December 18, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 18, 2015
Volume 15, Number 47

Dear Colleagues:

If you have claims outstanding with Health Republic, please take a moment to click on this link which will bring you to MSSNY’s grassroots action center and a letter which you can send to your elected State Senator and Assemblyman to call for action to assure that physicians and other healthcare stakeholders are paid for services rendered to patients of the now defunct Health Republic.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  MSSNY also continues to share with key legislators and the media our collective concerns regarding the severe consequences to physicians’ practices as a result of the collapse of Health Republic, and advocating for a special fund to assure physician claims for care provided to HR-insured patients are fully paid.

This includes sharing the results of our survey of nearly 1,000 respondents, which has generated extensive media coverage from across New York State, including the Wall Street Journal and New York Times.  Please add your voice to these efforts to better assure that physicians are not left holding the proverbial bag!

Submit All Your Claims Now!

In the meantime, you must submit all HR claims for services rendered up to and including November 30, 2015. Although we cannot project the outcome of this debacle, it is safe to report that if your claims are not filed, they will never be considered.

Send Us Your Bounced Checks!

MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds. If you have received notice from your bank that an HR check bounced, send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction.

On a related matter, if you are holding reimbursement checks from HR, they will bounce if you try to deposit it.  We urge you to send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor. Again, please email rmcnally@mssny.org.

Thank you for your patience while we continue to assist you in the process.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance



Alert from MSSNY General Counsel Don Moy:  NYS Court of Appeals Decision Exposes Physicians and Other Health Care Professionals to Liability to Non-Patient Members of the General Community
The majority’s decision in Davis v. South Nassau Communities Hospital must be viewed as alarming to physicians and other health care professionals.  Physicians who administer or prescribe medication to patients must be prepared to document that they advised the patient of the foreseeable side effects of the medication, and, in particular, if the medication could foreseeably impair the patient’s ability to safely operate an automobile. Physicians must be prepared to document that they advised the patient not to drive while taking the medication.

These are the facts in Davis v. South Nassau Communities Hospital (issued on December16, 2015): Patient W was treated by Dr. H at the ER of a hospital. As part of the treatment, the doctor intravenously administered to W an opioid narcotic painkiller and a benzodiazepine drug, and, allegedly, failed to warn W that such medication could impair her ability to safely operate an automobile. Shortly thereafter, W drove herself from the hospital and, while allegedly impaired by the medication administered to her, she crossed a double yellow line and struck a bus driven by plaintiff Davis.

The NYS Court of Appeals reversed an appellate court and held that under these facts, the doctor had a duty to warn the patient about the patient’s ability to drive safely, and the failure of the doctor to fulfill this duty to the patient could subject the doctor to liability to any member of the general community who is harmed as a result of the patient’s driving. The Court of Appeals opined that the “cost” of the duty  imposed upon physicians and hospitals is a “small one” because the “duty” requires the doctor to do no more than simply warn the patient of the dangers of driving. The Court emphasized that the doctor had no obligation to prevent the patient from driving.

The Court further held that its ruling does not create a new obligation on doctors because a doctor who administers prescribed medication already has a duty to advise the patient of the foreseeable side effects of the medication.  Rather, stated the Court, the ruling “merely extends” the scope of persons who may sue the doctor for failing to fulfill that responsibility to the patient.

The Court sought to limit the reach of its decision by stating that this decision should not be construed as an erosion of judicial precedent that courts need to proceed cautiously and carefully in recognizing a new “duty of care”.  Judge Leslie Stein issued a scathing dissenting opinion  and rebuked the majority decision  as  “precipitous” and contrary to the firmly established judicial precedent of the state that, in general, a physician’s duty is to the patient, and the corresponding liability may be extended to a non-patient only in rare and narrow circumstances, such as to an immediate family  member  where the physician knew or should have known  that treatment provided to the patient  could create risk of harm to immediate family members. To her knowledge, stated Judge Stein, there has been no precedent in the state that has held that a physician’s medical treatment of a patient could expose the physician to liability to an unidentified class of members of the general community.

Judge Stein stated that despite the majority’s attempt to limit the reach of its decision, she feared a “slippery slope” and that the decision could be precedent to expand liability to doctors in other areas of treatment. 


Congress Passes Year End Spending, Tax Relief Bills that Includes “Cadillac Tax” Delay, Extension of 9/11 Responder Health Coverage, and MU Hardship Provisions
The US House and Senate passed two massive legislative packages, an omnibus appropriations bill and tax revision bill, before Congress adjourned for the holidays.  Importantly, among the provisions is a 2-year delay of the so-called “Cadillac Tax” on benefit-rich health insurance plans enacted as part of the ACA that was to become effective in 2018.  Since this tax would strongly discourage employers from offering comprehensive health insurance coverage to their employees, the MSSNY House of Delegates adopted policy calling for this tax to be repealed.

The $1.1 trillion FY2016 omnibus appropriations package will fund federal agencies and programs through September 30, 2016. Many of the earlier debated policy riders, such as the proposal to “defund” Planned Parenthood, were omitted from the bill. In addition to the delay of the “Cadillac tax”, some of the other health-related provisions include the following:

  • Funds for the 9/11 emergency responder health care benefits were reauthorized and expanded;
  • A one-year delay of the health insurance tax (for 2017)
  • IPAB operational funding was cut by $15B (although the panel has never actually been established)
  • Requiring the HHS Secretary to implement an education campaign to inform breast cancer patients about the availability and coverage of breast reconstruction and other available alternatives post-mastectomy.
  • Breast cancer screening recommendations issued by the USPTF were blocked for 2 years
  • AHRQ funding was cut by $30M (earlier House version had zeroed out agency funding)
  • Funding for NIH was increased by $2B
  • Additional funds were provided for opioid prescription drug overdose prevention
  • $20M was provided for the National Diabetes Prevention Program
  • The annual ban on using CDC funding for gun violence epidemiological research was extended

A second $650B package extends a broad range of tax-related polices, including a two-year moratorium on the Medical Device Tax, also enacted as part of the ACA.

Moreover, there was a “last second” bill passed by Congress that grants CMS the authority to expedite applications for exemptions from Meaningful Use Stage 2 requirements for the 2015 calendar year through a more streamlined process, alleviating burdensome administrative issues for both providers and the agency.  In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use Stage 2 for a period of 90 consecutive days during calendar year 2015.  However, CMS did not publish the Modifications Rule for Stage 2 of meaningful use until Oct. 16. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.  The legislation is designed to address this flaw.

Click here for a more detailed summary from the AMA on Congress’ action.


State Supreme Court Justice Ruled Child Flu Vaccination Not Mandatory in NYC
State Supreme Court Justice Manuel Mendez ruled Thursday that the New York City Department of Health and Mental Hygiene (DOHMH) may not require that children receive a flu vaccination to attend “city-licensed preschools and day care centers, striking down one of the more ambitious public health initiatives of the Bloomberg administration.” Justice Mendez ruled that “the city had exceeded its authority” and if the city wants to require flu vaccines, the Legislature would have to vote to add it to the list. 

Physicians Dropped from Emblem Should Contact Their State and Federal Legislators To Supplement MSSNY’s Advocacy


Physicians who have been unfairly dropped from Emblem’s participating physician network are urged to contact their state and federal legislators from MSSNY’s Grassroots Action Site here and ask for them to take action to push Emblem to reverse its decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services, as well as the NYS Department of Health and Attorney General’s office.

Moreover, MSSNY has written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.   MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Importantly, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani last week to ask for “further clarity on this issue.”   Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.     


MSSNY and OASAS To Conduct CME Webinars On Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free, four part webinar series on opioid prescribing.  Entitled,Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open at here.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing.

Tuesday January 26, 2016, 12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Seltzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.

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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.


MSSNY Is Member of AMA’s Task Force On Opioid Abuse
The Medical Society of the State of New York is participating on the American Medical Association’s (AMA) national Task Force to Reduce Opioid Abuse.  The task force, established in 2014, consists of over 20 medical national specialty organizations and MSSNY is one of the eight state medical societies on the task force.  The goals of the task force are to:

  • Increase physicians’ use of effective PMPs
  • Enhance physicians’ education on appropriate prescribing
  • Reduce the stigma of pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing.

The task force ultimate goals are to create a behavioral shift in physicians to create a sense of urgency that they are a part of the solution to the opioid epidemic and to tap into their fundamental desire to effectively help their patients and improve their patients’ health.  The task force will also urge physicians to use PMPs to have a better—realistic—perspective about patients’ use of opioids.  Dr. Frank Dowling, MSSNY Councilor and Pat Clancy, Vice President of Public Health and Education are MSSNY appointees to the task force.

MSSNY has also developed a page entitled, “Opioids: What One Doctor Can Do.“  This page is located on the MSSNY website and is located in a blue box at the top of the home page:  www.mssny.org   The page provides information on the AMA Task Force, provides resources and best practices for physicians and also provides tools for physicians along with patient information.


NYS Connects with Other Prescription Monitoring Programs; Allows Prescribers to Assist In Reducing Doctor Shopping Across State Lines
New York State has announced that it has joined the National Association of Boards of Pharmacy PMP InterConnect hub which will allow participating states to share information from prescription monitoring programs to prevent consumers from “doctor shopping” for prescription drugs over state lines.  The New York’s Prescription Monitoring Program, (PMP) is an electronic system allows prescribers and pharmacists statewide to ensure patients do not obtain multiple prescriptions for dangerous controlled substances.  New York prescribers are required to check patient information on the PMP prior to issuing controlled substances, and this requirement was implemented under the ISTOP law.  New Jersey and Connecticut are both on the NABP PMP Interconnet hub, though other neighboring states, including Massachusetts, Pennsylvania and Vermont, are not.  MSSNY strongly supports this move and believes it will give important information to physicians about their patients.


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org 


Tomorrow Is Last Day to Submit PQRS Status Questions
If you have any questions regarding the status of your 2014 PQRS reporting or are concerned about potentially receiving the PQRS negative payment adjustment in 2016, please do not hesitate to submit an informal review request. CMS will be in contact with every individual eligible professional (EP) or PQRS group practice that submits a request for an informal review of their 2014 PQRS data. Additionally, revised 2014 Annual Quality and Resource Use Reports (QRURs) are now available via the CMS Enterprise Portal.  All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which is available now through December 16, 2015 at 11:59 p.m. Eastern Time. 

Follow these steps to submit an informal review request:

  1. Go to the Quality Reporting Communication Support Page (CSP)
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”
  7. Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

For additional questions regarding the informal review process, contact the Quality Net Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information.


MSSNY Teams with CA, FL and TX Medical Societies to Urge Meaningful Use Reforms
With uncertainty surrounding whether Congress would be able agree to changes to the overly burdensome meaningful use requirements, MSSNY teamed with the medical associations of California, Florida and Texas on a letter this week to CMS Acting Administrator Andy Slavitt urging needed reforms.  In particular, the letter notes that “Physicians across this country are uniformly frustrated, angry, and demoralized by these difficult regulations.  Most physicians are working hard to meet the requirements and cannot because of the lack of specialty measures, the all-or-nothing approach, vendor problems, the lack of interoperability or other issues beyond their control.  Many physicians have been early adopters of technology and are enthusiastic about using EHR as means to improve workflow, patient care and quality outcomes.  However, the EHR incentive program must have feasible and attainable requirements to help physicians achieve these goals rather than act as a burden and hindrance to EHR use by physicians”.

Reforms to the MU program urged in the letter include: delaying implementation of MU Stage 3; giving physicians proportional credit for the measures that are successfully completed, instead of the existing “all or nothing” approach; and expanding the hardship exemptions to recognize physicians who are victims of hacking or other disruptive technology problems related to their vendors, as well as physicians who are close to retirement.


PTSD and TBI in Returning Veterans: Identification and Treatment
Live CME Seminar at Southampton Hospital
Date and time:
January 7, 8-9 AM Live at Southampton Hospital

Presenter:        Dr. Frank Dowling

Program Summary: A look into the two most common disorders facing returning veterans today, from symptoms and diagnosis to treatment and recovery, and how to overcome the unique challenges posed by military culture.

For any questions, contact: Greg Elperin at gelperin@mssny.org

For more information, please read our flyer.

Please register here. 


New York Ties for Top Score in Preventing and Responding to Disease Outbreaks
A December study from Trust for America’s Health (TFAH) states that New York is “tied for top billing in terms of preventing, diagnosing and responding to disease outbreaks.” The TFAH used data from the Centers for Disease Control and Prevention to create a “scoring system with metrics such as flu vaccination rates, food safety and HIV/AIDS surveillance – and then evaluated each of the 50 states to see how they stacked up.” New York is among the five states that “maxed out at 8/10 points.” Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states—Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah—tied for the lowest score at three out of 10.

The report, from TFAH and the Robert Wood Johnson Foundation (RWJF), concluded that the United States must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea. 


Fight for Healthcare in Rural Communities

By Congressman Tom Reed (NY-23)

I care deeply about protecting access to health care and ensuring residents in rural areas have the resources and services they need. It is only fair that rural residents have equal access to quality primary and pediatric care as those living in urban areas. That is why we fought to secure funding for new health care access points across upstate New York.

Earlier this year, we introduced the Rural Hospital Access Act, which protects access to care by providing enhanced levels of Medicare funding to rural hospitals. This legislation makes permanent both the Medicare-dependent hospital program and the enhanced low-volume Medicare adjustment, which enable rural hospitals to offer the same medical services as are provided by hospitals in large cities. This is critically important because it allows seniors, veterans, and individuals with disabilities to receive quality health care right in their own communities.

The enhanced reimbursements provided by these Medicare programs have a direct impact on rural hospitals across upstate New York. An example is St. James Mercy Hospital, a central access point for residents in Steuben County. This hospital is currently undergoing a major restructuring, as part of a new vision for health care in their community. The enhanced reimbursements are critically important because they provide not only a crucial source of revenue, but also a sense of certainty and stability. This will allow rural hospitals like St. James to effectively serve local residents now and for generations to come.

Many of us depend on rural hospitals and medical facilities for health care, from pediatrics to inpatient and maternity services. It is only right we protect these services by supporting rural hospitals. We will continue fighting to ensure seniors, veterans, and individuals with disabilities have access to the care and services they need, regardless of where they live.

Congressman Tom Reed (NY-23)

2437 Rayburn House Office Building

Washington, D.C. 20515

(202)225-3161


Rep. Sarbanes:  Bill to Allow Retired Doctors to Retrain for Community Health
Rep. John Sarbanes (D-Md.) has reintroduced a bill that would allow physicians who have ceased practicing medicine to receive grants to become retrained if they pledge to work at a community health center, school health clinic or Veterans Affairs medical center for two years. This legislation would establish a grant program for medical schools, hospitals and non-profit organizations to create or expand their physician reentry programs which give physicians a streamlined process for credentialing and continuing medical education to return to medical practice after an absence. Funding could also be used to assist with credentialing fees, loan repayments and salaries. In return for this assistance, these physicians would serve at community health centers, VA medical centers or school-based health centers to help fill the shortage of primary care doctors. Participating physicians would be able to practice on a full- or part-time basis and would be covered under the Federal Tort Claims Act, which provides physicians with medical liability protection. 


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations During a Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.   Registration is now open to physicians and other public health officials here. Go to training session and upcoming sessions tab.

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional programs are: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

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.

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


MSSNY Adult Immunization Podcast Now Available
William Valenti, MD, chair of MSSNY’s Infectious Disease Committee and Monica Sweeney, MD, MPH, vice chair of MSSNY Committee to Eliminate Health Care Disparities, discuss adult immunization in an effort to educate and inform patients and physicians in New York State about the importance of adult immunization.   The audio podcast can be accessed here. 


