing from 0.3% in September 2010 to 41.7% in February 2014. Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the initiation of smoking among adolescents and young adults. Marketing of e-cigarettes uses cartoons, promotes fruity tobacco flavors, and providers sponsorship of events such as concerts and sporting events, all forms of advertising and marketing designed to appeal to children and young adults.  For the above discussed reasons, both MSSNY and NYSACHO find it imperative to prohibit the advertisement of tobacco products and electronic cigarettes and NY State and therefore supports corresponding legislation.

MSSNY, working together with numerous public health advocacy organizations, is also calling on the Legislature to pass a law to create a statewide minimum age of 21 to purchase tobacco and e-cigarettes.  MSSNY also supports banning the use of flavored substances in vaped products.

Altria Nears a Deal to Take 35% Stake in Juul

According to the Wall Street Journal, Altria Group is nearing a deal to take a 35% stake in e-cigarette startup Juul Labs at a roughly $38 billion valuation, an investment that would make Juul one of the most valuable private companies.It would more than double what Juul was valued at just a few months ago, a sign of how quickly the startup has been growing and Altria’s desire to find growth outside its shrinking cigarette business.

While many groups have come together to alert the public to the health threats of nicotine, the developments around expanded use of e-cigarettes and marijuana show just how vigilant we need to continue to be.

Please share your suggestions or thoughts with me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


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eNews

New York Exchange Enrollment Continues to Rise
As talks of health care reform continue to swirl in Albany and across the country, enrollment in New York’s Health Insurance Exchange continues to accelerate.  Even with the federal removal of the individual coverage mandate – an act widely expected to lead to a decrease in enrollment – this year is actually outpacing last year in New York.

According to the NY State of Health, more than 1 million New Yorkers had enrolled in non-Medicaid coverage in the Exchange through December 15, representing an increase of about 83,000 people over last year. New York’s uninsured rate is currently under 6%, with about three-quarters of the uninsured eligible for subsidized coverage.  Specifically, there were 247,411 enrolled in a qualified health plan; 776,481 enrolled in the Essential Plan; 413,576 enrolled in Child Health Plus, and 3,283,564 enrolled in Medicaid.

This week, as part of his “First 100 Days” Address, Governor Cuomo proposed to codify into law both New York’s Exchange as well as its “pre-existing conditions” protects for consumers.  While New York currently has a law protecting patients from being denied coverage because of a pre-existing condition, this law is tied to the federal ACA provisions that were put in doubt as a result of last Friday’s federal District Court Judge’s ruling that the ACA is unconstitutional.

In response to Judge O’Connor’s ruling, Dr. Madejski was quoted in several papers, including Newsday, Westchester Journal News, and Buffalo Business First, stating “While the ACA has many flaws that we urge Congress to work to fix, among its strongest attributes are its mechanisms to enable the purchase of health insurance coverage for millions through a variety of subsidy programs.” Amongst those flaws is the need to require exchange plans to offer out of network coverage.

With health insurance coverage through the Exchange under discussion in 2019, MSSNY will continue to push for measures to ensure patients have access to comprehensive and varied health insurance options, including out of network coverage.


Exciting Sections Meeting: Young Physicians, Residents/Fellows, Medical Students. Saturday, February 9, 2019 at the Marriott Courtyard in Westbury and MSSNY HQ. Hear national leaders in medical toxicology and social media in medicine. Read all about it here.


Judge Reviewing CVS-Aetna Orders DOJ to Respond to Community Concerns
US District Court Judge Richard Leon this week ordered the US Department of Justice to respond to numerous comments filed to it raising concerns with the proposed mega merger between CVS and Aetna.  According to media reports, this development is expected to delay approval of the merger until at least Spring 2019.

Among the comments to the US DOJ is a letter from MSSNY President Dr. Thomas Madejski summarizing MSSNY’s extensive concerns with this merger among corporate behemoths. The DOJ letter also appended testimony provided by MSSNY Immediate Past President Dr. Charles Rothberg at an October NY Department of Financial Services hearing.

The letter also summarizes the extensive concerns that had been raised by NY DFS Superintendent Maria Vullo, the American Medical Association (AMA), the American Antitrust Institute and New York State Assembly Insurance Committee Chair Kevin Cahill.

Moreover, last week, the Pharmacists United for Truth and Transparency (PUTT) and the Pharmacists Society of the State of New York (PSSNY) jointly filed a motion asking Judge Leon to stop CVS and Aetna from further integration while the Court determines the merger’s harmful effects.

The US DOJ had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition.  The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger in late November with numerous conditions.

MSSNY’s letter to the DOJ highlighted that, even though the NY DFS had approved the acquisition, it did so highlighting several problems with the merger, including that the companies had not “provided any concrete analysis that the CVS/Aetna merger would result in specific reduced costs for New York consumers, or any business plan or study of asserted improved health outcomes to benefit New Yorkers.”

Moreover, MSSNY’s letter to the DOJ reiterated the extensive concerns articulated by the AMA.  Judge Leon’s concerns about the transaction included the strong opposition by the AMA, which had argued to the DOJ that it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options.  


Physician Compare 30-Day Preview Period Extended to 1/7
On November 30, CMS opened the 30-Day Preview Period for the 2016 performance information targeted to be publicly reported on Physician Compare starting in early 2019. The preview was scheduled to end on December 31 at 8pm ET. We are extending preview through Monday, January 7 at 8pm ET (5 PM PT).

For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at QPP@cms.hhs.gov.

If you have any questions about Physician Compare, public reporting, or the preview period, please contact us at PhysicianCompare@Westat.com.


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DFS Superintendent Vullo to Depart in February
New York Superintendent of Financial Services Maria Vullo announced this week that she would be stepping down from the position on February 1, 2019.  The many important activities engaged in by Superintendent Vullo include her close scrutiny and criticism of the defects of the many health care mega mergers such as the proposed Anthem acquisition of Cigna, and the proposed CVS acquisition of Aetna. In her statement announcing her departure she noted that “I am especially proud to have led DFS in cybersecurity, having promulgated a final regulation in March 2017 that is now the national standard for the protection of our nation’s financial markets.  I also am tremendously proud of our work to protect women’s rights in the face of federal assaults, by mandating insurance coverage of contraceptives and abortions without cost-sharing, providing essential coverage for women suffering from maternal depression, providing a special health care open enrollment period for victims of domestic violence, and implementing New York’s Paid Family Leave law.”


Assemblywoman Crystal Peoples-Stokes Named Majority Leader of NYS Assembly; Assembly Committee Chairs Mostly to Remain the Same
Assemblywoman Crystal Peoples-Stokes (D-Buffalo) was appointed by Assembly Speaker Carl Heastie to serve as the Assembly Majority Leader. The majority leader is responsible for the day-to-day operational duties of the Assembly chamber, including overseeing the floor during debates.  She will replace Joe Morelle, who just won election to Congress in his Rochester-area seat.

“Serving alongside Crystal Peoples-Stokes, I have had the opportunity to see firsthand how hard she works for the people of Buffalo and for families across our state,” Speaker Heastie, said. “Crystal is a trusted colleague who I have known for many years, and her experience and dedication to improving the lives of all New Yorkers is why I know she will make an ideal partner in leading the Assembly Majority. Crystal is widely respected by her colleagues and I am proud to appoint her as the next Majority Leader of the People’s House.”

Speaker Heastie also announced Assembly Committee Chairs for the 2019-2020 Session this week.  Many of the Chairs of Committees of strong interest to physicians and patients will remain the same.  The Assembly Health Committee Chair will continue to be Richard Gottfried.  The Insurance Committee Chair will continue to be Kevin Cahill.  The Higher Education Committee Chair will continue to be Deborah Glick.  The Assembly Judiciary Committee Chair will continue to be Jeffery Dinowitz.  The Codes Committee Chair will continue to be Joseph Lentol and the Ways and Means Committee will continue to be led by Helene Weinstein.   Assemblyman Marcos Crespo has been appointed chairman of the Committee on Labor, replacing Michele Titus.


Physicians File Class Action Suit Against ABIM
A class action lawsuit against the American Board of Internal Medicine (ABIM) was filed in a Pennsylvania federal court on December 6.  The plaintiffs include several physicians board certified in internal medicine who allege that the ABIM maintenance of certification (MOC)

requirements violate the federal anti-trust laws.  The physician plaintiffs allege that initially board certified internists have lost hospital privileges if they do not obtain MOC. It is also alleged that initially board certified internists have been removed from the list of “preferred physicians” by health insurers if they do not maintain MOC.  A similar action had been brought in an Illinois federal court by the American Association of Physicians and Surgeons (AAPS), but was dismissed on the basis that the complaint merely made general conclusions, and failed to provide sufficient specific details.



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U.S. FDA Panel Votes for Prescribing Naloxone with Opioids
On Dec 18, an advisory panel to the U.S. Food and Drug Administration recommended prescribing the opioid overdose reversal drug, naloxone, with addictive painkillers.

The panel, which concluded a two-day discussion on ways to make the potentially life-saving drug readily available, voted 12-11 in favor of labeling changes for opioids that recommend co-prescribing the overdose antidote.


