Category Archives: eNews

September 15, 2017 – QPP for NEWBIES!


PRESIDENT’S MESSAGE
Charles Rothberg, MD
September 15, 2017
Volume 17
Number 35

Dear Colleagues:

Finally, there is a user-friendly video that shows physicians, in a straight and forward manner, how to avoid 4% Medicare Payment Penalties in 2019. IT’S SURPRISINGLY QUICK.  IT’S SURPRISINGLY EASY.  AND it is available at: https://www.ama-assn.org/qpp-reporting

The Quality Payment Program (QPP) is the new physician payment system created by the Medicare Access and CHIP Reauthorization Act (MACRA) and is administered by CMS. Because the QPP is new this year, MSSNY and the AMA want to make sure physicians know what they have to do to participate and the QPP’s “Pick your Pace” options for reporting. This is especially important for those physicians who have not participated in past Medicare reporting and programs and may be less FAMILIAR WITH the steps they can take to avoid being penalized under the QPP.

This SHORT  video developed by the AMA, titled “One Patient, One Measure, No Penalty: How to Avoid a Medicare Payment Penalty with Basic Reporting ,” offers step-by-step instructions on how to report so physicians can avoid a negative 4% payment adjustment in 2019.  Under the “Pick-Your-Pace” mode,  this is the TEST component.  DESPITE CMS CHARACTERIZATION OF ” one-patient, one-measure” on one claim, our VP of MSSNY’s Socio-Medical Economics Division  Regina McNally ADVISES PHYSICIANS THAT, “Just to be safe, file three or four measures on three or four patients just to makes sure the government gets it.”

The AMA and the Federation stressed to CMS the importance of establishing a transition period to QPP and, as a result, physicians need only to report on at least one quality measure for one patient during 2017 in order to avoid a payment penalty in 2019 under the Merit-based Incentive Payment System (MIPS). On this website , there are also links to CMS’ quality measure tools and an example of what a completed 1500 billing form looks like.

Regina McNally, strongly urges our members who are “lost” and want no part of MIPS to view this video. “This is the first video I have seen that simplifies the process, explains the process clearly and succinctly, and could help physicians from paying penalties,” she said.

Please visit: https://www.ama-assn.org/qpp-reporting

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large


September 14 Council Notes

  • MSSNY’s VP of Legislative and Regulatory Affairs John Belmont presented information on Physician Advocacy Network (PAL), an initiative aimed at getting MSSNY’s message out to legislators in an innovative new way. MSSNY recognizes that many physicians have relationships with various legislators and others activists.  The goal would be to have at least two or three members assigned as a liaison to each state legislator and for these PALs to meet personally with their assigned legislator at least twice a year to develop or further solidify relationships with elected officials. MSSNY is currently in the process of updating and retooling our key contact list to assist in our legislative advocacy and is looking for assistance from members in reaching out and identifying physicians who have close relationships with legislators. For more information, contact John Belmont at jbelmont@mssny.org or 518-465-8085.
  • Speaker Kira Geraci-Ciardullo, MD announced key information and deadlines for the House of Delegates meeting, which will begin on Friday, March 23, 2018 and will adjourn on Sunday, March 25, 2018. All activities will take place at the Adam’s Mark Hotel in Buffalo. The window for submitting Resolutions is January 22, 2018-February 9, 2018 at 5 pm.
  • A letter was sent by 41 state medical societies (including MSSNY), and 33 National Medical Specialty Societies, to Dr. Nora of the American Board of Medical Specialties regarding the ongoing contentious issue of MOC. The letter informed ABMS about both a high-level summit that recently took place regarding MOC, and an upcoming meeting in December with the ABMS, the Council of American Specialty Societies and state medical societies to share physician views and seek agreement on how to reshape the MOC process. Dr. Madejski will represent MSSNY at the December meeting.
  • Council reconsidered Resolution 2017-157: Development and Promotion of Evidence-based Ultrasound –First Radiation Mitigating Protocols, and voted to Not Adopt Resolution 157.
  • MESF will present Physicians Leadership Seminar on October 20-21, 2017 at the Albany Hilton. Topics include Where the NYS Legislature is Leading Us in Health Care; Strategic Leadership of the Health Care Enterprise: Creating Value in Turbulent Times; and Blue Ocean Thinking: Focusing on Where the Fish are Swimming. Featured speakers include Jon Chilingerian, Ph.D, Carole Carlson, MBA.


New Law to Prohibit Medical Record Charges When Needed to Support a Patient’s Government Benefit Application
Governor Cuomo has signed into law legislation (S.6078, Valesky/A.7842, Gottfried) that prohibits health care providers and facilities from charging patients for copies of medical records when such records are needed “for the purpose of supporting an application, claim or appeal for any government benefit or program”.  While existing law already prohibits charging for medical records when a patient is unable to pay, the purpose of the new law is to respond to numerous complaints lodged by patients where they were charged for medical records necessary to assist applications and appeals for government programs assisting lower income patients such as Social Security Disability Insurance (SSDI) and the Supplemental Nutritional Assistance Program (SNAP), or other government benefit program such as those for 9/11 first responders.  While noting that it did not condone the actions of health care providers who were charging low-income patients for medical records, MSSNY did express concerns that the terminology “any government benefit or program” in the legislation was too broad, and suggested that the bill be amended to specifically enumerate in the law those low-income government benefit programs to which this fee charge prohibition should apply. However, that change was not made. S6078 letter to the Governor

Centene to Buy New York’s Fidelis Care For $3.75 Billion
The Wall Street Journal (9/12) reported that Centene Corp. announced Tuesday that it will buy nonprofit health insurer Fidelis Care in a $3.75 billion deal. The deal adds 1.6 million members in New York to Centene. Centene is a leader in Medicaid managed care business and Medicare, and is also active in Affordable Care Act exchange plans. The deal is expected to close in the first quarter, according to the Journal.

Unlike its competitors Aetna, Anthem, UnitedHealth Group, and Humana, Centene is expanding into new markets and “has been able to successfully manage the costs of sick uninsured Americans buying individual policies on the ACA’s public exchanges. Centene had nearly 1.1 million customers enrolled in ACA marketplaces as of June 30 this year, compared to 617,700 at this time last year. Fidelis, the article says, is “an established player in New York’s Obamacare, Medicaid and Medicare Advantage markets.” Forbes (9/12)



Promo Code: MSSNY



The Law: Pharmacy Providers Cannot Demand Copays from Those Who Cannot Pay
The NYS Medicaid Pharmacy Program has been notified that some pharmacies are refusing to dispense medications to patients for their inability to pay the copayment. Social Security Act §1916 specifies that no Medicaid enrolled provider may deny care or services to an individual eligible for such care or services on account of such individual’s inability to pay a deduction, cost sharing, or similar charge. The September 2011 Special Edition Medicaid Update cover-page and the March 2012 Medicaid Update page 15, confirm this Federal law applies to all Medicaid providers, both fee-for-service and managed care. Providers may attempt to collect outstanding copayments through methods such as requesting the co-payment each time the member is provided services or goods, sending bills or any other legal means

Dr. Rosenblatt: Desperately Seeking Physician Support for Proposed Office-Based Surgery Guidance Changes
The NYS Department of Health has an Office Based Surgery (OBS) Advisory Committee, of which I have been a member since 2006.  In July of 2017, the NYS DOH decided it would conduct a voluntary pilot with OBS practices requiring them to report the number of cases they perform and the AMA-CPT codes of these cases via the Health Commerce System (HCS).

The first foray by the DOH to mine data was meant to be voluntary.  However, starting January 2018, the DOH wants to make the provision of this information mandatory by all NYS OBS practices. They feel that they have the authority to require this because of the following wording in the OBS law:

Reference: PHL § 230-d, 4. (b): “The department may also require licensees to report additional data such as procedural information as needed for the interpretation of adverse events.” http://www.health.ny.gov/professionals/office-based_surgery/law/docs/230-d.pdf

As a plastic surgeon, and MSSNY’s representative on the OBS Advisory Committee, I am only one of   a few practicing office-based physicians on the DOH Committee.  We practicing OBS physicians are outnumbered by the significant number of state employees and full-time hospitalists on the Committee. I have been speaking against this requirement for the following reasons:

  • Much of the data that the DOH is seeking and asking to be reported is publicly available. For example,  AAAASF already provides the number of cases done per 6-month period to the DOH.The law already requires an OBS physician or center to report certain types of adverse events (AE).
  • This kind of regular health record reporting requirement would be burdensome and not needed to develop policies to protect patients in office-based surgical facilities.
  • This proposed requirement represents an unfunded time consuming mandate for practicing physicians
  • I don’t agree that the law allows the DOH to require all OBS facilities to regularly report this information

For many plastic surgeons who provide OBS, the vast majority of our procedures are not reimbursed by insurance.  Therefore, AMA-CPT codes are not used for recording those procedures.

In NYS there are over 990 OBS facilities. https://www.health.ny.gov/professionals/office-based_surgery/practices/.  To locate a specific OBS site, click on Number of accredited practices by county and select the county of your choice.

Effective July 14, 2009, physician offices that perform surgical or invasive procedures using more than mild sedation or liposuction over 500cc under straight local must be accredited by one of these agencies:

There are about 650 OBSs that are certified by AAAASF, which provides the NYS DOH with the number of cases done. Neither AAASF nor the Joint Commission ask their facilities for those numbers; and therefore, doesn’t supply that information to the NYS DOH.  If the DOH wants the number of cases, they should ask the two other certifying agencies to provide them the data and not hassle the doctors.

So far during the voluntary reporting, only 179 of the over 900 OBS facilities in NYS have reported.   When the DOH leaders were asked what will occur if facilities do not report in 2018, their answer was that the OBS sites would be reported to the OPMC.  Can you imagine what the OPMC would do with the report of hundreds of non-reporting facilities?  They are overburdened by their current workload.

MSSNY and I are looking for support from all the NYS OBS facilities.  We need to mobilize the NYS Plastic Surgical Society, NY Regional Society of Plastic Surgery, Gastroenterology, invasive radiology and all other specialists who work in their own accredited office-based surgical facilities to urge the NYS DOH to obtain the data they seek from the OBS certifying agencies.

If you feel that the DOH is overstepping their charge, as I do, please call the DOH or Rosemarie Casale  (518) 408-1219) (Rosemarie.Casale@health.ny.gov) and express your displeasure at having to fill out more forms.

If you have any more ideas, I will be glad to speak to any of you.

William Rosenblatt MD
Past President of MSSNY
Vice-President AAAASF
wbrosenblattmd@verizon.net

Managed Care Network Physicians: Medicaid Provider Enrollment Requirement
Section 5005(b)(2) of the 21st Century Cures Act amended Section 1932(d) of the Social Security Act (SSA) and requires that effective January 1, 2018, all Medicaid Managed Care and Children’s Health Insurance Program providers must enroll with state Medicaid programs. The SSA requires that the enrollment include providing identifying information including name, specialty, date of birth, social security number, National Provider Identifier (NPI), federal taxpayer identification number, and the state license or certification number.

For example, if a physician currently participates in a network with a Medicaid managed care plan that provides services to, or orders, prescribes, or certifies eligibility for services for, individuals who are eligible for medical assistance, the physician must enroll with New York State Medicaid.

Common Enrollment Questions:

  • To check on your enrollment status, please call CSRA at 1-800-343-9000. Practitioners may also check the Enrolled    Practitioners Search function at: https://www.emedny.org/info/opra.aspx
  • If you are already enrolled as a Medicaid fee-for-service (FFS) provider and are listed as active, you will not have to enroll again.
  • If at one time you were a FFS provider, and your enrollment has lapsed (no longer actively enrolled), you may be able to keep your original Provider Identification Number (PID), also known as MMIS ID, by reinstating.
  • Practitioners who do not wish to enroll as a Medicaid FFS billing provider may enroll as a non-billing, Ordering/Prescribing/Referring/Attending (OPRA) provider. The enrollment form for this function is attached.
  • Enrollment in Medicaid FFS does not require providers to accept Medicaid FFS patients.

If you are not actively enrolled, please go to: https://www.emedny.org/info/ProviderEnrollment/index.aspx  and navigate to your provider type. Print the Instructions and the Enrollment form. At this website, you will also find a Provider Enrollment Guide, a How Do I Do It? Resource Guide, FAQs, and all forms related to enrollment in New York State Medicaid.

As a point of information, under 42 CFR 455.104 defines the following providers as excluded from the definition of “disclosing entity”:

  • Solo practitioners such as an individual physician, psychologist, or chiropractor.
  • Group of individual practitioners, such as a group of cardiologists, or a group of radiologists.”

Therefore, physicians do not need to complete Section 5.

If you have questions, please call Regina McNally


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!



Donate to AMA’s Physician Disaster Fund
MSSNY Councilor Josh Cohen, MD, MPH is also President, AMA Foundation Board sent a letter providing information as to how New York physicians can aid fellow physicians affected by the recent storms.

The physician community rallied together to help our peers in Texas who were adversely affected by Hurricane Harvey. Now, as a result of the havoc caused by Hurricane Irma, more of our colleagues are experiencing the same devastation in Florida and need our support. It is vital for doctors to quickly rebuild their medical practices to continue serving their communities. The AMA Foundation created the Physician Disaster Recovery Fund to offer relief to doctors in this time of great need.

Your gift today to the AMAF’s Physician Disaster Recovery Fund will directly support Texas and Florida to help to reestablish delivery of patient care by physician practices impacted by Hurricane Harvey and Hurricane Irma.