CDC Issuing Guidelines Urging Primary Care Physicians to Monitor Opioids
In a research letter in JAMA Internal Medicine, investigators “examined Medicare claims from 2013 to see which doctors prescribed opioids and how many prescriptions they filled.” The analysis revealed that “the drugs are prescribed by a broad cross-section of medical professionals – including doctors, nurse practitioners, physicians’ assistants and dentists – rather than concentrated among a small group of practitioners.”

Moreover, the analysis also revealed that on a “doctor-by-doctor level, pain management specialists and anesthesiologists handed out the most prescriptions for opioids,” but because there are more family physicians than specialists, as a group, “their number of painkiller prescriptions was higher than for any other category of health care worker.

In light of the findings, the Centers for Disease Control and Prevention issued new guidelines on December 14, urging primary-care physicians to closely monitor their patients’ use of opioids and take a more “conservative approach” to prescriptions in order to mitigate “a crippling epidemic of addiction to the powerful narcotics.”

Written comments must be received on or before January 13, 2016. You may submit comments, identified by Docket No. CDC-2015-0112 by any of the following methods:

  • Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
  • Mail:National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE., Mailstop F-63, Atlanta, GA 30341, Attn: Docket CDC-2015-0112.

Instructions: All submissions received must include the agency name and Docket Number. All relevant comments received will be posted without change to http://regulations.gov, including any personal information provided. For access to the docket to read background documents or comments received, go to http://www.regulations.gov.


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742

 



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

December 11, 2015 – MSSNY Aids Physicians in Taking Control of Their Practices

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 11, 2015
Volume 15, Number 46

Dear Colleagues:

First of all, Happy Chanukah to all who are celebrating the miracle of the holiday.

This year, the MSSNY HOD called for the creation of a Task Force that would explore and recommend options to assist MSSNY’s physicians in independent practice to remain viable in that environment. After a call for interested MSSNY members to participate, I put together a team of physicians from various specialties and geographic locations that had an interest and/or expertise in the subject.  Some physicians have business degrees while others have engaged in entrepreneurial projects transforming how they deliver health and wellness care to the residents of New York.  I selected Drs. Tom Lee and Paul Lograno to lead the effort.  To date, the group has had two meetings and has begun developing various options to help a broad spectrum of physicians in different practice environments. In the next few months, you will be hearing more about options available to you that many of your colleagues have embarked on that have helped them be happier physicians thriving in the turbulent environment of healthcare reform.

In addition to this effort, I have asked a group of MSSNY Councilors to develop guidelines that will guide how we collaborate with other groups of physicians who are seeking to remain out of network or who wish to engage in advocacy that relates specifically to their specialty practice. A Task Force to address physician burnout and stress will begin its deliberations in January under the leadership of Dr. Michael Privetera from the University of Rochester.

Tipping Point

The recent events concerning disenrollment of physicians from Emblem Health and United Healthcare as well as the Health Republic fiasco have become the tipping point.  WE WILL NOT SIT BACK AND TAKE THIS ANY LONGER.  If we cannot get collective negotiation or be assured that the private practice model will be supported by government legislative and regulatory reforms, then we must take matters into our own hands and develop mechanisms for group survival/individual survival.  For some, it will mean creating new physician-owned-and-run groups or IPAs.  For others, it will mean dropping out of many insurance products and establishing direct care practices. For others, there may be other models that some of you have developed.  MSSNY is working on highlighting successful options to opt out of the madness being foisted upon us.

Do you have an interest in getting involved?  Do you have a successful alternative model of delivering healthcare that is working for you?  Have you changed how you practice and become a happier and less stressed out physician while remaining in private practice?  Are you a young physician engaged in an innovative practice model?  We want you to get involved in our grassroots led effort.  Let us know.  We are bringing together talented and successful colleagues who have been quietly engaging successful strategies.

Contact Eunice skelly @ eskelly@mssny.org

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Senate Health Committee Chair Urges Emblem to Reconsider Dropped Physicians
Noting that he has “heard from a number of physicians as well as the Medical Society of the State of New York” regarding Emblem’s decision to not renew contracts with approximately 750 physicians, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani this week to ask for “further clarity on this issue.”   MSSNY had written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services in addition to contacting the State Legislature.

Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Physicians can send a letter to their legislators urging their efforts to reverse Emblem’s action from here.

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.

If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount. We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


Western New York Congressman Presses CMS to Assure That HR Claims Are Paid
Noting the several physicians he has heard from, Representative Chris Collins (R-Western New York) pressed CMS Acting Administrator Andy Slavitt this week to identify what steps the federal government could take to assure physicians and other health care providers are fully paid for the care that they have provided to their patients insured by collapsed co-op health insurer Health Republic.  The questioning occurred as part of a US House of Representatives Energy & Commerce Committee hearing into the functioning of state Exchanges.  MSSNY had written to the entire New York Congressional delegation late last week to share with them the numerous articles from papers in nearly every region across New York State highlighting the consequences of the collapse of Health Republic, and asking for their assistance to assure, once the full accounting and distribution of the assets of the Health Republic is completed, that health care providers are made whole.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  Physicians can send a letter to their state legislators and Governor Cuomo to urge that steps are taken, including the creation of a special state fund, to assure that these claims are fully paid.

Moreover, this week, the New York State Association of Health Underwriters announced its support for a special fund to assure Health Republic claims are paid.

MSSNY also continues to hear from dozens of physicians that reimbursement checks issued by Health Republic have been returned by the bank for insufficient funds.   If you have received notice from your bank that an HR check bounced, please let us know by sending an email to rmcnally@mssny.org


Cadillac Tax, Meaningful Use Relief Under Consideration in Year End Congressional Budget Talks
As Congress scrambles to pass a year end Budget bill, a number of health care issues of great importance to physicians continue to be under strong consideration for incorporation into the package.  This includes additional provisions that could provide some needed hardship exceptions to overly burdensome meaningful use requirements, as well as a delay in the implementation of the so-called “Cadillac Tax” on comprehensive health insurance coverage scheduled to go into effect in 2018.  The Cadillac Tax, a component of the ACA, imposes a 40% excise tax on group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage.  It would undoubtedly have a greater impact in higher cost states such as New York, and would further discourage employers form offering comprehensive health insurance policies to their employees.   MSSNY adopted policy at its 2013 House of Delegates meeting calling for legislation to repeal this tax.  Please remain alert for further updates on these items. 


Take this AMA Survey re Meaningful Use
In the AMA’s ongoing efforts to improve EHRs and interoperability of EHRs, the AMA is assisting the Office of the National Coordinator (ONC) with gathering information to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use. The following is a link to a 5-10 minute survey that will help ONC create a new standard that will reduce the number of pages in the summary of care, thus making it easier to find relevant information.  Please share the link with your members and encourage them to take the survey. The Office of the National Coordinator (ONC) has extended the survey deadline to December 23. Survey link http://goo.gl/forms/0fjoUxZwsS 


BNE Sends Letter Reminding You of E-Prescribing Requirement that Becomes Effective on March 27, 2016
The New York State Department of Health’s Bureau of Narcotic Enforcement has emailedl a letter to about 110,000 prescribers, through the Health Commerce System, reminding practitioners about the e-prescribing mandate that will take effect on March 27, 2016.  The letter encourages practitioners to begin E-prescribing if they have already implemented an E-prescribing software application or to begin the process to acquire an E-prescribing software application if they have not started the process.   A copy of that letter can be found here. BNE has also developed a patient brochure on e-prescribing and it can be found on BNE’s website.

New York State’s e-prescribing requirements for non-controlled and controlled substances will go into effect on March 27, 2016.   The NYS Department of Health’s Bureau of Narcotic Enforcement has provided information to physicians and other prescribers to assist them in their transition to electronic prescribing.   Practitioners should continue their efforts to become compliant with the law, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances (EPCS), and registering their certified software applications with the Bureau of Narcotic Enforcement.   According to state officials, over 35,000 prescribers have registered their systems with DOH.   This represents only about 1/3 of the prescribers in New York State.

For physicians who prescribe controlled substances, there are additional steps to complete in order to electronically prescribe controlled substances.  These include the following:

  • First, the software you currently use must meet all the federal security requirements for EPCS, which can be found on the Drug Enforcement Agency’s (DEA) web page. http://www.deadiversion.usdoj.gov/ecomm/e_rx/

Note that federal security requirements include a third party audit or DEA certification of the software.

  • Second, you must complete the identity proofing process as defined in the federal requirements.
  • Third, you must obtain a two-factor authentication as defined in the federal requirements.
  • Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found here.

EPCS systems must be registered through the ROPES system.  ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

  • Login to the Health Commerce System (HCS) at https://commerce.health.state.ny.us
  • Under “My Content” click on “All Applications”
  • Click on “R”
  • Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

EPCS became permissible in New York State and over 90% of the pharmacies can now accept e-prescribing for controlled substances, according to officials from BNE.

DrFirst and MSSNY have partnered to bring MSSNY members the industry’s leading e-prescribing solution at a special discounted price and information on this program can be found here. There are additional venders that now have software available to e-prescribe both non-controlled and controlled substances and information on these can be found at this link.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so shortly. The waiver process will be electronic. Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance.  DOH has indicated that more information on the waiver process will be available shortly.

E-prescribing of non-controlled substances is also required under the law; however, registering of this system with the state is not necessary. 


Bureau of Narcotic Enforcement’s Physician Info on Medical Marijuana Program
The New York State Department of Health’s Bureau of Narcotic Enforcement announces the availability of the required four hour medical use of marijuana course.  Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course. The Compassionate Care Act, signed into law on July 5, 2014, authorized the Department of Health to implement a Medical Marijuana Program in New York State. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must:

  • be qualified, by training or experience, to treat patients with one or more of the serious conditions eligible for medical marijuana;
  • be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law, in New York State;
  • possess a Health Commerce System (HCS) Medical Professions Account user ID and password;
  • possess an active Drug Enforcement Administration (DEA) registration number; and
  • complete the four hour Department-approved medical use of marijuana course.

Departmental officials anticipate that the four hour department approved online course is available to practitioners through the  TheAnswerPage, an established online medical education provider here.

The course will include the following topics, which are required in the regulations: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence.  The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course. Additional information regarding the practitioner registration process is available on the Department’s Medical Marijuana Program webpage, which can easily be accessed via the following link.

It is also expected that DOH will announce the process that physicians may be able to “certify” patients for receiving marijuana under the medical marijuana program.   It is anticipated that this process will be through the Health Commerce System.

Please monitor this webpage frequently for updates and the department may be contacted with any questions:New York State Department of Health, Bureau of Narcotic Enforcement,

Medical Marijuana Program, Riverview Center,50 Broadway,Albany, NY 12204

Call 866-811-7957 or email mmp@health.ny.gov


Letter Re E-Prescribing from Director of Bureau of Narcotic Enforcement

Dear Prescriber:

Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.  This mandate does not apply to veterinarians.  Electronic prescribing of both controlled and non-controlled substances is currently permissible in New York. 

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements.  Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health (DOH), Bureau of Narcotic Enforcement (BNE). 

Please be aware that implementation timelines for EPCS software vary and may be lengthy.  If you have not already begun this process, BNE strongly recommends that you begin immediately.   

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper, to allow for time to resolve technical or workflow issues prior to the mandate’s effective date. 

Useful information related to electronic prescribing, including frequently asked questions, information regarding the EPCS registration process, and a downloadable patient-centered brochure to help your patients better understand electronic prescribing can be found on our website at www.health.ny.gov/professionals/narcotic. 

If you have any questions about the electronic prescribing mandate, please call 1-866-811-7957, option 1.

Joshua Vinciguerra
Director
Bureau of Narcotic Enforcement


The NY Society of Addiction Medicine to Host 12th Annual Conference Feb. 5 & 6
The NY Society of Addiction Medicine (NYSAM) will host its annual conference February 5 and 6 at the Crowne Plaza Times Square Hotel, 1605 Broadway, NYC. The conference entitled, “Critical Role of Addiction Medicine in Healthcare Reform: Best Practices,” is designed for physicians, medical students/residents, and addiction professionals.  Registration is required and the cost is as follows: Full conference price—Before January 15, 2016  NYSAM Member Rate: $350 Non-Member Rate: $425 Non Physician Rate: $225.  Residents/Fellows/Medical Students are free. Registration may be made by visiting the NYSAM website here or by contacting Elisabeth Kranson at (518) 689-0142 or via email: ekranson@asapnys.org 


Adelphi University MBA Program for Suffolk/Nassau County Medical Societies
The Nassau and Suffolk Medical Societies cordially invite all physicians to attend one of the MBA Information Sessions to learn more about how an MBA degree can give you the tools necessary to be an effective leader, critical thinker, negotiator and problem solver. Mark your calendar now and plan to attend.

Where: Suffolk County Medical Society, 1767-14 Veterans Highway, Islandia

  • Tuesday, December 8, 2015
  • Tuesday, December 15, 2015
  • Friday, December 18, 2015

Come in between 4:00 pm to 6:00 pm

Where: Adelphi University, 55 Kennedy Drive, Hauppauge- 11788

  • Monday, December 7, 2015
  • Wednesday, December 9, 2015
  • Monday, December 14, 2015

Come in between 8:00 am to 3:00 pm

Don’t miss out on this opportunity to learn more about how you can successfully position yourself in today’s healthcare system.

RSVP Maureen Leslie at 516 237-8607 or leslie@adelphi.edu or SCMS at 631 851-1400.


Consumers Warned About Raw Milk Listeria Risk in Allegany County
Food Safety News (12/11) reports “consumers in New York’s Allegany County and surrounding area were told not to consume ‘unpasteurized’ raw milk from the Gerald E. Snyder Farm due to possible Listeria contamination.” The notice “came from the New York Department of Agriculture and Markets.”

The public health warning came from the New York Department of Agriculture and Markets.The Gerald E. Snyder Farm is located at RD#1, 1444 Randolph Rd., Alfred Station, NY. The department has not yet associated any illnesses with the product that is subject of the public health warning.


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742

 



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

December 4, 2015 – Are Your Health Republic Checks Bouncing?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
December 4, 2015
Volume 15, Number 45

Dear Colleagues:

As was reported in several media outlets this week, including Crains’ Health Pulse, Politico New York and WNYC, MSSNY has heard from many physicians outraged regarding the decision of EmblemHealth to drop hundreds of physicians from its network reportedly as part of its efforts to increase the use of value-based payments. However, at first glance, it appears that many of the recipients of these non-renewal letters were physicians in smaller practices who did not receive any advance notice by Emblem of its desire to migrate their payment structure to a value-based methodology.

Last week, the New York County Medical Society issued a press release warning of disruptions to long-standing patient-physician relationships, followed up by multiple MSSNY letters to the NYS Department of Financial Services (DFS) urging an investigation into how these actions by Emblem will affect its network adequacy and whether these physicians and their patients were truly given adequate notice.

We have been advised by DFS staff that they have initiated a review of Emblem’s action, and hope to have some answers to our questions next week.  Among the questions we have posed to DFS:

  • Were these 750 physicians dropped by Emblem given any advance notice of Emblem’s intention to drop them for any reasons including because they chose to deliver care to patients in a smaller practice setting?
  • Were any of these 750 physicians dropped by Emblem given the opportunity to enter into the value-based contracts espoused by Emblem to stay within Emblem’s physician network?
  • How many patients are impacted by Emblem dropping these 750 physicians from its network?  What is the total number of patient encounters with Emblem insureds that these 750 physicians provided over the last year?
  • What is the specialty of the physicians being dropped?  What are their hospital affiliations? Has DFS or DOH reviewed whether the dropping of these physicians will create shortages in any specialty or in any particular community served by Emblem?
  • How does the timing of the notice to these dropped physicians intersect with employer open enrollment periods?  For example, it was reported that the open enrollment date for New York City employees ends on October 31, just three days after patients received notice of these physicians being dropped. Were patients of these physicians given fair notice so that they could shop around for coverage for a health plan that includes their treating physicians?