Surgeon General Declares E-Cigarettes a Youth Epidemic
The US Surgeon General on Tuesday declared electronic cigarette use among America’s youth “an epidemic” and called for new restrictions on the products.

The action comes a day after release of a Monitoring the Future report, which confirmed that teen vaping nearly doubled in 2018, with one in five high school seniors reporting current use of e-cigarettes. More than 3.6 million teens in the U.S. reported that they regularly used the vaping products.

Recommendations in an advisory by Surgeon General Jerome Adams, MD, include banning vaping from establishments now covered by indoor smoke-free air policies, further restricting youth access to e-cigarettes in retail establishments, implementing new price policies, and banning marketing to youth. In his advisory, the Surgeon General singled out the new generation of e-cigarettes that have e-liquid contained in a cartridge, such as the brand Juul, as posing a particular risk to youth.

He added that despite these risks, approximately two-thirds of Juul users between the ages of 15 and 24 in one survey did not know that Juul always contains nicotine. (See Dr. Madejski’s comments in the introduction.)


MSSNY Symposium Call for Abstracts; Open through 4:00 pm Tuesday, January 22, 2019
MSSNY member residents, fellows and medical students are invited to submit abstracts for consideration for the MSSNY Symposium, to be held April 12, 2019 at the Westchester Marriott in Tarrytown. Submissions will be accepted until 4:00 pm on Tuesday January 22, 2019. See complete guidelines at http://www.mssny.org/Documents/RFS/Guidelines_2019a.pdf.

Please contact sbennett@mssny.org with any questions.

If you’d like to help score abstracts, contact sbennett@mssny.org.


Dr. First Banner


3rd and 4th District Meeting Jan 25-27 at the Mirror Lake Inn in Lake Placid.


Physician Fee Schedule Final Rule: Understanding 3 Key Topics
Here are the answers to frequently asked questions::

Topic: E/M

Q: What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?
View the response here.

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Topic: QPP

Q: How does the MIPS payment adjustment apply to clinicians, especially those who may switch practices during the performance year?

A: Below are the general rules on how the payment adjustment is applied, which is different than the legacy programs.

  1. A MIPS eligible clinician (NPI) who bills to the same TIN in the payment year as they did during the performance period will be assessed the payment adjustment under that TIN/NPI combination according to the final score earned from data submitted/collected under that TIN
  2. A MIPS eligible clinician (NPI) who bills to a (new) TIN in the payment year that they did NOT bill to during the performance period will be assessed the payment adjustment under that (new) TIN/NPI combination based on the most advantageous final score attributed to that NPI under any TIN/NPI combination for the performance period.

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Topic: Changes to MIPS Requirements

  1. Are there any changes to the data completeness requirements for the MIPS Quality performance category in 2019?
  2. No, the data completeness requirements are the same as in Year 2 (2018) even with the update to the submission terminology. Individual clinicians or groups submitting quality measure data on QCDR measures, MIPS CQMs, and eCQMs must submit data on at least 60% of the clinician or group’s patients that meet the measure’s denominator criteria, regardless of payer. Individual clinicians or groups submitting quality measure data on the Medicare Part B claims measures must submit data on at least 60% of the applicable Medicare Part B patients seen during the performance period.

Additionally, we have a fact sheet that provides additional information and scenarios on the MIPS payment adjustments.


American Board of Specialties on Continuing Board Certification: Vision for Future Commission Releases Report
The report, Draft Report for Public Comment which includes the Commission’s key findings and recommendations, will be posted on the Vision Initiative website for comment through Tuesday, January 15, 2019 at 10:00 p.m. EST.

We strongly encourage you to review the draft report and offer your comments by the January 15, 2019 deadline.

The American Board of Medical Specialties and its 24 Member Boards are committed to working with stakeholders to improve the continuing certification process so that it becomes a system that demonstrates the profession’s commitment to professional self-regulation, offers a consistent and clear understanding of what continuing certification means, and establishes a meaningful, relevant and valuable program that meets the highest standard of quality patient care. The Boards will seriously consider the Commission’s findings and recommendations once finalized, as they continue implementation of improvements and pilots currently underway.

Kristin Schleiter, JD
VP, Policy, Government Relations and Strategic Engagement
American Board of Medical Specialties
Direct 312-436-2686
Mobile 847-636-2779


AM Best Rates MLMIC A+
AM Best has assigned a Financial Strength Rating of A+ (Superior) and a Long-Term Issuer Credit Rating of “aa-” to MLMIC Insurance Company (MLMIC) (New York, NY). The outlook assigned to these Credit Ratings (ratings) is stable.

The ratings reflect MLMIC’s balance sheet strength, which AM Best categorizes as strongest, as well as its adequate operating performance, limited business profile and appropriate enterprise risk management. The ratings also benefit from the financial support provided by MLMIC’s direct parent company, National Indemnity Company, which is ultimately owned by Berkshire Hathaway Inc. [NYSE: BRK.A and BRK.B].

MLMIC’s risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR) is categorized as strongest and AM Best expects it to remain at a similar level in prospective years. The balance sheet strength assessment also considers the company’s track record of positive reserves development, as well as good financial flexibility provided by its publicly traded ultimate parent Berkshire Hathaway Inc.

MLMIC’s insurance portfolio is concentrated in the medical malpractice line of business. The company underwrites risks only within New York state, which represents one of the nation’s most challenging market environments. However, management has been able to operate successfully through underwriting cycles while maintaining MLMIC’s leading market position within New York.


Health Affairs: First Estimate of Physicians Telemedicine Use
The December issue of Health Affairs, using data from the AMA’s 2016 Physician Practice Benchmark Survey, provides the first nationally representative estimates of physicians’ use of telemedicine. In 2016, 15.4 percent of physicians worked in practices that used telemedicine for a wide spectrum of patient interactions, including e-visits as well as diagnoses made by radiologists who used telemedicine to store and forward data. In the same year, 11.2 percent of physicians worked in practices that used telemedicine for interactions between physicians and health care professionals. We found that in addition to specialty, larger practice size was an important correlate of telemedicine use. This suggests that despite regulatory and legislative changes to encourage the use of telemedicine, the financial burden of implementing it may be a continuing barrier for small practices.


Heart Group: Statins’ Benefits “Greatly Outweigh” Their Risks
For most patients who meet criteria for statin therapy, the benefits “greatly outweigh” the risks, according to a new scientific statement from the American Heart Association.

Here are some of the group’s conclusions, published in Arteriosclerosis, Thrombosis and Vascular Biology:

  • Statins prevent primary cardiovascular events in 5% of patients treated for 5 years (who achieve a 77-mg/dL reduction in LDL) and prevent secondary events in 10% of those treated.
  • Myopathy, including rhabdomyolysis, owing to statin use affects less than 0.1% of treated patients.
  • Severe liver toxicity occurs roughly 0.001% of the time.
  • Statins “modestly” increase the risk for diabetes, most often in patients with numerous other risk factors.

The absolute risks for additional adverse effects are listed in Table 7 of the document linked below.

AHA scientific statement in Arteriosclerosis, Thrombosis and Vascular Biology

AHA/ACC 10-year CV risk calculator


PAI Submits Comments in Response to Anti-Kickback Statute Request for Information (RFI
PAI submitted comments in response to the Anti-Kickback RFI, supporting the Department of Health and Human Services’ (HHS) efforts to modernize the Anti-Kickback Statute as well as the Beneficiary Inducement Civil Monetary Penalty Law (CMP). In its comments, PAI submitted several recommendations that would provide physicians relief from the antiquated aspects of these laws/regulation, including encouraging HHS to take the following key steps:

  • Establish clear exceptions to the Statute and CMP restrictions for payment models and demonstrations and other arrangements that promote physician-led initiatives to value-based care.
  • Allow physicians to align with other high-quality providers (clinical and non-clinical, including social support organizations) for greater coordinated care and a more holistic approach to patient care.
  • Encourage physician-patient relationships through greater patient incentives and rewards that promote and support the delivery of high-value, low-cost care and contribute towards greater coordinated care that improves outcomes.

More detailed recommendations include:

  • Permitting physicians and practices to enter into group purchasing arrangements for medical equipment and social support services on behalf of their patients.
  • Modernizing the statute to allow and provide for the infrastructure support and financial incentives necessary for value-based arrangements, for both providers and patients. The current exceptions, safe harbors, and waivers limited to certain models should be expanded to other APMs, demonstrations, and similar arrangements.
  • Strengthening physician-patient relationship by better alignment, including equipping physicians with tools that can be used to incentivize patient adherence to their care plans and help ensure medication adherence.
  • Allowing cost savings from rebates and negotiated discounts to be passed down from pharmacy benefit managers (PBMs) to patients and holding PMBs to stricter standards.
  • Creating additional safe harbors that allow physicians to establish arrangements with electronic health record vendors to further promote interoperability and health information exchange.
  • Clarifying the definitions of “value,” “risk,” and “market/market share” under the Statute and in their application to value-based payment arrangements.