Join us and please make a gift to the AMAF’s Physician Disaster Recovery Fund. Let’s work together to enable our fellow physicians to get back to the vital work of caring for their patients.

If you have already made a gift – thank you for your generosity!

Coding Tip of the Week
By Jacqueline Thelian, CPC, CPC-I, CHCA Medco Consultants, Inc.

Q: I have been denied by many insurance carriers for invalid radiology orders. What am I doing wrong?

A:  Diagnostic tests are currently under scrutiny from many insurers. To be sure your orders are in good order make sure they include the following:

  • The patient’s name
  • The test requested
  • Clinical indications for the test (diagnosis)
  • The legible name, signature and date of the ordering provider
  • Signature stamps are not acceptable
  • The Medicare Claims Processing Manual (Chapter 23, Section 10.1.2) states that the ordering physician must provide the diagnostic information at the time the study is ordered.

Also keep in mind insurance carriers are also verifying the orders with the ordering provider to make sure the medical necessity for ordering the test is documented. In some cases, the insurance carrier is leaving that responsibility up to the servicing provider.

The source document frequently referenced by the carriers is the DOH Medicaid Update May 2006 Vol.21, No 5, Documentation Requirements for Ordered Services. Check it out https://www.health.ny.gov/health_care/medicaid/program/update/2006/may2006.htm

If you have a coding or compliance question you would like to have answered please send your question to MSSNY at eskelly@mssny.org, and complete the subject line with “Tip of the Week.”

Feds: NY Paid $1.4B to Providers with Medicaid Compliance Problem
The AP (9/12) reports that New York State paid $1.4 billion in Medicaid funds in 2014 to long-term care providers who did not comply with state rules for the program, according to federal Office of the Inspector General report published Tuesday. The report “revealed a large number of providers who failed to document patient assessments, provide community-based services or provide written care plans to patients, all requirements spelled out in their contracts with the state.” New York Medicaid Director Jason Helgerson disagreed with the report’s conclusions, stating that many are “simple paperwork problems” and “wouldn’t be sufficient reason to demand full refunds from the providers.”

Many of the deficiencies outlined in the report amount to simple paperwork problems, he said, and wouldn’t be sufficient reason to demand full refunds from the providers, a move he likened to the “death penalty.” He said the report’s conclusion that $1.4 billion could have been saved is “a complete mischaracterization.”

“They’re suggesting that if any (provider) plan has any clerical error – if they have any deficiencies – we should recoup entire years of reimbursement,” he said. “If we were to basically ding them for a full year’s reimbursement, no one would ever sign that contract.”

He said the agency is looking at using fines as a way to ensure providers are complying with the rules.

“We want full compliance,” he said, “but at the same time we have to have a measured response.”

MSSNY President to Be Honored at Harvest Moon Ball in Glen Cove
MSSNY President Charles N. Rothberg is being honored at the Brookhaven Hospital Harvest Moon Ball at the Nassau Country Club in Glen Cove (Long Island) on Saturday, October 14, 2017 from 6PM to 10PM. Dr. Rothberg will be receiving the Dr. Jacob Dranitzke Award.  For tickets, to donate or be a sponsor, please go here.

Monroe County Joins ABMS Multi-Specialty Portfolio Program
The Monroe County Medical Society (MCMS) has joined the American Board of Medical Specialties’ (ABMS) Multi-specialty Portfolio Program. The program, functioning in the quality collaborative segment of the Society, will assist the organization in providing basic guidelines for clinical care across the region.

Based in Rochester, the Monroe County Medical Society covers Livingston, Monroe, Ontario, Steuben, Seneca, Wayne and Yates counties, advocating for betterment of health care in the region.

“As an ABMS Portfolio Program Sponsor, MCMS will ensure that we provide meaningful QI [quality improvement] project opportunities to the physicians in our region, bringing expertise of the Quality Collaborative and physician leadership oversight to the program,” said Christopher Bell, executive director of MCMS, in a statement. “We will encourage physicians to be innovative in their project designs or participate in projects developed within the Quality Collaborative and will welcome their feedback during the process to ensure they have input throughout it.”

In the early hours of the program, the MCMS expects 250 primary care physicians to participate. The result, as Bell stated, is intended to be a push for better quality control for health care in the region.

“MCMS’ participation in the Portfolio Program provides additional recognition of the valuable efforts these physicians and their teams are undertaking to improve the care of not only their current patient population, but through their various collaborations, even more patients and families throughout the state,” said David Price, executive director of the Portfolio Program.

Utilized nationwide, the Portfolio Program, to date, has initiated over 2,000 improvement efforts to health care systems.



CLASSIFIEDS



Great Neck – Medical Zoned Condo
2690 Sqft – $699,000 – quick easy access to North Shore University Hospital, Long Island Expressway and Long Island Rail Road. 10 Exam rooms plus waiting room & large secretary area http://bit.ly/2wXCbkQ . Call Chris Pappas, LAB 516-659-6508

Beautiful, Fully-Equipped Medical Suite for Rent or Share – Glen Oaks, NY
For Rent or Share – Glen Oaks, NY
(border of Queens & Long Island)
Available for full or half-days.
Beautiful, recently renovated office
available for part-time share
OR available for rent.
Centrally located /Close to expressways.
The practice is 5 minutes from LIJ/Northwell Hospital.
8 exam rooms/procedure rooms. Waiting room, break room and
personal office with private bathroom.
(~2500 sqft) Free WIFI.
6 parking spots for patients and 2 for doctor.
The previous tenant, a full-time primary care
physician with a part-time cardiologist coming
in turned it over to an associate a year ago
but has been here for about 10 years. He needed more space
and bought a building about 20 minutes away. Our building gets a lot of drive-by traffic and pedestrian traffic from the mall across the street. Weekly we have patients walk in inquiring about the practice.
The dental practice next door sees over 2500 patients per year and refers actively to the medical suite.

Follow the link for a video of the space (all furnishings, exam tables, chairs, oxygen, orthoscope included in lease – about $500k in value): https://youtu.be/f9gr62fKaVs

Contact Haresh at hareshshah54@hotmail.com or 516-220-3297


Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES

Child and Adolescent Psychiatrist – Lockport, New York, Eastern Niagara Hospital
Eastern Niagara Hospital is seeking a Full Time Medical Director for its 12 bed Child and Adolescent Psychiatric Unit.  Responsibilities include inpatient care, shared on-call responsibilities and Medical Director duties.  Competitive compensation package.  For more information, please contact David DiBacco at 716-514-5501 or email to physicians@enhs.org.


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

September 8, 2017 – Insurers Act BADLY!


PRESIDENT’S MESSAGE
Charles Rothberg, MD
September 8, 2017
Volume 17
Number 34

Dear Colleagues:

I need to inform you of recent adverse activities on the part of a few insurers.

Emblem Health appears to have begun notifying a number of participating physicians that they will no longer be in network effective Jan 1, 2018. This is reminiscent of a campaign two years ago, when approximately 700 physicians were not renewed in an apparent attempt to narrow Emblem’s networks.   In its recent letter, Emblem explained to physicians that this non-renewal was not related to quality or performance issues and need not be reported to credentialing bodies.

A few physicians have filed appeals with the company for re-consideration of their non-renewal status. Presently, one physician had his status overturned and will remain “in network” after
January 1.

Some physicians, already renewed by Emblem’s Medicare Advantage plan, still face uncertainty regarding their Emblem Health commercial line participation.

On an unrelated insurance issue, I was made aware that Anthem health, parent of Empire Blue Cross plans in New York, have been improperly collecting personal identifying information belonging to practice employees – including Social Security numbers, birth dates, and home addresses – in conjunction with the Empire Provider Application.

In this matter, Anthem staff appear to have misapplied 42CFR 455.104. that pertains to disclosure requirements for entities that bill various plans for federal funds— such as Medicare and Medicaid.  Individual solo-practices and some physician group practices are specifically excluded from the necessity to disclose a staff member’s personal information.

As a result of a conference call between MSSNY and Anthem, the insurer agreed to revise its application forms and data collection process.   I anticipate that in short time, they will produce an amended Empire Provider Enrollment Application and that they will properly discard any improperly collected information.  In the meantime, physicians in solo and small practices should be aware that the submission of this information is not required.

MSSNY also continues to seek legislation (A.2704/S.3943 – passed the Assembly this year, but not the Senate) that would require health plans to provide physicians with appropriate due process protections before they non-renew a physician’s contract.  You can send a prepared letter to your Senator by visiting MSSNY’s Grassroots Action Center today.

Late Breaking Response to MSSNY from Emblem Health:
“We continuously review our network as it relates to our membership and to reflect our partnerships in value-base arrangements. We emphasize that this change in our network impacted less than .05% of the physicians within our network. Emblem also recommends physicians who received a non-renewal notice have the option to appeal the decision relating to their Medicare agreement.”

For further information, please call VP of Socio-Medical Economics Regina McNally at 561-488-6100 ext. 334.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large


Top New York Court Rejects Right to Physician-Assisted Suicide
On September 7, the New York Court of Appeals ruled that physician-assisted suicide is not a fundamental right, and that it would not block the New York Legislature from passing legislation banning physician-assisted death. Physician-assisted suicide is illegal in most states, but in recent years, Colorado, California, Oregon, Vermont, Washington, and the District of Columbia have approved legislation allowing people to request life-ending medication from physicians. No state court, however, has recognized assisted suicide as a fundamental right. (Wall Street Journa l9/7)

The case was brought by three people with terminal illnesses. Two have since died. The plaintiffs had argued that the state’s existing ban on assisting a suicide should not apply to those seeking merciful ends to incurable illnesses.The court disagreed, noting that while state law allows terminally ill patients to decline life-sustaining medical assistance, it does not allow anyone to assist in ending patients’ lives. “The assisted suicide statutes apply to anyone who assists an attempted or completed suicide,” the court wrote in its unanimous decision. “There are no exceptions.”

In their lawsuit, the plaintiffs argued that New York’s prohibition on assisted suicide violated guarantees of equal protection under the law. They alleged the law unlawfully discriminates between terminally ill patients who have the option of dying by declining life-sustaining medical assistance and other terminally ill patients who are unable to hasten their deaths simply by rejecting medical assistance.

MSSNY’s Bioethics Committee is working on an Aid to Dying survey to gather New York physicians’ positions on this topic.

Gov. Reduces Health Insurance Barriers to Substance Abuse Treatment Coverage
New York Governor Andrew Cuomo announced new regulatory guidance this week to better assure New Yorkers can more readily overcome insurance coverage barriers to receiving medications necessary to treat a substance abuse disorder. It was part of a series of initiatives announced this week by the Governor to facilitate new addiction treatment, recovery and support services to residents suffering from substance use disorders in underserved communities throughout New York City and Long Island.

Specifically, a new regulation was issued by the New York Department of Financial Services (DFS) that will require insurers who offer large group coverage to allow consumers to appeal coverage denials for medically necessary addiction medications when they are not on the list of covered drugs.

The regulation calls for an insurer to notify the patient and the prescribing physician within 72 hours of the request and provide coverage of the non-formulary medication for the detoxification or maintenance treatment of a substance use disorder for the duration of the prescription, including refills.  Furthermore, the regulation requires an expedited appeal process for “exigent circumstances” where notification of the determination must be provided to the patient and the prescribing physician no later than 24 hours following receipt of the request.

Moreover, DFS issued a “circular letter”  to New York insurers designed to eliminate impediments to addiction services coverage, “to prevent insurers from excessively reviewing the medical necessity of opioid treatment, and to bar the inappropriate delay of coverage.”

MSSNY Attends DOH: Future of Integrated Care in New York State Workgroup
In 2016, the NYS Department of Health announced that the Fully-Integrated Duals Advantage (FIDA) program received federal approval to be extended until the end of 2019.  The FIDA program is designed to provide managed care coverage to individuals covered by both Medicare and Medicaid.  In response, the DOH workgroup on the Future of Integrated Care in New York State has committed to mapping out a strategy that would help New York State reach its objectives of increasing integration of services, providers, payments, and delivery systems.

The planning committee kicked-off in July where the NYSDOH and CMS presented on the value of integrating Medicare and Medicaid services while sharing insights into models that other states have found success in using. This week’s workgroup focused on target populations, covered services, care coordination/management elements, and assessment and service planning requirements. The Future of Integrated Care in New York State workgroup series will continue on with three additional meetings over the fall in which MSSNY will continue to participate and provide critical input.

Topics to be discussed in these future meetings include network adequacy, payment and rate considerations, and geographic scope.  For more information on the FIDA program, click here.



Promo Code: MSSNY


Addiction Medicine Track Offered at ASAP Conference on September 17, 2017
The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) and the Alcoholism and Substance Abuse Providers of New York State (ASAP) is now offering the Addiction Medicine Track at a September 17, 2018 conference.

The conference begins on Sunday September 17, 2017 and finishes on Monday September 18, 2017 and is being held at the Buffalo Niagara Convention Center in Buffalo, New York, near Niagara Falls
.  The ASAP conference runs concurrently and will actually finish on Wednesday September 20, 2017 for those who may wish to register for and stay for that.  To register for this program please click here.
This conference track is appropriate for physicians, nurse practitioners, physician assistants and any other staff who may find the material interesting or relevant.  This live activity, Addiction Medicine Track at ASAP’s 18th Annual Conference: Building Bridges, with a beginning date of 09/17/2017, has been reviewed and is acceptable for up to 15.00 prescribed credit(s).


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!


