MSSNYeNews: Richard Jewell and Scarlet Letters – January 24, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
January 24, 2020

Vol. 23  Number 4


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Colleagues:

No doubt you’re heard that the Governor’s proposed budget legislation is out.  In the Health and Mental Hygiene Section, there are many helpful proposals, among them reducing maternal mortality, regulation of PBMs, and removing flavored tobacco products. There are some that are unhelpful such as requiring more information in the physician profiles. Ironically, in the fiscal year 2015 budget, the Governor had actually proposed eliminating the profile website altogether. Quite a turnaround, no? 

But then we come to the poison pill –  Section L. Here, the Office of Professional Medical Conduct (OPMC) is further empowered to allow for “immediate publication of charges upon investigative requests.” Let that sink in for a moment. As if that isn’t enough, the powerful position of OPMC Executive Secretary is now removed from the Board Chair’s oversight and now overseen by the Commissioner directly. This similarly could shred due process.  

As I’ve previously shared, less than 3% of complaints to OPMC result in significant actions. Publication of charges prior to thorough investigation would effectively end a physician’s career. In 1976, Richard Jewell found a suspicious package in the Atlanta Olympic Park and alerted police, saving countless lives. For his effort, Jewell was hounded by the press and he became a person of interest. His life was ruined while attention was diverted from the real bomber.  Perhaps we could ask our Governor, as Raymond Donovan famously asked, to which office do physicians go to get their reputations back?  

I don’t know about you, but I feel that an MD or DO degree is a badge of honor. Section L of the Budget could turn your badges of honor into Scarlet Letters.  

Concerned? Upset? Outraged? Then, go here right now and tell Governor Cuomo and your legislators how you feel. Also, Lobby Day is March 4. Albany believes it’s a crisis ONLY when physicians act like it’s a crisis. Physicians, make no mistake – this IS a crisis. We need to pack the house. We need you. 

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

Arthur Fougner, MD
MSSNY President


Capital Update

The Week’s Legislative Podcast


Please Plan to Be in Albany for: MSSNY‘s Annual “Physician Advocacy Day” (3/4)
As we begin to unpack the Governor’s budget proposal and the legislative work at the Capitol continues, the need for physician advocacy and grassroots involvement is greater than ever. With the Governor’s budget proposal teeing up items for potential concern such as Medicaid cuts, legalized marijuana and changes to the physician disciplinary process, while also supporting reforms such as regulating PBMs and a flavored tobacco ban, it is imperative that physicians be in contact with their local legislators to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 4th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click here to register!

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

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

If you have any questions/comments, please contact Raza Ali at rali@mssny.org.       (ALI)


Governor Announces Proposed Budget
Governor Cuomo this week released his proposed $178 Billion Budget for the 2020-21 State Fiscal year, including measures to close a $6.1 billion Budget deficit, through creating a new Medicaid Redesign Team (MRT) to recommend $2.5 Billion in Medicaid savings, assuming an additional $2 billion in new tax revenue, and $1.8 billion in reduced payments to localities.  While we are still poring through the tens of thousands of pages of Budget bills, among the most notable items for physicians upon initial review:

Items of Significant Concern Include:

  • As previously announced, expanding the ability of the Commissioner of Health to notify the public that a physician is under investigation and to make it easier for the Commissioner to summarily suspend a physician license during a disciplinary investigation.  Send a letter to your legislators here: Please click here
  • Expanding the information on the physician profile to include office hours, whether accepting new patients, insurance participation information, and mandatory completion of a workforce survey.
  • Legalizing, regulating and taxing the production, distribution, transportation, and sale of recreational or “adult-use” marijuana.
  • Expanding the list of adult immunizations that can be provided by pharmacists to all those recommended by the ACIP.
  • Expanding the existing physician-pharmacist collaborative drug therapy program to include nurse practitioners and physician assistants 

Positive Items Under the Proposed Budget

  • Require the regulation of Pharmaceutical Benefit Managers (PBMs) with the Department of Financial Services (DFS) and to disclose financial incentives they receive
  • A comprehensive anti-smoking package including: prohibiting the sale or distribution of e-cigarettes or vapor products that have a characterizing flavor; prohibiting the sale of tobacco products  in all pharmacies; expanding the definition of “place of employment” to define indoor space and limit second hand smoke exposure;  restricting the advertising of vapor products;  requires manufacturers of vapor products to disclose to the DOH Commissioner and the public, information regarding the ingredients, by-products, or contaminants in vapor products; bans coupons and manufacturer discounts and displays in shops; and increases penalties for illegally selling tobacco products to minors.
  • Creating an administrative simplification work group to address health insurance hassles and to expedite physician credentialing applications.
  • Establishing the Behavioral Health Parity Compliance Fund for the collection of penalties imposed on insurance carriers who violate New York’s Behavioral Health Parity laws, which will be used to support the Substance Use Disorder and Mental Health Ombudsman program
  • Significantly reduce the interest rate on medical malpractice and other court judgments, from 9% to a market-based rate
  • Reduce the business income tax rate from 6.5% to 4% for businesses with 100 or fewer employees and with net income below $390,000 that file under Article 9-A.
  • $14.2 million in funding to ensure access to a full array of reproductive services for women due to the loss of Title X funding.
  • $8 million to improve maternal health outcomes and for the implementation bias training and incentives for an expansion of community health workers related to Maternal Mortality.
  • Continuation of funding for the Excess Medical Malpractice Insurance Program
  • Continuation of funding for the Committee for Physicians’ Health

Other Items of Note

  • Expanding the scope of New York surprise bill law to include in-patient services following an emergency admission.
  • Convene a new Medicaid Redesign Team (MRT) to come up with $2.5 billion in savings
  • DFS will be authorized to investigate pricing of any prescription drug if the price of such drug has increased by more than 100% within a one-year time period.
  • Capping the co-payments required of insured patients at $100 for a one-month supply of insulin.
  • Development of “NYHealthCareCompare”, a website that will allow New Yorkers to look up charges for medical services, the quality of services provided, and access information about financial assistance programs, as well as what to do about a surprise medical bill.
  • Local governments will be required to stay within 2% property tax increase, or be held accountable for excess growth in Medicaid costs

Several items of concern from previous Budgets, proposed but rejected, such as cuts to Medicaid payments for treating dual eligible patients, elimination of “prescriber prevails” under Medicaid, and expansion of CRNA scope of practice WERE NOT included (but could be brought up under the new MRT).
(DIVISION OF GOVERNMENTAL AFFAIRS)


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Marijuana Legalization Gains Additional Support in State Senate; MSSNY Continues to Raise Strong Concerns with Public Health Impacts
In a press conference held on Thursday Senator Pete Harckham (D-Westchester County) announced his support behind an amended recreational or ‘adult use” marijuana legalization bill sponsored by Senator Liz Krueger (D- Manhattan). Senator Harckham, thought to be one of the Senators that had previously opposed the legalization of marijuana, explained his support is the result of a key provision of the bill which would allocate roughly 25% of the revenue generated from the legalization to mental health and substance abuse prevention and treatment. Senator Harckham is the chair on the Senate Alcoholism and Substance Abuse committee.

Senator Krueger also indicated during the press conference that, if a consensus was not reached between lawmakers and the governor, she would be willing to put the issue aside until after the budget was passed.

MSSNY continues to oppose the legalization of recreational marijuana and we urge our members to send a letter to the legislature and to the governor opposing this legislation (please click here).  Last week, MSSNY joined with the New York State Association of County Health Officials in a statement (please click here ) re-iterating our groups opposition to the legalization of recreational or “adult use” marijuana given the recent CDC report confirming a direct link between legally obtained adult use cannabis and the nation’s outbreak of vaping related illnesses and deaths.   (ALI)


MSSNY Statement by Dr. Art Fougner on the Release of the State Budget
“The proposed Budget importantly advances several positive steps to promote public health, including restricting the sale of flavored tobacco products, regulating PBMs, and facilitating the ability of physicians to be more quickly approved into plan networks.

However, we are extremely concerned about the scope of the Budget proposals that would essentially strip physicians of important due process rights when a complaint has been filed with the Office of Professional Medical Conduct. We agree with the importance of acting quickly when it is imperative, but these proposals would completely undermine important and longstanding due process protections. Given that most complaints are dismissed without any sanction or action, this series of proposed changes to bypass these rights would create a substantial possibility of unfairly destroying an innocent physician’s career.

Due to our enormous liability costs and excessive regulations, New York already has the dubious reputation of being the worst state in the country to be a physician. Proposals like this will make it even more unattractive for physicians to choose New York to deliver patient care.

We welcome discussions to improve our disciplinary system to address gaps to help protect the public. However, these proposed changes are startling. We urge the Senate and Assembly to take a critical eye towards these overreaching proposals to assure patients can continue to receive the care they need.”                                                       (AUSTER)


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Forum Examines Prescription Drugs & Health Care Costs
On Wednesday, January 22, MSSNY Albany staff attended a forum hosted by the New York Health Plan Association (HPA), at the Empire State Plaza Convention Center, in Albany. The event, “Access to Innovation: How are States Addressing Prescription Drug Costs?”, looked at current spending trends associated with prescription drugs, and health care, and outlined potential policy options to address a range of issues. Among them were the use of comparative effectiveness in measuring the value and pricing of prescription drugs.

Leading the discussion was HPA”s President & CEO, Eric Linzer, who was joined by panelists Sarah Emond, from the Institute for Clinical and Economic Review (ICER), Assemblyman Daniel Rosenthal, Chair of the Subcommittee on Intergenerational Care, Helen Schaub from 1199SEIU, Charles Bell with Consumer Reports, and Eileen F. Wood, representing Capital District Physicians’ Health Plan.