CME WEBINARS

 “Public Health Preparedness 101” CME webinarJanuary 16, 2019 at 7:30am – Registration now open 

Are you prepared for a public health emergency?  And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here.  Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

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


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RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY STATEMENT IN RESPONSE TO JUDGE O’CONNOR’S ACA RULING


MSSNY Seal
MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

 

December 17, 2018
For Immediate Release

MSSNY STATEMENT IN RESPONSE TO JUDGE O’CONNOR’S ACA RULING

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

“Friday night’s Federal District Court ruling that the ACA is unconstitutional has the potential to wreak havoc with New York’s health care system, and our patients’ ability to obtain comprehensive health insurance coverage for the care they need.

While the ACA has many flaws that we urge Congress to continue to work to fix, among its strongest attributes are its mechanisms to enable the purchase of health insurance coverage for millions through a variety of subsidy programs.  These include expanded Medicaid coverage, tax credits and Basic Health plan coverage for those who earn too much to qualify for Medicaid.

Indeed, countless New Yorkers rely upon these mechanisms to obtain health insurance coverage that could be jeopardized if the court decision were to be upheld. Let’s work to make sure these important protections are maintained and enhanced.”

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

 

Media Contact:
Roseann Raia

Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516.488.6100 x 302
rraia@mssny.org

 

December 14, 2018 – Am. Bd. of Specialties Wants Your Opinion!

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


MSSNY eNews
December 14, 2018
Volume 21  Number 45

MSSNYPAC Seal

Colleagues:

My wife Sandra and I were honored to be able to join the New York State Society of Anesthesiologists for their Annual PGA in Manhattan last weekend.  Congratulations to outgoing President Dr. David Bronheim upon completion of a successful year.  I look forward to working on a number of issues of mutual interest to MSSNY AND NYSSA with incoming president Dr. Vilma Joseph. Special thanks to Stuart Hayman and Dr. Rose Berkun for their hospitality and friendship.

NYSSA provides a robust educational program in conjunction with their PGA and I participated in a panel discussion about possible passage of single payer legislation in New York State and other potential health care financing changes.  Subsequent to that, I traveled to Washington, D.C., along with MSSNY Senior Vice President for Legislative Affairs Morris Auster to participate in a discussion convened by the AMA about the last Medicare financing reform.

Medicare and You

The federal Medicare program continues to be the major driver in physician payment in the United States.  Medicare policies (and experiments) often create care and payment changes in the commercial insurance market and in Medicaid.  Medicare payment seems to be perpetually in need of reform.  The last major change in Medicare financing occurred with the passage of MACRA in 2015. MACRA was in part an attempt to provide a solution to the ongoing problem of the Sustainable Growth Rate formula, a flawed calculation that failed to compensate physicians and others fairly, and created an ongoing crisis of potential cuts that could have crippled a physicians’ ability to provide care and maintain their practice.  MACRA traded the SGR solution for a new payment system that promised to control costs while providing higher value care.  MACRA provides a carrot of bonus payments for participation in quality activities through the MIPS program for smaller practices, or through the QPP program in a variety of forms.  Unfortunately due to budgetary constraints the bonuses occur in the context of a tournament.  The lower performers receive a stick in the form of payment reductions.  Part of the design assumed that a movement away from fee for service Medicare would improve quality and restrain cost increases.  Due to the cost of replacing the SGR, payment increases have been limited and, with the sequestration process affecting the Federal budget, inadequate for practices to keep pace with inflation, and in many cases a poor return on the investment in resources required to participate and attempt to improve care.  In fact, from 2001 to 2017 while Medicare payments to hospitals and skilled nursing facilities have increased approximately 50% (8% above inflation), Medicare physician payments adjusted for inflation dropped 36%! (6% increase minus a 42% increase in the CPI)

Incentives Are Wrong

MSSNY continues to work with our partners at the AMA, and other State and Specialty Medical Societies to improve the care of our patients, and enhance physician satisfaction and practice sustainability.  Improper payment incentives and inadequate payment systems harm patients, and retard the development of a healthcare system that improves societal health and patient outcomes.

There was a wide ranging and robust discussion about issues and opportunities to improve patient care by changing the existing Medicare payment system at the Washington meeting.  Some of the challenges we face include:

  • The overall fiscal situation of the United States:  In a country with an expanding national debt and budget deficits approaching 1 trillion dollars per year, adding additional funds to support practice sustainability will be very difficult.  Trying to redirect existing funds from other areas that have benefited from the increased value provided to the system by physicians’ activities will be politically challenging.
  • After the first 5 years of MACRA, there is a five-year freeze on the Medicare Part B conversion factor. It was anticipated that there would be further modifications to the payment system before this went into effect.  This obviously would exacerbate the inequity in update differential payment highlighted above.
  • Demonstrating to lawmakers and regulators what we believe to be true—the highest quality, and most cost effective care to a patient is provided by physicians in a non-institutional setting.
  • Creating flexibility for physicians to have a real choice as to participation in new payment models. While there is much excitement about value based care, there is limited data that demonstrates its preference to traditional fee for service Medicare.  Some specialties may be best served by preservation of a fee for service model.  One of the great difficulties in MACRA implementation is the difficulty to come up with alternate payment models for physicians to consider across the spectrum of specialties and types of practice.  A bias toward large group structure to be able to afford the management tools for population health needed in risk contracting will not work in many rural or urban settings with limited resources, geographic challenges etc.
  • Reducing the regulatory and documentation burden of practice, including assuring our EMRs are truly functional.  It’s lunacy to continue as is a system that has physicians spend two-thirds of their time on non-clinical activity to get paid and not get sued.  That’s a 21st Century cure that I’d like to see.

MSSNY, through our House of Delegates, Socio-Economic committees, Council and AMA delegation, will continue to consider, explore, and advocate for policies that improve the our patients’ lives and that of our physician members.  I’m always interested to hear policy thoughts and feedback from our members.

Please share your suggestions or thoughts with me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


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eNews

Measles Advisory Update – Webinar Available at MSSNY CME Website
The New York State Department of Health issued an update on Tuesday, December 11th to the Measles Health Advisory in New York State.  You can view the advisory here.  There have now been at least 130 confirmed cases in the downstate region.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” on Wednesday.  This webinar has now been posted to https://cme.mssny.org .  Please check it out and keep yourself informed about the ongoing measles outbreak in New York State. 

MSSNY Submits Comments to Department of Justice re CVS-Aetna
As reported last week, US District Court Judge Richard Leon has considering delaying the proposed mega merger between CVS and Aetna.   He has ordered a hearing for December 18 and told the companies to present arguments by December 14 to convince him why the acquisition should be permitted.

This week, MSSNY submitted comments to the US DOJ that included testimony MSSNY Immediate Past-President Dr. Charles Rothberg delivered at the October 18 NY DFS hearing examining this transaction, as well as summarizing the extensive concerns with this merger among corporate behemoths that had been raised by NY DFS Superintendent Maria Vullo, the American Medical Association, the American Antitrust Institute and New York State Assembly Insurance Committee Chair Kevin Cahill.

The US Department of Justice (DOJ) had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition.  The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger in late November with numerous conditions.

While DFS’ conditional approval agreement addressed to some degree some of the concerns raised by MSSNY over the last year, MSSNY President Dr. Thomas Madejski issued a statement noting that physicians remained very concerned about the adverse impact to the health care delivery system in New York given the enormous reach of this transaction.

MSSNY’s letter to the DOJ highlighted that, even though the NY DFS had approved the acquisition, it did so highlighting several problems with the merger, including that the companies had not “provided any concrete analysis that the CVS/Aetna merger would result in specific reduced costs for New York consumers, or any business plan or study of asserted improved health outcomes to benefit New Yorkers.”

Moreover, MSSNY’s letter to the DOJ reiterated the extensive concerns articulated by the AMA.  Judge Leon’s concerns about the transaction included the strong opposition by the AMA, which had argued to the DOJ that it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options. 

Advocacy Alert – Please Urge Governor to Sign Bill Requiring Greater Transparency of Insurer Compliance with Mental Health & SUD Parity Laws
Physicians are urged to send a letter to the Governor requesting that he sign into law legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the NY Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.   A letter can be sent from here.

MSSNY, working together with the New York State Psychiatric Association and other specialty societies, had strongly supported this legislation as it passed the Legislature nearly unanimously.   The bill was delivered to the Governor on December 11, which means he has until December 22 to act. 

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS (https://dfs.ny.gov/consumer/health/cg_health_2018.pdf).

Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws.


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NY DFS Approves Cigna-Express Script Merger with Several Conditions
The New York Department of Financial Services (DFS) announced late Thursday that it had approved the purchase by Cigna of PBM Express Scripts.  MSSNY had submitted to DFS a letter detailing its concerns with this transaction in connection with the hearing that had been scheduled by DFS for last Friday, December 7, but the hearing was postponed after only one other group had requested to testify.

As noted in the last week’s e-news, MSSNY’s letter urged DFS to place meaningful “guardrails…to ensure that our patients’ ability to receive the care or medication they need from the physician or pharmacy of their choice is not disrupted or made more burdensome.” Concerns included: the anticompetitive effects of a health insurer purchasing a PBM when that PBM continues to provide services to other health insurance companies; the lack of a regulatory structure in New York regarding the actions of PBMs; and the risk of even more burdensome prior authorization requirements.