Texas Medical Society: Physicians Helping Physicians
The Texas Medical Foundation is soliciting funds to use for grants to help reestablish the delivery of patient care in physician practices in federally designated disaster areas damaged by Hurricane Harvey.

The program will help cover expenses (not covered by insurance or other sources of funding) for relocating or rehabilitating a physician’s medical office. This may include replacing equipment, aiding needed staff, rebuilding patient records, and other similar needs all towards the goal of helping affected physicians once again begin treating their patients. https://www.texmed.org/Harvey

For Members Only: Brooks Brothers Offers 15% Discount
Enroll for your complimentary Brooks Brothers Corporate Membership Card and Save 15%* on full priced merchandise at all Brooks Brothers U.S. and Canadian stores, by phone and online.
TO ENROLL FOR YOUR NEW MEMBERSHIP CARD:

  • Organization ID# 12479 and Pin Code# 19658and enroll at: Membership.BrooksBrothers.com
  • You will need to wait 30 minutes after you enroll before you register to shop online.
    TO SHOP ONLINE:
  • www.BrooksBrothers.com
  • At the top of the page click on My Account & then CREATE AN ACCOUNT.
  • Create new profile and at the bottom click on “I have a Corporate Membership Number”.
  • Enter 12 digit Membership Number.
  • Click on create and you will receive a Welcome Letter.  You are now ready to shop.


MSSNY President to Be Honored at Harvest Moon Ball in Glen Cove
MSSNY President Charles N. Rothberg is being honored at the Brookhaven Hospital Harvest Moon Ball at the Nassau Country Club in Glen Cove (Long Island) on Saturday, October 14, 2017 from 6PM to 10PM. Dr. Rothberg will be receiving the Dr. Jacob Dranitzke Award.  For tickets, to donate or be a sponsor, please go here.

Sept. 15: 2017 MSSNY Continuing Medical Education Provider Conference
To meet the challenges facing planners, providers and participants of CME, MSSNY recognizes the need for ongoing education and training of its Accredited Providers as well as physicians and other healthcare professionals in NYS.
The conference will take place on Friday, September 15, 2017, at the Westbury Marriott
.  The program is scheduled from 7:30 AM to 3:45 PM.

This conference will inspire participants to explore and interactively address challenges such as self-directed learning for physicians and compliance with the changing accreditation criteria that clearly address practice gaps and practice-based needs while creating opportunities for measurable change in physicians and reinforcing the undeniable link between a successful CME activity and quality improvement for physicians and patients alike.

Registration links and more information are available here.  Featured speakers include Steve Singer, PhD; Vice President of Education and Outreach, Accreditation Council for Continuing Medical Education (ACCME) and Mary Kelly, Project Administrator, AMA PRA Standards and Policy.  MSSNY President Charles Rothberg, MD will deliver the welcome and opening remarks. For more information, please contact Miriam Hardin at mhardin@mssny.org. More information.

Oct. 10-14: Free Vets Health Care Training Program Conference in Niagara Falls
The Medical Society of the State of New York, the New York State Psychiatric Association, and the National Association of Social Workers – New York State Chapter are hosting a two- day conference on
Friday, 10/13 Saturday,10/14 at the Niagara Falls Conference Center, 101 Old Falls St, Niagara Falls, NY.
The conference will consist of interactive seminars and panel discussions focusing on the current and evolving healthcare needs of veterans.

MSSNY and NYSPA will be conducting three CME accredited trainings for primary care physicians and specialists. The CME programs are “Invisible Wounds of War: PTSD, TBI & Combat-Related Mental Health Issues,” “Recognition, Management and Prevention of Veteran Suicide,” and “Substance Use Disorders among Returning Veterans.”


There is no cost, but separate registration will be required for both the trainings and conference. More information will be coming shortly.


Dr. Jerome Adams Sworn in As US Surgeon General
The new Surgeon General of the US, Jerome Adams, an anesthesiologist with a master’s degree in public health, was sworn in on Tuesday, September 5.  Dr. Adams previously served as Indiana’s health commissioner.

At the ceremony Tuesday afternoon, Dr. Adams said his motto as surgeon general will be to create “better health through better partnerships” in an effort to address wide-ranging health issues, such as the opioid epidemic, mental health and childhood obesity. He said that law and healthcare must work together to tackle the opioid fight.

Vice President Pence praised Dr. Adams for his work on cutting Indiana’s infant mortality rate, addressing Ebola and helping curb an HIV outbreak stemming from injection drug use. Dr. Adams said that he is eager to start helping victims of Hurricane Harvey as the “nation’s doctor” and reaffirmed his commitment to “letting the science lead him to facilitating locally-led solutions to difficult health problems.”

Plant-Based Diet As Effective As PPIs in Treating Laryngopharyngeal Reflux
Findings published online in JAMA Otolaryngology-Head & Neck Surgery reports that “a plant-based diet is just as effective as proton pump inhibitors in treating laryngopharyngeal reflux,” researchers found in a six-week study involving “85 patients with an average age of 60 treated with the P.P.I.s Nexium [esomeprazole magnesium] and Dexilant [dexlansoprazole], and 99 treated with alkaline water and the Mediterranean diet, a regimen low in meat and dairy, and rich in olive oil, nuts, fish, beans, fruits and vegetables.”

Garfunkel Wild Hosting 4th Annual Ambulatory Surgery Center Symposium
Garfunkel Wild will be hosting its 4th Annual Ambulatory Surgery Center Symposium on October 20, 2017 at the Crowne Plaza Times Square.  Speakers include representatives from major managed care organizations, CMS, state and national ASC association leaders, hospitals and management company executives, leading consultants and many more. To register or for more information, visit www.nymetroasc.com or call 516-393-2294.

According to CDC Stats, One in Three Americans Are Obese
The Trust for America’s Health and the Robert Wood Johnson Foundation released a report based on statistics from the Centers for Disease Control and Prevention that showed
one in three American adults and one in six children to be obese.
The highest obesity rates are found in West Virginia, Mississippi, Alabama, and Arkansas, although the rates of increase in some states may be stabilizing. Trust for America’s Health President and CEO John Auerbach commented, “The adult rates are showing signs of leveling off and the childhood rates are stabilizing. In our review of the policies and strategies, we found that many (states) show a lot of promise for reversing the trends and improving health if we make them a higher priority.”

The data compiled from the Behavioral Risk Factor Surveillance System, relies on self-reported weight data, “so it likely underestimates true rates.” Despite state obesity statistics leveling off, the data indicates that the nation is “at risk of poor health” if programs to address obesity lose funding, according to the Trust for America’s Health CEO.

District Court: Govt. “All But Ignored” Calls for Insurer Payment Transparency
The US District Court for the District of Columbia has ruled on a motion filed by the American College of Emergency Physicians (ACEP) in regard to its lawsuit against the federal government (ACEP v. Thomas E. Price, MD) that argued a regulation under the Affordable Care Act (ACA) violated Congressional intent.
“This is a clear step in the right direction,” said Rebecca Parker, MD, president of ACEP. “It does not invalidate the federal regulation, but
it supports ACEP’s contention that the federal agencies ignored significant concerns raised by public commenters regarding a lack of transparency by health insurance companies in determining payments.
Congress in the ACA required that reasonable amounts be paid for emergency care, based on an objective standard, when patients receive it outside of a qualified health plan’s network.”

The court remanded the case back to HHS for further explanation, saying that comments during the regulation’s development had been submitted to CMS expressing concerns “for example, that the methods it used to set payments were not transparent and could be manipulated by insurers…The Departments all but ignored these comments and proposals.”

ACEP originally filed suit in May 2016 against then-Secretary Burwell after the federal government did not address the concerns raised to CMS about out-of-network emergency physician payments, which the agency set at the “greatest of three” options: (1) Medicare (which often does not even cover providers’ costs) (2) In-network rates (set without the provider’s input) (3) “Usual and customary” (as determined by the health plans).  As written, this regulation opened the door for insurers to use non-transparent (“black box”) methods to determine these “usual and customary” payment amounts without providing any means to externally verify the data.

CMS Poster for Coding Information for Preventive Services
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html


CLASSIFIEDS



Beautiful, fully-equipped medical sweet for rent or share – Glen Oaks, NY
For Rent or Share – Glen Oaks, NY
(border of Queens & Long Island)
Available for full or half-days.
Beautiful, recently renovated office
available for part-time share
OR available for rent.
Centrally located /Close to expressways.
The practice is 5 minutes from LIJ/Northwell Hospital.
8 exam rooms/procedure rooms. Waiting room, break room and
personal office with private bathroom.
(~2500 sqft) Free WIFI.
6 parking spots for patients and 2 for doctor.
The previous tenant, a full-time primary care
physician with a part-time cardiologist coming
in turned it over to an associate a year ago
but has been here for about 10 years. He needed more space
and bought a building about 20 minutes away. Our building gets a lot of drive-by traffic and pedestrian traffic from the mall across the street. Weekly we have patients walk in inquiring about the practice.
The dental practice next door sees over 2500 patients per year and refers actively to the medical suite.

Follow the link for a video of the space (all furnishings, exam tables, chairs, oxygen, orthoscope included in lease – about $500k in value): https://youtu.be/f9gr62fKaVs

Contact Haresh at hareshshah54@hotmail.com or 516-220-3297


Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

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

August 25, 2017 – Northwell Out of Insurance Biz


PRESIDENT’S MESSAGE
Charles Rothberg, MD
August 25, 2017
Volume 17
Number 33

Dear Colleagues:

Yesterday, Northwell announced that it will close its insurer, CareConnect, due in large part to the flawed risk adjustment.

While physicians won’t be asked to absorb the losses—as was the case with the shuttering of insurer Health Republic almost two years ago—both of these situations suggest that if we want to encourage new entrants into the insurance market, regulators need to understand what “adjustments” do to the playing field.

Northwell was required to pay almost half its revenue into the pool (even though the ACA requires that 80% of premiums be spent on medical care). Both Congress and the ACA sought to promote new entrants to create a more competitive insurance market—but in attempting to level the playing field it has instead tilted it even further.

The risk adjustment was based on a flawed methodology that absurdly considered factors beyond actual claims experience. It scored non-financial factors like co-morbid disease—which was derived from insurer’s own data and the mining of physician records, but didn’t at all correlate with financial experience. Established, deep-pocketed insurers were able to mine data better to exploit this flawed methodology. New insurers were drained out of business.

This kind of dangerous “misunderstanding” on the part of regulators and policy makers is why I cannot easily welcome so-called “value based payment” reforms.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large


Northwell Will Shutter CareConnect Over ACA Uncertainty, Costs
Yesterday, CareConnect, which includes 22 hospitals, including North Shore University Hospital, Northern Westchester Hospital, and Lenox Hill Hospital, reported that they will exit the insurance market in 2018 “because of the uncertainty of the Affordable Care Act’s future” and costs. About 126,000 CareConnect policyholders “would remain covered while they transfer to new health providers.” CareConnect parent Northwell Health highlighted a $112 million payment into the ACA’s risk-adjustment pool this year, which represented 44 percent of CareConnect’s 2016 revenue from its small group health plan. CareConnect faced another such payment and “said it never received $150 million from the federal government in risk-corridor payments.” Newsday (NY) (8/24)

The New York Times (8/24) quotes Northwell CEO Michael Dowling saying in an interview that the politics are “so poisonous at the moment that nobody wants to sit down collectively and, in my view, do their duty to fix the things that need to get fixed…“It has become increasingly clear that continuing the CareConnect health plan is financially unsustainable, given the failure of the federal government and Congress to correct regulatory flaws that have destabilized insurance markets and their refusal to honor promises of additional funding.”

CareConnect was started in 2013 as a way for Northwell to direct patients to its hospitals and doctors, promising a simple, limited network of health providers and lower prices. But the business faced the same pressures many other insurers faced in the Affordable Care Act marketplaces. Many misjudged the business, charging too little for premiums and then taking losses as patients used more care than they projected. Bloomberg News (8/24) 

DFS re Careconnect’s Withdrawal from NY Health Insurance Market

“While it is unfortunate that the continued uncertainty across the nation due to the repeated actions of the federal government to undermine the Affordable Care Act at this time in the insurance cycle has caused CareConnect to begin an orderly wind down from the market, we recognize that this decision will help Northwell focus on its core mission to deliver healthcare services to New Yorkers. In spite of recent federal efforts to destabilize markets and threats to dismantle or not enforce the ACA, New York’s healthcare market remains robust and consumers across New York have real choice of coverage.

DFS will work with CareConnect on an orderly transition to ensure that all of its members know their full options and continue to receive healthcare coverage without interruption. Once again we call on the federal government to end this continued uncertainty, immediately act to protect our markets by fully paying the cost-sharing subsidies for good and not piecemeal, making the overdue risk corridor payments, fully enforcing the individual mandate, and stopping once and for all the partisan attacks on healthcare for all Americans. We appreciate that some members of Congress are seeking to turn this corner in a bipartisan manner and to maintain the ACA’s protections to stabilize markets.”

Iroquois Healthcare Alliance to Syracuse Post-Standard: Comprehensive Medical Liability Reform is Needed to Help Recruit Doctors in New York State
Noting that “upstate New York is suffering from a shortage of doctors”, this week Iroquois Healthcare Alliance President Gary Fitzgerald responded to an offensive letter to the editor from NYPIRG Executive Director Blair Horner that had appeared in the Syracuse Post-Standard that had called for the Governor to sign the potentially disastrous medical liability expansion bill that had passed the Legislature prior to the end of Session.