Governor Cuomo has introduced several proposals in his budget for 2021 related to prescription drugs, which the MSSNY Albany staff is reviewing, including a requirement that Pharmaceutical Benefit Managers (PBMs) disclose financial incentives received to the Department of Financial Services (DFS) and giving the Department of Financial Services power to investigate sudden large jumps in drug prices. We will update members as budget discussions move forward in the coming weeks.         (CARY)


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Partial Fill Prescribing on Senate Calendar
A measure that would enable the dispensing of a partially filled controlled substances prescription, is now on the Senate calendar for a vote.  The measure, S. 7115/A.9034, sponsored by Senator Gustav Rivera and Assemblymember John McDonald, would allow a prescriber to issue a partially filled prescription for a Controlled Substance II, III, IV, V to a patient.

The prescription would be recorded in the same manner as a refill and the remaining quantity of the prescription may be dispensed separately.   In 2016, Congress passed legislation that would enable partial fill prescription under the Comprehensive Addiction and Recover Act (CARA).  This state measure would allow New York State to conform to what is allowable under federal law.

A similar measure had passed during the 2019 legislative session, but was vetoed by Governor Andrew Cuomo.  This new bill addresses concerns expressed by the administration.  The Medical Society supports this measure and believes that it will help to reduce the amount of unused pain medication that can accumulate in home medicine cabinets and will allow prescribers to help patients balance the need to relive pain with an adequate supply of medication.    (CLANCY)


NYS DOH Issues Guidance on 2019 Novel Coronavirus (2019-nCoV)
The New York State Department of Health issued guidance on the 2019 novel coronavirus (2019-nCoV) and this includes healthcare providers and facilities collecting a travel history for patients presenting with febrile illness and remain aware of current outbreaks overseas. Patients who meet either of the following criteria should be evaluated as a person under investigation (PUI) in association with the 2019-nCoV outbreak.

Fever AND symptoms of lower respiratory illness (e.g., cough, shortness of breath) and in the last 14 days before symptom onset had:

▪ A history of travel from Wuhan City, China OR  Close contact with a person who is under investigation for 2019-nCOV while that person was ill. Fever OR symptoms of lower respiratory illness (e.g., cough, shortness of breath) and in the last 14 days before symptom onset:

▪ Had close contact with an ill laboratory-confirmed 2019-nCoV patient. A copy of the NYS DOH guidance is here.

MSSNY is planning to conduct a webinar on 2019 Novel Coronavirus (2019-nCov) in March.  More information will be available shortly.          (CLANCY)


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Registration Now Open for Steps to Physician Wellness and Resiliency
MSSNY is proud to announce our first webinar entitled Steps to Physician Wellness and Resiliency on February 25th from 7:30-8:30am. Jeffrey Selzer, MD will serve as faculty for this webinar.

Educational Objectives are:

  • Review the warning signs that stress, depression, anxiety or substance use may impact work or personal life
  • Identify strategies to increase personal empowerment toward making positive change, including self-assessment tools
  • Recognize self-monitoring strategies for stress related problems and know when to seek professional assistance

Register by clicking here.

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

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

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


Registration Now Open for Medical Matters: Virtual Drill: Incident Command System & Crisis Communications
MSSNY’s next Medical Matters will feature a Virtual Drill on the Incident Command System and Crisis Communications on February 19th from 6:00-8:00pm. Faculty for this program are: Arthur Cooper, MD; Pat Anders, MS, MEP; William Valenti, MD and Lorraine Giordano, MD.

Educational Objectives are:

  • Obtain information about local, state and national chain of command in a public health emergency and learn how to access resources
  • Understand the importance of planning for medical surge and triage of patients, as well as staff and family considerations, in the office-based practice setting during a health emergency
  • Develop an understanding that all public health emergencies can potentially have mental health implications for survivors and others connected with the event
  • Acquire skills for the management of patients in a public health emergency

Please note that there are recommended pre-course materials to be viewed prior to this virtual drill. You will be sent a link with your registration confirmation. We encourage all participants to examine these prior to the Virtual Drill.  Register by clicking here:  please click here

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

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

The Medical Society of the State of New York designates this live activity for a maximum of 2.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.   (HOFFMAN)                                                                                                                                                                                                  

 pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  zcary@mssny.org
rali@mssny.org
eNews


Transplant Policy That Will Help New Yorkers Clears Legal Hurdle 
A federal judge has denied a second motion for a preliminary injunction that would have halted a new liver transplant policy from taking effect. The policy, which could now be implemented in as soon as days barring an appeal from the plaintiffs, prioritizes the sickest patients over geographic location when it comes to organ allocation.  

“This is a big deal because it allows patients all over the country to be prioritized based on how sick they are, not on where they live,” said Motty Shulman, a partner at Boies Schiller Flexner, who has championed fair-organ allocation and spearheaded litigation to that end. “It’s consistent with the law, but it’s also fair. It removes any barriers for equitable allocation.” Plaintiffs that have challenged the policy’s implementation include a number of major hospitals and transplant centers in the South and Midwest that have benefited from the existing system.  

The court’s order denying the plaintiffs’ motion for a preliminary injunction noted that the Organ Procurement and Transplantation Network, which put forth the new policy, is not an agency subject to the Administrative Procedure Act. The act oversees federal agencies’ issuance of regulations.  

Proponents have remained steadfast that the new policy is a much-needed reform that helps to ensure every patient in need of an organ stands an equal chance of receiving one. A 2018 lawsuit that was led by Shulman and spurred the new policy included a plaintiff who lived in New York City and lacked the financial means to travel outside the area to transplant centers that historically have had much shorter wait times.
(Crain’s Health Pulse, Jan. 2)


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One More Vaping Death: Now, There Are Four
The NYSDOH has confirmed two more deaths in New York from vaping-associated illness: a woman in her 20s from the city and a woman in her 50s from Ontario County. To date, Gov. Andrew Cuomo said in a statement, that brings the number of vaping-related deaths in New York to four. He added that the department and its Wadworth Center Laboratory are working to get to the bottom of the situation, and that the state “will continue using every tool at our disposal until these illnesses and deaths stop.”


Deadline for abstract submission is 4 pm, Monday, February 3, 2020
MSSNY is very pleased to announce the 15th Resident/Fellow/Medical Student Poster Symposium. 

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

Click here for detailed guidelines 

We welcome the participation of residents and fellows. Participants must be MSSNY members, and membership is free for first-time resident members. Join online.


Many Physicians Would Give Up $20K+ for Better Work-Life Balance
Almost half of physicians would take a pay cut to work fewer hours, according to a survey conducted by Medscape. The top three factors physicians cited as contributing to burnout were bureaucratic tasks like charting and paperwork; spending too many hours at work; and lack of respect from administrators, employers, colleagues or staff. The online survey was conducted among more than 15,000 physicians in 29 specialties. Respondents represented three main age groups: millennials (ages 25-39), Generation X (ages 40-54), and baby boomers (ages 55-73). More than a quarter of physicians in each age group would give up between $20,000 and $50,000 per year in salary to work 20 percent fewer hours. Another third in each age group said they would give up $10,000 to $20,000 a year to work fewer hours.  

Medscape writes that these results are “a powerful statement” on behalf of physicians, suggesting that they want greater balance.  

This desire for more balance may partially contribute to the relatively high rates of burnout in the profession, experienced by 42 percent of survey respondents. Burnout was highest among Generation X physicians (48 percent), compared to millennials (38 percent) and baby boomers (39 percent). Read more here 



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Poor Glycemic Control in Childhood May Be Tied to T1D-Related Premature Death in Young Adulthood
Medwire News (1/23) reports, “People who die in young adulthood from acute complications of type 1 diabetes [T1D] are characterized by poor glycemic control during childhood,” researchers concluded in a study of 12,652 patients. The study revealed that “overall, people with diabetes were nearly three times more likely to die before the age of 30 years than those without.” The findings were published online in Pediatric Diabetes


Unhealthy LCD/LFD Scores May Be Associated with Higher Total Mortality in US
Clinical Endocrinology News (1/22) reports, “The health consequences of diet don’t largely depend on whether a person eats a high or low level of carbohydrates or a diet high or low in fat,” research suggests. What appears to be “more important is where the carbs and fats come from, according to an analysis that related diet and mortality rates in more than 37,000 American adults.” The study revealed that “unhealthy low carbohydrate diet [LCD] and low-fat diet [LFD] scores were associated with higher total mortality, whereas healthy LCD and LFD scores were associated with lower total mortality.” The findings were published online in JAMA Internal Medicine.  



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CMS

New Medical Narrative Report Template for Form CMS-1500 Submissions
To further assist medical providers in the implementation of the CMS-1500 for workers’ compensation patients, the Board has created a medical narrative report template that can be used to create the medical narrative that must accompany all CMS-1500 submissions. 

The top of the template includes the three elements most narratives require: the patient’s work status, the causal relationship of the injury to the patient’s work activities, and the patient’s percentage of temporary impairment. A medical narrative report may be found legally defective if these elements are missing. Medical providers must also include examination findings within their narrative, including the history of the injury/illness, objective findings based on the clinical evaluation, the patient’s plan of care and the diagnosis(es)/assessment of the patient. 

A link to the new template, as well as line-by-line instructions, can be found on the CMS-1500 section of the Board’s website at http://www.wcb.ny.gov/CMS-1500/requirements.jsp. A chart outlining the specific narrative requirements for each specialty is located on the same page.  

If you have any questions regarding use of the medical narrative report template, please write to the CMS-1500 mailbox at CMS1500@wcb.ny.gov.(  Jan.22,2020)


New 2019 Data Submission Resources Now Available on QPP Resource Library
CMS has posted the following new Quality Payment Program (QPP) resources to the QPP Resource Library to help eligible clinicians submit their 2019 Merit-based Incentive Payment System (MIPS) data until the submission period closes at 8:00 p.m. EDT on March 31, 2020.  