While MSSNY is still reviewing the final Opinion and Decision, at first glance, many of the conditions of approval appear similar to those that were required by DFS as part of its approval of the CVS acquisition of Aetna, including:

  • Prohibiting increased health insurance rates to pay for the cost of the acquisition;
  • Prohibiting dividends to be paid by Cigna without the express prior approval of DFS for 3 years;
  • Prohibiting preferential PBM pricing of Express Scripts to any Cigna-affiliated health insurer, to better ensure insurance competitors can continue to fairly purchase PBM services from Caremark;
  • Limiting changes to Cigna’s healthcare provider networks for 3 years, including maintaining access to non-chain New York pharmacies;
  • Contributing $20 million to New York State, to support health insurance education and enrollment activities and strengthen New York health care transformation activities, which may include payments to the New York State Health Care Transformation Fund
  • Requiring an independent third-party audit to assess whether Cigna employees have accessed Confidential Information from Express Scripts in violation of firewall policies; and

Furthermore, the decision contained a requirement that the parties “agree to take no action to oppose legislation” to directly regulate PBMs in New York State.

Nevertheless, physicians remain concerned with the increasing consolidation in the health care system.  MSSNY’s letter to DFS expressing concerns with this transaction, as well as its letter to the US DOJ regarding the CVS purchase of Aetna (see related article) noted that “the efficiencies that are promoted and marketed to supposedly occur are hardly ever borne out after these transactions are consummated.  Inevitably, these mergers create market dynamics that almost always result in further administrative burdens placed on physicians seeking to assure their patients receive the care or medication they need.

MSSNY Addiction & Psychiatric Medicine Committee Paper: Medicine and Marijuana
The Medical Society of the State of New York convened its members on the Addiction and Psychiatric Medicine Committee, the Bioethics Committee and its Health Disparities Committee for comments on the possibility that New York State government may seek legalization of recreational marijuana.  Comments were also expressed by committee members on the existing marijuana program for medicinal purposes.    

American Board of Specialties on Continuing Board Certification: Vision for Future Commission Releases Report
The report, Draft Report for Public Comment which includes the Commission’s key findings and recommendations, will be posted on the Vision Initiative website for comment through Tuesday, January 15, 2019 at 10:00 p.m. EST.

We strongly encourage you to review the draft report and offer your comments by the January 15, 2019 deadline.

The American Board of Medical Specialties and its 24 Member Boards are committed to working with stakeholders to improve the continuing certification process so that it becomes a system that demonstrates the profession’s commitment to professional self-regulation, offers a consistent and clear understanding of what continuing certification means, and establishes a meaningful, relevant and valuable program that meets the highest standard of quality patient care. The Boards will seriously consider the Commission’s findings and recommendations once finalized, as they continue implementation of improvements and pilots currently underway.

Kristin Schleiter, JD
VP, Policy, Government Relations and Strategic Engagement
American Board of Medical Specialties
Direct 312-436-2686
Mobile 847-636-2779 

DFS Fines Aetna and Oscar More Than $2.5 Million For Violations Of Insurance Law
NY Department of Financial Services (DFS) Superintendent Maria Vullo announced this week DFS had imposed fines against Aetna and Oscar totaling more than $2.5 million for violations of New York Insurance Law.  According to the DFS press release, Aetna will pay a civil penalty of $1.95 million for violations including the failure to make prospective determinations, including pre-authorizations, and failure to acknowledge and respond to members’ complaints within required timeframes.  Oscar Insurance Corp. will pay a civil penalty of $576,950 for violations including the failure to adhere to deadlines for utilization reviews and failure to include detailed explanations of adverse determination notices.

Regarding Aetna, a DFS market conduct examination found that from 2012 through 2015, Aetna failed to comply with a number of consumer/provider protections, including: completing pre-authorizations determinations within three business days of receipt of all necessary information; Responding to members’ complaints within the required time frames; sending initial adverse determination letters to the insured and providers within 30 days; and making an appeal determination within 60 days of all necessary information to conduct an appeal.

Under the consent order, Aetna will review and revise all of its procedures related to utilization review, appeals, grievances and complaints to ensure that timely determinations and notifications are given to insureds, providers, and other recipients.  Moreover, Aetna will reprocess all preventive care claims where cost sharing was inappropriately applied and make overdue payments, including interest; and reprocess all claims that were inappropriately denied, and make overdue payments, including interest.

Regarding Oscar, a DFS market conduct examination found that from 2013 through 2015, Oscar failed to comply with a number consumer/provider protections, including: failing to make a determination for prospective utilization reviews within three business days; Failing to make a determination for concurrent utilization reviews within one business day; and failing to include an accurate and detailed explanation of the clinical rationale for the denials in the adverse determination notices;

Under the consent order, Oscar Insurance will be: revising EOB statements to include the appropriate forfeiture language; revising adverse determination notices to include a detailed explanation of the clinical rationale for denials; and reviewing and revising all procedures, related to utilization review to assure that timely determinations are made.

A copy of the Aetna consent order can be found here.

A copy of the Oscar Insurance Company consent order can be found here.


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Millions Expected To Drop Health Coverage in 2019 with Repeal of ACA Penalty
Kaiser Health News piece predicts that millions of Americans are likely to drop their health insurance for next year now that the ACA’s penalty for not having coverage has been eliminated. The Congressional Budget Office predicted that “the repeal of the penalty would move 4 million people to drop their health insurance next year – or not buy it in the first place – and 13 million in 2027.” The article says some consumers “who from the start hated the Affordable Care Act, or Obamacare as it is often called, will drop their coverage as a political statement,” while others will do so because of affordability.


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NY Hospitals Reach Settlement, Agree To Stop Improper Billing of Rape Survivors
A group of New York hospitals has agreed to pay restitution to rape survivors and revise billing procedures as part of a legal settlement, state Attorney General Barbara Underwood announced Nov. 29.

The settlement resolves allegations that the hospitals illegally billed at least 200 forensic exams to rape survivors, ranging from $46 to $3,000 each, according to Ms. Underwood.

Hospitals are Brookdale University Hospital Medical Center in Brooklyn; Montefiore Nyack (N.Y.) Hospital; New York Presbyterian/Brooklyn Methodist Hospital; New York-Presbyterian/Columbia University Irving Medical Center; Staten Island-based Richmond University Medical Center; and Bronx-based St. Barnabas Hospital. Columbia University, which employs physicians, is also included.

The hospitals have agreed to pay restitution to rape survivors, in addition to costs, and implement written policies to prevent rape survivors from receiving bills for their rape exams. The settlements follow an investigation of billing practices for forensic rape examinations at Brooklyn Hospital Medical Center. Ms. Underwood said the investigation resulted in an agreement with the hospital, and her office initiated a statewide investigation of billing practices for rape exams at other facilities.

New York law requires that hospitals bill rape exams to the state Office of Victim Services directly, unless the sexual assault survivor voluntarily decides to assign the costs to a private health plan. (Becker’s Hospital Review 11/30)

Free Dinner Symposium for Physicians in Independent Practice
To address the needs of physicians in independent practice, PrescRXptive Communications and E Central Medical Management are co-sponsoring the third annual Toolkit for Independence: Tips and Techniques for a Successful Medical Practice, a complimentary dinner symposium packed with insights to help independent medical practices thrive. The event will be held on Thursday, January 10, from 5:30 – 9:30 p.m. at Jewel Restaurant in Melville.

The symposium is free for physicians and office managers who are accompanied by a physician. The evening includes a cocktail hour and sit-down dinner. There are limited seats available. For additional information, call 631-606-0525. To register, visit http://toolkit-for-independence.eventbrite.com/. 

2019 ACPH Call for Abstracts Now Open through March 29, 2019
Showcase your work at the American Conference on Physician Health (ACPH)! The conference, which is being hosted by the American Medical Association, Mayo Clinic and Stanford University School of Medicine, is being held September 19-21, 2019 at the Sheraton Charlotte Hotel/Le Meridien in Charlotte, NC. Authors are invited to submit abstracts for consideration as part of the 2019 ACPH. Submissions will be accepted from December 10, 2018 to March 29, 2019.

Submit your abstract in one of two categories:

  • Research: submitted as either a poster or oral presentation
  • Workshop: submitted as an interactive session

*research and non-research workshops considered

Be sure to visit the conference website physician-wellbeing-conference.org to review important details in our “Call for Abstracts” section, as well as the instructions for submitting abstracts. Submissions for all abstracts must be made electronically via the abstract submission form, information available at the ACPH 2019 Call for Abstracts website. Please contact us at physicianhealth@ama-assn.org with any questions or requests.