To read the Iroquois letter, click here.  The Iroquois Healthcare Alliance represents numerous hospitals and health systems across upstate New York.  The NYPIRG letter to the editor had been a response to an August 1 op-ed from Onondaga County Medical Society President Dr. Mary Abdulky calling for the Governor to veto this legislation.

The IHA letter noted that “the bill for which Horner advocates is a lone piece of medical malpractice liability legislation, hastily passed in the well-known Albany-style darkness during the end of the legislative session…What makes sense, what is crucially needed and what will result in fewer doctors fleeing this state, is a comprehensive package of medical liability legislation that also addresses the ability to recruit and retain doctors in New York state, especially those in our Upstate rural and underserved areas.

Also this week, an op-ed from Dutchess County President-elect Dr. Jay Jalaj urging Governor Cuomo to veto this legislation was in the Poughkeepsie Journal.

Physicians must continue to contact the Governor at 518-474-8390 to urge that he veto this legislation, as well as sending a letter from here.



Promo Code: MSSNY




DFS Fines MVP $200,000 for Improperly Denying Claims and Charging Co-Pays and Deductibles for Preventative Services
Companies Agree to Pay Restitution to 356 Members and to Correct Problems

Financial Services Superintendent Maria T. Vullo announced the Department of Financial Services (DFS) has fined MVP Health Plan Inc. and MVP Health Insurance Company $200,000 for incorrectly applying cost-sharing to members’ claims and improperly denying some claims for preventive healthcare services.  The companies agreed to pay the fine and to correct claims processing procedures in a consent order reached with DFS.  The companies have agreed to make restitution, including interest, to 356 of its members.

The companies have agreed to make restitution, including interest, totaling approximately $9,000 to 356 of its members.  MVP Health Plan Inc. is a not-for-profit health maintenance organization; MVP Health Insurance Company is a for-profit insurer that sells small group policies and policies to individuals.  The two companies insure approximately 100,000 members in New York’s individual and small group markets.

The violations, which occurred between 2011 and 2013, were uncovered in a DFS examination of the insurers.  The DFS examination found that some members’ claims were improperly denied by the insurers.  In other cases, members were erroneously charged cost-sharing expenses, such as improper co-payments or deductible charges.  The violations involved instances of improperly processing claims involving more than a dozen kinds of healthcare screening or preventive services.  These included screening for breast, cervical and colorectal cancer, depression, hearing loss and obesity in children and adults.

In addition to restitution and the fine, the consent order directs the companies to update their claims processing system, provide training for claims examiners, and explain to providers how to handle certain mandated services under the federal Affordable Care Act and New York law.

The DFS consent order requires the companies to provide DFS with documentation to verify that they have complied with the terms of the order.

More Than 400,000 New Yorkers Paid Penalty for Going Uninsured in 2015
The New York Post (8/21) reports that 405,610 New York tax payers, more than 4 percent of total tax filers in the state, paid a combined “shared responsibility payment” fee of more than $186 million under the Affordable Care Act in 2015. The Post reports the comparatively healthy, uninsured young people are so-called “invincibles.” These tax filers “failed to obtain health insurance in 2015” and were required to pay a tax penalty under the ACA. The article notes that ACA penalty fees are set to rise in 2016 and 2017.

AMA and Physicians’ Advocacy Institute Submits Detailed Comments to CMS to Reduce MIPS Program Hassles
The American Medical Association this week submitted detailed comments to CMS regarding their proposed changes to the MACRA MIPS and APM programs for the 2018 performance year (which will impact payment for care provided to Medicare patients in the year 2020).  The Physicians Advocacy Institute, of which MSSNY is a board member along with 9 other state medical societies, also submitted detailed comments to CMS.

For more information about the AMA comments, click here.   For more information about the MACRA resources the PAI provides for physicians, click here.

Among the comments raised in the AMA and PAI letters to CMS:

  • The AMA and PAI letters express support for the proposed expansion of the low-volume threshold from 100 annual Medicare patients and $30,000 in annual allowed Medicare Part B Charges to 200 patients and $90,000, and urges CMS to notify individuals and groups as soon as possible that they qualify for the low-volume threshold exemption;
  • The AMA and PAI letters express support for CMS’ proposal to maintain the cost category weight at zero for the 2018 performance period, similar to 2017. The AMA letter noted that it believes CMS needs additional time to develop, test, and refine new episode-based cost measures prior to including them in the MIPS program in future years.
  • The AMA and PAI letters express support for CMS’ proposal within the Advancing Care Information (ACI) category of MIPS to extend certified electronic health record technology (CEHRT) flexibility for performance year 2018 and the proposed hardship exemption for small practices.
  • The AMA and PAI letters express support for CMS proposal to maintain the data completeness criteria for quality category measures at 50% for the 2018 MIPS performance period, and express concerns with a proposal to increase this threshold to 60% for the 2019 MIPS performance period.
  • The AMA letter notes its opposition to including items or services beyond the physician fee schedule, especially Part B drugs, when determining MIPS eligibility, applying the MIPS payment adjustment, and in cost score calculations.
  • The AMA letter contains a number of recommendations to simplify the overall MIPS scoring methodology, including setting a low performance threshold, maintaining the 70-point additional performance threshold, eliminating bonus points from the calculation of future performance thresholds, maintaining stability in program requirements in future years, and increasing the reliability threshold.

AMA President Dr. David Barbe said in a statement. “CMS has been a good partner in smoothing out the bumps but the program still needs to be more understandable and less burdensome. The complexity is an obstacle to the goal of promoting innovative approaches to encourage higher value care. We applaud CMS’ decision to allow for another transition year for MIPS, recognizing the challenges physicians face both bureaucratic and technological. The willingness to compromise will help physicians and patients alike.”

NYC Public Hospitals Treating Larger Share of Mental Health Patients
The New York Times (8/22) reports that mental health patients are being increasingly treated by the city’s strained public health system, as private hospitals divert patients and close psychiatric beds. Public hospitals’ share of psychiatric beds was more than three times those in private hospitals, according to the Independent Budget Office report released last month. Anthony Feliciano, director of the Commission on the Public’s Health System, a citywide health advocacy organization, said, “The public hospitals are taking care of a lot more of the most vulnerable population, while the private hospitals get away with not doing it.”


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!



High School Hours Begin Too Early in Day; 8:30 AM Is Optimal Start Time
A recent report by the National Center for Education Statistics found that “only a fraction of high schools are starting later than 8:30AM, which is what the American Academy of Pediatrics recommends.”

Pediatricians have argued that early school start times can result in sleep deprivation for teenagers and, “in turn, a decline in academic performance, an increased risk of car accidents and physical and mental health issues.” The average start time for US high schools is 7:59AM, according to the study. Only 13 percent of high schools start later than 8:30AM, while 46 percent start before 8AM.


For Members Only: Brooks Brothers Offers 15% Discount
Enroll for your complimentary Brooks Brothers Corporate Membership Card and Save 15%* on full priced merchandise at all Brooks Brothers U.S. and Canadian stores, by phone and online.
TO ENROLL FOR YOUR NEW MEMBERSHIP CARD:

  • Organization ID# 12479 and Pin Code# 19658and enroll at: Membership.BrooksBrothers.com
  • You will need to wait 30 minutes after you enroll before you register to shop online.
    TO SHOP ONLINE:
  • www.BrooksBrothers.com
  • At the top of the page click on My Account & then CREATE AN ACCOUNT.
  • Create new profile and at the bottom click on “I have a Corporate Membership Number”.
  • Enter 12 digit Membership Number.
  • Click on create and you will receive a Welcome Letter.  You are now ready to shop.

JAMA: Hospital Should Do More for Patients Admitted for Heroin Overdoses
study published Tuesday in JAMA stated that not enough is being done “during hospital encounters” to intervene in patients’ opioid addictions. The study found that “among people who had overdosed on heroin, the filling of opioid prescriptions fell by 3.5 percent, while medication-assisted treatment increased by only 3.6 percent,” following their hospitalizations.

The study covered “more than 6,000 people who survived an overdose from an opioid.” The study’s lead author, Julie Donahue, said, “Forty percent of those with a heroin overdose and 60 percent of those with a prescription opioid overdose filled a prescription in the six months after overdose for the very kind of medication that contributed to the overdose in the first place.”

Survey: Physicians Are Warming Up to Single-Payer Model
In a recent Merritt Hawkins survey, 56 percent of doctors were found to support single-payer healthcare. The results represent a big change from those of the same survey in 2008, where 58 percent of respondents opposed a single-payer system.

The change is due to three main reasons, according to Merritt Hawkins, a physician recruitment firm who spoke to more than 1,000 doctors for the survey. First, doctors seek clarity and stability in healthcare reform. Next, it’s a generational issue, as young doctors come up, there is less resistance to a single-payer format. And lastly, there is a feeling of resignation among doctors who believe single-payer is inevitable so it should be adopted sooner rather than later.

Influenza Vaccine Payment Allowances Annual Update for 2017-2018 Season



Why I Joined MSSNY


CLASSIFIEDS


Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

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

S.1297 – Student Athletes Cardiac Arrest

May 23, 2017

Hon. Catherine T. Nolan
Chair, Assembly Education Committee
Room 836 Legislative Office Building
Albany, New York 12248

Dear Assemblywoman Nolan:

The Medical Society of the State of New York wishes to express its significant concerns regarding Assembly Bill 3452 which would require cardiac screening of student athletes and Assembly Bill 6050/S. 1297, which requires the development of regulations for the treatment and monitoring of students who exhibit signs of sudden cardiac arrest.  Both of these bills were on the Assembly Education Committee agenda for May 23.  While we of course agree with the goals of these bills to prevent sudden cardiac arrest in student athletes, these bills have some flaws which we are urging be addressed.

Sudden death in young athletes is a rare but tragic event which MSSNY wants to work with all interested parties to help to prevent.  The possibility that young, well-trained athletes at the high school, college, or professional level could die suddenly seems incomprehensible.  It is a dramatic and tragic event that devastates families and the community.  Physical exertion associated with competitive sports and other physical athletic activities can exacerbate a pre-existing condition and can result in an untimely death of a student.  However, experts have concluded that to require a cardiac screening for every individual who seeks to in any school sponsored athletic activity poses a potential unnecessary emotional toll on the student athlete and could also incur a significant financial burden on the family as cardiac screenings in young people, without a family history, may not be covered under insurance.

In this regard, the Medical Society of the State of New York supports Assembly Bill 6538, sponsored by Assemblymember Michael Cusick.   A. 6538 has already passed the New York State Assembly and is on its companion measure, S. 3149, sponsored by Senator Andrew J. Lanza, is advancing in the New York State Senate.  This measure adds to the existing Health Care and Wellness Education and Outreach Program within the New York State Department of Health. The bill would require DOH to provide educational materials for students and their parents and guardians regarding sudden cardiac arrest. The materials would be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart Association.  The materials would include an explanation of sudden cardiac arrest, a description of early warning signs, and an overview of options that are presently available for screening.   The State of New Jersey currently has a similar program where brochures are sent home to parents and guardians.  We believe this is a positive legislative approach for addressing this difficult issue.

Regarding A.3452, we are concerned that experts have recommended against mandatory cardiac testing.  While competitive sports are associated with an increase in the risk of sudden cardiovascular death (SCD) in susceptible adolescents and young adults with underlying cardiovascular disorders, the United States Preventive Services Task Force does not recommend universal screening with Electrocardiography for any individual, let alone children under the age of 18.  The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events.  The USPSTF ranks this as D—which means that the USPSTF recommends against this service and that there is a moderate or high certainty that the service has no benefit or that the harms may outweigh the benefits.   Additionally, the USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events.  The USPSTF has concluded that the current evidence is insufficient to assess the balance of benefits and harms of the service.   Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Instead, the American Heart Association recommends that pre-participation screening of athletes include a history and physician exam and A complete and careful personal and family history and physical examination designed to identify (or raise suspicion of) those cardiovascular lesions known to cause sudden death or disease progression in young athletes is the best available and most practical approach to screening populations of competitive sports participants, regardless of age.

Regarding A. 6050/S. 1297, we agree with the concept of requiring course instruction for coaches, physical education teachers, nurses and athletic trainers on the signs and symptoms of sudden cardiac arrest.  However, we are concerned that the bill”s language does not specifically include medical personnel, such as pediatric or family physicians, cardiologists, emergency department physicians or organizations representing these groups of individuals in the development of such educational program.   Additionally, it should be noted that the most important way to effectively treat sudden cardiac arrest with student athletes is for schools to have and to have individuals trained to use an automated external defibrillator (AED). An AED is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation and pulseless ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of electrical therapy which stops the arrhythmia, allowing the heart to reestablish an effective rhythm.  Having individuals trained within the school systems to use AEDs would be a significant step forward.

We very much want to work with you to assure that individuals who work with student athletes are properly trained in recognizing the signs and symptoms of cardiac arrest.  However, at the same time, we do not want to subject patients to what often are unnecessary tests that have been recommended against by national experts.  Moreover, we believe it is very important that physician experts be involved in the development of educational materials for families and school personnel involved in overseeing student athletes.   Working together, we can all help to prevent these tragic incidents in the future.

Thank you for your consideration of our comments.   Please do not hesitate to contact us if there are any questions.