Please let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


MSSNY’S Advocacy Matters CME Series Webinar On December 8th
Jason Helgerson, NYS Medicaid Director to Discuss Delivery System Reform Incentive Payment Program (DSRIP) and the Move to Value Based Payment

Jason Helgerson, New York’s Medicaid Director, will present on the State’s Delivery System Reform Incentive Program (DSRIP) and on the move to value based payment on MSSNY’s December 8th Advocacy Matters program. The program will run from 12:30- 1:30PM.

DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.

To read our flyer, please click here.

Calling All Doctors Who Have Been Terminated by Emblem
MSSNY is trying to collect data on the physicians who have been terminated by Emblem health. We cannot help you if we do not who you are. We are in constant contact with The Department of Financial Services in an effort to assist New York State physicians who have received these notices from Emblem.

Please email our VP of Socio-Medical Economics Division Regina McNally at rmcnally@mssny.org with your name and contact information. 


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


File by Dec. 16 to Avoid Medicare Pay Cut of 2-4 %
Practices that may have thought they were safe from Medicare payment penalties next year could be in for an unpleasant surprise if they don’t take action now.

Problems with how the Centers for Medicare & Medicaid Services (CMS) has been collecting and analyzing data related to the Physician Quality Reporting System (PQRS) and the value-based payment modifier are leading to inappropriate penalties of 2-4 percent of Medicare payments for thousands of physicians.

How to avoid the penalty: File an informal review request with CMS before midnight EST on Dec. 16. CMS has said it will verify incentive eligibility and payment adjustment determinations for practices that file such a request.

Additional information about the process and contact information for questions is available in CMS’ informal review fact sheet.

Note: CMS has said the informal review system will be down Dec. 3-7 and unable to accept requests during that time.


Register Now For Final 2015 E-Prescribing CME Webinar on Dec. 9
MSSNY will host its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members. Registration is now open to MSSNY physicians by clicking here.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  •  Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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.

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013. The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.  


US Senate Passes Controversial Bill to Revise ACA and Defund Planned Parenthood
By a 52-47 vote, the United States Senate passed legislation (HR 3762) on Thursday that would repeal significant components of the Affordable Care Act.  Specifically, the bill would repeal the taxes on medical devices and the so-called “Cadillac” tax on comprehensive health insurance policies (slated to go into effect in 2018).  It would also reduce funding for the Public Health and Prevention fund created under the ACA and repeal the expansion of Medicaid contained in the ACA.  Furthermore, it would set at $0 the fines for individuals who fail to purchase health insurance coverage and large employers who fail to provide coverage to their employees, essentially repealing these mandates.  Of greatest controversy, the legislation would also defund Planned Parenthood for one year.

While the bill is expected to be passed by the House of Representatives, it is almost certainly going to be vetoed by President Obama, and there are insufficient votes for an override.    The significance, however, is that it is likely to be the first time a bill repealing large sections of the ACA has been approved by the entire Congress.  New York’s Senators Charles Schumer and Kirsten Gillibrand voted against the bill.


Revitalizing MSSNY’s Organized Medical Staff Section – Get Involved!
MSSNY members are invited to get involved in the reestablishment of our OMSS. OMSS is a viable entity to advance the interests of your medical staff, your group practice or your institution, and to air and have MSSNY help address your issues.

OMSS also offers a prime opportunity for leadership development.

We would like to invite you to participate in an online meeting at which candidates for office will introduce themselves, and elections will be held. A slate of previously nominated candidates will be presented, and nominations will be accepted from the floor. Even if you are not running for office, please join to have your vote counted. The webinar (telephone only option also available) will take place on Saturday, December 12, 2015 at 8:00 am and should last no more than two hours.

Kindly email eskelly@mssny.org at your earliest convenience to let us know if you will be participating.


Opportunity for Physician Peer Reviewers
The Empire State Medical, Scientific and Educational Foundation, Inc. (ESMSEF) would like to invite you to participate in physician peer review with our organization.  We have a need for physician reviewers who are board certified and in active practice.  We have an urgent need for physicians in all specialties.

ESMSEF is a subsidiary of the Medical Society of the State of New York (MSSNY) and has been performing independent medical peer review since 1984.  The Foundation currently has several contracts in New York State to perform medical peer review services.  The reviews to be performed are retrospective in nature and are time sensitive.  We generally allow approximately 10 days for completion of the physician review.  Reviews may be sent to your home or office or may be performed in our offices in either Westbury or Camillus (Syracuse).  Issues to be reviewed include medical necessity, diagnosis assignment and/or quality of care issues.

If you are interested in participating in peer review, please contact Jane Steinman, Physician Reviewer Coordinator at 1-800-437-2234 or via email at jsteinman@esmsef.com to request an application. Or, you may download our application from the “Careers” section of the Foundation website at www.esmsef.com


MSSNY Announces 2016 Medical Matters Schedule for 2016
MSSNY will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled “Immunizations During a Disaster,” with Dr. William Valenti as faculty.  All programs will begin at 7:30am.

Registration is now open to physicians and other public health officials:

https://mssny.webex.com/mw3000/mywebex/default.do?siteurl=mssny

  • Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.

Further information on these programs can be found here

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. 

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


Senate Finance Report on Solvadi Pricing: Profits over People
Gilead Sciences prioritized maximizing its revenue over recouping research and development costs and ensuring patient access when pricing its breakthrough hepatitis C treatment, Sovaldi, according to a Senate Finance Committee report released yesterday.

“Gilead pursued a calculated scheme for pricing and marketing its Hepatitis C drug based on one primary goal, maximizing revenue, regardless of the human consequences. There was no concrete evidence in emails, meeting minutes or presentations that basic financial matters such as R&D costs or the multi-billion dollar acquisition of Pharmasset, the drug’s first developer, factored into how Gilead set the price. Gilead knew these prices would put treatment out of the reach of millions and cause extraordinary problems for Medicare and Medicaid, but still the company went ahead,” stated the report. The drug costs $1,000 per pill or $84,000 per patient for a 12-week course of treatment. According to the report, fewer than 3% of eligible Medicaid beneficiaries received the treatment last year because of the drug’s high price. Gilead says it disagrees with the report’s findings, noting that it provides financial assistance for the treatment to uninsured individuals. (Wall Street Journal 12/1)


Mandatory Electronic Prescribing in New York State
Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements. Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health, Bureau of Narcotic Enforcement (BNE).

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper. This will allow for time to resolve technical or workflow issues prior to the mandate’s effective date.

Please be aware that implementation timelines for EPCS software vary and may be lengthy. If you have not already begun this process, it is recommended that you begin immediately.

The laws regarding issuing and dispensing prescriptions for controlled substances, from paper to the electronic method, have not changed. Only the format has changed.

Useful information related to electronic prescribing, including frequently asked questions and information regarding the EPCS registration process, can be found on BNE’s website here.


ACEP: Under New Reg, Plans Not Required To Pay Fairly for Emergency Care
A new regulation issued by the Department of the Treasury, the Department of Labor and the Department of Health and Human Services last week stated that health insurance companies can pay doctors in emergency departments essentially whatever they like, opening the door to the possibility of reimbursements that do not even cover the costs of care.  The American College of Emergency Physicians (ACEP) expressed astonishment at the ruling, given the feedback emergency physicians have given to CMS over several years, as well as the timing.  Dr. Jay Kaplan, president of ACEP, said that the organization was considering legal action.

“This new ruling will significantly benefit health insurance companies at the expense of physicians, because they know hospital emergency departments have a federal mandate to care for everyone, regardless of ability to pay,” said Dr. Jay Kaplan.  “They will continue to shift costs onto patients and medical providers, as well as shrink the number of doctors available in plans.  Instead of requiring health plans to pay fairly, this ruling guarantees that insurance companies can pay whatever they want for emergency care.  If history tells us anything it’s that insurance companies prefer to pay as close to nothing as possible, while building their war chest for profits and litigation.”

“This is a scary environment for patients,” said Dr. Kaplan.  “Insurance companies are alleging that doctors are charging too much, rather than admitting they are paying too little.  This ruling by CMS unfortunately suggests that the federal government is on the side of Big Insurance rather than patients and their physicians.”


Classifieds

Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org

Modern 3000 sq. ft. medical office to rent near the United Nations.
Handicapped accessible; private reception area; secretarial area available; 6 exam rooms.  Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.

Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

November 20, 2015 – Doctors Owed Millions by HR

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 20, 2015
Volume 15, Number 44

Dear Colleagues:

MSSNY continues to communicate regularly with key staff at the New York Department of Financial Services (DFS), the New York State of Health, and the Governor’s office to obtain necessary information for physicians to be able to help their patients with the enrollment decisions they will have to make, as well as to assure that physicians are fully compensated for the care they have provided to patients insured by Health Republic.

This week, MSSNY’s advocacy on behalf of physicians treating Health Republic insured patients received much press attention across New York State this week after publicly releasing the results of its survey regarding the huge amounts of payments outstanding to these physicians. Of the over 850 respondents to MSSNY’s survey, 42% have outstanding claims to Health Republic, of which:

  • 9% are owed $100,000 or more
  • 19% are owed $25,000 or more
  • 47% are owed $5,000 or more

At the same time, MSSNY has heard from multiple physician practices that are owed between $1 and $5 million. Combining the survey results with financial data received from numerous physician practices across the state, it’s estimated that physicians across New York State are owed at least tens of millions of dollars from Health Republic.

Articles were printed in Crains Health Pulse, Newsday, the Syracuse Post-Standard; Buffalo Business First and the Riverhead Local.

At a time when the State is seeking to engage physicians and patients in new payment models and new networks, it is imperative that the State insure that physicians are treated fairly by insurance companies when they participate in such state-promoted products and innovation.  We are very concerned that physicians may be very reluctant to participate in what they view as risky health reform initiatives that promise upside benefits but ultimately could put their medical practices at risk.

Last week, DFS announced that Health Republic enrollees who do not select a new plan by November 30 will be auto-enrolled in Excellus, MVP or Fidelis for the remainder of 2015, provided consumers pay their premium by December 10.  In addition, Fidelis, Excellus, and MVP agreed to credit any deductible and out-of-pocket amounts that consumers have already paid through their Health Republic coverage during 2015 – helping ensure that individuals who make the transition will not be required to restart these payments in 2015.

Physicians who have not completed MSSNY’s survey yet may do so here.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Advice from Socio-Medical Economics re Closing of Health Republic (HR), Effective November 30, 2015
We are aware that there are misconceptions and confusion regarding the patient’s financial liability with this Co-Op failure. The fact that the Co-Op is closing on November 30th does not make medical care and treatment not covered when provided by an HR in-network practitioner to HR enrollees.

If an in-network HR physician is treating a HR enrollee, by contract, the physician is prohibited from billing the patient beyond any applicable deductible, coinsurance or copayment for covered services.  Billing beyond these amounts is considered “balance billing.” This balance billing prohibition is good for the term of the contract which ends on November 30, 2015.  HR and the NYS Department of Financial Services (DFS) have issued notices for patients to call a special hotline number (1-800-342-3736) with concerns about being billed beyond their cost sharing amounts. Staff from DFS indicated that they are trying to create a user-friendly system for physicians to research the patients’ 2015 deductible standing. If possible, if DFS can create a central repository for this research, it would be very helpful for physicians and their staffs.

For those physicians who have outstanding claims with Health Republic (HR) and want to be on record with regard to their debt resulting from this closure, please utilize one consumer complaint form from the following link to record the total dollar value expected from HR.  Submitting this information to DFS will not constitute any commitment from DFS or HR with respect to your recovery concerning your claims.

The HR patient is financially responsible for any unmet 2015 deductible and charges for non-covered services.  These would be the only exceptions that an HR in-network physician could bill an HR enrollee for through 11/30/15.

The New York State of Health has prepared the following Q&A to assist HR enrollees with the transition.   Some of this information should be helpful for our MSSNY members, as well:  http://info.nystateofhealth.ny.gov/sites/default/files/Health%20Republic%20FAQs%2011-16-15.pdf

Part of the Q&A for the patients reads as follows:

  1. What if I have already met or have paid towards my deductible in my current plan?
  2. If you are enrolled in a Health Republic plan that has an annual deductible, the NYS Department of Financial Services is working to ensure that your new health plan will not charge you for the amount of deductible you already met in 2015. Keep your records. You may need to provide your new plan with evidence that you have met all or part of the 2015 deductible.

We are in the process of asking HR, Excellus, Fidelis, and MVP if there will be a computer system for you to be able to verify a patient’s 2015 deductible status.  So far, we have been told that the specific mechanism has not yet been defined.  As soon as we are advised, we will be sure to alert you.

However, if you are scheduling a visit for a former HR enrollee for services rendered from 12/1 through 12/31/15, it is urged that you ask the patient to bring their latest HR EOB that shows their 2015 deductible standing.  If it has been met, the patient would only be liable for their co-payment or co-insurance.  If their 2015 deductible has not been met, you would be able to charge them that amount up to your contracted fee schedule with Excellus, Fidelis, or MVP.

If you have additional questions concerning this matter, please email Regina McNally, VP, Division of Socio-Medical Economics at rmcnally@mssny.org


Survey of the Week

How is your ICD-10 Implementation Working?
Please answer this one question survey.



Opportunity for Physician Peer Reviewers
The Empire State Medical, Scientific and Educational Foundation, Inc. (ESMSEF) would like to invite you to participate in physician peer review with our organization.  We have a need for physician reviewers who are board certified and in active practice.  We have an urgent need for physicians in all specialties.

ESMSEF is a subsidiary of the Medical Society of the State of New York (MSSNY) and has been performing independent medical peer review since 1984.  The Foundation currently has several contracts in New York State to perform medical peer review services.  The reviews to be performed are retrospective in nature and are time sensitive.  We generally allow approximately 10 days for completion of the physician review.  Reviews may be sent to your home or office or may be performed in our offices in either Westbury or Camillus (Syracuse).  Issues to be reviewed include medical necessity, diagnosis assignment and/or quality of care issues.

If you are interested in participating in peer review, please contact Jane Steinman, Physician Reviewer Coordinator at 1-800-437-2234 or via email at jsteinman@esmsef.com to request an application.  Or, you may download our application from the “Careers” section of the Foundation website at www.esmsef.com

CMS Finalizes Rule for Medicare “Virtual” Bundled Payments for Lower Joint Replacement
Despite concerns expressed by many physician and hospital groups, Medicare payments for hip and knee replacements in Buffalo and New York City metropolitan areas, as well as 65 other regions across the country, will be subject to a “virtual bundling” program, according to an announcement this week from CMS.   For more information, click here, here  and here.

Under the new program, the “Comprehensive Care for Joint Replacement (CCJR)” model, acute care hospitals in certain 67 geographic areas will receive retrospective reward payments or face financial liability relating to episodes of care for lower extremity joint replacement (LEJR).  While Medicare payments to hospitals, physicians and other providers would continue to be made on a fee for service basis, the acute care hospital that is the site of surgery would be held accountable for spending during the episode of care. There is a 5 year performance period, beginning April 1, 2016, and ending December 31, 2020.

Under the program, the episode of care begins with an admission to a participant hospital of a beneficiary who is ultimately discharged under MS-DRG 469 (Major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (Major joint replacement or reattachment of lower extremity without major complications or comorbidities) and ends 90 days post-discharge in order to cover the complete period of recovery for beneficiaries. The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions.  Depending on the hospital’s quality and cost performance during the episode, the hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs.