CME WEBINARS

“Public Health Preparedness 101” CME webinar
January 16, 2019 at 7:30am – Registration now open

Are you prepared for a public health emergency?  And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here.  Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

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


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DISABILITY

What Should Clinicians Know About Disability?
Approximately 1 in 5 adults reports a disability, and health care professionals play distinctive roles in defining disabilities and treating individuals with them. Better care for the great diversity of people with disabilities “requires better engagement with and reflection upon the rich and complex meaning of disability,” writes Joel Michael Reynolds, The Hastings Center’s Rice Family Fellow in Bioethics and the Humanities, in the AMA Journal of Ethics. Reynolds outlines a set of recommendations and duties clinicians have when encountering patients with disabilities, including the responsibility to recognize the authority of these people as experts about their own experiences. Read the article.


CMS

QPP Tip: Avoiding 2020 MIPS Payment Adjustment – The Minimum to Report
The “test” and “partial” participation options that were available for the CY 2017 MIPS participation period are no longer available for the CY 2018 MIPS participation period. To avoid the 2020 MIPS payment adjustment, based on 2018 MIPS participation, physicians will need a minimum of 15 points across all four MIPS categories – quality, improvement activities, promoting interoperability, and cost. Potential ways to achieve the minimum 15 points include:

  • 100 percent score in improvement activities category – reporting medium/high weight activities to achieve a total of 40 points
  • Achieving 18 points out of a total of 60 points (if reporting 6 measures) for the quality category
    • Reporting six measures for at least 60 percent of applicable patients
    • Earning the maximum 10 points for a high-performance score for at least two measures, which have benchmarks and are not “topped out” measures
  • Reporting the ACI base score measures and either:
    • Reporting at least one quality measure for at least 60 percent of applicable patients
    • Reporting one improvement activity
    • Receiving a small practice bonus
    • Receiving a complex patient bonus of at least three points


For additional information, please see Step 5 of the Navigating the QPP Resource  available on PAI’s MACRA QPP Resource Center.

 


Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day or by month. Price is negotiable. Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

58th Street room1 58th Street room2 58th Street room3


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

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


December 7, 2018 – Marijuana: Right or Wrong?

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


MSSNY eNews
December 7, 2018
Volume 21  Number 44

MSSNYPAC Seal

Colleagues:

There is significant public pressure to permit the recreational use of marijuana.

Given the new political makeup of the New York State Legislature come January, it is a distinct possibility that legislation to legalize its use will be a high priority.  Particularly given that many of the states surrounding New York—Vermont, Massachusetts, Connecticut, and New Jersey— not to mention the entire country of Canada, have acted or are soon to act to legalize its use.

We have shared with many our support for eliminating the threat of criminal sanction for marijuana use, but also concern with its outright legalization, citing statistics from other jurisdictions such as Colorado where legalization has occurred.

We have had meetings throughout the fall with top staff to the Governor, the New York State Health Department and with key legislators.  We have engaged allies such as the NYS Association of County of Health Officials.  We have testified at several regional forums.  And we have engaged with the media regarding our concerns, including the Buffalo News and Syracuse Post-Standard.

What Are Our Concerns?

And most recently, through the hard work of MSSNY’s Addiction and Psychiatric Medicine, the Preventive Medicine and Family Health Committee, and the Committee to Eliminate Health Disparities, we developed a paper that sets forth our continuing concerns with legalizing recreational marijuana, but also sets forth several recommendations that we believe are absolutely essential if the Legislature acts to legalize it.  Our recommendations are many, but some ideas include:

  • Prohibiting the sale of any type of marijuana products to anyone younger than 25 years of age;
  • Prohibiting the sale of any type of marijuana products to pregnant and post-partum women;
  • Prohibiting the sale of any flavored type of marijuana;
  • Limiting the amount of marijuana an individual may obtain to ensure that there is no “marijuana shopping” to obtain large amounts for resale
  • Developing an electronic system to prevent individuals collecting large amounts of marijuana from multiple sources
  • Prohibiting use in public areas similar to tobacco legislation
  • Establishing a public awareness campaign similar to the tobacco program that would highlight the risks of marijuana to discourage vulnerable populations, youth, individuals with a history of addiction and mental illness from using marijuana
  • Prohibiting marketing and advertising to youth, (similar to the tobacco control program) ;
  • Requiring child proof packaging with information about poisoning and overdose; and
  • Limiting marijuana product sales to state-operated entities; and
  • Assuring a portion of the revenues  should support establishment of addiction treatment and rehabilitation of substance use disorder programs 

Given the substantial amount of revenue New York State could achieve through permitting the sale of recreational use marijuana, we anticipate seeing a proposal in the state budget.

Now is the time to engage with your local legislators to let them know of your perspective on this issue. We understand that physicians may have diverging perspectives on the merits of legalization of marijuana.  Indeed, the physicians on MSSNY’s committees had diverging perspectives.  But they all agreed regardless of these perspectives that the state must place strong guardrails around any legalization proposal to prevent against harm to the public that could occur.

Stay tuned for further details.

Please share your suggestions or thoughts with me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


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eNews

New York City Council Passes Resolution in Support of Single Payer Legislation
The conversation regarding single payer legislation in New York continued on Thursday as Assembly Health Committee Chair Richard Gottfried and others testified before the New York City Council, which was considering (and ultimately adopted) a resolution in support of the far-reaching proposal . During his testimony, Assemblyman Gottfried noted that new iteration of the plan would include long-term care and would be financed by mostly by higher earners via a “broad-based progressively graduate taxes,” adding at least $159 billion to the state’s tax rolls each year. In addition to a payroll tax (80% paid by employers), he referenced an additional tax on capital gains and dividends.

Assemblyman Gottfried also noted that the bill would “make sure doctors, hospitals and other providers are paid fairly – and today, most of the time, they are not.” He explained, “…the legislation explicitly requires that provider payments be reasonable, related to the cost of providing the care, and assure an adequate supply of the care.  No coverage today has that guarantee.” Gottfried believes that savings will be garnered via elimination or reduction in bureaucracy and administrative burdens and asserts that physician payments will not decrease.

The Greater New York Hospital Association testified at the hearing to express its strong concerns, citing a lack of federal funding, escalating taxes and potential reductions in payment to hospitals, stating “There are huge obstacles in the way…and we do not believe these obstacles can be overcome.” Municipal unions also discussed their concerns about the proposal, even as Assemblyman Gottfried assured union leaders that concessions would be made addressing their concerns.

Also, it was reported this week that enrollment through the NYS Exchange is up this year for 2019 coverage, despite Congress’ elimination of the individual mandate.  According to its press release, more than 930,000 consumers had enrolled in coverage in a Qualified plan or the Essential Plan, including 51,000 new consumers. 

MSSNY Urges DFS to Reject Cigna-Express Scripts Transaction
Noting that “physicians are extremely worried about the adverse impact to patient care as a result of the increasing consolidation in the health care industry” MSSNY President Dr. Thomas Madejski this week urged the New York Department of Financial Services (DFS) to reject the proposed acquisition of Express Scripts by Cigna. In particular, he noted that the merger of behemoths in health care seldom occurs in a vacuum – It almost always prompts “copycats” to counteract the enormous bargaining leverage the newly merged entity will have.

If the transaction is to be approved, Dr. Madejski urged DFS to place meaningful “guardrails…to ensure that our patients’ ability to receive the care or medication they need from the physician or pharmacy of their choice is not disrupted or made more burdensome.”

The letter was sent in conjunction with a public hearing scheduled by DFS Superintendent Maria Vullo for Friday, December 7 examining this proposed transaction. The hearing has been rescheduled for January 10, 2019. Among the concerns raised by Dr. Madejski in his comment letter to the Superintendent included:

  • The anticompetitive effects of a health insurer purchasing a Pharmaceutical Benefits Manager (PBM) when that PBM continues to provide services to other health insurance companies. The concern is that the accumulation of power across the health insurer and PBM industries will disadvantage New York’s several regional health insurance companies thereby potentially reducing health insurer competition in many regions of the State;
  • The combined entity will leverage its significant new market power to impose even more burdensome prior authorization hassles for physicians and their staff that already unduly interfere with patient care delivery, at a time when New York physicians spend an inordinate amount of time on receiving prior authorizations.
  • The lack of a regulatory structure in New York regarding the actions of PBMs.

The letter also urged that, if the transaction is to be approved, Cigna should be required to reduce prior authorization burdens, support efforts to regulate PBMs, and to contribute towards enhancing the ability of the DFS to investigate health insurer violations of New York’s extensive managed care laws.

US Federal Judge Puts the Brakes on CVS-Aetna
As reported in numerous media sites, US District Court Judge Richard Leon has considered delaying the proposed mega merger between CVS and Aetna. He has ordered a hearing for December 18 and told the companies to present arguments by December 14 to convince him why the acquisition should be permitted.  

The US Department of Justice (DOJ) had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition. The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger last week with numerous conditions.

While DFS’ conditional approval agreement addressed to some degree some of the concerns raised by MSSNY over the last year, MSSNY President Dr. Thomas Madejski issued a statement noting that physicians remained very concerned about the adverse impact to the health care delivery system in New York given the enormous reach of this transaction.

Judge Leon’s stated concerns included the strong opposition by the American Medical Association, which last summer submitted extensive documentation to the DOJ urging it to reject the merger, arguing it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options. “Given that I have to decide, based on what I expect to be well-informed and thoughtful public commentary — I specifically already mentioned the American Medical Association’s lengthy concerns that they have put in writing previously,” Judge Leon said.