Sincerely,
Morris Auster, Esq.
Pat Clancy
Hon.  Kemp Hannon
Hon. Carl Marcellino
Hon.  Richard Gottfried
Hon.  Jeffrion L. Aubry
Members:  Assembly Education Committee

 

 

 

 

 

 

 

A.3079 – Prohibiting participation in torture and improper treatment of prisoners

May 12, 2017

To: Members of the NYS Assembly Codes Committee: 

RE: A.3079– AN ACT to amend the public health law, the education law and the labor law, in relation to prohibiting participation in torture and improper treatment of prisoners by health care professionals 

The Medical Society of the State of New York is writing to you relative to the above referenced legislation which would bar health care professionals from participating in torture or improper treatment of prisoners.  The bill also provides a means by which health care professionals responsible for the care of prisoners or detainees can refuse an order to directly or indirectly participate in torture and to insist on providing professional responsible care and treatment.

The Medical Society of the State of New York and the American Medical Association believe that any involvement by physicians in torture is incompatible with the physician’s role of healer.  There are core ethical principles under the Code of Medical Ethics that both organizations have adopted.   After almost 18 months of study of this issue by the BioEthics Committee, the Medical Society’s Council adopted on Nov. 19, 2009, MSSNY POLICY 95.973 Physician Involvement in Interrogation and in Torture. (copy attached) The statement, says in part, that:

“Physicians who engage in any activity that relies on their medical knowledge and skills, regardless of jurisdiction or location, must continue to uphold principles of medical ethics. Physicians must not engage, directly or indirectly, in torture or in interrogations. Questions about the propriety of physician participation in interrogations and in the development of interrogation strategies may be addressed by balancing obligations to individuals with obligations to protect the public interest, e.g. from terrorist attack. Precedent for this may be found in public health ethics in which physicians’ expertise inform guidelines, policies, and procedure that lead to the imposition of relatively minor hardships on individuals for public welfare. However, when a physician is directly and clinically involved with an individual, the physician’s obligations to the individual take precedence over public interests”.

The Medical Society of the State of New York at its 2015 House of Delegates unanimously reaffirmed MSSNY Policy 95.973 on this matter.

The Medical Society, supports the basic intent of the bill, i.e. that physicians should not conduct, support, aide, abet, or condone the torture of prisoners. However, we remain troubled by the issue of whether this legislation is necessary since torture is already a federal crime. Furthermore, current statements in the Geneva Convention, Military Manual of Conduct and from professional societies (e.g. AMA) already provide an explicit basis for refusal to participate in torture. It is not clear that a central purpose of the legislation – i.e., to provide physicians with an additional legal basis and therefore more powerful platform to refuse to participate in torture will in actuality have such an effect in circumstances in which a commanding officer directs a physician to participate in torture. The bill provides no practical recourse for physicians who are intimidated by military superiors into withholding reports of torture. There are inherent challenges and barriers to evidentiary discovery for accusations of torture in the military and prisons.  Physicians may be poorly positioned to defend themselves since, ostensibly, many of these incidents would occur overseas. Physicians would have to overcome claims of national security and national defense and would have to operate in domains in which civil authority will be limited.

At this time, the Medical Society of the State of New York and the American Medical Association is supportive of continued Congressional inquiries into interrogation techniques used by the military as well as the role of physician and non-physician health care providers.  We believe that this is the proper venue for this issue.

We will continue to work with you on this most important matter as it continues to be considered and examined.

Sincerely,

 

Morris Auster, Esq.

Pat Clancy, VP

 

 

August 18, 2017 – NYTimes Editorial WRONG!


PRESIDENT’S MESSAGE
Charles Rothberg, MD
August 18, 2017
Volume 17
Number 32

Dear Colleagues:

Today’s New York Times editorial in support of legislation to expand malpractice lawsuits is an affront to every physician in New York State.  The editorial board members should be ashamed to look their doctors in the eye the next time they need their services, which they apparently must take for granted.

We have sent a response to the Times that highlights the threat to patient care this bill would undoubtedly bring about should it be signed into law.  Their editorial completely ignores this risk, despite the fact that we were recently named the worst state in the country to be a physician, and despite the fact that surveys of hospital Emergency Departments across the state have shown that many do not have sufficient on-call specialty care to meet expected patient demand.

They also repeat the tired line of New York being only one of a handful of states without such “date of discovery” exceptions to their statute of limitations law, without at all acknowledging that most other states with such laws have limitations on damages to balance these costs.

They also failed to acknowledge that the situation involving Lavern Wilkerson was the result of the application of the much shorter statute of limitations for municipal hospitals as compared to private hospitals.  As I have repeatedly stated, were the circumstances involving Lavern’s case to occur at a private hospital, she would have had ample time to sue her doctors and hospitals.

Rather than advancing legislation to correct that imbalance, trial lawyers have manipulated the issue to bring us to the verge of a huge explosion of lawsuits, at a time when physicians cannot take on any new costs.  And patient care in New York is bound to suffer.  In addition to more payouts, there will also be an explosion of meritless litigation given the drafting errors in this bill that may cause this legislation to apply to far more cases than simply alleged misdiagnoses of cancer.

Apparently, the New York Times does not care.

I am a regular reader of the Times.  I find it ironic that the Times will often warn their readers about the importance of understanding an issue comprehensively rather than simply reacting emotionally; yet when it comes to medical malpractice legislation they are clearly viewing this issue through one lens only.

We must continue to make the public aware of the damage this bill will cause to our healthcare system.  In this regard, I want to thank the many physicians across the State who have taken the time to send op-eds to their local papers warning of the consequences to care in their communities.  Some examples are here , here and here.  We anticipate that many more will be published in the near future.

I also want to thank the many physicians who have taken the time to contact the Governor.  Physicians should continue to do by calling his office at 518-474-8390 and sending a letter here.

Since this bill has not yet been officially delivered for his consideration, it is clear that the Governor and his staff are trying to be very thoughtful in their analysis of legislation.

With all the problems in our health care system, and still facing the possibility of huge cuts coming from Washington, we cannot tolerate any new costs.  We urge Governor Cuomo to veto this legislation and work to develop legislation that both addresses the Lavern situation and establishes needed systemic reforms to better assure timely patient access to care.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large

DFS Announces Insurance Premium Rates for 2018; Slight Decrease from Insurers Requests
Individual health insurance premium rates will increase 14.5%, and small group premiums will increase 9.3%, according to an announcement this week from New York Financial Services Superintendent Maria Vullo.  The DFS press release noted that it reduced the insurers’ requested 2018 rate increases by more than 3.8 % overall for the 300,000 enrolled in individual plans.  For small group plans, with more than 1 million insureds, DFS reduced insurers’ requested 2018 rate increases by 2.4%.

The press release noted that the premiums were set despite the uncertainty regarding the continued availability of the ACA’s Cost Sharing Reduction (CSR) subsidies for insurers. Specifically, it was noted that “ DFS will continue to fight for payment of the CSRs so that consumers are not further harmed by federal government actions. However, in light of the ongoing uncertainty regarding CSR payments by the federal government… DFS is granting an additional rate factor based on information that insurers had provided to DFS in May 2017 that estimated potential funding loss. The additional factor only applies to the individual rates of silver plans.”

The press release further noted that “Underlying medical costs continue to be the main drivers of premium rate increases, reflecting a nationwide trend. For the 2018 individual rates announced today, drug costs account for the largest share (26 percent) of all medical costs, with specialty drug costs increasing about 49 percent. Inpatient hospital costs account for the second largest share of medical expenses (19 percent), followed by physician specialty services (12 percent) and diagnostic testing/lab/x-ray (10 percent).”

For a full listing of the premium rates requested and approved on a company by company basis, please view the press release here.


AG Announces Joint State-Federal Settlement with Maker of Epipens
New York Attorney General Eric Schneiderman announced this week that New York State had agreed to join a state-federal $465 million settlement with drug maker Mylan to resolve allegations that Mylan knowingly underpaid rebates owed to Medicaid for EpiPens that were dispensed to Medicaid beneficiaries. Under the settlement, New York will receive $38.5 million.

To read the AG’s press release, click here.  The press release notes that the settlement resolves allegations that Mylan submitted false statements to the Centers for Medicare and Medicaid Services (CMS) and several states reliant on EpiPen rebates, and knowingly underpaid its obligations for Medicaid drug rebates to the State Medicaid Program for EpiPens.

DFS Issues Transgender Health Guidance to Health Plans
NYS DFS issued guidance on transgender health in a circular letter to health plans.  The letter advises plans to request additional information before denying benefits for procedures that are not routinely provided to a specific gender. Insurers may not discriminate against transgendered or gender non-conforming individuals who file health claims for conditions that are not normally associated with the gender with which they identify. The circular letter is here.


2017 MSSNY Continuing Medical Education Provider Conference
To meet the challenges facing planners, providers and participants of CME, MSSNY recognizes the need for ongoing education and training of its Accredited Providers as well as physicians and other healthcare professionals in NYS. This conference will inspire participants to explore and interactively address challenges such as self-directed learning for physicians and compliance with the changing accreditation criteria that clearly address practice gaps and practice-based needs while creating opportunities for measurable change in physicians and reinforcing the undeniable link between a successful CME activity and quality improvement for physicians and patients alike.

The conference will take place on Friday, September 15, 2017, at the Westbury Marriott.  The program is scheduled from 7:30 AM to 3:45 PM.  Registration links and more information are available here.  Featured speakers include Steve Singer, PhD; Vice President of Education and Outreach, Accreditation Council for Continuing Medical Education (ACCME) and Mary Kelly, Project Administrator, AMA PRA Standards and Policy.  MSSNY President Charles Rothberg, MD will deliver the welcome and opening remarks. For more information, please contact Miriam Hardin at mhardin@mssny.org. Our flyer with information is here.

MSSNY Counsel Don Moy: Please Read the 2018 Family Leave Law
Virtually every employer in NYS must start preparing for phased in implementation of the NYS Paid Family Leave law, which begins in 2018.  The State of New York website gives detailed summaries regarding the law, and the obligations of employers and employees under the law.  Perhaps the attached information can be helpful in the event a medical practice or county medical society is not aware of this website.


FREE Drug Discount Card for Your Patients

Many of your most vulnerable patients have trouble affording medication. The New York Rx Card can help with those prescription costs and is a free program available to all New York residents. There are no eligibility requirements or forms to fill out. Tell your patients to simply take the card into the pharmacy to get savings of up to 75% on prescription medications for their whole family. New York Rx Card is a proud supporter of Children’s Miracle Network. A donation will be made to your local CMN hospital each time a prescription is processed through the New York Rx Card. Your patients can find and print their FREE card here!



DOH Releases Children’s Medicaid Transformation Plan
The state released a draft plan on August 16 regarding how it will transform the children’s Medicaid program and transition children currently covered by fee-for-service Medicaid to managed care plans. The transformation of the children’s Medicaid system is intended to improve access to care for high-needs children, according to the document. One way the state aims to do that is by consolidating the six waivers currently authorizing home- and community-based services for children into a single waiver. It also aims to shift more children in need of care management for chronic conditions, including behavioral health issues, into health homes. Currently there are 16 health homes across the state that have been designated to serve children. (Crains 8/16)


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!


CMS Announces End to Two Mandatory Bundled Payment Programs, and Proposes Rollback to Joint Replacement Program
CMS announced this week that it was intending to cancel two of its Medicare bundled payment demonstration programs and make substantial changes to a third program. Specifically, the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) incentive payment model announced last year would be cancelled, and the number of regions across the country required to participate in the Comprehensive Care for Joint Replacement (CJR) model adopted in 2015 would be cut in half.

To read the full press release, click here.

The EPM and Cardiac Rehabilitation Incentive Payment models were scheduled to begin in January 2018. CMS stated that it was proposing to eliminate these two models to give the agency “greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute-care spectrum.”  According to the press release, CMS expects in the future to “increase opportunities for providers to participate in voluntary initiatives rather than large mandatory episode payment model efforts.”

Moreover, the number of regions required to participate in the Joint Replacement bundled payment program was cut from 67 to 34.  Hospitals in the other 33 regions could continue to participate voluntarily. To read the entire proposed rule, click here.  Based upon an initial review of the rule, it appears the Buffalo metropolitan area has been removed entirely from mandatory participation in this program (p.26)   While the New York City metropolitan area will remain in the mandatory program, several hospitals in the MSA have been exempted from voluntary participation (p. 27).

MSSNY Travel Discount Program
MSSNY is pleased to offer an exclusive worldwide travel discount service to our members. Savings average 10-20% below-market on all hotels and car rental suppliers around the world.

Save time and money.  Let Local Hospitality negotiate the best deals and comparison price for you.  Any hotel, any car, anywhere, anytime. Click here to save on your next trip.

Survey: Medical Groups Find Complying with MIPS Extremely Burdensome
A recent survey by Medical Group Management Association (MGMA) has found that most physician practices are finding it challenging to comply with the Merit-Based Incentive Payment System (MIPS). Approximately 82% of medical practices identifies the system as “very” or “extremely” burdensome.  Responding medical groups also noted health information technology as a major inhibitor in their ability to provide quality patient care.  The survey includes responses from 750 group practices with the largest representation among independent medical practices and in groups with 6 to 20 physicians.

Reminder: Medicaid Billing for Prescription Drugs when Prescribed by Unlicensed Residents, Interns and Foreign Physicians in Training
The purpose of this article is to provide a reminder regarding NYS Medicaid’s billing requirements for drugs when prescribed by unlicensed residents, interns and foreign physicians in training only.