In the first year, 2016, there would payment rewards only for the hospital, no penalties.  Starting in 2017, the financial penalties are phased in.  In 2017, the potential penalty is capped at 5%.  In 2018, the penalty would be capped at 10%, and in 2019 and 2020, the penalty is capped at 20%.

CMS notes that “a participant hospital may wish to enter into certain financial arrangements with collaborating providers and suppliers who are engaged in care redesign with the hospital and who furnish services to the beneficiary during an episode. Under these arrangements, a participant hospital may share payments received from Medicare as a result of reduced episode spending and hospital internal cost savings with collaborating providers and suppliers, subject to parameters outlined in the rule. Participant hospitals may also share financial accountability for increased episode spending with collaborating providers and suppliers.”

The 67 areas across the country encompass numerous major population centers including 800 hospitals.  The locations where this “virtual bundling” program will occur include Erie and Niagara counties in Western New York, and Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk and Westchester counties in downstate New York.


Medicare Advantage Plan to Shut Down
Touchstone Health HMO, a Medicare Advantage plan, will wind down operations at the end of the year, ending coverage for more than 10,000 members.

The White Plains insurer posted a notice on its website that informed members in New York City and Westchester and Orange counties that they would “no longer be enrolled beginning January 1, 2016.”

In October 2010, the insurer had about 17,000 members, with optimistic projections of clearing the 20,000 threshold. But membership fell 36%, to 10,864, in October 2015, according to CMS data.

Founded in 1998, the company is majority-owned by Essex Woodlands, a health care venture-capital fund, and Garden City, L.I.’s HealthCare Partners IPA. Essex Woodlands has a 60% stake—its managing director, Steve Wiggins, a founder of Oxford Health Plans, is on Touchstone’s board—with the rest held by HCP.

By the end of 2014, Touchstone was $8.5 million below its minimum net worth requirements, with assets exceeding liabilities by $9.6 million. The insurer earned $402,000 in net income on $157.9 million in revenue, with a profit margin under 1%.

A spokesman for the state Department of Financial Services said the closure “was a voluntary decision by the company. We’re working with the company and other regulators to help ensure consumers are protected.” (Crains 11/12/15)


MSSNY Announces Physician’s Emergency Preparedness Toolkit; Earn up To 15 Free CMEs
The Medical Society of the State of New York announces the creation of the Physician’s Emergency Preparedness Toolkit.  This toolkit provides resources necessary to enhance public health security and preparedness for all hazards and contains an extensive list of electronic resources for physicians to use during, or in preparation of, public health emergencies.   Upon completion of the toolkit, physicians can receive up to 15 hours of free continuing medical education credits.

The toolkit is comprised of four modules and is available at the MSSNY CME website here.   Physicians new to the MSSNY CME site will need to create a username and password.   Once registered, and logged into the site, click “My training page” on the toolbar located at the top of the instruction page.   The modules discuss liability protections for physicians during a public health emergency, provides information on the federal and state framework for responding to a public health emergency, and the best practices for a public health emergency.

The toolkit also includes:

  • A physician “go” bag checklist
  • An emergency preparedness checklist
  • A Psychological Impact desk reference card
  • A Biological, Chemical and Radiological Terrorism desk reference card

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 designated this enduring material for a maximum of 15 AMA PRA Category 1 Credits TM. Physicians should claim only the credits commensurate with the extent of their participation in the activity.

MSSNY has also created an Emergency Preparedness Podcast.  The podcast features discussions with several of New York’s preeminent experts on emergency preparedness and focuses on a remembrance of the events of September 11th, 2001 and on MSSNY’s efforts toward an aware and prepared physician and healthcare provider community in New York State.  The podcast can be accessed here.

The toolkit was created by members of the MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response Committee in cooperation with the New York State Department of Health.  A copy of the flyer for the toolkit and podcast is here.

For further assistance and/or questions please contact Pat Clancy at pclancy@mssny.org or Melissa Hoffman at mhoffman@mssny.org


“With 44 Rx Opioid Related Deaths A Day, What Can One Physician Do?”
The Medical Society of the State of New York announces that its website has resources, tools, best practices, and voluntary education programs to help physicians to better understand the opioid epidemic.  The Medical Society is one of eight state societies that is part of the AMA’s Task Force to Reduce Opioid Abuse.   Established in 2014, this task force has embraced five concepts for implementation throughout the nation. The Task Force believes that physicians have a professional obligation to reverse the nation’s opioid epidemic. The five goals of The Task Force are:

  • Increase physicians’ registration and use of effective PMPs
  • Enhance physicians’ education on effective, evidence-based prescribing
  • Reduce the stigma of pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing

MSSNY recognizes the severity of this public health epidemic and is committed to implementing solutions to combat it.  In New York, we have already reduced the incidence of doctor shopping by 86% because physicians are checking the Prescription Monitoring Program prior to prescribing a controlled substance. MSSNY also supported legislation to increase access to naloxone to reduce deaths from overdose.  MSSNY also supports efforts increase voluntary education and training for physicians on safe prescribing practices.   According to IMS data, New York has seen substantial decreases in the number of prescriptions written for oxycodone, hydrocodone and other controlled substances. New York’s utilization rate for these medications is below other states that currently require prescriber education of opioid medications. But there’s more to do.   The MSSNY website provides information on best practices that physicians may find helpful when considering a controlled substance and common recommendations found in opioid prescribing guidelines, including tools such as opioid calculators. Additionally, there are free continuing medical education programs through the PCSS-O and prevention and other information for your patients.  To learn more, click here.

MSSNY representatives to the AMA Task Force to Reduce Opioid Abuse are MSSNY Councilor, Frank Dowling, MD and Pat Clancy, MSSNY Vice President for Public Health and Education. Further information can be obtained by contacting Pat Clancy at pclancy@mssny.org.


Register Now For Final 2015 E-Prescribing CME Webinar on Dec. 9th
The Medical Society of the State of New York will host its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here. Select training session and the upcoming tabs.

The webinar will be held on Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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.

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013. The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.


MSSNY Announces 2016 Medical Matters Schedule for 2016
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled “Immunizations During A Disaster,” with Dr. William Valenti as faculty.  All programs will begin at 7:30am.

Registration is now open to physicians and other public health officials:

https://mssny.webex.com/mw3000/mywebex/default.do?siteurl=mssny

Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016. Further information on these programs can be found here

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.

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


Informal Review Request Period for 2016 Value Modifier Open Now Through November 23, 2015
The period for requesting an informal review of the 2016 Value Modifier is open now and ends November 23, 2015. For groups with 10 or more eligible professionals (EPs) that are subject to the 2016 Value Modifier, CMS established an Informal Review Period to request a correction of a perceived error in their 2016 Value Modifier calculation. These groups may request an informal review of their 2016 Value Modifier determination, now through November 23, 2015 11:59pm EST.

The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician EPs.

The 2014 Annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. For groups with 10 or more EPs that are subject to the 2016 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who bill under the group’s TIN in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2016.

Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.

Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).


NY Worker’s Compensation Board Proposes Regulation Changes
As of November 12, 2015, the following proposed regulation changes have been published to the Board’s website:

Amendment of 12 NYCRR 324.3 (Variances)

Amendment of 12 NYCRR 324.4 (Optional Prior Approval)

Amendment of 12 NYCRR 311.1 (Funeral Expenses)

Amendment of 12 NYCRR 325-1.4 (Authorization for Medical Services)

Amendment of 12 NYCRR 300.5 (Stipulations)

Repeal of 12 NYCRR 300.13, 300.15 and 300.16 and Addition of 12 NYCRR 300.13 (Administrative Review, Full Board Review and Reconsiderations)

Amendment of 12 NYCRR 300.27 (Meetings of the Board)

Amendment of 12 NYCRR 300.36 (Section 32 and Voluntary Binding Review)

The proposed regulation changes will be published in the November 10, 2015 edition of the State Register. Comments on the proposed regulations will be accepted for 45 days, from November 10, 2015 through December 28, 2015.

Please send questions or comments on the proposed regulations to: Heather M. MacMaster, Associate Attorney, Workers’ Compensation Board, 328 State Street, Schenectady, New York 12305-2318, telephone: (518) 486-9564, or email your comments to the Board atregulations@wcb.ny.gov.


From NY Workers Compensation Board: December District Dialogue Sessions
Thank you to all who attended our Fall District Dialogue Sessions. We are very fortunate for everyone’s participation and contribution, making our District Dialogues a continued success. Please join us for our Winter 2015 District Dialogue Sessions. This will be the Board’s sixth District Dialogue Session since we began holding these sessions in September 2014. We hope you will join us at one of our District Offices. The locations, dates and times are as follows:

WC Schedule_Updated

 

*Due to the relocation of the Albany District Office, the Albany District Dialogue date is still to be determined. An update will be sent when a location, date and time are decided.

It will be here before you know, so be sure to mark your calendars! We look forward to seeing and hearing from you.

If you have any questions, please contact Outreach@wcb.ny.gov


Classifieds

Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Modern 3000 sq. ft. medical office to rent near the United Nations.
Handicapped accessible; private reception area; secretarial area available; 6 exam rooms.  Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.


Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

November 13, 2015 – Does Health Republic Owe You Money?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 13, 2015
Volume 15, Number 43

Dear Colleagues:

The news of the financial meltdown of Health Republic has grown increasingly grim.

Questions are being raised if or how much physicians, hospitals and others will be paid for the care they have provided to HR-insured patients.  As such, it is imperative that physicians complete a MSSNY survey sent to you multiple times this week to aggregate the amounts that you are due from Health Republic. Hospital associations have been quoted in numerous news reports as being owed over $150 million.

We need to get similar hard data from physicians to help MSSNY advocate on your behalf to be treated fairly.  If you have not already responded, please complete this survey NOW by clicking here.

As of this writing, more than 40% of the survey respondents have outstanding claims to Health Republic, of which:

  • 7% are owed $100,000 or more
  • 15% are owed $25,000 or more
  • 43% are owed $5,000 or more
  • 74% are owed $1,000 or more

Combining the survey results we have received so far with financial data received from numerous physician practices across New York State, it is estimated that physicians across New York State are owed at least tens of millions of dollars from Health Republic.

MSSNY has been in continuous contact with DFS and New York State of Health officials to obtain necessary information for physicians to be able to help their patients with the enrollment decisions they will have to make.  We have also been advocating to these officials to assure that physicians be fully paid for the care they have provided to patients insured by Health Republic.

Certainly, the financial meltdown of Health Republic is a strong reason why many have called for the New York State Legislature to enact a special fund to assure claims will be paid and prevent against similar problems in the future.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance

For Late-Breaking News: See item below

Health Republic Enrollees to Transition to Excellus, MVP or Fidelis Coverage
Health Republic enrollees who do not select a new plan by November 30 will be auto-enrolled in Excellus, MVP or Fidelis for the remainder of 2015, according to an announcement today by the NYS Department of Financial Services and NY State of Health.

In addition, Fidelis, Excellus, and MVP have agreed to credit any deductible and out-of-pocket amounts that consumers have already paid through their Health Republic coverage during 2015 – helping ensure that individuals who make the transition will not be required to restart these payments in 2015.

According to the press release, during the third week of November, individuals enrolled in Health Republic through NYSOH and who have not yet selected a new health plan for December 1, 2015, will receive an auto-enrollment notice from NYSOH telling them — based on their county of residence – whether they will be auto-enrolled in either Fidelis Care, Excellus, or MVP.  Individuals who reside in the Rochester area (including Livingston, Monroe, Ontario, Seneca, Wayne and Yates counties) will receive an offer to enroll from Excellus. Individuals who reside in Ulster County will receive an offer to enroll in MVP.  Individuals who reside in all other counties of the state will receive an offer to enroll from Fidelis Care. In order for coverage to become effective, individuals will need to make their premium payment for the month of December 2015. Consumers will be auto enrolled into the same metal tier or option that is most similar to the coverage the individual selected through Health Republic.

As noted in the DFS press release, under New York law, Health Republic members who are: a) in an ongoing course of treatment with a physicians for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when their new coverage becomes effective, may be able to continue to receive care from their physician for up to 60 days (or through pregnancy) under their new health insurance policy, even if the physician does not participate with the new health insurer (subject to agreement by that physician).


Affiliation between Albany Med and Saratoga Hospital Still Being Worked Out
The Albany (NY) Business Review (11/9, French, Subscription Publication) reported that “details of the planned affiliation between Albany Medical Center, the second-largest health system in the Albany area, and Saratoga Hospital are still being worked out” and may not be finalized for months. However, “another affiliation being pursued by Albany Med provides a roadmap for what the agreement might look like,” a deal with “Columbia Memorial in Hudson.” Under that agreement, “Albany Med’s board” would have “a say in approving new board members for Columbia.” However, “Columbia Memorial’s board of directors would still recruit and select those new directors.” 


PTSD and TBI in Returning Veterans: Identification and Treatment 

Date and time:   December 4, 12:30 – 1:30 PM via WebEx

Presenter:          Dr. Joshua Cohen

Program Summary: A look into the two most common disorders facing returning veterans today, from symptoms and diagnosis to treatment and recovery, and how to overcome the unique challenges posed by military culture.

For any questions, contact: Greg Elperin at gelperin@mssny.org

Please register here. 


REGISTER NOW FOR FINAL 2015 E-PRESCRIBING CME WEBINAR ON DEC. 9TH
The Medical Society of the State of New York will host     its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here. Select training session and then upcoming tabs.

The webinar will be held on Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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. 

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org 

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.   The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.   


Startup Cureatr Targeting Albany Market.
The New York Business Journal (11/11, French) reports healthcare startup Cureatr, which notifies “a patient’s primary care doctor in real-time if that patient goes to the emergency room,” will start by targeting the Albany area. The company is currently working at Albany Medical Center “and is now working on partnering with the other major hospital systems in the region, CEO Dr. Joe Mayer said.”


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations during a Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.

Registration is now open to physicians and other public health officials here. Go to training session and upcoming sessions tab.

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include:  Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

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.

Further information or assistance in registering for any of these programs, may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 


AMA Urges Department of Justice to Reject Further Health Insurer Consolidation; MSSNY Makes Similar Request to NY-DFS
The AMA has written to the Department of Justice, Antitrust Division, to urge that DOJ block the proposed mergers of health insurance giants Anthem (the parent of Empire BC/BS) and Cigna, as well as Aetna and Humana.  MSSNY had previously written to the New York Department of Financial Services (DFS) to urge that either the proposed Anthem-Cigna merger be rejected in New York State, or require that the merged entity agree to reform numerous market conduct issues that were identified in the recent DFS 2015 Guide to Health Insurers.  Concerns with the proposed mergers has also been the subject of numerous op-eds written by County Medical Society Presidents across New York State, including in the Binghamton, Buffalo and Jamestown papers.

According to a recent AMA report, the proposed health insurer consolidation would significantly enhance the market power and/or raise competitive concerns of these combined entities in multiple states across the country, including, within New York State, Long Island, New York City and the Hudson Valley.

Among the key points in the AMA letter to the DOJ were:

  • The proposed mergers are occurring in markets where there has already been a near total collapse of competition.
  • A growing body of peer-reviewed literature suggests that greater health insurer consolidation leads to price increases, as opposed to greater efficiency or lower health care costs.  The mergers would reduce pressures on plans to offer broader networks to compete for members and would create fewer networks that are simultaneously under no competitive pressure to respond to patients’ access needs.
  • Health insurer monopsony, or buyer power, acquired through the proposed mergers would, as the Department of Justice has found in earlier cases, likely degrade the quality and reduce the quantity of physician services.  In the long run health insurer exercise of monopsony power may motivate physicians to retire early or seek opportunities outside of medicine that are more rewarding. This would exacerbate an already significant shortage of primary care physicians in the United States;
  • There is no evidence supporting the insurer’s claim that the proposed mergers would lead to greater efficiencies and innovative payment and care management programs; and
  • Fostering competition, not consolidation, benefits American consumers through lower prices, better quality, and greater choice.