  • 2019 Data Submission FAQs – Answers commonly asked questions about data submission for the 2019 performance period. 
  • 2019 Data Submission Demonstration Videos 
  • Manual Attestation of Improvement Activities – Provides an overview of how a third-party intermediary can report MIPS data on behalf of a group within the QPP portal and how to modify the Improvement Activity score by manually attesting to measures. 
  • Manual Attestation of Promoting Interoperability Measures – Shows how a third-party intermediary can submit MIPS data on behalf of a group within the QPP portal and how to modify the Promoting Interoperability score by manually attesting to measures. 

SIGN UP TO RECEIVE ALERTS FROM MSSNY’S GRASSROOTS ACTION CENTER 

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When you subscribe to the Medical Society of the State of New York Grassroots Action Center, the Division of Governmental Affairs will alert you when legislation and issues of importance to physicians and patients, either in the NYS legislature or in Congress, are at critical stages.

Accordingly, contact from constituents would be vital to influencing the path and future of that legislation or issue.

Alerts will be accompanied by recommended actions you or your designee can take to have maximum impact such as calling, tweeting and emailing a customizable letter to your legislators.

If you are concerned with health care policy formation in New York State, please subscribe today by texting MSSNY to 52886 and you will be prompted to enter your email address.  When you sign up, it is best to use your NY-based voting address or practice address (if you do not reside in NY) for your alerts.

Contact the Division of Governmental Affairs at 518-465-8085 or albany@mssny.org if you have questions or comments.  Thank you.
(WILKS)


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RENTAL/LEASING SPACE

Midtown Medical Office for Rent
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Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties. Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
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JOB OPPORTUNITIES

NYS Job opportunity headline

ANNOUNCEMENT OF ANTICIPATED JOB OPPORTUNITY
Open to the Public Community Health Program Manager 3 – 24123 $109,956 – $138,763 / M-4
NEGOTIATING UNIT Management Confidential (06)
LOCATION Division of Family Health Corning Tower, Empire State Plaza Albany, NY 12237
MINIMUM QUALIFICATIONS TRANSFER: Current NYS employee with one year or more of contingent-permanent or permanent competitive service in a title at or above Grade 29/M-3 and eligible for transfer under Section 52.6 of the Civil Service Law.
PROVISIONAL*: a bachelor’s degree AND seven years professional public health experience in a governmental public health agency or public health program* that receives funding from a public health governmental agency. Of the seven years required experience, three years must include supervision of professional staff and the following management responsibilities: program planning and implementation, AND program evaluation and monitoring, AND development and implementation of policies and procedures.
The required professional experience must include either:

  1. Designing or implementing a public health outreach, promotion, or disease prevention program; OR
  2. Conducting disease surveillance or a disease control

For the purposes of this recruitment, a public health program focuses primarily on the prevention of disease through outreach and public health education or health promotion, including population-based plans of care, not just plans of care for individual patients, or the study of the prevalence or causes of disease through population-based studies. Examples of non-qualifying experience include, but are not limited to: Read More


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Looking for a tutor for Initial Pediatric Board Exam
Flexible hours, Negotiable rate. If interested please email at: pedboardhelp@gmail.com


 

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

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

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

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

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



 

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

 

MSSNYeNews: Raymond J. Donovan’s Good Name – January 17, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
January 17, 2020

Vol. 23  Number 3


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Colleagues:

In 1987, Reagan’s former Secretary of Labor Raymond J. Donovan was accused of corruption and mob connections in a case involving NY subway contracts. Needless to say, the press had a field day with a Reagan cabinet official linked to organized crime. After a brief trial, in which the defense called no witnesses, the jury quickly returned an acquittal on all counts. Following the verdict, Donovan famously asked, “Which office do I go to to get my reputation back?

In his State of the State, Governor Andrew Cuomo announced he was calling for streamlined physician discipline proceedings with transparency as well. While no details have been revealed as of yet, this seems at first blush, quite concerning. And sure enough, right on cue, the media is already jumping in. The Syracuse Post-Dispatch featured anecdotes of physicians’ criminal activity, damning with a broad brush. So, I call out the media here and now— “Balance, Reporters – You Need Balance.”

Let me assist in providing such balance. There are over 100,000 physicians in NY State. In 2016, about 10,000 reports were made to NY’s Office of Professional Medical Conduct. Out of those, about 300 resulted in serious actions. You read it right – 300 out of 10,000 or less than 3%. And the time it took was the result of painstaking investigation with full due process rights provided.

Again, without details, it is difficult to know just what cases would trigger this transparency or result in summary loss of license. A physician’s license can already be pulled if he/she is deemed an imminent threat to public safety. I am quite sure no one would argue. However, plastering a physician’s name on the front page of every newspaper in the state for any claim by a disgruntled patient is quite a different matter, especially before all the facts are known. The allegations against Donovan were serious, yet a jury quickly concluded after the prosecutors’ weak case that the indictments should never have been brought. Should all NY physicians be now treated as badly as Donovan? A claim of misconduct from the state is more than just a bad Yelp Review. It can be a career ending. Is this truly what the governor is asking for? Drop a dime and cover a doctor with slime?

In these days of record physician burnout, the last thing NY State needs is a Salem, Part Deux. Feel free to let me know how you feel. I urge everyone reading this to make plans to let all of Albany know how we feel on March 4.

We must all hang together for assuredly we will all hang separately.
Benjamin Franklin

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

Arthur Fougner, MD
MSSNY President


Capital Update

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The Week’s Legislative Podcast


SAVE THE DATE: MSSNY‘s Annual “Physician Advocacy Day” (3/4) Please Plan to be in Albany!
On January 8th the New York State Legislature returned to Albany for the 2020 session. As the New Year rings in and a new session begins, the need for physician advocacy and grassroots involvement is greater than ever. With the Governor’s State of the State Address teeing up items for potential concern such as Medicaid cuts, legalized marijuana and changes to the physician disciplinary process, but also supported reforms such as regulating PBMs and a flavored tobacco ban, it is imperative that physicians be in contact with their local legislators to ensure the physician community’s message is well-represented.

One opportunity is to participate in MSSNY’s “Physician Advocacy Day” that will be held on Wednesday, March 4th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click here to register!

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

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program.  Please work with your County Medical Societies to schedule appointments for physicians to meet with their elected representatives.  If you have any questions/comments, please contact Raza Ali at rali@mssny.org.                  (ALI)


MSSNY Continues to Push Back Against Troubling Proposal to Bypass Disciplinary Due Process
With the Governor’s proposal to bypass important due process protections for physicians during disciplinary proceedings likely to be part of the 2020-21 Executive Budget, all physicians are urged to contact their legislators please click here to urge that the Legislature reject this proposal.

MSSNY President Dr. Art Fougner issued a statement (statement) and has been quoted in numerous media outlets across the State of New York (read here) that MSSNY is anxious to work to address gaps in the disciplinary process to protect the public, but also has strong objections to what has been publicly announced.

“Recognizing that there are enormous professional implications when disciplinary action is taken against a physician, or even when there has been an accusation, we must also ensure that fair due process is provided when a physician is accused of professional misconduct” Dr. Fougner stated. In fact, very few complaints made to the Office of Professional Medical Conduct ever result in any findings of misconduct.

More information about this proposal will be released next week.  (AUSTER)


Please Urge Your Legislators to Reject Unfair Medicaid Cuts
With the Governor’s soon to be released Executive Budget likely to include significant cuts to the State’s Medicaid program to address its estimated $4 billion Budget deficit, physicians are urged to contact their legislators (here) ask that they restore the recent 1% cut to Medicaid payments and to reject further cuts.

MSSNY recently joined on to a letter with several other physician and health care provider associations to protest the recent 1% across the Board Medicaid cuts announced New Years’ Eve.  MSSNY has publicly stated (MSSNY response) that these cuts are particularly offensive given the already grossly inadequate payments for physician care under Medicaid and Medicaid Managed Care in New York, and that New York physicians were not the beneficiaries of increases given last year to other health care sectors.  Indeed, New York Medicaid physician payment is a microscopic part of New York’s overall Medicaid Budget, with New York ranking 46th in the nation for reimbursement for Medicaid physician payment generally and 47th for primary care.   In short, the already tiny amount we currently spend for community based physician care helps to reduce costs in the Medicaid program, and should not be forced to share in the burden of addressing this deficit.