  • NYS Medicaid accepts prescriptions written by providers legally authorized to prescribe per NY Education Law, Article 131, Section 6526, and 10 NYCRR 80.75(e). This includes unlicensed residents, interns and foreign physicians in training programs, under the supervision of a NY State Medicaid enrolled physician.
  • In accordance with NY Education Law, NYS Medicaid does NOT require the name and signature of the supervising physician to be included on the prescription.
  • Effective January 2014, NYS fee-for-service Medicaid implemented claims editing that enforced the OPRA requirement for healthcare professionals, practice managers, facility administrators, and servicing/billing providers.
  • Because NYS Medicaid’s provider enrollment system can only accept licensed providers, pharmacy claims for services ordered by unlicensed residents, interns and foreign physicians in training programs reject when initially submitted for payment.

The following two (2) options continue to be available to pharmacies, to enable payment for prescription drug claims when prescribed by unlicensed residents, interns and foreign physicians in training only:

  1. Resubmit the claim using the National Provider Identifier (NPI) of the enrolled NYS Medicaid provider (the intern or resident’s supervising physician) as the secondary NPI.
  2. In the event the pharmacy’s billing system is limited to submitting only one prescriber NPI number, or the NPI number of the supervising physician cannot be obtained, then use the urgent/emergency override option (outlined below).

Directions for Urgent/Emergency Override

If you have a prescription written by an unlicensed resident, intern or foreign physician in a training program you will receive a reject code of “56” via NCPDP transaction stating the provider has a non-matched Prescriber ID listed in NCPDP field number 511-FB.

In the case of claims for items prescribed by unlicensed residents, interns or foreign physicians in training programs, pharmacies can provide the medication and receive reimbursement by resubmitting the claim using the following emergency override procedure:

In the Reason for Service Code Field (439-E4) also known as the Drug Utilization Conflict Field – enter “PN” (Prescriber Consultation) In the Result of Service Code Field (441-E6) – enter one of the following applicable values (1A, 1B, 1C, 1D, 1E, 1F, 1G, 1H, 1J, 1K, 2A, 2B, 3A, 3B, 3C, 3D, 3E, 3F, 3G, 3H, 3J, 3K, 3M, 3N, or 4A)

In the Submission Clarification Code Field (420-DK) also known as the Drug Prescription Override Field – enter “02” (Other Override).

Please note that the above override should NOT be used for a licensed prescriber who has not yet enrolled in NYS Medicaid. In the event of a prescription being sent by a non-enrolled licensed prescriber, the prescriber should be encouraged to enroll in the NYS Medicaid Program. Information regarding how to enroll can be found here.

Medicaid Fee-For-Service (FFS) to Systematically Enforce Legislation Limiting Initial Opioid Prescribing to a Seven Day Supply
In accordance with New York State Public Health Law, effective August 24th, 2017, the Medicaid FFS program will be implementing a seven (7) day supply limit on initial opioid prescribing for acute pain. This is a change from the current editing, implemented on December 5, 2013, which set the limit to a fifteen (15) day supply on initial opioid prescriptions. Information on this legislation can be found on page 6 of the July 2016 Medicaid Update.

Prior authorization (PA) will be required for claims that do not meet the above criteria.

To obtain a PA, please contact the clinical call center at 1-877-309-9493. The clinical call center is available 24 hours per day, 7 days per week with pharmacy technicians and pharmacists who will work with you, or your agent, to quickly obtain a PA.

The most up-to-date information on the Medicaid FFS Pharmacy Prior Authorization (PA) Programs and a full listing of drugs subject to the Medicaid FFS Pharmacy Programs can be found here and here.

Medicaid enrolled prescribers can also initiate PA requests using a web-based application. PAXpress® is a web based pharmacy PA request/response application accessible here.



Why I Joined MSSNY




CLASSIFIEDS


Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

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

A.7218A – Tanning Salons

ON ASSEMBLY HEALTH AGENDA                                     A. 7218A (JAFFE)

IN SENATE HEALTH COMMITTEE                                    S. 5585A (BOYLE)

An act to amend the                                                                                                             public health law, in                                                                                                             relation to  tanning facilities

This bill would prohibit children age of 18 and under from using tanning facilities and it removes the procedures to grant 17 to 18 year olds access to tanning booths. Tanning devices are dangerous to health and well-being of children and should be banned from use by them. Consequently, the Medical Society of the State of New York supports this bill. 

The United States Department of Health and Human Services and the World Health Organization’s International Agency for Research on Cancer have classified UV radiation from tanning devices as carcinogenic to humans, in the same category as tobacco and tobacco smoking.  A review of seven studies found a seventy five percent increase in the risk of melanoma in those who had been exposed to UV radiation from indoor tanning before the age of 35.  With the rising incidence of melanoma and non-melanoma skin cancer in the United States, as well as increasing usage of tanning parlors for cosmetic purposes by the public, the medical community supports legislative and regulatory efforts to severely curb access to these devices.

Epidemiologic data suggest that most skin cancers can be prevented if children, adolescents, and adults are protected from UV radiation; however, melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for adolescents and young adults 15-29 years old.  Moreover not only is indoor tanning associated with melanoma, but new evidence demonstrates that ever-use of indoor tanning beds is associated with a 69% increased risk of early-onset basal cell carcinoma (BCC), the most common form of skin cancer. Risk of developing BCC was higher in those who begin indoor tanning at earlier ages (less than 16 years old).

The Medical Society of the State of New York has adopted policy to eliminate tanning salons in the State of New York and strongly supports this legislation.  According to the American Cancer Society, skin cancer is the most diagnosed cancer in the United States. About 95,400 invasive skin cancers will be diagnosed in the US, and more than 87,000 of these will be of melanoma, the most serious form. The American Cancer Society has noted that the highest risk for skin cancer lies in avoiding the use of indoor tanning facilities. Because the harmful effects of UV exposure accumulate over time, indoor tanning devices pose a greater risk for teens due to the misleading claims by the industry. This is one of the many reasons New York currently prohibits indoor tanning for children under the age of 17 (Chapter 105 of 2012).

Currently, The US Food and Drug Administration is reviewing federal regulations for indoor tanning devices for the first time since 1985.  New York has proven to be proactive in this regard and should, once again, take definitive steps to prevent this avoidable cancer that takes the lives of so many New Yorkers.

For all the reasons above, the Medical Society of the State of New York supports this measure and urges it passage.

PFC/support

6/5/17

August 11, 2017 – MOC: There Has To Be A Better Way


PRESIDENT’S MESSAGE
Charles Rothberg, MD
August 11, 2017
Volume 17
Number 31

Dear Colleagues:

This week, MSSNY joined 32 other state medical societies—along with a number of national specialty societies—in signing a letter that was sent to the ABMS and its boards outlining the problems associated with Maintenance of Certification (MOC). The group has requested a meeting with ABMS for December.

There is a long-standing absence of transparent communication from the certifying boards. The letter we have signed onto—and the proposed meeting—are steps towards making the boards aware of the significant problems physicians are having with MOC.  We want to work with the leaders of the certifying boards to ensure physician self-regulation.

Among the many things I oppose regarding MOC are the high stakes exams that cost physicians thousands of dollars to comply and take time away from work. There is a lack of relevance to the process—they test knowledge but there is no evidence that they test competence. The theoretical purpose of these exams is to assure competence and evidence of lifelong learning, when in fact they accomplish neither goal. In fact, the MOC exams simply do not relate to the way physicians practice medicine.

Another issue is the ability of the board to withdraw certification.  Clinical practice is always evolving, based on the health needs of the population, technical advances and physician interests.  A board should not be able to retract a certification that a physician has earned; for example, a physician who is board certified in pediatrics and goes on to earn a board certification in ophthalmology should not have his or her pediatrics certification clawed back (this happened to OB-GYNs that treated men).  If you earn a B.S. in psychology from Harvard and end up becoming a journalist, does that void the B.S. in psychology?

The certifying boards have a history of overreaching. They need to return to the business of providing certification that physicians have completed their training with a certain level of competence.

The MOC process needs to be restructured. There simply has to be a better way.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large

Another Voice Calls for Governor Cuomo to Veto Medical Liability Bill
This week, Monroe County Medical Society President Dr. Peter Ronchetti’s letter entitled “Neither Patients nor Physicians Benefit from Medical Liability Bill” ran in the Rochester Business Journal. “This bill would do nothing to improve the ability of New Yorkers to access high-quality health care or improve outcomes,” writes Dr. Ronchetti. “In fact, if passed, at the very least it will drive physicians out of New York and create a barrier to new physicians choosing to practice here.” Click here to read Dr. Ronchetti’s letter in full.

Physicians: Tell Gov. to Reject Liability Expansion Bill/Call for Comprehensive Liability Reform

All physicians are urged to continue to call Governor Cuomo at 518-474-8390 and send a letter here urging that he veto a so-called “cancer only” medical liability statute of limitations expansion bill (S.6800/A.8516) that passed the Legislature over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.

Please urge that legislation be enacted that provides for comprehensive medical liability reform. This ambiguously drafted bill, introduced in the final days and passed in the final hours of the 2017 Legislative Session, would expand the medical liability statute of limitations for cases involving “alleged negligent failure to diagnose a malignant tumor or cancer”.   The bill would permit lawsuits 2.5 years from the “date of discovery” of such alleged negligence, up to an outside limit of 7 years.  Actuaries have estimated that this legislation could increase already exorbitant premiums by 10-15% at a time when no increases can be tolerated.

Again, please urge the Governor to veto this bill and encourage your colleagues to do the same! Please let the Governor know how this bill will harm patient care and exacerbate existing physician shortage issues in your community.

Trump’s Shift on Opioid Crisis
President Donald Trump on Thursday declared the country’s opioid epidemic “a national emergency,” just days after HHS Secretary Tom Price said the opioid misuse epidemic could be “addressed without the declaration of an emergency.” President Trump said he’s drafting the necessary paperwork to put the declaration into effect.

According to the Washington Post, Trump delivered the announcement “to reporters outside a national security briefing” in Bedminster, New Jersey, adding his Administration is “going to spend a lot of time, a lot of effort and a lot of money on the opioid crisis.” The Post says the declaration of emergency will permit the Administration “to remove some barriers and waive some federal rules enabling states and localities to have more flexibility to respond.”

Implementation of Face to Face Documentation Requirement for NY Medicaid Home Health Coverage
Please see this guidance from the New York State Department of Health announcing that, effective July 1, there must be a documented face-to-face (F2F) encounter by a physician or other care provider with certain Medicaid insured patients for the initial authorization for home health services provided by a Certified Home Health Agency (CHHA).    The requirement is the result of a provision contained in the Affordable Care Act.

As set forth in the guidance, the F2F documentation requirements for Medicaid patients in need of home health care only apply to Medicaid fee-for-service (FFS) coverage serviced by CHHAs. The CHHA must maintain a copy of the F2F documentation in the clinical record.  F2F rules are not applied to managed care cases, or to cases that are personal care service-only.  Moreover, DOH confirmed that the following are also exempt from Medicaid F2F documentation requirements: Fully Integrated Duals Advantage (FIDA); Medicaid Advantage; Special Needs Plans (SNPs); the Program for All-Inclusive Care for the Elderly (PACE); and Health and Recovery Plans (HARP).

MSSNY worked together with the Home Care Association of New York State (HCA) to draft guidelines well before the July 1 effective date for DOH to use as the basis for implementation of the Medicaid F2F rules required by the ACA. The purpose was to ensure a streamlined process for physicians and home care agencies, and the narrowest applicability of the requirements to avoid the kinds of extensive, onerous, duplicative and confusing standards set by the U.S. Centers for Medicare and Medicaid Services (CMS) in the case of F2F for Medicare home health services.


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!


DSRIP Program Reduces Potentially Preventable Readmissions and ER Visits, According to DOH
New York Medicaid Director Jason Helgerson recently announced the progress that New York’s Medicaid Delivery System Reform Incentive Program (DSRIP) has made, noting that New York had closed its second year with a 14.9% reduction in Potentially Preventable Readmissions and an 11.8% reduction in Potentially Preventable ER Visits.

The report also noted that, if the current Reduction rates are maintained, New York will achieve its goal of a 25% reduction in avoidable hospital use by DSRIP Year 5.  The report also noted that New York’s Performing Provider Systems (PPS) have earned a total of $2.4 billion, which is 95% of all available funds.

While these are important achievements for New York’s DSRIP program, MSSNY continues to raise concerns to state officials that funds allocated to many of these PPS across the State are not ultimately being distributed to the downstream PPS participating providers to support their efforts in helping to bring about these important reductions.



Why I Joined MSSNY



For Members Only: Brooks Brothers Offers 15% Discount
Enroll for your complimentary Brooks Brothers Corporate Membership Card and Save 15%* on full priced merchandise at all Brooks Brothers U.S. and Canadian stores, by phone and online.

TO ENROLL FOR YOUR NEW MEMBERSHIP CARD:

  • Organization ID# 12479 andPin Code# 19658and enroll at: BrooksBrothers.com
  • You will need to wait 30 minutes after you enroll before you register to shop online.

TO SHOP ONLINE:

  • BrooksBrothers.com
  • At the top of the page click on My Account & then CREATE AN ACCOUNT.
  • Create new profile and at the bottom click on “I have a Corporate Membership Number”.
  • Enter 12 digit Membership Number.
  • Click on create and you will receive a Welcome Letter.  You are now ready to shop!


Calling All IMGs!
Essen Health Care will host an IMG Symposium on August 16th from 6-8 pm at Jacobi Medical Center in the Bronx. Topics range from Navigating Residency: What to Expect to Residency Application and Interview Tips; and from Organized Medicine and Support Network to Primary Care Pathway.