Prior to approving the merger with conditions, New York DFS Superintendent Maria Vullo had stated publicly her very significant concerns about the scope of this transaction on health care delivery.

The numerous articles on this issue have also noted that it is unclear if Judge Leon has the power to reject the merger, or simply question whether the conditions are satisfactory to meet antitrust concerns.

MSSNY has been discussing with AMA antitrust experts the possible next steps that could be taken to prevent this merger from being advanced.  Given the fluidity of this situation, please remain alert for further updates.


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DOH Brings Stakeholders Together to Set Parameters for Midwife Led Birthing Centers
MSSNY, together with the American College of Obstetricians & Gynecologists (ACOG) – District 2, have been participating in an ongoing series of discussions among several stakeholders organized by the NYS Department of Health seeking to establish regulations permitting midwife-led birthing centers (MBC) in New York.  Legislation permitting these centers was signed into law by Governor Cuomo in 2016 but implementing regulations have not yet been completed.   Other participants in these discussions include associations representing hospitals, midwives, and birth centers.

The DOH staff  have sought to clarify a number of questions in developing the implementing regulations including: the definition of which expectant mothers are “a patient at low risk”; the required level of review by the State to establishing a MBC including whether it should require a certificate of need (CON);  the scope of collaborative agreements between midwives and OB-GYNs; the scope of transfer agreements between MBCs and area hospitals; and whether, as argued forcefully by ACOG, there should be a required agreement of an MBC to a regional perinatal center (RPC) to assure that the best interests of expectant mothers and their babies are met. 

Medicare Rights Center: “45.1% of Online Provider Directories Inaccurate”
In 2017’s audit report, CMS found that 45.1% of provider directory locations listed in online directories were inaccurate. In the early 2018 report, 52.20% of the provider directory locations listed had at least one inaccuracy. Now, the third such report shows that 48.74% of the provider directory locations listed had at least one inaccuracy. The types of inaccuracies remain the same: the provider was not at the location listed; the phone number was incorrect; or the provider was not accepting new patients when the directory indicated they were.

These inaccuracies put people with Medicare in a difficult position. Not having access to accurate directories when they are making decisions about their Medicare options can lead to beneficiaries choosing MA plans based on illusory networks. Coupled with CMS’ current campaign that blatantly favors MA over Original Medicare, risks are mounting that people will mistakenly enroll in an MA plan that is not right for them. Once enrolled, they may find that they are reaching out to doctors that are unreachable, not in the areas they expected, not accepting new patients, or perhaps not part of the network at all. There’s even a chance that people with Medicare could suffer from lack of access to care by choosing a network without providers that are accessible or genuinely accepting new patients.

In the 2017 report, CMS announced they had sent 31 Notices of Non-Compliance, 18 Warning Letters, and 3 Warning Letters with a Request for a Business Plan. In the early 2018 report, they announced 23 Notices of Non-Compliance, 19 Warning Letters, and 12 Warning Letters with a Request for a Business Plan. In this latest report, 18 Notices of Non-Compliance, 15 Warning Letters, and 7 Warning Letters with a Request for a Business Plan were sent.

Earlier this year, CMS reiterated previous warnings that “[monetary penalties] and other enforcement actions may be imposed,” but this has not happened…” (Medicare Rights Center)

CVS: New Script Benefit for Employer-Sponsored Insurance Plans in 2019
CVS Health Corp announced as of the beginning of 2019 a new prescription benefit option for employer-sponsored plans that will ensure clients receive all rebates and discounts paid by drugmakers. The new plan, called “guaranteed net cost,” may serve to counter criticism of pharmacy benefit managers (PBMs), often the beneficiaries of rebates paid by pharmaceutical companies. Forbes (12/5) reports, “In August, CVS grabbed headlines when it disclosed that it has historically retained 2% of rebates negotiated with drug makers, which this year translates to 3% of the company’s annual earnings per share, or about $300 million.” The move by CVS echoes a growing trend among PBMs generally to increase transparency on drug pricing for consumers.


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Millions Expected To Drop Health Coverage in 2019 with Repeal of ACA Penalty
Kaiser Health News piece predicts that millions of Americans are likely to drop their health insurance for next year now that the ACA’s penalty for not having coverage has been eliminated https://khn.org/news/without-obamacare-penalty-think-itll-be-nice-to-drop-your-plan-better-think-twice/ The Congressional Budget Office predicted that “the repeal of the penalty would move 4 million people to drop their health insurance next year – or not buy it in the first place – and 13 million in 2027.” The article says some consumers “who from the start hated the Affordable Care Act, or Obamacare as it is often called, will drop their coverage as a political statement,” while others will do so because of affordability.


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CME WEBINARS

The Continued Public Health Threat of Measles: 2018 CME Webinar
December 12, 2018 at 7:30am – Registration now open

In response to the recent and expanding measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 roster.  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 program here.

Educational Objectives:

  • Increase physician’s awareness of the role of measles as a re-emerging infection.
  • Discuss strategies to improve vaccination rates.
  • Explore herd immunity and the role it plays in recent measles outbreaks.

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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Residents, Fellows, Students

SAVE THE DATE: MSSNY SECTIONS ANNUAL MEETING: YPS, RESIDENTS, FELLOWS, AND STUDENTS
The Meeting will be held on Saturday, February 9, 2019 at the Marriott Courtyard in Westbury, with YPS and RFS business meetings held at MSSNY headquarters down the street. Presentations will be given on Opiates and Social Medial. More to follow!


New York Medicaid

2019 Meaningful Use – NY Medicaid EHR Incentive Program
The Centers for Medicare & Medicaid Services recently published rulemaking impacting the NY Medicaid EHR Incentive Program and aligning it with the Merit-based Incentive Payment System (MIPS). 2019 meaningful use requirements for all eligible professionals include:

  • 2015 Edition Certified EHR Technology
  • Stage 3 objectives and measures
  • Minimum 90-day EHR reporting
  • 6 clinical quality measures (CQMs), including one outcome or high priority measure
  • Full calendar year CQM reporting

The thresholds for Stage 3 Objective 6 Coordination of Care measures 1 and 2 will not increase. These measures will remain at more than 5% for 2019 meaningful use and the remainder of the program.

The eCQI Resource Center has posted the 2019 CQMs. These align with MIPS, so eligible professionals may be able to participate in both the NY Medicaid EHR Incentive Program and MIPS.

Questions? Resources about meaningful use, including tip sheets, webinars, and frequently asked questions are available at https://health.ny.gov/ehr. For additional assistance, please contact program support at 1-877-646-5410 or hit@health.ny.gov.


CMS

CMS Cuts Payments to 11,000 Nursing Homes, Cites Readmission Rates
Medicare is modifying one year’s worth of payments to 14,959 skilled nursing facilities based on readmission rates, according to a Kaiser Health News report. Nearly 11,000 nursing homes will face penalties, while nearly 4,000 others will receive bonuses, the report states.

The payments factor in how often nursing home residents are rehospitalized within 30 days of leaving. They aim to reduce preventable hospital admissions of residents and dissuade nursing homes from discharging patients too quickly, according to the report.

Nursing homes will receive the bonuses and penalties during the fiscal year that began Oct. 1 and ends Sept. 30, 2019. The bonus for best-performing nursing homes is 1.6 percent more per Medicare patient, and the worst-performing nursing homes will see a penalty of nearly 2 percent of each payment.

The incentive payments, which do not apply for patients covered by private Medicare Advantage, are part of CMS’ Skilled Nursing Facility Value-Based Purchasing Program. To determine the payments, Medicare factored in performance on the program’s hospital readmissions measure during calendar year 2017 and examined improvement made since calendar year 2015.

Scores for individual nursing facilities nationwide are available here. (Becker’s Hospital Review  Dec 3)


Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day or by month. Price is negotiable. Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

58th Street room1 58th Street room2 58th Street room3


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

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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


November 30, 2018 – Single Payor Update!

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
November 30, 2018
Volume 21  Number 43

MSSNYPAC Seal

Colleagues:

The MSSNY Enews staff had some well-deserved rest during the Thanksgiving holiday.  During the holiday, I spent some time with family and friends and many of my patients.  I also spent some time on MSSNY business and reflected on all I have to be thankful for.

I’m thankful for each and every one of our members.  Your support of MSSNY allows us to continue to advance the interests of our patients, the public health of the citizens of New York State, the best practice of medicine, and stewardship of our profession.  I’m thankful for each of our MSSNY Committee members, and especially my Committee Chairs. Their devotion to creating and crafting policy to improve care, and to promote the art of science and medicine, is critical to the lifespan and health span of our fellow New Yorkers.

Thanks to the MSSNY Council members. We truly are in a new Golden Age of medicine.  Your help in prioritization and refinement of the many activities that occur under the MSSNY umbrella is invaluable to me as we work to continue to expand our reach and impact on behalf of our patients. I’m especially thankful for the thoughts and efforts of my colleagues in the Office of the President, Dr. Bonnie Litvack, Dr. Arthur Fougner, and Dr. Charles Rothberg. They provide constant feedback and assistance to me as we represent MSSNY across the state and throughout the nation.