Office of National Coordinator Seeks Physician Input on Aspects of Meaningful Use
In an effort to improve the interoperability of EHRs the AMA is assisting the Office of the National Coordinator (ONC) with gathering information to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use.   The AMA has asked physicians to take a 5-10 minute survey that will help ONC create a new standard that will reduce the number of pages in the summary of care document, thus making it easier to find relevant information.     The survey link is here. The survey will close on November 30.


Doctors Without Borders Recruiting Doctors; Info Session on Nov. 19 in Manhattan
Doctors Without Borders is recruiting qualified MEDICAL AND NON-MEDICAL professionals in New York to respond to ongoing humanitarian crises and join their team of dedicated humanitarian aid workers. They are hosting a recruitment information session at their New York headquarters New York Recruitment Info Session Thursday, November 19, 2015 at 7:00 PM at Doctors Without Borders, 333 Seventh Ave, Second  Floor, NY, NY.  Click here to learn more. Click here to register for the New York session


Deadline for Review of Informal Review Extended until November 23

Question: When is the new deadline to appeal two penalties?

Answer: CMS has extended the deadlines for physicians and group practices facing two different Medicare penalties in 2016 to request an informal review if they believe the government made a mistake. The penalties, which whittle down reimbursement, are levied under Medicare’s Physician Quality Reporting System (“PQRS”) and the Value Based Payment Modifier (“VBM”) program. The original deadline for an informal review of both penalties had been November 9, 2015 but has now been extended until November 23, 2015.

In PQRS, Medicare penalizes physicians for unsatisfactory reporting of clinical quality data. The penalty in 2016, based on performance in 2014, will lower fee-for-service payments by 2%. Physicians, medical groups, and accountable care organizations can learn if they are due for a pay cut by obtaining a PQRS feedback report for 2014.

The CMS website explains how to obtain the report. Requests for an informal review can only be made online through the Quality Reporting Communication Support Page of CMS. CMS promises a decision, which is final, within 90 days.

To read more about this deadline extension and how to file for informal reviews, please visit:https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.

If you have any questions, please contact Kern Augustine Conroy & Schoppmann, P.C. at 1-800-445-0954 or via email at info@DrLaw.com.


AMA Summary of the 2016 Medicare Physician Fee Schedule Final Rule
On October 30, 2015, CMS released the (1,358 page) 2016 Medicare Physician Fee Schedule (PFS) Final Rule with comment period. CMS has issued a general fact sheet and a PQRS payment adjustment fact sheet. Table 62 shows the impact of the rule on individual specialties. The AMA submitted detailed comments on the Proposed Rule on September 8, 2015. The Final Rule is scheduled for publication in the Federal Register on November 16, 2015. CMS will accept comments by 5 PM on December 29, 2015, regarding interim final relative value units (work, practice expense, and malpractice); interim final HCPCS codes (in the Preamble and Addendum C); and changes to the physician self-referral HCPCS/CPT codes (tables 50-51). 

Physician Payment Update & Misvalued Codes Target
The Medicare Access and Chip Reauthorization Act (MACRA) called for annual updates of 0.5 percent from July 2015 through 2019. The Protecting Access to Medicare Act of 2014 (PAMA) set an annual target for reductions in PFS spending, from adjustments to relative values of misvalued codes. Then the Achieving a Better Life Experience (ABLE) Act of 2014 accelerated those targets, increasing the target to 1 percent for 2016 and keeping it at 0.5 percent for 2017 and 2018.

The AMA opposed these targets as completely unnecessary. The RUC and CMS have been engaged in intensive efforts to identify and address misvalued services for many years, long before Congress got involved. CMS has recognized the RUC’s vital role in helping value Medicare services. Since the RUC Relativity Assessment Workgroup began in 2006, the RUC and CMS have identified over 1,900 services through 16 different screening criteria for further review, and the RUC has recommended reductions and deletions for 1,045 services, leading to redistribution of nearly $4 billion.

In the final rule, CMS brought its methodology more in line with AMA and RUC recommendations, and rolled back planned payment reductions for both radiation treatment services (completely) and lower GI endoscopy (partially). Together with redistributions recommended by the RUC, this yields a net savings of 0.23 percent, requiring a 0.77 percent reduction to meet 1 percent target. Taking into account the 0.5 percent positive update (and a -0.02 percent budget neutrality adjustment), the 2016 Medicare conversion factor is reduced by 0.29 percent to $35.83, just 10 cents below the 2015 conversion factor of $35.93. 

Advanced Care Planning
CMS finalized separate Medicare payment for two CPT codes for advance care planning services, which include conversations between patients and their physicians before an illness progresses and during treatment. The rule specifically referenced the AMA recommendations. This represents not only a win for CPT, the RUC, and the AMA, but also a turning point towards a new approach to pay for advance care planning. The Medicare statute currently provides coverage for advance care planning under the “Welcome to Medicare” visit available to all Medicare patients, but they may not need these services when they first enroll. Separate payment for advance care planning codes recognizes the additional time needed to conduct these conversations, and provides a greater opportunity and more flexibility to have these planning sessions at the most appropriate time for patients and their families. CMS is also finalizing payment for advance care planning when it is included in the “Annual Wellness Visit.” 

“Incident to” Services
In the 2014 PFS final rule, CMS set explicit requirements that “incident to” services must be furnished consistent with applicable state law, including state licensure and other requirements for the “auxiliary personnel” providing the services. In the 2016 PFS final rule, CMS is also requiring that “the physician or other practitioner who bills for incident to service must also be the physician or other practitioner who directly supervises the auxiliary personnel who provide the incident to services.” (Incident to services may also be billed by clinical psychologists, PAs, NPs, CNSs, and certified nurse-midwifes. General supervision is sufficient for chronic care and transitional care management services, except patient visits.) The AMA and other physicians expressed concerns that this requirement – and CMS’ proposal to remove current regulatory language widely interpreted as allowing the supervising physician (or practitioner) to be someone different from the person who initiated the patient’s treatment and is overseeing their general care – would adversely impact the physician community, particularly group practices and multispecialty clinics. Fortunately, CMS agreed to continue its policy that the supervising physician (or practitioner) for a particular incident to service does not have to be the same person who is “treating the patient more broadly” and is adding clarifying regulatory language to that effect. The rule also finalizes regulatory changes that prohibit auxiliary personnel from providing incident to services if they have been excluded from Medicare, Medicaid, or other federal health programs or have had their enrollment revoked. 

Other Payment Issues

  • Primary Care Bonuses End: While not highlighted in the final rule, it is important to keep in mind that the 10 percent incentives – that section 5501(a) of the Affordable Care Act established for Part B services by primary care practitioners – are scheduled to end on December 31, 2015.
  • Phase-In of Significant RVU Reductions: The PAMA specified that a decrease in value for a service of 20 percent or more, without a change in the underlying code for the service, must be phased-in over a two-year period. CMS is adopting its proposal to reducing the value for a service by 19 percent in the first year, and by the remainder in the second year.
  • Misvalued Code Changes/Lower GI Endoscopy Services: CMS is adopting codes for lower gastrointestinal endoscopy as revised by the CPT Editorial Panel and related values “more closely tied” to the RUC’s recommendations.
  • Misvalued Code Changes/Radiation Therapy: CMS did not finalize the new code set for radiation therapy treatment. Changes will be implemented, over 2 years, to the utilization rate for capital equipment used in radiation therapy, to 35 hours per week (70 percent utilization) instead of 25 (50 percent utilization). CMS also seeks comment on the price and usage of linear accelerators.
  • Part B Drugs/Biosimilars: Payment for a biosimilar biological product will be based on the average sale price of all biosimilar biological products within the same billing/payment code.
  • Technical Errors: There are two errors in the Final Rule that will be corrected in a technical correction notice:

o The 0.5 percent update was not applied to the Anesthesia conversion factor. With the appropriate application, we estimate that the correct 2016 Anesthesia conversion factor should be $22.4426.

o The work GPCI (geographical practice cost index) floor, extended under MACRA until January 1, 2018, was not applied. The GPCI tables incorrectly list work GPCIs below 1.0 for 51 localities.

Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging
PAMA requires that providers who order advanced diagnostic imaging services consult with AUC via a clinical decision support mechanism. PAMA also requires CMS to specify AUC from among those developed or endorsed by national medical professional specialty societies and other provider-led entities; to approve clinical decision support mechanisms; to collect additional information on the Medicare claim form; and to develop a prior authorization program based upon the claims information. CMS is establishing which organizations are eligible to develop or endorse AUC, the evidence-based requirements for AUC development, and the process CMS will follow for qualifying provider-led entities. Consistent with concerns expressed by the AMA, CMS says it will not have AUC in place and ready for consultation by ordering physicians by the January 1, 2017 deadline, so the requirement for consultation will be delayed. Also consistent with AMA advocacy, CMS is reconsidering application of the AUC to emergency departments, and will review this issue in next year’s PFS rule. 

Medicare Opt-Out
Prior to MACRA, physicians and practitioners that wished to renew their opt-out were required to file new valid affidavits with their Medicare Administrative Contractors (MACs) every 2 years. CMS clarifies in the final rule that under MACRA, physicians and practitioners that filed valid opt-out affidavits on or after June, 16, 2015 are not required to file renewal affidavits. Such physicians and practitioners may cancel the renewal by notifying all MACs with which they filed an affidavit in writing, at least 30 days prior to the start of the new two-year opt-out period. 

Physician Quality Reporting System (PQRS)
Despite objections from the AMA and other physician specialty societies, CMS is maintaining the same strict minimum measure reporting requirements—of nine measures covering three National Quality Strategy domains—for the 2016 reporting period which determines the 2018 PQRS payment adjustment. Individual eligible professionals (EPs) or group practices that fail to satisfactorily report or otherwise participate in PQRS for 2016 will receive a 2 percent negative payment adjustment on covered professional services in 2018. CMS is finalizing additions to the PQRS measure set to fill gaps, and deleting measures considered “topped out,” duplicative, or replaced. The 2016 PQRS measure set will have 281 measures and the GPRO Web Interface will have 18. CMS will allow group practices to report quality measure data using a Qualified Clinical Data Registry (QCDR), as required under MACRA. 

Physician Compare
All 2016 individual EP and group practice PQRS measures will be available for public reporting on Physician Compare. This includes ACO measures and “CAHPS for PQRS survey” measures for groups of two or more EPs that have the required sample size and collect data via a CMS-specified certified CAHPS vendor. CMS is withdrawing its plan to indicate (on profile pages) which EPs and which group practices receive a VM bonus, but is finalizing the inclusion on Physician Compare of:

  • Certifying board, including the American Osteopathic Association Board;
  • An indicator for individual EPs who satisfactorily report PQRS Cardiovascular Prevention measures in support of the Million Hearts initiative (on profile pages);
  • Individual and group-level QCDR measures;
  • In the downloadable database: Value Modifier tiers for cost and quality; whether the EP or group practice is high, low, or neutral on cost and quality; the resulting payment adjustment; which eligible EPs or group practices did not report quality measures to CMS; utilization data for individual EPs; and
  • An item (or measure)-level benchmark based on the Achievable Benchmark of Care (ABC™) methodology, displayed as a five-star rating.

Value-Based Payment Modifier (VM)
CMS will no longer apply an automatic VM penalty to TINs receiving a PQRS penalty, if on informal review at least 50 percent of EPs avoid the PQRS penalty. If CMS does not have sufficient data to calculate their VM quality score, they will be considered “average quality.” CMS is finalizing the following key provisions for the 2016 reporting period/2018 payment adjustments:

  • The VM will apply to nonphysician EPs who are Physician Assistants (PAs), Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Anesthetists (CRNAs) practicing either in groups or as solo practitioners.
  • The quality-tiering methodology will apply to all groups and solo practitioners. However, PAs, NPs, CNSs, and CRNAs will not receive downward adjustments under quality-tiering in 2018.
  • The maximum upward adjustment under quality-tiering will continue at: o +4.0 times the adjustment factor for solo physicians and groups with 10 or more EPs.

o +2.0 times the adjustment factor, for solo physicians and groups with 2 to 9 EPs.

o +2.0 times the adjustment factor for solo and groups of PAs, NPs, CNSs, and CRNAs.

  • The amount of payment at risk is: o -4.0 percent for groups of physicians with 10 or more EPs.

o -2.0 percent for solo physicians and groups with 2 to 9 EPs.

o -2.0 percent for solo and groups of PAs, NPs, CNSs, and CRNAs.

Beginning with VM adjustments in 2017:

  • The VM is waived for EPs and groups if at least one EP who billed for PFS items and services under their TIN participated in the Pioneer ACO Model, Comprehensive Primary Care Initiative, or other similar Innovation Center model (such as Comprehensive ESRD Care Initiative, Oncology Care Model, and the Next Generation ACO Model).
  • The Medicare Spending per Beneficiary measure will only apply to EPs with at least 125 episodes.
  • For solo practitioners and groups with 2 to 9 EPs, the All-Cause Hospital Readmissions measure will not be used in the quality calculation.

Medicare Shared Savings Program (MSSP)

  • The final rule adds a “Statin Therapy for the Prevention and Treatment of Cardiovascular Disease” measure in the Preventive Health domain to align with PQRS reporting.
  • Measures can stay or revert to “pay for reporting” if a measure owner determines they no longer align with updated clinical practice or cause patient harm.
  • The rule clarifies how EPs in an ACO can meet their PQRS requirements.
  • “Primary care services” include claims submitted by Electing Teaching Amendment hospitals and exclude certain services furnished in Skilled Nursing Facilities.

Physician Self-Referral Law
The physician self-referral law prohibits: (1) a physician from making referrals for certain “designated health services” (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship, unless the requirements of an applicable exception are satisfied; and (2) the entity from filing claims with Medicare (or billing another individual, entity, or third party payer) for those DHS furnished as a result of a prohibited referral. The final rule establishes two new exceptions and clarifies certain terms and requirements.

New Exceptions: Permit payment to physicians by hospitals, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs), to compensate non-physician practitioners under certain conditions; and permit timeshare arrangements for the use of office space, equipment, personnel, items, supplies, and other services. CMS believes these will enhance access to care, particularly in rural and underserved areas.

Physician-Owned Hospitals: The ACA established new restrictions on physician-owned hospitals, including setting a baseline physician ownership percentage they cannot exceed, and requiring statements of physician ownership on websites and in advertising. CMS is clarifying that a broad range of actions comply with these requirements, and finalized changes to the physician ownership calculation, effective January 2017, to include all physicians, not just those who refer to the hospital.

Clarifying Terminology and Policy Guidance: Relating to settlement of overpayments resulting from physician self-referral law violations is designed to “reduce perceived or actual noncompliance.”