IMGs are invited to participate in a pre-symposium networking from 5:30 PM to 6:00 PM. If you are driving please park in Parking Lot #4. The lot will be open from 5:30 PM to 8:00 PM.

Click here for more information on the symposium.

Check out MSSNY’s New CME Website and Listen to our Many Podcasts!
Did you know that we recently updated and completely revamped the MSSNY CME website?  Check it out here (Note: new users to the site will need to create an account).  You can earn free CME credits on emergency preparedness topics that range from our four-part Physician’s Electronic Emergency Preparedness Toolkit to Ebola, a Perspective from the Field or Mosquito Borne Diseases.  We also have a module on concussion in pediatric and adult patients as well as a CME accredited podcast on the same topic.

MSSNY also has more than ten informative podcasts that you can listen to here.  There are multiple brief podcasts on immunizations as well as others on Zika virus and MSSNY’s Physician’s Emergency Preparedness Toolkit.  Each podcast offers insight from medical experts on topics they are extensively well versed on.


CLASSIFIEDS


Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

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

August 4, 2017 – Hospital Consolidations and Med Staff Independence


PRESIDENT’S MESSAGE
Charles Rothberg, MD
August 4, 2017
Volume 17
Number 30

Dear Colleagues:

With the announcement last week that John T. Mather Memorial Hospital in Port Jefferson has signed a letter of intent to join Northwell Health, it’s imperative that we contemplate the impact of hospital consolidation on the independence of the medical staff.

There is an inherent value in the independence of the medical staff. According to NY State law, “the medical staff shall be organized and accountable to the governing body for the quality of the medical care provided to all patients…and establish objective standards of care and conduct.” Additionally, the law requires that the medical staff monitor patient care performance, including monitoring practitioner compliance with bylaws of the medical staff.

Physicians as a rule have a strong commitment to their institutions—and want to see them thrive—so they tend to be supportive when consolidations are proposed, as they often include an infusion of funds for hospital infrastructure and medical services that benefit patients and the community.

But a relatively small medical staff has little leverage in arguing with a huge health system over rules and policies that affect medical care and medical decision-making.

Do these hospital consolidations constrain the medical staff so much that the needs of the community are not being served?

A constant theme of the Organized Medical Staff Sections of MSSNY and the AMA has been the necessity to have strong medical staff bylaws.  In consolidation, a staff could lose hard-won provisions protecting due process rights for physicians and clinical decision-making authority.

Those who object to rules that they feel impede care can be labeled as disruptive, or subject to sanctions that will harm their careers.

Might pressure be applied to interfere with long-standing referral patterns and require that referrals be made within the overall system?

Consolidation can include many benefits for the institution, the physicians and the patients they both serve, but care must be taken to ensure that the medical staff does not lose sight of its responsibility to ensure the best possible care for patients.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large


In Syracuse Post-Standard, Onondaga County Medical Society President is the Latest Voice Calling for Comphrehensive Liability Reform
In a letter published in The Post-Standard in Syracuse on Tuesday, Onondaga County Medical Society President Dr. Mary Abdulky writes, “If signed by Gov. Andrew Cuomo, this bill (S6800/A8516) could worsen the exodus of physicians leaving New York to practice in other states that are more economically advantageous. We already lose 55 percent of the resident physicians trained here to other regions of the country, and face some difficulty attracting new physicians to the area due to the excessive medical liability premiums that our physicians must pay.”

Physicians: Tell Gov. to Reject Liability Expansion Bill/Call for Comprehensive Liability Reform
All physicians are urged to continue to call Governor Cuomo at 518-474-8390 and send a letter here urging that he veto a so-called “cancer only” medical liability statute of limitations expansion bill (S.6800/A.8516) that passed the Legislature over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.

Please urge that legislation be enacted that provides for comprehensive medical liability reform. This ambiguously drafted bill, introduced in the final days and passed in the final hours of the 2017 Legislative Session, would expand the medical liability statute of limitations for cases involving “alleged negligent failure to diagnose a malignant tumor or cancer”.   The bill would permit lawsuits 2.5 years from the “date of discovery” of such alleged negligence, up to an outside limit of 7 years.  Actuaries have estimated that this legislation could increase already exorbitant premiums by 10-15% at a time when no increases can be tolerated.

Again, please urge the Governor to veto this bill and encourage your colleagues to do the same! Please let the Governor know how this bill will harm patient care and exacerbate existing physician shortage issues in your community.


Senate Confirms Dr. Jerome Adams as Surgeon General
The US Senate has approved Jerome Adams, MD, to be the next surgeon general. Pledging to take on the nation’s opioid epidemic, he wrote in his nomination committee statement: “The addictive properties of prescription opioids is a scourge in America and it must be stopped.”

Over the past weeks, numerous publications across the country included quotes from MSSNY President Charles Rothberg, MD regarding Dr. Adams’ nomination, including this from the New York Times: “Charles N. Rothberg, president of the Medical Society of the State of New York, said Dr. Adams reminded him of C. Everett Koop, who was surgeon general through much of the 1980s. ‘Dr. Adams has a proven track record to make public health a priority despite political hurdles,’ Dr. Rothberg said in an email. ‘Dr. Adams is in touch with the public needs.’”

HBO’s VICE News Video: Doctors Explain Why U.S. Healthcare Is So Expensive
VICE News visited several doctors—including MSSNY’s Dr. Donald Moore—in an attempt to make sense of our convoluted health care costs. What do the doctors say is needed to improve overall cost and care? Many of them shared the same solution. Watch the video here.

White House Opioid Panel Urges Trump to Declare State of Emergency
In an interim report released this week, the White House Commission on Combating Drug Addiction and the Opioid Crisis described the crisis as unparalleled and urged President Trump to declare the US opioid misuse epidemic a national emergency. The report states, “It would also awaken every American to this simple fact: If this scourge has not found you or your family yet, without bold action by everyone, it soon will. … You, Mr. President, are the only person who can bring this type of intensity to the emergency and we believe you have the will to do so and to do so immediately.”

Editing Human Genes
A team of biologists in Oregon have successfully edited genes in human embryos to correct a disease-causing mutation, according to a study published this week in Nature, a weekly international journal of science. The experiment is not the first of its kind, but it is the first such study completed in the US and goes beyond past research in both scope and findings. The study “marks a major milestone and…raises the prospect that gene editing may one day protect babies from a variety of hereditary conditions,” but also raises ethical concerns about human genetic engineering. (Source: New York Times, 8/2)

Letter to the Editor re: The Skinny on “The Skinny”
Dear Editor:

In the past two editions of Enews our President, Charles Rothberg MD, touched upon crucial issues that impel consideration of what role our medical society should play in advocacy for our patients and the practice of medicine.

The Department of Health and Human Services has embarked on a mission to cripple the effectiveness of the Affordable Care Act (ACA) using taxpayer money to create 23 videos disparaging “Obamacare” including several testimonials by physicians.  It is illegal for HHS and the executive branch to engage in direct advocacy, “purely partisan activity” or promoting legislation.   The current administration has also failed to offer assurances to insurers that key components of the ACA such as enforcement of the individual mandate and cost sharing subsidies will be carried out.

These policy decisions have served to imperil the stability of the insurance market and hence the health of our patients.  The executive branch is empowered to execute legislation, and until directed otherwise by Congress, has a responsibility, legally and morally, to work diligently in carrying out the provisions of the ACA.  Anything less places our patients and practices in harm’s way for partisan expediency.   The AMA endorsed Tom Price for Secretary of HHS and it is time we use or advocacy role to place pressure on Secretary Price, the administration and our congressman to act first and foremost to protect the health of our patients.

Despite the recent failure of attempts to repeal the ACA there will be continued efforts to either repeal, replace or reform the legislation.  This is appropriate as there are many areas for improvement.  During the continuing policy debates it is important that we as physicians are aware of the enormous beneficial impact the ACA has had to date for many our patients.   In May 2017 New York released the report on open enrollment for 2017.

More than 3.6 million people or about 18% of New Yorkers were enrolled in health insurance through the ACA (Marketplace and Essential Plans).  This corresponds to a decrease in the rate of uninsured New Yorkers from 10 to 5 % in the past 4 years.  Share of enrollees by region within New York is proportional to population indicating that this program is not one that is more beneficial to downstate versus upstate or within the urban, suburban, or rural regions of our state.

The collapse of proposed legislation to repeal the ACA during the past few weeks offers an opportunity for our state and national society to advocate for bipartisan initiatives to preserve the achievements within our state while addressing many of the still present shortcomings within our healthcare system.

What has become evident in the past few months, although still unspoken in some quarters, is a consensus that affordable healthcare is a right for which our government has a responsibility.  The way this right to healthcare is attained is a matter of partisan policy but the ideal of affordable healthcare for all guaranteed by our society through governmental action is no longer a partisan divide.

Neil Herbsman MD
Gastroenterology of the Bronx
1600 Hering Ave.
Bronx, New York


Check out MSSNY’s New CME Website and Listen to our Many Podcasts!
Did you know that we recently updated and completely revamped the MSSNY CME website?  Check it out here (Note: new users to the site will need to create an account).  You can earn free CME credits on emergency preparedness topics that range from our four-part Physician’s Electronic Emergency Preparedness Toolkit to Ebola, a Perspective from the Field or Mosquito Borne Diseases.  We also have a module on concussion in pediatric and adult patients as well as a CME accredited podcast on the same topic.

MSSNY also has more than ten informative podcasts that you can listen to here.  There are multiple brief podcasts on immunizations as well as others on Zika virus and MSSNY’s Physician’s Emergency Preparedness Toolkit.  Each podcast offers insight from medical experts on topics they are extensively well versed on.



Why I Joined MSSNY




Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!



Quality Payment Program Hardship Exception Application for 2017 Transition Year Now Open
Clinicians Can Now Submit Quality Payment Program Hardship Exception Applications

The Quality Payment Program Hardship Exception Application for the 2017 transition year is now available on the Quality Payment Program website.

MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons:

  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of Certified EHR Technology (CEHRT)

There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or, exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application.

About the Hardship Exception Application Process

In addition to submitting an application via the Quality Payment Program website, clinicians may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application.

To submit an application, you’ll need:

  • Your Taxpayer Identification Number (TIN) for group applications or National Provider Identifier (NPI) for individual applications;
  • Contact information for the person working on behalf of the individual clinician or group, including first and last name, e-mail address, and telephone number; and
  • Selection of hardship exception category (listed above) and supplemental information.

If you’re applying for a hardship exception based on the Extreme and Uncontrollable Circumstance category, you must select one of the following and provide a start and end date of when the circumstance occurred:

  • Disaster (e.g., a natural disaster in which the CEHRT was damaged or destroyed)
  • Practice or hospital closure
  • Severe financial distress (bankruptcy or debt restructuring)
  • EHR certification/vendor issues (CEHRT issues)

Please note: Once an application is submitted, you will receive a confirmation email that your application was submitted and is pending, approved, or dismissed. Applications will be processed on a rolling basis.

For More Information


MACRA/QPP: Pick Your Pace and New Resources
The AMA continues to hear from physicians who feel unprepared to participate successfully in Medicare’s new Merit-based Incentive Payment System, despite the transitional flexibility provided for 2017.  In particular, it seems that physicians who never participated in Medicare reporting programs before need basic information on how to avoid a payment penalty in 2019 through minimal reporting in 2017.

To help address this need, which we believe is particularly acute for physicians in smaller practices, the AMA is extending “Pick Your Pace” activities to run through the end of the year to disseminate simple instructions on how to report “one patient, one measure, no penalty.”    To help amplify our outreach for this educational effort, we are encouraging state medical societies and national medical specialty societies to participate and share this information from now through Dec. 31.

The AMA developed a short video, entitled “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,” which is accessible on the AMA web site at ama-assn.org/qpp-reporting.  Also on this web site physicians can find a sample CMS-1500 claim form, links to quality measures on the CMS web site, a link to the CMS MIPS eligibility tool, and other materials.   Please visit this page, view the resources, and consider joining us for a coordinated outreach to physician practices so that we can help as many physicians as possible avoid a negative 4 percent Medicare payment reduction in 2019.

MIPS Action Plan
The AMA has released a new customizable resource, the MIPS Action Plan, geared towards helping physicians think strategically about how to successfully implement MIPS in 2017. This resource will help physicians determine the right course of action for their practice, provide recommended steps to meet program requirements, and measure their performance against important milestones. DON’T DELAY – act now to avoid penalties and succeed in MIPS for 2017.


CLASSIFIEDS


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

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

July 28, 2017 – The Skinny on “The Skinny”


PRESIDENT’S MESSAGE
Charles Rothberg, MD
July 28, 2017
Volume 17
Number 29

Dear Colleagues:

With the overnight failure of the “skinny bill,” apparently due to the miscalculation of a slender and fractured Senate majority, it’s time to draw parallels to the New York State legislature, our own physician advocacy, and what happens to our initiatives when the divisions overcome what our organizational/professional objectives are (paralysis).

It is worth mentioning that the Congressional Budget Office estimated that 16 million fewer people would have health insurance by the end of the decade. Estimates are here.

Of course, we must now move forward to improve the health and coverage of our patients and the funding of our practices and infrastructure. 