We must do more to assure patients have access to timely needed care.  However, this cut will do nothing to assure adequate care for New York’s neediest patients, and in fact, make this problem even worse.  Please urge your legislators to reverse the cuts, and to prevent future cuts (click here)                                                                                      (AUSTER)


MSSNY Joins Effort to Enact Comprehensive Law to Prohibit Flavored Nicotine and Tobacco Products
Gregory Threatte, MD, President of Albany County Medical Society and MSSNY President Arthur Fougner, MD participated in a press conference this week calling upon the NYS Legislature to enact bills that would ban all flavored e-cigarettes, including menthol. The groups also called for legislation that would also ban all flavored tobacco products, such as chewing tobacco and cigarillos. The press conference included Senator Brad Hoylman, Assemblymembers Linda Rosenthal, Rodneyse Bichotte and Tremaine Wright and other public health groups. MSSNY supports S. 428-B/A. 47-
A, sponsored by Senator Hoylman and Assemblywoman Rosenthal, which would prohibit the sale of flavored e-cigarettes, including menthol, and S.6809/A.8808, sponsored by Senator Hoylman and Assemblymember Bichotte, which would ban flavored tobacco products.  Passage of this legislation is now more critical since a state Supreme Court judge struck down New York State regulations called for by Governor Cuomo that would have banned flavored vaping products.  Physicians are encouraged to send a letter to their legislators and to the Governor about these bills through MSSNY Grassroots Action Center (GAC) here.
(CLANCY,CARY,ALI)  


NYS Senate Health Committee Moves Package of Bills on E-cigarettes
The Senate Health Committee this week moved several legislative e-cigarette proposals to the Senate Rules Committee.   S.428B, sponsored by Senator Brad Hoylman, would prohibit the sale and distribution of flavored e-cigarettes.  S.3905A, sponsored by Senator Gustavo Rivera, would regulate electronic cigarettes in the same way as tobacco products to prevent access to products by persons younger than 21 years. S.4249A, sponsored by the Senator Monica Martinez, would create restrictions for the locations of tobacco stores and electronic cigarette stores to be at least 200 feet away from a school or place of worship.              (CLANCY)


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Legislation to Expand Mandate For Pain Management For All DEA Prescribers on Senate Calendar
A measure that would expand the coursework under the current pain management requirement has moved to the Senate calendar.  S.7102, sponsored by Senator Brian Benjamin, would expand the topics within the three hour course to include techniques that would reduce the likelihood of overdose and spread of blood-borne diseases by those who use drugs; medications used for the treatment of addiction and information about becoming a buprenorphine prescriber.

The Medical Society of the State of New York is opposed to this measure.  MSSNY staff has been discussing the implications of this measure with Senators and Senate staff and its effect on prescribers who may have already taken course work to meet the requirement.   Physicians and other health care providers who have a DEA license were required to take a three hour course on pain management, palliative care, addiction that included the state and federal requirement for prescribing controlled substances, appropriate prescribing, managing acute pain, palliative medicine, prevention, screening and signs of addiction, responses to abuse and addiction and end of life care.

This requirement passed the Legislature in 2016 and physicians were required to have taken this program by July 1, 2017.  The law also requires that DEA prescribers take the course every three years—2020 is the start of a new cycle and physicians are again required to take this course.      (CLANCY)


MSSNY Opposes Legislation to Allow Estheticians & Others to Perform Laser Hair Removal
A bill (S.2834/A.821) that would allow estheticians, and others, to perform laser hair removal with only minimal physician oversight, was reported out of the Senate Committee on Consumer Protection at its first meeting of 2020, on Tuesday, January 14. MSSNY has long opposed this legislation as it would essentially legitimize a currently unregulated practice to perform a procedure that should only be done by an appropriately trained and educated individual, under physician supervision.

MSSNY indicated in its’ memo of opposition that it appreciates the intent of the legislation to increase safety and oversight and is working with the sponsors to make changes to the bill that establishes critical physician oversight and ensures patients’ safety.          (CARY)


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Partial Fill Prescribing Moves Forward in Senate
Legislation that would enable the dispensing of a partially filled controlled substances prescription, is moving forward quickly and is now on the Senate calendar for a vote.  The measure, S. 7115/A.9034, sponsored by Senator Gustav Rivera and Assemblymember John McDonald, would allow a prescriber to issue a partially filled prescription for a Controlled Substance II, III, IV, V to a patient.  The prescription would be recorded in the same manner as a refill and the remaining quantity of the prescription may be dispensed separately.

In 2016, Congress passed legislation that would enable partial fill prescription under the Comprehensive Addiction and Recover Act (CARA).  This state measure would allow New York State to conform to what is allowable under federal law.   A similar measure had passed during the 2019 legislative session, but was vetoed by Governor Andrew Cuomo.  This new bill addresses concerns expressed by the administration in its veto message. The Medical Society supports this measure and believes that it will help to reduce the amount of unused pain medication and will allow prescribers to help patients balance the need to relive pain with an adequate supply of medication.   (CLANCY)


Physicians Ordering Home Care for Your Patients – Are You Aware of the Impact of the New Medicare PDGM Methodology?
Physicians should be aware that Medicare has just implemented a new system for how it pays for patient home care services through a new methodology known as the Patient-Driven Groupings Model (PDGM).  The PDGM relies more heavily on clinical characteristics and other patient data to classify home health services into defined payment categories. While part of CMS’ effort to shift Medicare payment away from volume-based payment towards value-based payment, it could also produce new documentation responsibilities for physicians.

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

The Home Care Association of New York State has shared with MSSNY a suite of resources for physicians interested in learning more about the PDGM.  To read more about what physicians ordering home care services need to know about this program, please review: Brochure  and Physicians Toolkit Guide

At the November 7, 2019 meeting of the MSSNY Council, a resolution was adopted to monitor implementation of the PDGM “to determine whether this new program will impose additional administrative burdens on physicians certifying home care services for their patients, and/or whether it will impede patients from receiving needed home care services”.  To that end, please let us know if this system is causing new difficulties in ensuring your patients get the home care services they need.         (AUSTER)


Registration now open for Medical Matters: Virtual Drill: Incident Command System & Crisis Communications
MSSNY’s next Medical Matters will feature a Virtual Drill on the Incident Command System and Crisis Communications on February 19th from 6:00-8:00pm. Faculty for this program are: Arthur Cooper, MD; Pat Anders, MS, MEP; William Valenti, MD and Lorraine Giordano, MD.

Educational Objectives are:

  • Obtain information about local, state and national chain of command in a public health emergency and learn how to access resources
  • Understand the importance of planning for medical surge and triage of patients, as well as staff and family considerations, in the office-based practice setting during a health emergency
  • Develop an understanding that all public health emergencies can potentially have mental health implications for survivors and others connected with the event
  • Acquire skills for the management of patients in a public health emergency

Please note that there are recommended pre-course materials to be viewed prior to this virtual drill. You will be sent a link with your registration confirmation. We encourage all participants to examine these prior to the Virtual Drill.  Register by clicking   here Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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

The Medical Society of the State of New York designates this live activity for a maximum of 2.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  zcary@mssny.org
rali@mssny.org

 

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Three US Airports (JFK Included) Screen for Novel Virus from China
Today, in response to an outbreak of novel coronavirus, public health screening will begin at three major U.S. airports that receive travelers from Wuhan, China, the CDC announced. Starting today, airports in San Francisco (SFO), New York (JFK), and Los Angeles (LAX) will screen for symptoms associated with this virus in travelers arriving from direct or connecting flights from Wuhan, where the outbreak originated, the agency said in a statement.

Officials said that they expect to see cases of this novel virus “around the world” as people start to look for it more and that it is highly plausible at least one case will occur in the U.S.

Screening will begin Friday night at JFK for a flight that arrives around 10 p.m., CDC officials said in a conference call on Friday. JFK is one of two airports, along with SFO in San Francisco, that receive travelers on flights directly from Wuhan. Officials said that LAX was included because of the large volume of passengers coming from indirect flights.

Passengers will be screened about symptoms and fever at the airport and people of concern will be triaged for evaluation, including a more detailed exam and questions about exposures. Then, they will be referred to a facility where, ultimately, diagnostic tests can be performed. CDC said its lab “already has the ability to identify the pathogen,” with the exact sequence of the virus, which is publicly available. They added that they are working on a test to identify the virus to distribute to state health departments.

In the statement, CDC said it is deploying about 100 additional staff at the three airports to supplement staff at CDC quarantine stations.


SIGN UP TO RECEIVE ALERTS FROM MSSNY’S GRASSROOTS ACTION CENTER 

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When you subscribe to the Medical Society of the State of New York Grassroots Action Center, the Division of Governmental Affairs will alert you when legislation and issues of importance to physicians and patients, either in the NYS legislature or in Congress, are at critical stages.

Accordingly, contact from constituents would be vital to influencing the path and future of that legislation or issue.

Alerts will be accompanied by recommended actions you or your designee can take to have maximum impact such as calling, tweeting and emailing a customizable letter to your legislators.

If you are concerned with health care policy formation in New York State, please subscribe today by texting MSSNY to 52886 and you will be prompted to enter your email address.  When you sign up, it is best to use your NY-based voting address or practice address (if you do not reside in NY) for your alerts.

Contact the Division of Governmental Affairs at 518-465-8085 or albany@mssny.org if you have questions or comments.  Thank you.
(WILKS)


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Survey: Gen-X physicians More Likely to Report Burnout
Physicians ages 40 to 54, grouped together as Generation X, were more likely to report feeling burned out than the millennial and baby boomer doctors surveyed by Medscape in its latest report on job-related stress and suicide risk among doctors.

The survey was completed by about 15,000 physicians in 29 specialties. Medscape defines burnout as “long-term, unresolved, job-related stress leading to exhaustion, cynicism, detachment from job responsibilities and lacking a sense of personal accomplishment.”

Dr. Carol Bernstein, vice chair of faculty development and well-being at Montefiore Medical Center and the Albert Einstein College of Medicine, said in the report that the midcareer period, which Gen Xers are in, can be particularly stressful.

“In addition, I suspect that group is juggling multiple roles outside of work, including caring for children as well as elderly parents, and working as well as planning for retirement,” Bernstein said in the report.

Overall, the rate of physician burnout, at 42%, has fallen slightly from a rate of 46% five years ago. Forty-eight percent of women said they felt burned out, compared with 37% of men. About half of physicians said they would take a pay cut if it meant more free time.

Doctors said bureaucratic tasks such as charting and long hours were leading drivers of stress.

Specialists in urology, neurology and nephrology reported the highest rates of burnout, with about half of those respondents saying they have experienced it. (Crain’s Health Plus Jan. 15) Public health and preventive medicine doctors, ophthalmologists and orthopedists reported the lowest rates, approximately 3 in 10.