  • Compensation paid to a physician organization cannot take into account the referrals of any physician in the physician organization (as opposed to the referrals of a physician who stands in the shoes of the physician organization).
  • Employees and independent contractors do not have to sign arrangements with the physician organization and a DHS entity.
  • Exceptions to the referral and billing prohibitions can be based on a collection of documents.
  • The terminology that describes these types of arrangements was made more consistent.
  • The term of leases and personal service arrangements lasting at least 1 year, and otherwise compliant, does not have to be in writing.
  • Expired lease and personal services arrangements can continue indefinitely if otherwise compliant.
  • A 90-day grace period is allowed to obtain missing signatures, inadvertent or not.
  • DHS entities can give physicians items used solely for a purpose identified in the statute.
  • A financial relationship does not exist when a physician provides services to hospital patients in the hospital, if both the hospital and the physician bill independently for their services.
  • The exception for ownership in publicly traded entities allows over-the-counter transactions.
  • The definition of a locum tenens physician was simplified.
  • Geographic service areas were clarified for FQHC and RHC physician recruitment exceptions.
  • Under the retention exception, retention payments based on physician certification may be no more than 25 percent of the physician’s current annual salary averaged over 24 months 


 


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org


Office Near UN for Rent
Modern 3000 sq. ft. medical office to rent near the United Nations. Handicapped accessible; private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.

Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

November 6, 2015 – NY Is Not Part of the Herd

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 6, 2015
Volume 15, Number 42

Dear Colleagues:

Standing Up for Your Beliefs and Position

Our state medical society has a long history of leading change in many controversial areas, often being the lone voice of advocacy or opposition.  History has proven that those well-reasoned and critically analyzed positions have been spot on in their assessments and recommendations.  During the tenure of the previous two presidents, MSSNY took such positions, specifically on the SGR—when were the only state that did not sign onto the national letter.  Once again, our society has risen to lead by example.

This past week, I declined to sign onto a national letter asking for particular changes in the National Association of Insurance Commissioners’ Model Bill for network adequacy. Instead, we chose to draft our own letter highlighting the merits of the more robust network adequacy legislation accomplished in New York’s legislation wrought in part through the efforts of our Immediate Past President Dr. Andrew Kleinman.  Numerous attorney generals and legislators in other states have been looking at New York’s legislation as being more protective of patient needs in access to care via network adequacy.  In addition, our state’s legislation has protected both patients and physicians when these medical services have been sought out of network.  Other state medical societies have been looking at our efforts in this arena and are opting to follow our lead in this arena.

As New Yorkers, we have always understood the challenges that prompt us to go beyond conventional participation in advocacy efforts.  We are prepared to be contrarians when solutions proffered by others shortchange our patients and profession.  We are proud of the legislation on surprise bills and network adequacy that protects New York’s patients and physicians even when our lone voice of advocacy engenders bogus claims of “limited networks that are robust” or are alluded to as purveyors of conspiracy theories.

What gives us the fortitude to be the lone person advocating for the best interests of our patients and doctors?  It is our commitment to the oaths we made to protect our patients and profession when we first entered the profession.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Council Notes
At the meeting on November 5, Council approved the following:

  • Childhood Vaccination Resolution
    MSSNY will support the repeal to eliminate all non-medical exemptions for childhood vaccinations prior to attending school in New York State.
  • Resolution 113:
    Resolution 113 was amended and adopted as follows: That the Medical Society of the State of New York investigate logistics of including MSSNY and County Medical Society opt-out dues in the NYS Department of Education biennial registration billing and payment.
  • Resolution 60:
    Council adopted substitute resolution 60, which states that MSSNY will work with the NY chapters of the American Academy of Pediatrics to advocate for the following: that health insurers comply with the law that required them to provide coverage for autism and related services; insurers take the necessary steps to include sufficient physicians in networks; work with AMA and other societies to advocate for federal legislation to require self-insured plans to provide such coverage; work with similarly interested organizations to identify gaps in services and treatment.
  • Resolution 117:
    MSSNY will seek legislation and regulation that vertically integrated hospital systems must prove to the DOH a need to employ an individual physician in the market place and obtain a Certificate of Need for each of their employed physicians and that the certificate of need process include an evaluation of the employment agreement, insofar as it be limited to fair market values of physician services and not include ancillary services.
  • Presidential Appointments to the Council Workgroup
    The workgroup will develop guidelines for collaborating with non-MSSNY physician groups seeking MSSNY engagement.
  • Presidential Nomination to AMA Senior Physicians Section
    Dan Koretz, MD will serve as the Senior Physician Section liaison with the AMA.  Dr. Koretz will provide two-way communication between MSSNY and the SPS through participation in virtual Assembly calls and the annual and interim meetings.
  • Virtual Council Meeting in January
    The January Council meeting will be held remotely, with various locations around the state connecting via WebEx.


NY Practices Waiting To See Impact Of New ICD-10 Coding System
POLITICO New York (11/3, Velasquez) reports healthcare providers in New York State “say it’s still too early to know what sort of repercussions the new [coding] system will have on their operations,” one month into the transition. As of October 1, those providers who are “covered by the Health Insurance Portability Accountability Act (HIPPA) had to transition to a tenth version of the International Statistical Classification of Diseases, also known as ICD-10.” Regina McNally, the vice president of socio-medical economics at the Medical Society of the State of New York, says, “If there are going to be some problems of any significance, we have to wait a little further down the road before those issues.”


Medical Journal Article Concludes that Higher Spending Physicians Sued Less; Profound Implications for Value-Based Payments
As was widely reported in the Washington Post  and the New York Times this week, a British Medical Journal article concluded that physicians who spent the most health-care resources on hospitalized patients had the lowest likelihood of being sued.   MSSNY will be sharing these articles with key legislators and Cuomo Administration officials, noting that the results of this study have profound consequences for efforts to shift commercial and Medicaid payments to a value-based construct.  Physicians could find themselves in a “Catch 22” situation, where in acting to assure their patients are able to get all the care they need and to reduce the risk of being sued, they may find themselves being penalized by public payors and commercial insurance companies for exceeding spending targets used under such value-based payment paradigms.

In the study, researchers tracked more than 24,000 Florida physicians over a nine-year period and found that in six specialties, physicians who were found to have spent the most health-care resources on hospitalized patients had the lowest likelihood of being sued.


MSSNY Joins AMA and Other Medical Societies in Seeking Congressional Intervention to Delay Unworkable Meaningful Use Requirements
As new CMS regulations will make Stage 3 of the electronic health record (EHR) meaningful use program even less achievable and more disruptive, MSSNY joined 110 other medical associations in a joint letter initiated by the AMA to members of the Senate  and the House urging Congress to intervene.  The letters point out that “the Centers for Medicare & Medicaid Services (CMS) has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.”

MSSNY Board of Trustees member and Saratoga Springs ENT Dr. Robert Hughes and MSSNY staff recently joined physician leaders from other states in Washington DC to advocate for numerous bills including legislation (HR 3309, Ellmers) to reduce the hassles associated with complying with onerous federal regulations governing the use of electronic medical records.  The bill contains a provision to postpone the implementation of Meaningful Use Stage 3 until 75% of physicians can meet Meaningful Use Stage 2.

Physicians are encouraged to email their members of Congress and tell them that the nation’s patients and physicians need significant changes to meaningful use Stage 3. They also can submit comments on the Stage 3 regulations during the 60-day comment period that ends Dec. 15. The AMA’s dedicated website BreakTheRedTape.org makes it simple to submit comments directly to Congress and CMS.


Final 2016 Medicare Physician Fee Schedule rule issued
Late last Friday, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Physician Fee Schedule rule for 2016, along with a fact sheet describing many of its most notable provisions.

The AMA notes that as a result of the interplay between numerous statutory provisions, the Medicare fee schedule conversion factor will be reduced by 0.29% in 2016, from $35.93 to $35.83.

Here’s why: The Medicare Access and Chip Reauthorization Act (MACRA), which repealed the SGR, increased the conversion factor by 0.5% on July 1 and called for additional annual updates of 0.5% from 2016 through 2019.  However, the Protecting Access to Medicare Act of 2014 enacted in April 2014, established an annual target for reductions in Medicare payment schedule expenditures that result from adjustments to misvalued codes.  The Achieving a Better Life Experience Act of 2014, enacted in December 2014, accelerated the application of the expenditure reduction target, setting targets of 1% for 2016 and 0.5% for 2017 and 2018.  Unfortunately, the Medicare payment rule only identified “misvalued code” changes that achieved 0.23% in net reductions, which required CMS to impose a 0.77% reduction to all Medicare professional services, more than offsetting the increases contained in MACRA.

Among its numerous provisions, the Medicare fee schedule rule for 2016 includes provisions to establish payments for advanced care planning.  It also sets forth terms for the bonus and penalties physicians will face in the Value-Based Modifier Program in 2018 based upon 2016 performance.  Groups of physicians with 10 or more face a bonus or penalty of +/- 4%; while solo practitioners and or physicians in groups of 9 or less face a bonus or penalty of +/- 2%.  The program will sunset after 2019 as part of the transition to the Merit Based Incentive Payment System (MIPS).


More Leeway in Two-Midnight Rule
CMS issued changes to the two-midnight rule last week that give physicians broader leeway to determine if someone should be treated on an inpatient basis. But the controversial policy is largely intact. Whether a hospital will be reimbursed for an inpatient stay that lasts fewer than two nights will depend on such factors as the severity of a patient’s symptoms and the likelihood of an adverse event. Inpatient stays that do not keep a patient in the hospital overnight will be prioritized for review. “We will continue to monitor hospital admission practices and look for any evidence of gaming,” CMS told Modern Healthcare. But instead of sending recovery audit contractors who are paid to dispute claims to conduct the initial review, quality improvement organizations will be the first to investigate. GNYHA was among the plaintiffs in a class-action suit filed earlier this year that challenged reimbursement cuts made in association with the two-midnight rule. The group voiced support for the changes in a memo released on October 30.


MSSNY’S Advocacy Matters CME Series on November 10: Foster Gesten, MD to Focus on State Health Innovation Plan (SHIP)
Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.   

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please click here.

The objectives of November 10th Advocacy Matters  program are as follows:

1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.

  1. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  2. Describe the five strategic pillars and three enablers of system transformation.
  3. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please go to mssny.webex.com and click on the “Upcoming” tab.  A “Register” link appears to the right of the program name.

To read the flyer, please click here.

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

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment.  Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

Accreditation Statement: 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.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified.

The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.


Avoid Medicare Penalties
Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, – 2.0% but it could be more. Understanding the rules can be confusing but is necessary. MSSNY has arranged special rates for members from Covisint – a service to help practices with PQRS reporting.  With Covisint PQRS you can confidently avoid the 2017 payment adjustment of -2.0%.

Covisint features include:

  • Paper and electronic data collection methods
  • Web-based application access and data entry
  • Easy and Quick …
    The measures group option only requires 20 patients

HIPAA-compliant database

Automated data submission

MSSNY Members save $100. Call (516) 488-6100, Extension 403 or email: eskelly@mssny.org for your MSSNY Member discount code. Use it at the time of submission and receive a discounted submission rate of $199.

Have questions about PQRS? Plan to attend one of our live Q&A sessions to get all of your questions answered and more. Thursday, November 19, 2015 at 11:00 am ET – Click here to add this meeting to your calendar.

Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more 


MSSNY To Conduct E-Prescribing Webinars Monday, Nov. 9 and Monday, Dec. 9
MSSNY will host two free continuing medical education webinars on E-prescribing for MSSNY members on Monday, November 9th and Wednesday, December 9, 2015 at 7:30 a.m.

Registration is now open to MSSNY physicians by clicking here.

Select “Training Center” and the “Upcoming” tab.  Then click “Register” link to the right of desired session.

A copy of the flyer can be found here.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,”  includes the following educational objectives are:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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. 

Further information can be obtained by contacting Miriam Hardin at mhardin@mssny.org or Terri Holmes at tholmes@mssny.org.  

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.   The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances from March 27, 2015 to March 27, 2016.  


Buyer Beware: Too Good to Be True?
There are now over 40 insurers competing for medical liability insurance in NYS. Sometimes premium quotes can seem too good to be true.  This might be because insurers are providing less coverage, shifting coverage from occurrence to claims made, or offering an attractive discount that may not persist.  If a quote seems too good to be true, give MLMIC a call at (716) 648-5923. We’ve seen a lot in our 40 years in NYS and can often spot differences that may make a difference. 


MEDCO Offering Free Crosswalk Guides
FREE Crosswalk Guides (18 Specialties) are available here:www.medcoconsultants.com.


Do You Want to Present Your Project at MSSNY’s 11th Annual Symposium on April 15?
MSSNY is pleased to announce our 11th Resident/Fellow/Medical Student Poster Symposium on Friday, April 15, 2016 at the Westchester Marriott in Tarrytown, New York from 2 pm – 4:30 pm. Click here for detailed guidelines.Deadline for abstract submission is 4 pm, Monday, January 25, 2016.We welcome the participation of your residents and fellows. Participants must be MSSNY members, and membership is free for first-time resident members.
Join online at www.mssny.org.


Be There! Fall Residents,YPS and Students Get Together in NYC Next Friday
Anuradha Khilnani, MD and the New York County Medical Society, in collaboration with the AMA, is hosting a networking social for physicians, residents and medical students.

When:   Friday, November 13

When:   7-9 pm

Where: The Royalton Hotel 44 W. 44th St


For Your Patients: Q&A for Health Republic Members

Q. I was previously notified that my Health Republic coverage would end on December 31, 2015. Is this a change?

A. Yes, this is a change. Your Health Republic coverage will end one month earlier on November 30, 2015.

Q. Why is my Health Republic coverage ending sooner?

A. Based on an in-depth review by the NYS Department of Financial Services and the federal Center for Medicare and Medicaid Services (CMS), it has been determined that it is in the best interest of consumers to wind-down coverage under Health Republic on November 30, 2015 rather than at the end of the year.

Q. How do I select a new plan?

A. You can:

Log in to your Marketplace account before November 16th and visit the “Plans” tab at the top of the screen.

  • Select “Find a New Plan” at the bottom of the screen to see your health plan options.
  • Once you have chosen your plan, be sure to select “confirm and checkout” to confirm your enrollment in your new plan for December 1, 2015 coverage.
  • Or, you can call our special customer service helpline at 1-855-329-8899 and our customer service representatives will help you select a new plan or give you contact information for an in-person assistor in your area who can help you.

Q. What should I consider when I select my new plan?

A. You should consider:

  • Whether your health care providers are in the new health plan’s network.
  • Whether the prescription drugs you take are covered by the new plan.
  • The premium cost of the new plan.

To find contact information for the health plans offered on NY State of Health and links to each health plan’s provider network directory visit http://info.nystateofhealth.ny.gov/PlanCustomerService 1

Q. Do I have to select the same metal tier (platinum, gold, silver, bronze) as I am enrolling in Health Republic?

A. No. You can select any health plan that is available in your area and any metal tier.

Q. What happens if I don’t select a plan by November 15?

A. In order to ensure you are covered during the month of December 2015 you must pick a new plan by November 15th.

Q. Do I still have coverage for the month of November?

A. Yes. Provided that you pay any required premium for the month of November 2105, you are covered by Health Republic through November 30, 2015.

Q. What if I have already met or have paid towards my deductible in my current plan?

A. If you are enrolled in a Health Republic plan that has an annual deductible, the NYS Department of Financial Services is working to ensure that your new health plan will not charge you for the amount of deductible you already met in 2015. Keep your records. You may need to provide your new plan with evidence that you have met all or part of the 2015 deductible.

Q. Will my providers be in my new plans’ network?

A. You should ask both your providers and the plan you are considering joining about whether your providers participate with the new plan. To find contact information for your health plan and a link to the plan’s provider network directory visit at: http://info.nystateofhealth.ny.gov/PlanCustomerService

Q. What if I am receiving treatment when my Health Republic coverage ends on November 30, 2015 and my provider is not in the new plan’s network?