Finally, I’m most thankful for the MSSNY staff.  Mr. Phil Schuh, our MSSNY Executive Vice President, leads a talented and devoted team that supports and enhances our efforts on behalf of our members.

I hope that each of you were able to spend time with your families and have had some time to recharge your batteries for the important work you do for the people of New York.

I also had some time to catch up on some reading and recommend to you an article in Health Affairs which discusses how “to fix” primary care.

I’ve been practicing geriatric medicine for a number of years. Experts have been trying to fix primary care from the time I entered medical school. The solutions proposed haven’t changed much. However, we are always on the lookout for new solutions in this changing climate for physicians.

Please share your suggestions or thoughts with me at comments@mssny.org.

Excelsior!

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance for Doctors


eNews

Single Payor Legislation Update
With Democrats now in control of both Houses of the State Legislature, it significantly enhances the possibility of the enactment of the New York Health Act (NYHA), legislation to establish a single payer system. NYHA would provide universal insurance coverage without copays, deductibles or premiums for all New Yorkers. It would also prohibit health insurance companies from offering similar coverage.

According to the recent RAND study it would require $139 billion in new tax revenue (a 156% increase) by 2022. The bill has passed the Assembly several times in recent years but was never voted on in the previously Republican controlled Senate. Its current incarnation is sparse – just 23 pages of text – and does not include significant details sought by many stakeholders regarding how such an enormous proposal would be implemented.

Earlier this fall, MSSNY and New York County Medical Society leadership met with Assembly Health Committee Chair Richard Gottfried (and NYHA bill sponsor) to discuss questions expressed by physicians both in opposition and in support of the NYHA bill, including:

  • How burdensome will prior authorization requirements be?
  • What will be the process for patients to appeal when recommended care has been denied?
  • How meaningful will be the right for physicians to collectively negotiate with a NYHA Board?
  • Could state budget limitations result in a grossly inadequate Medicaid-type payment structure that would make it impossible for many physicians to remain in practice in New York?
  • Should liability reform be included given the enormous medical costs arising from “defensive medicine”?

In recent days leaders in New York state government have tempered expectations following the election.  Incoming Senate Majority Leader Andrea Stewart-Cousins stated this week that “It’s a conversation we have yet to have in the Senate…I can certainly commit to having it heard.”  Governor Cuomo has stated “Conceptually I think it’s the right way to go in. I believe it’s more feasible financially on the national level. No state has been able to finance the transition costs.”  Democratic Senator Elect Alessandra Biaggi, a strong supporter of the single payer concept stated “…that’s going to mean taking some time to be thoughtful about how we’re going to pay for it.” Bill Hammond, noted health policy expert and the Empire Center’s Director of Health Policy, has repeatedly voiced concerns over the many possible negative consequences of the proposal.

Senator Gustavo Rivera, who is widely expected to take over as Chair of the Senate Health Committee in 2019, stated this week that he and Assemblyman Gottfried would soon be releasing a new version of the New York Health Act to address concerns from “stakeholders”. He did acknowledge that it is an “incredibly complicated piece of legislation”, admitting that change would be gradual and would not take place overnight, stating “If it were to pass today, it would still take two to three years to put all the regulations together that would be necessary to make the transition.”

The NYHA seemingly has a path forward this year with Democrats controlling state government, but it remains to be seen if all sides will align, configuring the details necessary to make the system actually work and gathering enough support to bring it to fruition.  One “wild card” is the fact that there will be 14 new Democratic State Senators in Albany in 2019.  With the consideration of this issue so fluid, please remain alert for further updates.

NY Comptroller Tom DiNapoli Discrepancies Show I-STOP Needs to Be Better
A new audit has found about a third of New Yorkers on Medicaid being treated for opioid addiction received a prescription for narcotic painkillers over a four-year period — highlighting a potential problem nationwide with drug monitoring systems. The New York comptroller’s audit this week said of those addicts who found a doctor to prescribe them opioids between Oct. 1, 2013, and Sept. 30, 2017, 3 percent — or nearly 19,000 people –sought medical care for an overdose within a month of filling those prescriptions. Twelve died.

The audit found that treatment programs did not always check the state’s Internet System for Tracking Over-Prescribing (I-STOP) database. The study found a sample of 25 patients from three treatment programs received more than 1,000 Medicaid opioid prescriptions while in treatment for abuse over the four-year period. New York law requires treatment programs to check the I-STOP database every time a medication-assisted opioid was prescribed for take-home use.

DiNapoli recommended that the DOH develop a method for notifying treatment programs when the database shows Medicaid recipients receive potentially dangerous prescriptions. His office also suggested the programs upload their own patient info when accessing the database, and that the DOH conduct risk assessments for individuals receiving medication-assisted treatment.



NY Rx Card Banner


NY DFS Approves CVS-Aetna with Several Conditions
The New York State Department of Financial Services (DFS) announced their final approval of the massive proposed acquisition of Aetna by CVS, albeit with numerous conditions, paving the way for the consolidation of two of the nation’s largest healthcare companies. New York was one of the last states to approve the transaction after it was approved by the US Department of Justice and several other states.

The full list of conditions, designed to ensure fair business practices by the merged entity, can be found here. The conditions include:

  • Prohibiting use of funds from any Aetna company or affiliate covering New Yorkers to pay for its acquisition;
  • Prohibiting costs derived from the acquisition, including executive compensation, from being passed on to any domestic or foreign Aetna New York insurer;
  • Prohibiting increased health insurance rates to pay for the cost of the acquisition;
  • Prohibiting dividends to be paid by Aetna without the express prior approval of DFS for 3 years;
  • Prohibiting preferential PBM pricing to any Aetna-affiliated health insurer licensed in New York, to better ensure insurance competitors can continue to fairly purchase PBM services from Caremark;
  • Limiting changes to Aetna’s healthcare provider networks for 3 years, including maintaining access to non-chain New York pharmacies;
  • Contributing $40 million to New York State, to support health insurance education and enrollment activities and strengthen New York health care transformation activities, which may include payments to the New York State Health Care Transformation Fund
  • Requiring an independent third-party audit to assess whether Aetna employees have accessed Confidential Information in violation of firewall policies.

Moreover, the DFS press release noted that “CVS committed at the DFS public hearing in October and as part of the approval process that CVS Health and its subsidiaries will take no action to oppose” legislation requiring a New York license for PBMs to operate.

While the conditional approval agreement addresses to some degree some of the concerns raised by MSSNY over the last year, physicians remain very concerned about the adverse impact to the health care delivery system in New York given the enormous reach of this transaction.  MSSNY President Dr. Thomas Madejski stated “We thank the DFS for their efforts to push for legislation to control the ability of PBMs to limit patient access to needed medications. We applaud the extensive review that the DFS provided to this transaction and the conditions they imposed to help minimize the enormous impact that this merger will have on our health care system.  We do remain concerned, however, that there may not be sufficient steps imposed to control the enormous power that this merged entity could use to marginalize physician-led medical homes as it expands its corporate driven healthcare model. Physicians fully expect that the merger will further reduce competition in New York’s health insurance market.  This is one more reason why physicians deserve the right to collectively bargain against corporate behemoths that seek to limit our ability to deliver needed care to patients.”

MSSNY will also be providing testimony for a December 7 DFS hearing to express its similar concerns with the proposed acquisition of PBM Express Scripts by Cigna.


Daily_113018
Would You Like to Share MSSNY’s The Daily with Other Professionals in your Practice?

MSSNY is ready to extend this popular member benefit to the PAs and NPs on your staff.

If you’re interested, please send the email addresses of the appropriate professionals in your office to rraia@mssny.orgso they can begin to enjoy this daily sweep of healthcare news.

 


MSSNY Raises Concern with DOH Proposal Regarding Office-Based Surgery Reports
MSSNY has written to the New York State Department of Health to express its concerns and suggested revisions to regulations proposed by the NYSDOH that would require Office-Based Surgery (“OBS”) practices to report cumulative procedural information to NYSDOH. The proposed reporting requirements were published in the New York State Register on October 17 with a 60-day comment period.

The proposed regulation would require each OBS practice to report in a “form and format specified by the Department” information including, but not limited to, practice identifiers, types of procedures, and number of each type of procedure performed in office-based surgery practices.  The proposed regulation would also set forth the manner for how adverse events are reported to DOH, as well as grant the DOH discretion to use the data gathered to develop and implement guidelines and criteria for quality improvement.

The MSSNY comments to the NYSDOH note its agreement with the goal of the proposed regulation to help place in context how frequent or rare particular adverse events are occurring in OBS settings, given the importance of quality improvement to assuring patient safety.  However, MSSNY expressed concerns with the lack of needed specificity in the proposed regulation, including the specific information OBS practices will be required to report to DOH on an ongoing basis.

Moreover, MSSNY’s comments raise concerns that some practices could find it difficult to report procedural information in a manner to be determined by DOH given that physicians are at different stages of implementing Electronic Health Record (“EHR”) systems.  Given the significant EHR implementation challenges facing many physicians, some physicians have either not implemented them or use very rudimentary systems, making a new requirement for the collection and reporting of information difficult to satisfy.  Furthermore, there were concerns with the possibility that procedures could be required to be reported by its CPT code, even though some OBS facilities do not internally track these services by CPT code (since they are not submitted to insurance).