First Study by CDC: Evidence of Links Between Lung Injury with Use of E-Cigarettes
The Centers for Disease Control and Prevention said Tuesday that a new study, along with state-based evidence, strengthens the link between lung injury associated with the use of e-cigarettes or vaping products and the use of THC-containing products obtained from informal sources, including family and friends as well as online sellers.


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Statistics Indicate Alcohol Use Been Rising for Two Decades
The AP (1/14) reports a new federal health statistic indicates “Americans are drinking more now than when Prohibition was enacted;” moreover, “it’s been rising for two decades, and it’s not clear when it will fall again.” The stats “show a rise in per-person consumption and increases in emergency room visits, hospitalizations and deaths tied to drinking,” but teen drinking is down. The article details history of alcohol use in the U.S., and cultural attitudes surrounding drinking.

The Hill (1/14) reports “Americans drink, on average, 2.3 gallons of alcohol per year in the form of beer, wine and mixed beverages, according to a new analysis of federal health statistics.” This “news comes just a day after it was announced by beverage industry trackers that U.S. wine consumption dropped in 2019 for the first time since 1994.”



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As of December 5, 2019, Influenza is Prevalent in NYS
At this time, Section 2.59 of the New York State Sanitary Code (10 NYCRR § 2.59) requires all health care and residential facilities and agencies regulated pursuant to Article 28, 36, or 40 of the Public Health Law to ensure that all personnel, as defined in the regulation, not vaccinated against influenza for the current influenza season wear a surgical or procedure mask while in areas where patients or residents are typically present. https://www.health.ny.gov/diseases/communicable/influenza/seasonal/providers/prevention_of_influenza_transmission/ See Influenza Activity, Surveillance and Reports for to access the full weekly report. For information about the “flu mask regulation” and the current status of the Commissioner’s declaration, please visit www.health.ny.gov/FluMaskReg. Download the data used in this dashboard at Health Data NY.


Pan-Resistant Candida auris in New York Detailed
Three cases of pan-resistant Candida auris in New York highlight the need for continued C. auris surveillance, researchers write in MMWR.

From August 2016 through June 2019, some 800 cases of C. auris were identified in the state. Of isolates that underwent susceptibility testing, nearly all were resistant to fluconazole, two-thirds to amphotericin B, and 4% to echinocandins. For three patients, isolates were resistant to all three antifungal classes:

  • The three patients were 50 or older with multiple comorbidities; none had traveled recently.
  • Pan resistance appeared to develop after treatment with echinocandins, the first-line treatment for C. auris.
  • There was no epidemiologic link among the three.
  • These patients did not appear to transmit pan-resistant C. auris to others or to the environment.

The authors advise, “Patients on antifungal treatment for C. auris should be monitored closely for clinical improvement, and follow-up cultures should be obtained. Repeat susceptibility testing should also be conducted, especially in patients previously treated with echinocandins.”

MMWR article (Free)
Background: HIV and ID Observations post on C. auris and antimicrobial resistance (Free)


DEA Data: More Than 100 Billion Pain Pills Saturated the Nation Over Nine Years
The Washington Post (1/14) reports that data from the Drug Enforcement Administration “shows that more than 100 billion doses of oxycodone and hydrocodone were shipped nationwide from 2006 through 2014 – 24 billion more doses of the highly addictive pain pills than previously known to the public.” In July, The Post “reported that the data revealed that the nation’s drug companies had manufactured and distributed more than 76 billion pain pills.” The “two additional years of information – 2013 and 2014 – was recently posted by a data analytics company managed by lawyers for the plaintiffs in a massive lawsuit against the opioid industry.”



press conference on January 13
Dr. Gregory Threatte, president of the Albany County Medical Society and Dr. Art Fougner, MSSNY President, participated in a press conference on January 13 calling for the elimination of all flavored e-cigarettes and tobacco products, including menthol flavors.   Dr. Hazel Dukes, President of the NAACP New York State conference, Senator Brad Hoylman, Assemblymembers Linda Rosenthal, Rodneyses Bichotte and Tremaine Wright, joined with more than 40 organizations from across the state to call for a full and immediate end to the sale of flavored tobacco products in NYS.

Doctors and NAACP President: Ban All Forms of Flavored Tobacco
Public health officials, leaders of the state NAACP and other advocates urged Albany lawmakers on Monday to target all forms of flavored tobacco — including menthol combustible cigarettes — in their expected crackdown on vaping.

With the Senate and Assembly set to advance a package of e-cigarette bills as early as next week, advocates said that menthol cigarettes, smokeless tobacco, hookah and other products should be included in any statewide flavor ban.

“Don’t confuse the delivery device with the underlying toxin,” Gregory Threatte, president of the Medical Society of the County of Albany, told lawmakers during an afternoon news conference at the Legislative Office Building.

Hazel Dukes, president of the NAACP New York State Conference, argued that a ban on all flavored tobacco products “is long overdue” given the industry’s history of using these products to target children and minorities.

“This is nothing new,” she said at the news conference. “The device may have evolved but the deceptions have not. For generations the tobacco industry has been targeting our youth, and particularly African American kids, with flavor products, especially menthols.”

Dukes urged lawmakers to “immediately end this immoral, discriminatory practice of targeting kids” by ending sales of all flavored tobacco products in New York.


CMS

Upcoming QPP Service Center Hold Times
Due to the opening of the 2019 MIPS data submission period, the Quality Payment Program (QPP) Service Center is projecting an increase in volume of calls and emails between January and March 2020, resulting in longer wait times.

CMS recommends the following to minimize wait times and ensure successful 2019 submission:

  • Use One Method to Report Issues— Due to the increase in volume at the QPP Service Center, to minimize backlog, please use only one method of reporting for the same issue (email or phone). Note: Cases are processed in the order in that they are received regardless of the manner in which the Service Center was contacted. Please allow time for processing.
  • Submit Your Data Early— We encourage you to submit your 2019 MIPS performance period data early during the submission period. Early submission will allow you plenty of time for Service Center assistance if needed.
  • Call the Service Center at Off-Peak Hours— We strongly recommend calling the Service Center during off-peak hours (8:00 AM-10:00 AM ET OR 2:00 PM-8:00 PM ET).

For More Information

  • Visit the QPP Resource Library to review new and existing QPP resources.
  • Contact the Quality Payment Program at 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov. Reminder: to receive assistance more quickly, consider calling during non-peak hours—before 10:00 AM and after 2:00 PM ET.
  • Customers who are hearing impaired can dial 711 to be connected to a TRS Communications Assistant.

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

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

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

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

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

 

MSSNYeNews: A Hard Rain’s A ‘Gonna Fall – January 10, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
January 10, 2020

Vol. 23  Number 2


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Colleagues:

As I wing my way toward the AMA’s State Legislation Advocacy Meeting in Florida, I keep thinking about Governor Cuomo’s State of the State speech. While there are things we most certainly can support, when he got to healthcare, the tone shifted. As I wrote previously, Medicaid is the largest item responsible for NY’s $6B budget deficit. The Governor had already cut payments 1%, but he went further. He blamed local spending for much of the problem and offered that his initial Medicaid Redesign would need Redesign.

We also learned that he would propose legislation to boost OPMC and physician discipline. As it so happens, on Monday, MSSNY will be meeting with DOH and OPMC and will learn more about specifics.

All too often, we hear about physician burnout, physician suicide and how physician wellness is on the DOH agenda. It appears ironic to talk about burnout and wellness when the state is cutting payments and talking about streamlining physician discipline. If physicians feel that someone has stuck a “Kick Me” sign on their backs, it is understandable. Medicine has become a profession of Rodney Dangerfields. I can hear him now – “When I see patients, I get no respect. After Press Ganey gets me, the Insurers, Trial Lawyers and Government get their licks in, too.”

Getting physicians to join together has been likened to herding cats. However, in the coming weeks and days, we all really do need to band together. Stay tuned to MSSNY updates as many devilish details remain to be hashed out. Trust me, this is serious. If we don’t work collegially and collectively, we are sunk. The 1% Medicaid Cut was but a test of our resolve. Far worse may be coming down I-87.  Please consider this year’s March 4th Lobby Day in Albany, our day to make them hear all of us. I call on all NY’s physicians, Medical Staff Societies, Specialty Societies, Ethnic Societies to text MSSNY to 52886 to get our Grassroots alerts and updates. Also, please contribute to our MSSNY-PAC as well. No contribution is too small. We need all the help we can get. Quoting David Byrne as I have previously: “This ain’t no party. This ain’t no disco. This ain’t no foolin’ around.”

And it’s a hard, it’s a hard
It’s a hard, it’s a hard
It’s a hard rain’s a gonna fall.
Bob Dylan, A Hard Rain’s A Gonna Fall

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

Arthur Fougner, MD
MSSNY President


Capital Update

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Governor Cuomo Proposes Changes to OPMC Processes; MSSNY Expresses Strong Objections
Governor Cuomo released his 36th proposal as part of a package of policy changes in 2020. The plan calls for changes in the way that DOH investigates, disciplines and monitor physicians, physician assistants and specialist assistants licensed in New York. Details of the proposed changes include:

  • Making investigations public “when the Commissioner of Health deems it warranted”, as well as, making administrative warning actions public.
  • Eliminating lifetime licensure to ensure out of state physicians with a NY license periodically renew.
  • Amend the Public Health law to allow the State Health Commissioner to suspend a physician’s license, at the start of an investigation, if the commissioner deems that physician to be a risk to the public. This would be a lessened standard from the current “imminent danger” standard currently required for a summary suspension.

In response, MSSNY released the following statement:  “New York’s Physicians have a great interest in working with the State Health Department to ensure that New York’s disciplinary process moves swiftly when necessary to remove those from practice that present a threat to the public. To that end, we have worked proactively with the administration and legislature on laws to enhance the ability of OPMC to “summarily suspend” physicians in certain instances where it would be imprudent to wait for a final action. And it is imperative that we work for improvements to this system as issues arise that interfere with its mission to protect the public.