Transgender Issue

Also this week, health insurance for certain members of our Armed Forces became an issue. I thought I’s share relevant MSSNY and AMA policy. MSSNY supported the following resolution:

  • 969 Removing Barriers to Care for Transgender Patients:

MSSNY supports the resolution being presented at the American Medical Association’s

A’08 Meeting by the AMA-Medical Student Section and AMA-Resident and Fellow Section which asks that the AMA (1) support public and private health insurance coverage for treatment of gender identity disorder, and (2) oppose categorical exclusions of coverage for treatment of gender identity disorder when prescribed by a physician. (HOD 2008-171)

Moreover, the President of the AMA, Dr. David Barbie, issued their statement on the issue:

  • AMA policy also supports public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient’s physician. According to the Rand study on the impact of transgender individuals in the military, the financial cost is a rounding error in the defense budget and should not be used as an excuse to deny patriotic Americans an opportunity to serve their country. We should be honoring their service – not trying to end it.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large

AMA Summary of What Occurred Last Night and What the Actual Issues Were
Early this morning, the so-called “skinny” or “partial ACA repeal” package was defeated by a vote of 49 to 51 with Senators Collins, Murkowski and McCain joining all 48 Democrats in opposing the proposal.  Elements included in the “skinny” package were:

  • Repeal of the individual mandate by zeroing out the penalty beginning after December 31, 2015.
  • Repeal of the employer mandate by zeroing out the penalties, but only from January 1, 2016 to December 31, 2024.
  • Extend the moratorium on the medical device tax from December 31, 2017 to December 31, 2020.
  • Increase for three years (2018 to 2020) the maximum contribution limit to health care savings accounts (HSA) to the amount of the deductible and out-of-pocket limitations.
  • Defund Planned Parenthood for one year (and expands the one-year defunding to certain other providers that provide abortions if they receive more than $1 million in federal and state funding).
  • Sunset the funding for the Prevention and Public Health Fund after FY 2018.
  • Provide $422 million in additional funding for the Community Health Center Program in 2017.
  • Amend section 1332 of the ACA (Waiver for State Innovation) by: authorizing and appropriating $2 billion for states that submit or implement state innovation waivers; requiring HHS to approve a 1332 waiver if the secretary determine that the application meets the benefit comprehensiveness, cost sharing, enrollment, and budget neutrality guardrail requirements; requiring a waiver determination within 45 days (instead of 180 days); and extending waivers from 5 to 8 years with unlimited renewals for 8-year periods that may not be cancelled by the secretary.

This is not the end of the process.  Hearings and bipartisan discussions about legislation to stabilize the individual market are anticipated when Congress returns from the August recess. We extend thanks and deep appreciation to physician, patient, hospital and other provider groups that joined the AMA in this effort and made this outcome possible.   The ingredients for this success were sound policy guided by clear objectives, effective AMA spokespersons, a broad based coalition and a tremendous grassroots response and engagement with elected officials.

There is much more work to be done on this and other issues to improve the health of the nation.

Tell Gov. to Reject Liability Expansion Bill/Call for Comprehensive Liability Reform
All physicians are urged to continue to call Governor Cuomo at 518-474-8390 and send a letter here  urging that he veto a so-called “cancer only” medical liability statute of limitations expansion bill (S.6800/A.8516) that passed the Legislature over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.  Please urge that legislation be enacted instead that provides for comprehensive medical liability reform.

This ambiguously drafted bill, introduced in the final days and passed in the final hours of the 2017 Legislative Session, would expand the medical liability statute of limitations for cases involving “alleged negligent failure to diagnose a malignant tumor or cancer”.   The bill would permit lawsuits 2.5 years from the “date of discovery” of such alleged negligence, up to an outside limit of 7 years.  Actuaries have estimated that this legislation could increase already exorbitant premiums by 10-15% at a time when no increases can be tolerated.

This week, op-eds appeared in papers across the State from the Presidents of the Albany County , Monroe County and Chautauqua County medical societies urging Governor Cuomo to veto the bill.   The Legislative Gazette also had an article that referenced the opposition of MSSNY and the Lawsuit Reform Alliance.

Again, please urge the Governor to veto this bill and encourage your colleagues to do the same! Please let the Governor know how this bill will harm patient care and exacerbate existing physician shortage issues in your community.




Drinking Alcohol 3 to 4 Days a Week Tied to Lowest Risk for Diabetes
Moderate drinking spread out over several days during the week is associated with the lowest risk for diabetes, according to a study in Diabetologia. Some 70,000 Danish adults without diabetes completed questionnaires about their drinking habits and then were followed for a median of 5 years, during which 2% developed diabetes.

The lowest diabetes risks were among men who reported consuming 14 drinks per week and women who consumed 9 drinks per week. After multivariable adjustment, men who consumed 7–13 drinks or 14 or more drinks over 3–4 days weekly had 30%–40% lower risks for diabetes than those who consumed less than 1 drink weekly. Women who consumed 1–6 drinks or 7 or more drinks over 3–4 days saw similar risk reductions.

The researchers point to numerous study limitations but conclude, “Our results further indicate that frequent consumption of alcohol is associated with the lowest risk of diabetes.” As one potential mechanism, they note that the polyphenols in red wine “may exert beneficial effects on blood glucose control … thereby lowering the risk of type 2 diabetes.” Diabetologia article




Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!



For Members Only: Brooks Brothers Offers 15% Discount
Enroll for your complimentary Brooks Brothers Corporate Membership Card and Save 15%* on full priced merchandise at all Brooks Brothers U.S. and Canadian stores, by phone and online.

TO ENROLL FOR YOUR NEW MEMBERSHIP CARD:

  • You will need to wait 30 minutes after you enroll before you register to shop online.

TO SHOP ONLINE:

  • www.BrooksBrothers.com
  • At the top of the page click on My Account & then CREATE AN ACCOUNT.
  • Create new profile and at the bottom click on “I have a Corporate Membership Number”.
  • Enter 12 digit Membership Number.
  • Click on create and you will receive a Welcome Letter.  You are now ready to shop!


CTE in Football Players: Characteristics in Brain Donors Explored
A study of some 200 donated brains from American football players shows a generally increasing prevalence of chronic traumatic encephalopathy (CTE) with higher levels of play.

The deceased donors’ football exposure ranged from two players with only pre-high school experience (neither of whom had CTE) to 111 with National Football League experience (99% of whom had CTE).

All cases of CTE had shown mood, behavioral, or cognitive symptoms, according to interviews with family members, whereas motor symptoms were common mostly in severe cases. Also common in severe cases was the accumulation of neurodegenerative proteins, such as amyloid-beta.

The authors, writing in JAMA, caution against estimating CTE prevalence on the basis of their “convenience” sample, saying their purpose was to characterize CTE’s neuropathological and clinical features. An editorialist agrees, writing that “such a sample is likely to be biased to include more impaired individuals.” JAMA article.


Research: Sperm Count, Concentration Declining Among Men in Western World
Research published in Human Reproduction Update http://bit.ly/2uGlLda found “a 52.4 percent decline in sperm concentration and a 59.3 percent decline in total sperm count among North American, European, Australian and New Zealand men” in 2011 compared with 1973.” The study also indicated that “the quality was worse.” For the study, investigators looked at “data from 185 studies and 42,000 men. The researchers report that while the investigators did not see “a similar decline in non-Western men – those from Africa, Asia and South America,” they “admitted that this absence of a trend may be due to a lack of data.” They added that additional research is required “to determine causation,” investigators “think that our lifestyle choices (smoking, stress and obesity) may be to blame for the drop in sperm count.”

Explanation of Special Status Calculation
The Centers for Medicare and Medicaid Services (CMS) has introduced new information on qpp.cms.gov that indicates whether clinicians have “special status” and can therefore be considered exempt from the Quality Payment Program.

To determine if a clinicians’ participation should be considered as special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data. A series of calculations are run to indicate a circumstance of the clinician’s practice for which special rules under the Quality Payment Program will affect the number of total measures, activities or entire categories that an individual clinician or group must report. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), Rural, Non-patient facing, Hospital Based, and Small Practices.

For more information, please visit the Quality Payment Program website.

Now Available: Accredited Online Course – Quality Payment Program 2017 Merit-Based Incentive Payment System: Improvement Activities Performance Category
A new, online and self-paced overview course on the Quality Payment is now available through the MLN Learning Management System. Learners will receive information on:

  • The Improvement Activities performance category requirements, and how this category fits into the larger Quality Payment Program
  • The steps you need to take to report Improvement Activities data to CMS
  • The basics about scoring of the Improvement Activities performance category

This course is the third course in an evolving curriculum on the Quality Payment Program, where learners will gain knowledge and insight on the program all while earning valuable continuing education credit. Keep checking back with us for updates on new courses. First time learners will need to register for the MLN Learning Management System. Once registered, learners will be able to access additional courses without having to register. For information on how to login or find training, please visit our MLN Learning Management System FAQ sheet.

The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires June 1, 2020. AMA PRA Category 1 Credit™ is a trademark of the American Medical Association.

Accreditation Statements
Please click here for accreditation statements.


CLASSIFIEDS


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Medical Space Available for Leasing
Currently (last 7 years) occupied by Lab Corp.
2,500 sq. ft. ADA compliant.
25-15 Steinway Street, Astoria, NY 11103
Please contact Landlord: 1-800-283-0602;
e mail: wwwevans@yahoo.com

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

Physician Opportunities



Job Posting – Chief Medical Officer – Cayuga Medical Associates

Cayuga Medical Associates (CMA), a growing multi-specialty group located in the heart of the beautiful Finger Lakes Region in Central New York, is currently seeking a Chief Medical Officer to work within the organization. This newly created senior leadership position is designed to ensure that high quality, service-oriented patient care is delivered by Cayuga Medical Associates’ physicians on a consistent basis. The Chief Medical Officer has primary responsibility for clinical issues pertaining to the delivery of patient care services, patient satisfaction, and quality at the practice level. This position will report to the President of CMA, with an administrative dyad/partnership to the Chief Operating Officer. In this role, the Chief Medical Officer will work in an administrative capacity 2 days a week, and will practice as a physician for the remaining 3 days of the workweek.

This position will require the physician to:

  • Engage in Physician recruitment, engagement and retention, in collaboration with President and Chief Operating Officer
  •  Set and communicate performance, service standards and expectations to  all providers
  •  Exercise professional clinical leadership regarding specific cases or questions of quality or compliance
  • Assist with compensation model refinements and redesign, with specific focus on quality and productivity metrics
  •  Oversee CMA’s Physician Action Council (PAC)
  •  Develop and implements physician peer review system, medical policies, and clinical programs

Qualifications for this position include:

  • Graduate from accredited medical school and appropriate residency training
  • Board certified physician in a primary care or related sub-specialty area
  •  Active NYS medical license
  •  At least 3-5 years of relevant work experience in a physician practice setting, prior experience in physician leadership role preferred
  • Strong leadership skills to develop a close, collaborative working relationship with senior leadership team, physician leaders, and practice  management staff

The Finger Lakes region of New York offers endless opportunities for outdoor adventures, as well as rich support of the arts and diverse cultural opportunities, excellent school districts, and charming villages, towns and small cities to call home.  If you are dedicated to excellence and possess a commitment to patient-centered care, please submit your CV and cover letter to cma_hr@cayugamedicalassociates.org or fax to (607) 277-1415, attention Human Resources. CMA offers a competitive pay and benefits package and is an equal opportunity employer.


Position Available for Critical Care Physician to Join Established Practice in Nassau County, Long Island, NY.
The Physician will join our existing team of Board-Eligible/Board-Certified Intensivists. This is a PT/FT position including both nocturnal and daytime responsibilities. The Physician will work with a dedicated group of highly trained mid-level practitioners, respiratory therapists and nurses to provide Critical Care at St. Francis Hospital in Roslyn, NY. St. Francis was ranked one of the top 10 hospitals in the nation for Cardiac Care and is top rated nationally in seven other adult specialties.
We are expanding our Intensivist Program and are expecting to add an Intensivist to our group.
Nassau Chest Physicians, P.C. was established in 1978 to provide state-of-the-art care to patients with pulmonary diseases on Long Island. We have expanded our practice to include 8 Intensivist/Pulmonologists and 5 pure Intensivists. Since 2006, we have assumed management of Critical Care services at St. Francis Hospital-The Heart Center in Roslyn, NY.
St. Francis Hospital is New York State’s only specialty designated cardiac center and is a nationally recognized leader in cardiology and heart surgery, ear-nose-throat, gastroenterology and GI surgery, geriatrics, neurology and neurosurgery. More cardiac procedures are performed at St. Francis than at any other hospital in New York State. The hospital is located on the North Shore of Long Island; approximately 30 minutes from Manhattan. The hospital combines unrivaled expertise in cardiovascular medicine with top-ranged nursing (AACN Magnet Award) to provide the very best in patient care.
In addition, St. Francis offers excellent Thoracic, Vascular, Oncologic, Neurosurgical, and Orthopedic Surgical Programs. We have a very active Emergency Department. The hospital offers the latest in technologies such as Therapeutic Temperature Modification, Impella, ECMO and LVAD. Our excellent and experienced medical staff supports strong medical and surgical subspecialty programs.

Aside from Certified Critical Care Nurses, many who have more than 20 years of experience and are expert at caring for this complex patient population, we have a growing pool of Intensivist mid-level practitioners who work hand in hand with our Intensivist physicians to coordinate the care of the critically ill patient, minister to them and perform procedures.

Of course, a New York License is required. J1 or H1 VISAS accepted.
Additional Salary Information: Salary and benefits are competitive and commensurate with experience. Interested applicants, send resume to: dr.sorett@nassauchest.com


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