Recognizing the goal of the regulation to facilitate quality improvement and patient safety, MSSNY has also suggested that DOH amend the regulation to permit OBS accrediting bodies to file these reports on the physician’s behalf since the information sought by DOH often overlaps with reports that many physicians are already making to their respective OBS accrediting bodies.

Physicians with comments on this proposal can send them to regsqna@health.ny.gov.


Garfunkel Ad


US Life Expectancy Decreases Again, CDC Report Finds
On its front page, the Wall Street Journal (11/29) reports data from the Centers for Disease Control and Prevention show that life expectancy for Americans declined again last year by one-tenth of a year, to 78.6 years. An increase in suicides, as well as the continued effects of the opioid crisis, influenza, pneumonia, and diabetes factored into the statistics, the Journal explains.

The data “continued the longest sustained decline in expected life span at birth in a century, an appalling performance not seen in the United States since 1915 through 1918.” The report found “men could anticipate a life span of 76.1 years, down a tenth of a year from 2016,” and “life expectancy for women in 2017 was 81.1 years, unchanged from the previous year.” “Suicides and drug overdoses pushed up U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.” Dr. Robert Redfield, the director of the CDC, said, “These sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable.”


Claims Data Show Telemedicine Visits Surging in US
Woman doctor in telemedicine health conceptJAMA reported that telemedicine visits in the US “have increased sharply,” but “the vast majority of American adults still receive care from doctors in person rather than via remote technology.”

Thirty-two states had passed laws that required parity in insurance coverage and reimbursement for telemedicine by 2016, so the researchers looked at insurance claims data from OptumLabs Data Warehouse for the period from 2005 to 2017 to see how the laws affected those claims. They found telemedicine visits rose from 206 visits in 2005 to “more than 202,000 visits in 2017,” with most of the growth occurring in the last years of the study period. Those visits translated to “an average annual compound growth rate of 52 percent from 2005 to 2014 and an annual average compound growth rate of 261 percent from 2015 to 2017.”


New Online Tool Displays Cost Differences for Certain Surgical Procedures
CMS launched a new online tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers. The Procedure Price Lookup tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider.

“Price transparency in health care is a priority for the Trump Administration. Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs,” said CMS Administrator Seema Verma.

The Procedure Price Lookup tool is launching as required by Congress in the 21st Century Cures Act. Medicare’s statutes require that CMS maintain separate payment systems for different types of healthcare providers, meaning both CMS and patients may pay different amounts for the same service, depending on the site of care.

Procedure Price Lookup, part of the agency’s eMedicare initiative, joins other patient-oriented transparency tools, including an overhauled version of the agency’s drug pricing and spending dashboards, which provide patients with Medicare and Medicaid spending information for thousands more drugs than ever before and, for the first time, list the prescription drug manufacturers that were responsible for price increases.

CMS recently launched the eMedicare initiative to empower beneficiaries with cost and quality information. This announcement included the launch of an enhanced interactive online decision support feature to help people better understand and evaluate their Medicare coverage options. eMedicare also offers a mobile-optimized out-of-pocket cost calculator to provide beneficiaries with information on overall plan costs and prescription drug costs.

For a blog post on the Procedure Price Lookup took by Administrator Verma, please go here.

The Procedure Price Lookup tool is available here.


Dr. First Banner


Boston Partners Mandates Flu shots for All 74K employees
Boston-based Partners HealthCare is requiring all 74,000 employees to receive flu shots for the first time, reports The Boston Globe.

Under the mandatory flu shot policy, employees who don’t get vaccinated or provide a valid reason for skipping the flu shot could lose their jobs. The policy applies to all hospital-based workers, as well as thousands of employees who work at Partners’ corporate office in Somerville, Mass.

“If you are able and remain unwilling to protect yourself and protect our patients [from the flu], you probably should not be working in healthcare,” Gregg S. Meyer, MD, Partners’ chief clinical officer, told The Boston Globe. “My sincere hope is that absolutely no one will lose their job over it. … We will do everything we can to convince people.”

The policy took effect this fall. So far, 99 percent of employees have received a flu shot or an exemption for religious or medical reasons, Partners officials told The Boston Globe.

Partners modeled the system wide policy on a mandatory vaccination policy Boston-based Brigham and Women’s implemented in 2017.

Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, has notified parents that if their children are not vaccinated, or if they follow an alternative vaccination schedule, that they will be denied medical services. They also notified parents that they will not honor Florida State law that allows for religious exemptions to vaccines.


Unitedhealth Group to Buy Seattle Primary Care Clinic
UnitedHealth Group will acquire a controlling stake in Polyclinic, a large physician-owned primary and specialty care clinic in Seattle — the latest move in the company’s push to expand its direct patient care business, according to The Seattle Times. Under the deal, Polyclinic’s 210-physician practice would merge with Optum Health, a subsidiary of UnitedHealth. The Optum business manages physician groups around the country.

Polyclinic was founded in 1917 by six Seattle physicians and has grown to become one of the largest multispecialty groups in the nation. Despite its ability to scale in size, the practice found it hard to compete with other Seattle area healthcare providers such as Swedish Medical Center and the University of Washington Medical Center.

By merging with Optum, Polyclinic will be able to tackle “the things that you just need to be big enough to afford to do,” UnitedHealth Group CEO David Wichmann told investors during a meeting in New York, according to the Times.

The deal also will expand the clinic’s access to technologies and other physician groups within Optum. The acquisition needs approval from the Federal Trade Commission and would supplement a separate deal with DaVita Medical Group to acquire the 500-physician Everett Clinic, a primary and specialty clinic based in Seattle, and Northwest Physicians Network, a 1,000-plus physician practice in Pierce County, Wash.


Romaine Lettuce

It’s OK to Eat Some Romaine Lettuce Again;
Just Check the Label
The FDA narrowed its blanket warning from last week, when it said people shouldn’t eat any romaine because of an E.coli outbreak. The agency reported on November 26 that the romaine linked to the outbreak appears to be from the California’s Central Coast region. It said romaine from elsewhere should soon be labeled with harvest dates and regions, so people know it is good to eat.

Consumers should not eat romaine that doesn’t have the label information, the FDA said. For romaine that doesn’t come in packaging, grocers and retailers are being asked to post the information by the register.

Romaine harvesting recently began shifting from California’s Central Coast to winter growing areas, primarily Arizona, Florida, Mexico and California’s Imperial Valley. Those winter regions weren’t yet shipping when the illnesses began. The FDA also noted that hydroponically grown romaine and romaine grown in greenhouses aren’t implicated in the outbreak.

The labeling arrangement was worked out as the produce industry called on the FDA to quickly narrow the scope of its warning so it would not have to waste freshly harvested romaine. Consumers can expect to start seeing labels as early as this week. It noted that the labels are voluntary and that it will monitor whether to expand the measure to other leafy greens and produce.

The FDA said the industry committed to making the labeling standard for romaine and is considering longer-term labeling options for other leafy greens.


CME WEBINARS

“Evidence-Based Treatment for Tobacco Dependence”
WEBINAR December 4th
REGISTRATION NOW OPEN 

Register now for “Evidence-Based Treatment for Tobacco Dependence” webinar on, December 4, 2018 at 7:30 a.m.   This program is being jointly sponsored by St. Peter’s Health Partners Community Health Programs; the Medical Society of the State of New York and Glens Falls Hospital Health Promotion Center.

Michael B. Steinberg, MD, MPH, FACP, Director of Rutgers Robert Wood Johnson Medical School Tobacco Dependence Program will serve as faculty for this program.  The objectives are for physicians to: 1) Increase their knowledge of seven FDA-approved tobacco treatment pharmacotherapies. 2) Counsel smokers by prescribing tobacco treatment pharmacotherapy to improve their tobacco cessation attempt outcomes including the use of combination therapy. 3) Increase their knowledge in regard to public insurance plans that cover NRTs.  4) Understand the importance of implementing a tobacco dependence treatment policy within their practice which includes the 5As.

This program can be attended either via Webex or at a remote site in the North Country. View the flyer and register here.

This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Medical Society of the State of New York (MSSNY) and St. Peters Health Partners.  MSSNY is accredited by the 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. 

Additional information or assistance with registration may be obtained by contacting Community Health Programs for Webex assistance: (518) 459-2550 – or- for remote site registration contact Shannon Morrison-Gaczol at smorrison-gaczol@glensfallshosp.org.


The Continued Public Health Threat of Measles: 2018 CME Webinar
December 12, 2018 at 7:30am – Registration now open

In response to the recent and expanding measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 roster.  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 program here.

Educational Objectives:

  • Increase physician’s awareness of the role of measles as a re-emerging infection.
  • Discuss strategies to improve vaccination rates.
  • Explore herd immunity and the role it plays in recent measles outbreaks.

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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Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day or by month. Price is negotiable. Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

58th Street room1 58th Street room2 58th Street room3


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

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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