At the same time, an appropriate balance is needed. Recognizing that there are enormous professional implications when disciplinary action is taken against a physician, or even when there has been an accusation, we must also ensure that fair due process is provided when a physician is accused of professional misconduct. Indeed, most complaints of alleged misconduct do not become actual findings of misconduct. Yet with Google and Yahoo search functions, an unproven allegation could linger forever in cyberspace, and permanently and unfairly scar a reputation. We look forward to reviewing the text of this proposal as it becomes available and working with the Legislature and Governor to ensure we maintain the critical balance of protecting the Public while also protecting against the consequences of unfounded allegations.”

MSSNY Division of Governmental Affairs Staff will keep our members updated as discussions move forward, in the coming months, in Albany.                               (DIVISION OF GOVERNMENTAL AFFAIRS)             


Governor Cuomo Outlines 2020 Health Priorities at State-of-the-State
On Wednesday, January 8th, members of the New York State Senate, Assembly, and other governmental dignitaries, gathered in the Convention Center for Governor Cuomo’s State-of-the-State speech, where he outlined his 2020 agenda, including his health priorities. MSSNY will likely support many of these initiatives, while other items raise serious concerns, at first glance, and require close monitoring, this session. The following is the full list of issues MSSNY Staff will closely follow, and potentially take action if necessary, in the coming months:

  • Proposal for legislation to address the OPMC disciplinary process that would enact periodic renewal requirements for New York physicians, physician assistants and specialist assistants to maintain their licenses and ability to practice in the state if they practice out of state. He will also seek to update the public health law to strengthen disciplinary oversight and allow for quick removal of providers who present a risk to patients; ensure the public can access up-to-date information about physicians and any professional conduct concerns; and give the Office of Professional Medical Conduct authority to increase patient safety and physician accountability.
  • Reducing the small business tax from 6.5% to 4%.
  • Expands Access to Buprenorphine, an important advance in Medication Assisted Treatment, which, like methadone and injectable naltrexone, is used in combination with counseling, to help people reach and sustain recovery from Opioid Use Disorder.
  • Governor Cuomo will direct the Department of Health (DOH), to require all hospitals statewide to develop protocols for their emergency departments to address Opioid Use Disorder based on the standard of care for treatment or referral for treatment. The Enacted Budget also prohibits health plans from requiring prior authorization for Medication Assisted Treatment.
  • Legalizing Gestational Surrogacy Current state law creates legal uncertainty for parents of children conceived by reproductive technology. The governor’s proposal establishes criteria for surrogacy contracts, providing for the nation’s strongest protections for parents and surrogates. His proposal will also streamline the “second parent” adoption process, removing outdated barriers and extending common-sense protections for New York families.
  • A proposal to legalize recreational marijuana.
  • Proposal to ban all flavored nicotine vaping product, including menthol flavors. The governor has also proposed banning vaping advertisements aimed and youth and to authorize the NYS Department of Health to regulate the sale of chemicals used in vaping-related products and ban the sale of vaping product carrier oils deemed a hazard to public health. His proposal also includes legislation that would prohibit the online, phone and mail order sale of e-cigarettes and would require that only registered retailers be allowed to purchase e-cigarettes using these methods.
  • Legislation to crack down on retailers that illegally sell untaxed cigarettes and other tobacco products in New York State. Under the Governor’s proposal, retailers who acquire untaxed cigarettes from other states or other sources and sell them illegally in New York would face possible closure. The Governor is also proposing strengthening penalties and fines for retailers that sell tobacco products to people under 21 years of age.
  • A proposal for the Department of Health, the Department of Financial Services, and the New York State Digital and Media Services Center- a joint enterprise of the Office of Information Technology Services and Office of General Services – to create a consumer-friendly website, called NYHealthcareCompare, where New Yorkers can easily compare the cost and quality of healthcare procedures at hospitals around the state. The platform will also provide consumers with educational resources designed to help consumers know their rights including financial assistance options, what to do about a surprise bill and more.
  • Require the registration of all PBMs and oversight by DFS.
  • Proposal to develop a three part plan to lower prescription drug costs for all New Yorkers. The Governor’s proposal would cap insulin co-payments at $100 per month for insured patients to help address the rising cost of insulin that has resulted in diabetes patients rationing, skipping doses and not filling prescriptions.
  • A call for legislation banning fentanyl analogs — a deadly synthetic opioid that is 50 to 100 times more potent than morphine — by making them subject to the same criminal sale or possession penalties as other controlled substances. The legislation will also empower the New York State Health Commissioner to ban any new fentanyl analogs that have been added to the federal schedule of controlled substances, allowing the State to deal with these deadly substances in real time rather than play catch up.
  • A proposal calling for legislation to prevent individuals from receiving New York State gun licenses if they commit a crime in another state that is similar to a crime that would disqualify them from owning a gun in New York State. New York law currently prohibits individuals from obtaining a gun license if they commit certain New York misdemeanors that are deemed “serious offenses.” However, the law does not prohibit individuals from obtaining a New York gun license after committing comparable misdemeanors in another state.
  • Expanding the surprise bill law to: prohibit billing of patients by out of network physicians and hospitals for emergency care for amounts above the applicable cost-sharing amounts; and to require disclosure of facility fees to patients in Article 28 and Office-Based surgery settings.

Proposed Cuts to Medicaid
On January 1, 2020, Governor Cuomo implemented a 1% across-the-board cut to the state’s Medicaid program & we anticipate additional proposed reductions to the program when his budget is released. The Governor did not provide more details about his plans to address the $6 Billion Budget deficit, except for his goal to convene a new Medicaid Redesign Team (MRT). More details will come when Governor Cuomo releases in his New York State Budget on this cut and the other proposals contained in his State of the State. MSSNY Division of Governmental Affairs staff will follow with more information as it becomes available. At this time, it is unclear whether each of these initiatives will be pursued in the State Budget or through stand alone “program” legislation.
(DIVISION OF GOVERNMENTAL AFFAIRS)        


MSSNY Calls for a Reversal of Medicaid Cut; Please Join Our Efforts
MSSNY joined several other specialty societies and health care provider associations in a letter to Governor Cuomo this week urging that the recently enacted 1% cut to Medicaid physician payments be reversed.  The letter noted that “The State’s Medicaid program has not adequately reimbursed for increased costs and critical policy initiatives since the Medicaid Redesign Team (MRT) changes began to take effect” and that “In spite of these cost increases in the past decade, providers have not had a trend factor to recognize the basic expenses of providing care to the poor, elderly and disabled in our State.”

In MSSNY’s own statement on this cut (click here for MSSNY statement), MSSNY President Dr. Art Fougner noted that physicians are “confounded by the announced cuts”, given that “Medicaid physician payment remains a very small part of New York’s overall Medicaid Budget” and that “New York has one of the lowest Medicaid to Medicare physician payment ratios in the country”. With New York State facing a $6 Billion Budget deficit for the 2020-21 fiscal year, further steep cuts could be proposed in the soon-to-be released Governor’s Executive Budget.  Physicians are urged to contact their legislators to act to reverse these cuts, and prevent further cuts. click here.                                                                        (AUSTER)


Senate Health Committee To Act on Package of Bills Regarding E-Cigarettes
On Monday, January 13th, the Senate Health Committee will take action on several legislative e-cigarette proposals.  S. 428B, sponsored by Senator Brad Hoylman, which would prohibit the sale and distribution for use in e-cigarettes.  S. 3905A, sponsored by Senator Gustav Rivera, which would regulate electronic cigarettes in the same way as tobacco products to prevent access to products by persons younger than 21 years.  S. 4249A, sponsored by the Senator Monica Martinez, which would create restrictions for the locations of tobacco stores and electronic cigarette stores to be at least 200 feet away from a school or place of worship.

The Medical Society of the State of New York supports banning all flavored e-cigarettes, including menthol and supports legislation that would also ban all flavored tobacco products, such as chewing tobacco and cigarillos.  On January 13th, MSSNY President Arthur Fougner, MD, and Gregory Threatte, MD, President of the Albany County Medical Society will participate in an Albany press conference on e-cigarettes with members of the Legislature and will join with other public health groups, in advocating for measures that would prohibit the sale of flavored tobacco products and e-cigarettes, including menthol.   

In December,  MSSNY has joined with other public health organizations that called upon the Governor, the Senate and Assembly leaders, and members to pass legislation that would prohibiting the sale of flavored nicotine and tobacco products which will protect our young people from the scourge of the myriad health problems and addictions caused by flavored tobacco products and e-cigarettes. Physicians are encouraged to send a letter through MSSNY Grassroots Action Center (GAC)  here.>
(CLANCY)


Legislation to Expand Mandate For Pain Management for All DEA Prescribers
A measure that would expand the coursework under the pain management requirement will be acted upon by the Senate Health Committee next week.  S. 7102, sponsored by Senator Brian Benjamin, would include requirements that would reduce the likelihood of overdose and spread of blood-borne diseases by those who use drugs; medications used for the treatment of addiction and information about becoming a buprenorphine prescriber.  Additionally, the bill requires prescribers to update standards and approvals as necessary according to best practices for providing patient centered care with the consideration of social determinants of health and co-occurring disorders.

The Medical Society of the State of New York is opposed to this measure.  Physicians and other health care providers who have a DEA license were required to take a three hour course on pain management, palliative care, addiction that included the state and federal requirement for prescribing controlled substances, appropriate prescribing, managing acute pain, palliative medicine, prevention, screening and signs of addiction, responses to abuse and addiction and end of life care.