A. If you are either: a) in an ongoing course of treatment with a provider for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when your new coverage becomes effective on December 1, 2015, then you may be able to continue to receive care from your provider for up to 60 days (or through pregnancy) under your new health insurance policy, even if your provider does not participate in your new health insurer’s network. To receive transitional care, your provider must agree to accept as payment your new health plan’s reimbursement for such services and to certain other conditions of providing care under the new policy. If your provider agrees, you will receive the services as if they were being provided by a participating provider. You will only pay for any applicable in-network cost sharing. You, your representative or your provider should contact your new health insurer to determine if you are eligible for transitional care. To request transitional care, call your new health plan’s customer service and let them know that you are new the plan and ask how to request transitional care. If you experience any problems with the process, you can call the NYS Department of Financial Services toll free number 1-800-332-3736 for assistance in filing this request with your health plan.

Q. What should I do if I have scheduled procedures or medical care in December 2015?

A. If you have care scheduled during the month of December 2105, you should do the following:

  • Visit the NY State of Health website, call the NY State of Health Customer Service Center at 1-855-329-8899 or visit an in-person assistor to review your plan options.
  • Ask your provider which health plans they participate with.
  • Select your health plan.
  • Call your new plan’s customer service to tell them that you have scheduled procedures or care in December 2015 and ask if you need prior-authorization.

Q. If I select a plan for December 1, 2015 will I be automatically enrolled into that plan for January 1 or do I need to make a separate plan selection for January coverage?

A. Current Health Republic enrollees will need to return to the Marketplace beginning on November 16 to select a plan with an effective date of January 1, 2016.

Q. Can assistors offer support to current Health Republic members by phone instead of only providing in-person assistance?

A. Yes. Assistors can provide support telephonically to current Health Republic enrollees in order to assist in selecting plans for December 1, 2015 and January 1, 2016.


CMS Extends Deadline for PQRS Informal Review Process

CMS is extending the 2014 Informal Review period. Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, PQRS group practices, and Accountable Care Organizations (ACOs) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment now have until 11:59 p.m. Eastern Time on November 23, 2015 to submit an informal review requesting CMS investigate incentive eligibility and/or payment adjustment determination. This is an extension from the previous deadline of November 9, 2015.

All informal review requestors will be contacted via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 23, 2015 at 11:59 p.m.EST.

Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment – Informal Review Made Simple (available on the PQRS Analysis and Payment webpage) for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.

 

 

 

 


Classifieds


Office for Rent Near UN
Modern 3000 sq. ft. medical office to rent near the United Nations. Handicapped accessible; private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-Specialty Group Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.
Job requirements:
• Current Board Certification / Recertification
• Current & Unrestricted NYS license, DEA & NPI
• Must be on panels of managed Medicaid and HMO plans
• Working knowledge of EMR
• Take detailed patient history
• Do physical examinations
• Order medically necessary tests, equipment, etc
• Be able to make complex decisions
• Write Prescriptions
• Provide treatments
• Venipuncture
• Give injections
• Follow-up – evaluation of test results and with patients
• Provide referrals to specialists
NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to: medicmiche@aol.com or hrld_weissman@yahoo.com


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’ Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com.


PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room; large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

Council Meeting – November 5, 2015

       AGENDA
Council Meeting
Thursday, November 5, 2015, 9:00 a.m.
Long Island Marriott
 101 James Doolittle Blvd.
                                                                     Uniondale, NY  11553                                                                       

A. Call to Order and Roll Call

B. Approval of the Council Minutes of September 17, 2015

C. New Business (All New Action & Informational Items)

1. President’s Report: 
    a. DISRIP and  Value Based Payments Presentations by the following: (VIA Webinar)
         Greg Allen, Director, NYSDOH
          Division of Financial Planning & Policy
         Marc Berg, MD, PhD., Principal, Advisory
         KPMG, LLP
         Douglas Fish, MD, Medical Director, NYSDOH
         Division of Program Development & Management Office of Health Insurance Program

    b. Presidential Appointments to the 2016 Nominating Committee

c.  Presidential Appointments to the Council Workgroup – Pursuant to the decision for developing guidelines for collaborating with non-MSSNY physician groups seeking MSSNY engagement, I am appointing the following Councilors and individuals to work on the development of these guidelines:

        Kira Geraci-Ciardullo, MD – Speaker, HOD
        (to insure that the guidelines are consistent with MSSNY Bylaws)
        Howard Huang, MD- Councilor and Chair of the group
        Mark Adams, MD – Councilor
        Parag Mehta, MD  –  Councilor
        Michael Goldstein, MD – President, New York County Medical Society
        (to represent interests of  OON group in Manhattan)
        Robert A. Viviano, DO  –  Resident & Fellow Section Councilor
        (to represent issues related to NYSOMS engagement)
        Liz Dears, Esq.  – VP MSSNY and liaison for Coalition of Specialty Societies

    d. Presidential Nomination to be appointed to the AMA Senior Physicians Section
             (For Council Approval)

 2. Secretary’s Report  –  Nominations for Life Membership & Dues Remissions 

 3. Board of Trustees Report – Dr. Latreille will present the report (handout at Council)

4. MSSNYPAC Report –  Dr. Sellers will present the report (handout at Council)

5. MLMIC Update –  Edward Amsler will present a verbal report

6. AMA Delegation Update – Dr. Kennedy will present a verbal update (handout at Council)

7. MESF Update – Dr. Kleinman will present the report (handout at Council)

8.  Commissioners  (All Action Items )
1. Commissioner of Science and Public Health, Frank G. Dowling, MD
          (FOR COUNCIL APPROVAL)
                a. MSSNY Infectious Diseases Committee, Childhood Vaccination Resolution
This Resolution was submitted to Council by the Medical Society of the County of Queens and referred to the Infectious Diseases Committee for review and recommendation to the Council
(Dr. Valenti will be on the phone)

2. Commissioner of Governmental Relations, Gregory Pinto, MD (FOR COUNCIL APPROVAL)
           Legislative and Physician Advocacy Committee
     a. MSSNY’s 2016 Legislative Program
     b. MSSNY HOD Resolution 60,
           Third-Party Payment for Evaluation and Management of  Developmental Disorders
             c. MSSNY HOD Resolution 65, Patients’ Compensation System
             d. MSSNY HOD Resolution 109, Mandatory Reporting of Elder
             e. MSSNY HOD Resolution 113, Medical Society Dues as Part of Biennial Registration
             f. MSSNY HOD Resolution 117,
          Monopolization of Healthcare by Vertically Integrated Health Systems

  1. Councilors  (All Action Items from County Societies and District Branches)
    (no written reports submitted)

D. Reports of Officers (Verbal Reports)       

  1.      Office of the President
  2.      Office of the President-Elect
  3.      Office of the Vice President
  4.      Office of the Treasurer – Financial Statement for the period 1/1/15 – 9/30/15
  5.      Office of the Speaker

E. Reports of Councilors  (Informational)

  1.          Kings and Richmond Report – Parag H. Mehta, MD
  2.          Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
  3.          Nassau County Report – Paul A. Pipia, MD
  4.          Queens County Report – Saulius J. Skeivys, MD  (no written report submitted)
  5.          Suffolk County Report – Frank G. Dowling, MD
  6.          Third District Branch Report – Harold M. Sokol, MD
  7.          Fourth District Branch Report – John J. Kennedy, MD
  8.          Fifth District Branch Report –Howard H. Huang, MD
  9.          Sixth District Branch Report – Robert A. Hesson, MD
  10.          Seventh District Branch Report – Mark J. Adams, MD
  11.          Eighth District Branch Report – Edward Kelly Bartels, MD
  12.          Ninth District Branch Report  –  Thomas T. Lee, MD
  13.          Medical Student Section Report – Charles A. Kenworthy (no written report submitted)
  14.          Resident and Fellow Section Report – Robert A. Viviano, DO
  15.          Young Physician Section Report – L. Carlos Zapata, MD (no written report submitted

F. Commissioners (All Committee & Sub-Committee Informational Reports/Minutes)

  1. Commissioner of Science & Public Health, Frank G. Dowling, MD
    a. Long Term Care Subcommittee Minutes, September 30, 2015
    b. Eliminate Health Care Disparities Minutes, October 9, 2015
  1. Commissioner of Communications, Joshua M. Cohen, MD, MPH
    a. MSSNY Communications Division Report                       
  1. Commissioner of Governmental Relations, Gregory Pinto, MD
    a. Conference Call with Dave Whitlinger, CEO, NYeC
    b. Health Information Committee Minutes, June 22, 2015
    c. HIT Committee Minutes, September 25, 2015z
    d. Quality Improvement Committee Minutes, September 30, 2015       

G. Report of the Executive Vice President

  1. Membership Dues Revenue Schedule
  2. Report of the Coalition of State Medical Societies

H. Report of the General Counsel
                    (no written report submitted)

I. Report of the Alliance
1. Alliance Report

J.  Other Information/Announcements

  1. Sign on letter re State funding to be dedicated to improving healthy food options
  2. VBP Workgroup Meeting (handout at Council)
  3. Technical Design Subcommittee Draft Recommendations (handout at Council)
  4. Letter to Troy Oechsner, Executive Deputy Superintendent, NYS Department of Financial Services re merger of Anthem BC/BS and Cigna
  5. AMA Letter to Dr. Simon re appointment to the Joint Commission Board of Commissioners
  6. Letter dated October 27, 2015 re Comments on Draft NAIC Network Adequacy Model Bill 

K. Adjournment

 

October 30, 2015 – Chicken Little Was Wrong!

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
October 30, 2015
Volume 15, Number 41

Dear Colleagues:

The sky is falling! The sky is falling! Y2K is here again!

All of our fear and angst with regard to the complete overhaul of our diagnostic coding system did not kill us (yet). From all accounts, health plans may have experienced minor glitches, but they claim that they expeditiously fixed any problems so that we did not feel any significant pain.

To my knowledge, no physicians had to use any of the more exotic new codes like V91.07-“burn due to water skis on fire” or V97.33- “sucked into a jet engine.”

CMS, according to yesterday’s press release, states that there is an expectation that “this change will enable providers to capture more details about the health status of their patients to improve patient care and public health surveillance.”  Really! It is an insult to physicians in the trenches to be told how to quantify their life’s work by the switching of the numbers game in midstream. However, since CMS and other health plans are the fiduciary, we were forced (kicking and screaming) to make some concessions.

If any of you have experienced significant maladies from the transition, please call Regina McNally in our Socio-Medical Economic Division at 516-488-6100 ext 332, who will alert any carrier that is causing you cash flow harm.

CMS reports that they are “carefully monitoring the transition and is pleased to report that claims are processing normally.” Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Following this time table, more meaningful information will be available on the ICD-10 transition in November.

According to their press release, CMS “is continuing its vigilant monitoring process of the ICD-10 transition and shared the following metrics detailing Medicare Fee-for-Service claims from 10/1-10/27.” Their stats are as follows: total claims submitted-4.6 million per day; total claims rejected due to incomplete or invalid diagnosis codes— 2.0% of total claims submitted; total claims rejected due to invalid ICD-9 codes— 0.11% total claims. 

From what we have NOT heard, the sky did not fall.
Now that we have survived the first “tsunami,” we can move onto the next fiasco—e-prescribing.

We have five months to batten down the hatches.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


NYDFS, NYSOH, CMS Announce Additional Actions Regarding Health Republic
The New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace (NYSOH), and the CMS today announced additional actions regarding Health Republic Insurance of New York and a transition plan for Health Republic customers.

On September 25, 2015, NYDFS directed Health Republic to cease writing new health insurance policies and announced that the co-op will commence an orderly wind down after the expiration of its existing policies. However, a subsequent NYDFS and CMS-led review of Health Republic’s finances has found that the company’s financial condition is substantially worse than the company previously reported in its filings to NYDFS. In light of these developments, NYDFS and the NYSOH Marketplace have determined that it is in the best interest of consumers to end all Health Republic policies – both individual and small group – on November 30, 2015 so that customers can transition to new coverage after that date.


From Regina McNally, VP Socio Med; Here Are Contact Numbers for Insurers
Recently, I have been hearing from our members that many have been having difficulty reaching various health plans and/or health insurance related entities.  So, I contacted many of these organizations to create a one-stop shop for contact information.

Please share this with your colleagues and office staff.

If you or your staff has better contacts to get your issues resolved, please be sure to continue to utilize those contacts. The attached is meant to be helpful for those persons who do not have that first point of contact or need another point of contact with an organization.

Of course, I continue to be available to you and yours for situations whereby an impasse has been reached and I might be of some assistance. I am here to help. Click here to view the contact list.


House and Senate Both Pass Budget Package to Raise Debt Ceiling and Prevent Medicare Premium Increases
This week, both the US House of Representatives and the US Senate passed a sweeping Budget package to raise the debt ceiling limit until 2017 and to prevent a 52% increase to millions of seniors’ Medicare premiums that otherwise would have gone into effect in 2016. The House passed the Budget package by a 266-167 vote and the Senate passed it by a 64-35 vote. The only New York member of Congress who voted against it was Rep. Lee Zeldin (R-Suffolk County).

Of particular concern, the package would extend for an additional year, through 2025, the 2% Medicare payment sequester provisions that had originally been enacted by the Budget Control Act of 2011.

The Budget package also contains a number of controversial provisions, including: a measure to limit Medicare payments to hospitals for services provided at newly acquired physician practices to the same fee that would be paid for health care services provided in a private physician office; a measure to require generic drug manufacturers to pay additional rebates to the Medicaid program if the price of the drug has increased faster than inflation; and a measure to repeal a section of the ACA that requires employers with more than 200 employees to automatically enroll new full-time equivalents into a qualifying health plan if offered by that employer.

The Budget agreement will also provide two years of relief from existing sequestration spending caps that could have resulted in cuts to a number of public health programs, including the National Institute of Health, Agency for Healthcare Research and Quality and Primary Care Training Programs.

To read a comprehensive summary of the provisions, click here.


AMA Scorecard on EHR Usability Shows Many Vendors Not Meeting User-Centered Goals
The AMA announced this week that a comparative EHR Usability Framework it had partnered with MedStar Health to develop shows many EHR vendors are not meeting basic standards for user-centered design and formal usability testing processes. 

Using information supplied by the vendors to the Office of National Coordinator (ONC) and available publicly, the MedStar Human Factors Center and AMA collaborators reviewed 20 prevalent EHR products.  The review used a 15-point methodology and assigned a numeric value based on the vendor’s compliance with best practices for UCDA score less than 15 means basic usability process standards were not met. Vendors are only required to report the process they followed for eight EHR features that are considered important areas for patient safety. Thus a perfect score using the AMA/MedStar framework only reflects the processes used to design these eight capabilities and does not reflect the design and evaluation of the hundreds of other capabilities in the EHR or the actual usability experienced by physicians and other end-users.

The AMA announcement noted that its’ goal is to promote EHR vendor adherence to UCD best practices as represented in the 15-point usability framework in the design and redesign of their products. To improve the usability of EHRs there is a need to better promote rigorous usability development processes based on recognized methods and standards. This framework can be used by ONC to improve their certification program, and as a method to track improvements EHR vendors make as they recertify their products over time.

Physician experiences documented by the AMA demonstrate that most EHR systems fail to support effective and efficient clinical work, and continued issues with usability are a key factor driving low satisfaction with many EHR products,” said AMA President Steven J. Stack, M.D. “Our goal is to shine light on the low-bar of the certification process and how EHRs are designed and user-tested in order to drive improvements that respond to the urgent physician need for better designed EHR systems.”

To read more, click here.


MSSNY’S ADVOCACY MATTERS CME SERIES on Monday, November 10
Foster Gesten, MD: Focus on State Health Innovation PLAN (SHIP)

Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health, will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.  

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please go to the following this link.