This requirement passed the Legislature in 2016 and physicians were required to have taken this program by July 1, 2017.  The law also requires that DEA prescribers take the course every three years—2020 is the start of a new cycle and physicians are again required to take this course.  MSSNY is in the process of updating its current pain management program and it will be available by spring. (CLANCY)


MSSNY Opposes Legislation to Allow Estheticians & Others to Perform Laser Hair Removal
A bill that would allow estheticians, and others, to perform laser hair removal with only minimal physician oversight, was reintroduced in 2019 and is on the agenda for next week’s Senate Committee on Consumer Protection. MSSNY has long opposed this legislation as it legitimizes in statute a currently unregulated practice to perform a procedure that should only be done by an appropriately trained and educated individual, under physician supervision. Procedures involving lasers have the potential to cause painful burns and permanent scarring if not used properly.

A 2013 article in the Journal of the American Medical Association (JAMA) reported on a study that showed that, despite the fact that approximately only 1/3 of laser hair removal procedures are performed by non-physicians, 75.5% of hair removal lawsuits from 2004 to 2012 were performed by non-physicians, and that from 2008 to 2012, this percentage increased to 85.7%. MSSNY appreciates the efforts of the sponsors to provide greater regulation of a currently unregulated practice, but in its current form, MSSNY opposes this legislation. We will continue to work with the sponsors to ensure the bill is amended to establish necessary oversight of this practice and to ensure patients’ safety.                      (CARY)


Barclay Elected as New Assembly Minority Leader
Assemblymember Will Barclay (R-Pulaski) has been elected by the Assembly Republican Conference as the new Minority Leader of the New York State Assembly.  Assemblyman Barclay previously served as Ranking Member of Assembly Ways & Means Committee and, prior to that, as Ranking Member of the Assembly Insurance Committee.  He replaces Assemblymember Brian Kolb in this post.  MSSNY congratulates Assemblymember Barclay on this new position, and looks forward to working with him.                                          (AUSTER)


AG James Stops Public Charge Rule From Taking Effect
The United States Court of Appeals for the Second Circuit denied the Trump Administration’s efforts to immediately reverse preliminary injunction on the president’s Public Charge Rule. In September 2019, Attorney General James filed a motion to seek a preliminary injunction to stop the Trump Administration’s public charge rule from going into effect. In August 2019, Attorney General James and a coalition that included the attorney general of Connecticut and Vermont, as well as the City of New York filed a lawsuit challenging the Trump Administration’s Public Charge rule which aimed to deny green cards and visas to immigrants who use government assistance programs.

The preliminary injunction seeks to stop the public charge rule from taking effect arguing that it would harm millions of non-citizens and their family members by deterring them from accessing public benefits that they are lawfully entitled to receive. As New York braces to confront the $6 billion dollar budget gap with DOH’s decision to cut Medicaid payments by 1% in 2020 as well as overall Medicaid enrollment decline, individuals who would have otherwise had access to healthcare are at risk of living with undiagnosed and untreated conditions.                                                                              (ALI)


SAVE THE DATE: MSSNY‘s Annual “Physician Advocacy Day” (3/4)
On January 8th the New York State Legislature welcomed back returning members to Albany! As the new session begins, the need for physician advocacy and grassroots involvement is greater than ever.  Physicians can sign up to participate in MSSNY’s “Physician Advocacy Day” which will be held on Wednesday, March 4th in the Lewis Swyer Theatre in the Egg, Empire State Plaza, Albany NY. Click here to register!

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

A brief luncheon to which members of the NYS Legislature are invited to speak with their constituents will follow the morning program. County medical societies will also be scheduling appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Raza Ali at rali@mssny.org.                                                               (ALI)


“Doctor Are You Ready?” CME Webinar on January 15; Registration Now Open
Disasters big and small happen every day.  Be sure to find out how best to be prepared at MSSNY’s next Medical Matters webinar: Doctor Are You Ready? on January 15th at 7:30am.  Kira Geraci-Ciardullo, MD, MPH immediate past speaker of the house and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here

Educational objectives are:

  • Explore core preparedness competencies every physician should possess
  • Describe emergency situations that arise on a regular basis
  • Identify resources to acquire preparedness training

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

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

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


MSSNY & St. Peter’s Health Partners to Host Four Grand Rounds Seminars
The Medical Society of the State of New York and St. Peter’s Health Partners are providing four CME live seminars for the Veterans Matters programs. The following seminars will take place at St. Peter’s Hospital in Mercy Conference Rooms 1 – 4, 315 S Manning Blvd, Albany, NY 12208.

  • The Special Mental Health Needs of Women Veterans
        When: January 15, 2020 at 7:00 am
    Faculty: Malene Ingram, MD (Col., US Army Reserves)
  • Substance Use Disorders (SUDs) in Veterans
        When: January 22, 2020 at 7:00 am
    Faculty: Thomas Madejski, MD
  • PTSD in Returning Veterans
        When: January 29, 2020 at 7:00 am
    Faculty: Adolph Meyer, MD
  • Military Culture: Everything Physicians Need to Know about Veterans as Patients
        When: February 5, 2020 at 7:00 am
    Faculty: Lt. Cl. Lance Allen Wang

Reservations can be made by contacting Lori Weaver at Lori.Weaver@sphp.com or (518) 874-6914. Please click here to view the flyer.

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

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


eNews

TODAY!
MSSNY Responds To Gov.’s Statement on Physician Discipline Proposal
“New York’s Physicians have a great interest in working with the State Health Department to ensure that New York’s disciplinary process moves swiftly when necessary to remove those from practice that present a threat to the public.  To that end, we have worked proactively with the Administration and Legislature on laws to enhance the ability of OPMC to “summarily suspend” physicians in certain instances where it would be imprudent to wait for a final action. And it is imperative that we work for improvements to this system as issues arise that interfere with its mission to protect the public.

At the same time, an appropriate balance is needed. Recognizing that there are enormous professional implications when disciplinary action is taken against a physician, or even when there has been an accusation, we must also ensure that fair due process is provided when a physician is accused of professional misconduct.  Indeed, most complaints of alleged misconduct do not become actual findings of misconduct. Yet with Google and Yahoo search functions, an unproven allegation could linger forever in cyberspace, and permanently and unfairly scar a reputation.  We look forward to reviewing the text of this proposal as it becomes available and working with the Legislature and Governor to ensure we maintain the critical balance of protecting the Public while also protecting against the consequences of unfounded allegations.”


MSSNY President Criticizes Governor Cuomo’s Medicaid Cuts
Politico Pro (1/6) reports that healthcare providers, insurers, and others are pushing back against “the state’s new 1 percent across-the-board reduction in Medicaid spending” calling for Gov. Cuomo “to take a more targeted approach as it looks to close a $4 billion budget gap in the coming months.”

Dr. Art Fougner, the president of the Medical Society of the State of New York (MSSNY), said,Physicians are confounded by the announced cuts to their payments for care delivered to Medicaid beneficiaries… This is particularly difficult to accept given that they were not the beneficiaries of increases to Medicaid payments recently granted to other parts of the health care system. In fact, Medicaid physician payment remains a very small part of New York’s overall Medicaid Budget.”


WSJ: Former MSSNY President Warns Risks of Expanding Marijuana Industry
In a letter for the Wall Street Journal (1/6) former President of the Medical Society of the State of New York Dr. Thomas J. Madejski, wrote:

Regarding your editorial “The Vaping-Marijuana Nexus” (Dec. 26): Tobacco, marijuana and vaping companies mislead the public on the clear harms associated with wider use of today’s higher-THC-content marijuana and inhaling substances other than clean air. Opponents of expansion of marijuana availability acknowledge concerns about disparate enforcement of drug laws. But the costs to society from legitimizing the addiction industry far outweigh the benefits. Meanwhile, proponents of recreational marijuana push the false narrative of a tax windfall for governments and improved safety for users while ignoring the harms: mental-health issues, addiction, acute and chronic lung disease, domestic violence and more.”

Thomas J. Madejski, M.D.
Albion, N.Y.
Jan. 7, 2020
Dr. Madejski Is the Immediate Past President of MSSNY.


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Staten Island Hospital Opens Opioid Treatment Center for Teens, Young Adults
Richmond University Medical Center in Staten Island has opened a medication-assisted treatment center for people ages 16 to 24 who are struggling with opioid-use disorder.

The center, funded by a Statewide Health Care Facility Transformation Program grant, is in the Center for Integrative Behavioral Medicine, also known as the Silberstein Clinic, at 1130 South Ave.

The opening comes about a year after the Staten Island Mental Health Society became a division of the medical center in a merger.

A substance-use program has existed for adolescents ages 11 and older and their families, said Dr. Joel Idowu, chairman of psychiatry and behavioral health sciences at the medical center. However, he said, older people with opioid-use disorder also can benefit from medication-assisted treatment.

The treatment “offers something that frees you to be able to go to work and live your life like any other person,” Idowu said. “The medication is effective and helps people to stay sober, and it reduces the risk of overdose.”

An injectable form of one such medication, buprenorphine, is available through the new program, he said, adding that it comes in convenient monthly doses.

For most patients, insurance covers the treatment.

The medical center noted in a filing with the state that opioid misuse, including heroin misuse, among adolescents and young adults has “risen dramatically in the past two decades.” However, it said, treatment capacity for the population remains “extremely low,” and Staten Island has the highest incidence of opioid use and related deaths in the city.