The objectives of November 10th Advocacy Matters program are as follows:

  1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.
  2. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  3. Describe the five strategic pillars and three enablers of system transformation.
  4. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please click here to register.

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

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment. Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified. The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials. 


Op-Ed in Support of Collective Negotiation in Binghamton Press & Sun Bulletin
Broome County Medical Society President Dr. Michael Herceg authored an op-ed in the Binghamton Press & Sun Bulletin this week calling on the NYS Legislature to pass a bill (A.336, Gottfried/S.1157, Hannon) strongly supported by MSSNY to permit independently practicing physicians the ability to collectively negotiate patient care terms with market dominant health insurers.  To read the op-ed, click here: The op-ed highlights many of the challenges that New York physicians face in seeking to be able to continue to deliver the timely quality care expected and deserved by patients, including overly burdensome insurer-imposed administrative hassles, rapidly increasing deductibles and exorbitant medical malpractice insurance costs.


Avoid Medicare Penalties
Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, – 2.0% but it could be more. Understanding the rules can be confusing but is necessary. Attention MSSNY Members! Save $100. Call (516) 488-6100, Extension 403 or email: eskelly@mssny.org for your MSSNY Member discount code. Use it at the time of submission and receive a discounted submission rate of $199.

Have questions about PQRS? Plan to attend one of our live Q&A sessions to get all of your questions answered and more. Thursday, November 19, 2015 at 11:00 am ET – Click here to add this meeting to your calendar.

Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more information.


Study Says Popular Over-The-Counter Cold Medicine Doesn’t Work
A study published in the Journal of Allergy and Clinical Immunology: In Practice suggests that the over-the-counter oral decongestant phenylephrine “simply doesn’t work at the FDA-approved amount found in popular non-prescription brands, and it may not even work at much higher doses.” Researchers at the University of Florida “failed to find a dose of phenylephrine within the 10 mg to 40 mg range that was more effective than a placebo in relieving nasal congestion.”  The study is available at: http://bit.ly/1WkmcEN


USPSTF Recommends Blood Glucose Screening For All Overweight Adults between Ages of 40 And 70
In the recommendations appearing Oct. 27 in the Annals of Internal Medicine, the US Preventive Services Task Force (USPSTF) advises blood glucose testing for all adults who are overweight and who are between the ages of 40 and 70, even if they display no symptoms of diabetes.
The specifics of the screening recommendations, classified as Grade B, note additional risk factors for patients with a high percentage of abdominal fat, high cholesterol, high blood pressure, physical inactivity, and smoking.” For those patients whose glucose levels are normal, re-screening every three years was recommended. 


Doctors Without Borders Recruiting Doctors; Info Session on Nov. 19 in Manhattan
Doctors Without Borders is recruiting qualified MEDICAL AND NON-MEDICAL professionals in New York to respond to ongoing humanitarian crises and join their team of dedicated humanitarian aid workers. They are hosting a recruitment information session at their New York headquarters New York Recruitment Info Session Thursday, November 19, 2015 at 7:00 PM at Doctors Without Borders, 333 Seventh Ave, Second  Floor, NY, NY.  Click here to learn more. Click here to register for the New York session


CMS Now Accepting Comments on Section 101 of MACRA through November 17
On October 15, the Centers for Medicare & Medicaid Services (CMS) announced an extension to the comment period for the Request for Information (RFI) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The comment period, which was originally 30 days and scheduled to close on November 2, 2015, will now close on November 17, 2015.

The RFI seeks public comment on Section 101 of MACRA, which is subject to notice and comment rulemaking. Section 101 repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and implements scheduled PFS updates, including a higher update rate for “qualifying participants in Alternative Payment Models (APMs)” beginning in 2026.

Section 101 also adds the new Merit-based Incentive Payment System (MIPS) for eligible professionals (EPs); sunsets payment adjustments under the current Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program; and consolidates aspects of those programs into the new MIPS.

In addition, Section 101 of the MACRA promotes the development of APMs by providing incentive payments for certain EPs who participate in APMs and by encouraging the creation of additional Physician-Focused Payment Models (PFPMs).

Submit a Formal Comment by November 17
CMS encourages the public to submit comments by November 17. Comments can be submitted in several ways, including:

  1. Electronically
  2. By regular mail
  3. By express or overnight mail
  4. By hand or courier

For more information, view the complete Medicare Access and CHIP Reauthorization Act of 2015 and visit the CMS website.


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Established, Newly Renovated Multi-Specialty Group Practice.
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• Must be on panels of managed Medicaid and HMO plans
• Working knowledge of EMR
• Take detailed patient history
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• Order medically necessary tests, equipment, etc
• Be able to make complex decisions
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3 exam rooms; one consulting room; large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

October 23, 2015 – Social Media Is Pow! Pow! Powerful

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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October 23, 2015
Volume 15, Number 40

Dear Colleagues:

This week, we followed the story of the near closing down of the family practice residency program at Columbia University/New York Presbyterian Hospital.  The reports indicate that the closures were not due to financial constraints but rather to “strategic priorities.”  The event serves as an excellent case study for health policy, communications and business school students.

I will be delving more into some of the valuable insights offered by this real-time case in my November News of New York column.  Today, I would like to focus on the power of social media.  Most of us are familiar to some extent of its value and power.  For the least engaged of us, we may participate for social purposes; most of have family members who are fully immersed in social media.  Yet, in the case of the residents and faculty in the family practice residency program, social media was used not as a social tool but rather as a powerful tool for action.

Social media as a power tool for action is a concept well known to younger physicians and medical students.  They use it not only for social purposes but also for change management.  It is not merely a “keeping you up-to-date” tool.  Rather, it is an informational tool used expressly to effect action and change.  Therein, lies the key difference in how social media is used by younger physicians versus older physicians.  If older physicians engage in social media professionally, it is to disseminate knowledge.  When younger physicians engage social media, they disseminate knowledge AND seek to effect change.  It is not merely a cerebral tool—rather, it is a tool to effect change.

The speed with which Columbia University/Presbyterian Hospital reversed its decision regarding the family practice program and the power of the individuals and entities that weighed in on the decision to reverse change attests to the value of social media to effect change.  It is a tool for organizing stakeholders and entities that can effect change when individuals, by themselves, are incapable of effecting change.

While many organized medicine organizations have captured the power of social media as a tool for disseminating knowledge, I believe most have not fully captured or harnessed the capabilities to the extent that the residents in the Family Practice Program at Columbia did when they managed a reversal of the program’s closure.  It is time we as a state society and amalgam of county and specialty societies begin to explore how we, too, can convert our use of social media from merely knowledge dissemination to a  powerful action tool for effective change.

Decision can be reversed!

While I laud the residents and faculty that used these tools to effect change, I think there is a larger brilliant teaching moment to be gained from this event.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC


DOH Bureau of Narcotic Enforcement Information on Medical Marijuana Program
The New York State Department of Health’s Bureau of Narcotic Enforcement announces the availability of the required four-hour medical use of marijuana course. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course. The Compassionate Care Act, signed into law on July 5, 2014, authorized the Department of Health to implement a Medical Marijuana Program in New York State. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must:

  • be qualified, by training or experience, to treat patients with one or more of the serious conditions eligible for medical marijuana;
  • be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law, in New York State;
  • possess a Health Commerce System (HCS) Medical Professions Account user ID and password;
  • possess an active Drug Enforcement Administration (DEA) registration number; and
  • complete the four hour Department-approved medical use of marijuana course.

Departmental officials anticipate that the four hour department approved online course is available to practitioners through the TheAnswerPage, an established online medical education provider here.

The course will include the following topics, which are required in the regulations: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence.  The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course. Additional information regarding the practitioner registration process is available on the Department’s Medical Marijuana Program webpage, which can easily be accessed via the this link.

Please monitor this webpage frequently for updates and the department may be contacted with any questions: New York State Department of Health, Bureau of Narcotic Enforcement,

Medical Marijuana Program, Riverview Center,50 Broadway, Albany, NY 12204; Call 866-811-7957 or email mmp@health.ny.gov for more information. 


MSSNY Joins Physician Leaders in our Nation’s Capital to Advocate for Administrative Simplification
This week, Saratoga Springs ENT and MSSNY Board of Trustees member Dr. Robert Hughes joined MSSNY staff and physician leaders from other states in Washington DC to advocate for legislation to reduce some of the overwhelming bureaucratic hassles physicians are facing in various aspects of the Medicare program.  Joint advocacy meetings with representatives of the California, Florida and Texas medical associations were held with numerous Senators and Representatives who serve on key health care policy committees in support of legislation to:

  • Reduce the hassles associated with complying with onerous federal regulations governing the use of electronic medical records (HR 3309, Ellmers);
  • Restore some fairness in the conducting of audits by Medicare Recovery Audit Contractors (HR 2568, Holding);
  • Repeal the excise tax on comprehensive health insurance plans (“Cadillac Tax”) that was contained within the ACA scheduled to go into effect in 2018 (several bills including: S.2075, Brown; S.2045, Heller; and HR 2050, Courtney).

There was wide support for many of the provisions contained within each of these proposals, and substantial efforts are being made to incorporate elements of these proposals into various end of year “must do” bills under development by Congress.  Meetings were held with the offices of Senator Charles Schumer, Rep. Tom Reed (Ways & Means Committee) and Rep. Chris Collins (Energy & Commerce Health Subcommittee) from New York; Senator John Cornyn, Rep. Dr. Michael Burgess and Rep. Kevin Brady (Chair, W&M Health Subcommittee) from Texas; Senator Bill Cassidy (Senate HELP Committee) from Louisiana; Rep. Dianne Black (W&M Health Subcommittee) and Rep. Marsha Blackburn (E&C Health Subcommittee) from Tennessee; and Rep. Dr. Tom Price (W&M Health Subcommittee) of Georgia.


MSSNY’S ADVOCACY MATTERS CME SERIES on Monday, November 10

Foster Gesten, MD to Focus on State Health Innovation PLAN (SHIP)

Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health, will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.  

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please go to the following this link.

The objectives of November 10th Advocacy Matters program are as follows:

  1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.
  2. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  3. Describe the five strategic pillars and three enablers of system transformation.
  4. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please go to https://mssny.webex.com and click on the “Upcoming” tab.  A “Register” link appears to the right of the program name.    

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

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment. Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified.

The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.


NY Judge Rules Against Lawsuit that Makes Assisted Suicide a Crime
On October 19, a state civil judge ruled against a lawsuit that makes assisted suicide a felony. Judge Joan Kenney ruled that while she was sympathetic to the patients’ plight, the US Supreme Court has already found that New York state laws prohibiting assisted suicide do not violate civil rights.

Attorney General Eric Schneiderman argued against assisted suicide because of New York’s “longstanding commitment to the preservation of life,” he said. In her decision, released on October 19, Judge Kenney quoted a 1997 ruling by former US Supreme Court Chief Justice William Rehnquist that states laws barring lethal medication do not “infringe on fundamental rights.”

The patient plaintiffs, a 55-year-old former FedEx worker with AIDS, an 81-year-old retired attorney with bladder cancer and a 60-year-old philanthropist with Lou Gehrig’s disease — are appealing the decision.

Currently, assisted suicide is legal in Montana, Washington, New Mexico, Oregon and Vermont.


AMA Expresses Concerns with NAIC Proposal to Enhance Network Adequacy
The AMA has written to the National Association of Insurance Commissioners (NAIC) to express concerns with several aspects of its proposal to revise its Managed Care Plan Network Adequacy Model Act, which has not been updated since 1996.  The purpose is to develop template legislation for consideration by State Legislatures.  While states are certainly not required to enact these model acts, they are often given strong consideration.  To view a copy of the letter, click here.

The letter does reference several positive aspects of the NAIC proposal, including: stronger regulation and transparency of provider directories; a shift away from using accreditation as a “deeming” tool; a focus on access to appropriate specialty care, including pediatric specialty care; and transparency in carriers’ selection standards have been included in the draft model act.

However, the letter also sets forth several concerns with the template proposal that have been highlighted to AMA by specialty societies and state medical societies from across the country, including MSSNY.  These include:

  • The draft legislation fails to require prior approval by regulators of health plan networks;
  • The draft legislation fails to require that tiered networks be sufficiently comprehensive to meet insured’s needs;
  • While the draft legislation outlines several types of quantitative measurements that may be used to measure network adequacy, it fails to require the use of these quantitative standards;
  • The draft legislation could be construed to permit health insurers to use telemedicine technologies to meet network adequacy requirements; and
  • The draft legislation would greatly undermine the incentive for health insurers to establish comprehensive physician networks by permitting insurers to only have to pay their woefully inadequate in-network rates or Medicare rates, for care by out of network physicians in a hospital.  This element of the Model Act revisions would give enormous new powers to health insurance companies, far different than the very carefully crafted compromise law enacted in New York State in 2014 that balanced the need for patients to avoid facing sometimes very large “surprise” medical bills with the need to assure that physicians are paid fairly for providing this needed care in often life-threatening situations.

MSSNY is also developing its own letter to the NAIC that will raise similar concerns. 


From NGS: Claims Submitted for Hepatitis/Pneumococcal Vaccines Denied in Error
Description of the Problem

National Government Services has identified a claims processing issue in which claims for the following immunization and administration procedures codes incorrectly denied due to an incorrect diagnosis code. Codes: G0010, G0009, 90630, 90669, 90670, 90732, 90739, 90740, 90743, 90744, 90746, 90747

What This Means to You

A system error impacted providers who submitted claims for these services in which they reported ICD-10-CM diagnosis code Z23.The system issue has caused these claims to deny

in error as having an invalid diagnosis code.

                                              Current Status of Problem

A mass adjustment will be made to claims that denied in error; adjustments will be completed soon. It is unnecessary to resubmit the claim or to request an appeal. No provider action is needed.
Please watch the Production Alerts section of our website and Email Updates for additional information regarding this issue. We apologize for any inconvenience this may have caused. 


Register Now For E-Prescribing CME Webinars
MSSNY is hosting two free continuing medical education webinars on E-prescribing on November 9 and December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here.

Select training center and the upcoming tabs.   A copy of the flyer can be found here. The webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 a.m.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives are:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.

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.

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013. The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.  


Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days.  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide.

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately.

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay.  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact rraia@mssny.org for your cards. 


  MSSNY’s Amazing Doctors

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Dr. Amar Atwal, Dr. Ephraim Atwal and Dr. Ken Anthone 

Three surgeons, Drs. Kenneth D. Anthone, Amar Atwal and Ephraim Atwal offered free cataract surgeries on October 16 at their clinic, Atwal Eye Care in Cheektowaga (Erie) for non-insured and low income area residents as well as military veterans, and recent immigrants. Dr. Anthone has donated 150 cataract surgeries locally with the Eyes On America Foundation. Dr. Amar Atwal is the Founder and Medical Director of Atwal Eye Care/ Buffalo Care Associates and Buffalo Ambulatory Surgery Center. Dr. Ephraim Atwal specializes in Laser Vision Correction including LASIK and PRK. This was the group’s seventh year providing free surgery to people in need.


Five MSSNY Members Will Be Honored at Westchester Doctors of Distinction
The Third Annual Westchester Doctors of Distinction Award will be held on October 29 at the Bristal in Armonk. The honorees are:

  • Craig Zalvan, MD for the Humanitarian Award
  • Scott D. Hayworth, MD for the Lifetime Achievement Award
  • Andrew Kleinman, MD for Leadership in Medical Advocacy Award
  • Robert Gary Josephberg, MD for Excellence in Medical Research
  • Mark Russakoff, MD for Leadership in Medical Advocacy

For more information, call 914-949-2990

 


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PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room;  large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

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