The new program is aimed at addressing those gaps in care and aligning with the state’s Medicaid reform priority of integrating medication-assisted treatment into primary-care settings. (Crains’ Health Plus) Jan 6


NYS Flu Statistics for Week of January 4
During the week ending January 4, 2020

• Influenza activity level was categorized as geographically widespread. This is the sixth consecutive week that widespread activity has been reported.
• There were 10,085 laboratory-confirmed influenza reports, a 9% increase over last week.
• The number of patients hospitalized with laboratory-confirmed influenza was 1,964, a 34% increase over last week.
• There were no influenza-associated pediatric deaths reported this week. There has been one influenza-associated pediatric death reported this season.
https://www.health.ny.gov/diseases/communicable/influenza/surveillance/2019-2020/flu_report_current_week.pdf

Widespread Flu Activity Reported in 46 States

As of the last week of December, “widespread” flu activity was reported by health departments in 46 states. More ominously, a second measure — the percentage of patients with flu symptoms visiting medical clinics — shot up almost to the peak reached at the height of the 2017-18 flu season, which was the most severe in a decade. About 61,000 Americans died of flu that season, the CDC said. (The original estimate of 79,000 was revised downward last year; the agency said the number changed as more death certificate information became available.)

This year’s flu vaccine may not be particularly effective against the strain of the virus now widespread in the United States, experts said. According to the CDC, it is worth getting the shot because people who are vaccinated fare better if struck by the flu than those who are not.


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CDC Updates Guidelines for Discharging Vaping Patients
After a new study found at least one quarter of vaping-related rehospitalizations and deaths occurred within two days of discharge, the CDC now recommends outpatient follow-up within 48 hours, according to the CDC’s Morbidity and Mortality Weekly Report published Jan. 2.

A recent analysis of previously hospitalized EVALI patients found common comorbidities among patients who were readmitted or died after discharge. The findings prompted the CDC, in consultation with the Lung Injury Response Clinical Working Group, to revise EVALI patient guidelines, which previously recommended outpatient visits within two weeks of discharge.

Guideline updates for providers include:

  1. Confirming that vital signs have not significantly changed for at least 24 to 48 hours before discharge.
  2. Ensuring outpatient primary care or pulmonary specialist follow-up, ideally within 48 hours of discharge.
  3. Planning discharge care, early follow-up and management of any comorbidities.
  4. Following best practices for medication adherence.
  5. Ensuring access to mental health and substance use disorder services.

US Cancer Death Rates See Largest Single-Year Drop on Record
Overall cancer death rates in the U.S. fell by 2.2 percent from 2016 to 2017, the largest single‐year drop ever recorded, according to a report from the American Cancer Society. The annual report estimates the numbers of new cancer cases and deaths expected this year. It also compiles the most recent data on cancer occurrence from the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries and the North American Association of Central Cancer Registries.


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CMS

CMS Releases MIPS Results for 2018: 5 Things to Know
CMS published 2018 results for the Merit-Based Incentive Payments System program Jan. 6.

Five things to know about the results:
1. CMS Administrator Seema Verma said 2018 participation in MIPS, created under the 2015 Medicare Access and CHIP Reauthorization Act, exceeded participation rates in 2017.
2. More clinicians will receive a positive payment adjustment compared to the 2017 performance year, with nearly all eligible clinicians participating in MIPS getting a payment boost in 2020.
3. In total, 889,995 clinicians saw a MIPS payment adjustment, whether negative, neutral or positive. Ninety-eight percent of those clinicians will receive a neutral or positive payment adjustment.
4. Additionally, more rural and small practices will see positive payment adjustments compared to the 2017 performance year.
5. More clinicians are earning Qualifying Alternative Payment Model Participant status under the Advanced APM path than in the previous reporting year.

“Positive payment adjustment will remain modest in part because, under the MACRA law, the positive and negative payment adjustments must be budget neutral,” Ms. Verma said. “This means that the funds available for positive payment adjustments are limited to the estimated decrease in payments resulting from the negative payment adjustments. However, because the thresholds have been lower, many providers have qualified. As the program matures, we expect that the increases in the performance thresholds in future program years will create a smaller distribution of positive payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries and positive adjustments will increase.”

To view the full results, click here.


MSSNY Benefit – Protect your hearing with American Hearing Benefits


Deadline to Submit 2019 Registration and Attestation Info for MIPS Is March 2
The deadline to submit 2019 data for (CMS) Medicare Promoting Interoperability Program is March 2, 2020. 

As a reminder, in 2018, CMS transitioned to the QualityNet System (also known as CMS’s Hospital Quality Reporting [HQR] system) for hospitals that attest to CMS for the Medicare Promoting Interoperability Program. By transitioning to one system, CMS continues in their effort to streamline data submission methods.

Specific submission details for each program are listed below.

  • Medicare Eligible Hospitals and Critical Access Hospitals (CAHs) – These participants must attest to CMS through the QualityNet Secure Portal.
  • Medicaid Eligible Professionals (EPs), Eligible Hospitals, CAHs – These participants should follow the requirements of their State Medicaid agencies to submit their meaningful use attestation.
  • Dual-Eligible Hospitals and CAHs – Those who qualify for both the Medicare and Medicaid Promoting Interoperability Programs are required to demonstrate meaningful use to CMS through the QualityNet Secure Portal (not their State Medicaid agency).

Registering on Behalf of a Medicaid EP?
An EP can designate a third party to register and attest on his or her behalf. To do so, users working on behalf of an EP must have an Identity and Access Management System (I&A) web user account (User ID/Password) and be associated with the EP’s National Provider Identifier (NPI). If you are working on behalf of one or more EPs and do not have an I&A web user account, please visit I&A Security Check to create one.

Note: States and territories will not necessarily offer the same functionality for registration and attestation in the Medicaid Promoting Interoperability Program. Check with your state or territory’s Promoting Interoperability Program to see what functionality is offered.

Additional Resources

For More Information

Visit the Registration and Attestation page on the CMS Promoting Interoperability Programs website.

Medicare & dual-eligible hospitals participating in the Medicare & Medicaid Promoting Interoperability Programs may contact the QualityNet help desk for assistance at 1 (866) 288-8912 or qnetsupport@hcqis.org.


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PAI Comments on Stark Law and Anti-Kickback Proposed Rules
On December 31, PAI submitted comment letters in response to two proposed rules proposing modifications to the Anti-Kickback (AKS) Statute and the Physician Self-Referral (Stark) Law. The letters are attached and summarized below. Please share widely with your medical association staff and physician members.

PAI was generally supportive of both the Centers for Medicare and Medicaid Services’ (CMS’s) and the HHS Office of the Inspector General’s (OIG’s) efforts to remove regulatory barriers and create alignment between the Stark Law and AKS exceptions and safe harbors to encourage participation in APMs and innovative payment arrangements. We were also supportive of the new definitions related to value-based arrangements, including Value-Based Enterprise (VBE), VBE Participant, Value-Based Activity, Value-Based Purpose, etc., bought sought additional clarification on what would/would not satisfy these definitions and whether existing arrangements could be used to satisfy these definitions for the safe harbors and exclusions. PAI’s specific comments in response to each proposed rule are summarized below.

Anti-Kickback Statute Proposed Rule
PAI was supportive of the following proposed new safe harbors and updates to existing safe harbors, and made additional recommendations in response to each:

  • Care Coordination Arrangements (CCAs) – PAI sought additional clarification on the “commercially reasonable” standard under AKS
  • VBAs with Substantial Downside Risk – PAI recommended a more flexible definition for “risk-sharing”
  • VBAs with Full Financial Risk – PAI expressed concerns that the VBAs with Full Financial Risk safe harbor would only be made available to larger, more integrated systems, and that smaller and rural practices may not be able to enter traditionally defined “full risk” models even though they are embracing downside risk
  • Patient Engagement and Support Arrangements – PAI strongly supported focusing on improving access to items, services, and supports that address social determinants of health (SDOH)
  • Blanket Safe Harbor for CMMI Model Participants
  • Donation of Certain Cybersecurity Technology and Related Services – PAI urged the OIG to ensure that the donors must donate the technology with “no strings attached” tied to future upgrades, maintenance costs, etc.
  • Outcomes-Based Payment Arrangements – PAI encouraged the OIG to also include full and partial capitation payments
  • Updates to the EHR Safe Harbor – PAI opposed proposals that would allow the safe harbor exception to apply if the items or services were “deemed” to be interoperable, and urged how important it is for the OIG to continue focusing on how the data and systems are actually being used and information is being shared to ensure that information blocking is not occurring.
  • Updates to the Warranties Safe Harbor
  • Updates to the Local Transportation Safe Harbor – PAI supported expansion of this safe harbor to include ride-sharing services and urged the OIG to further expand the safe harbor to be inclusive of urban areas as well as “provide a ride” and telephonic-related programs and services
  • Updates to the ACO Beneficiary Incentive Program – PAI codifying protections for beneficiaries but requested additional guidance on what is required for such protected beneficiary remunerations
  • Exceptions for Telehealth Technology Definitions for In-Home Dialysis – PAI did not support the requirement that donations of such technology must be made available to all eligible Part B beneficiaries, as this may restrict small and rural providers from offering such donations entirely 

Stark Law Proposed Rule
PAI was supportive of the following proposed exceptions and made additional recommendations in response to each:

  • Exceptions for Full-Risk Models – PAI commented that full-risk should be more inclusive of other types of arrangements in addition to capitated payments, including bundled and episodic payments, and that additional flexibility should be considered for demonstrating “full-risk” arrangements
  • Exceptions for VBAs with Meaningful Downside Financial Risk to the Physician – PAI expressed concerns with defining “meaningful downside risk” and believed that the 25% threshold is too high and should be decreased to 5%
  • Exceptions for General VBAs – PAI supported general exceptions for VBAs, regardless of risk, as we believe this exception will be most applicable for independent, small, and rural practices. However, PAI did support the contribution requirement of 15% for VBAs under such exceptions as it could adversely impact the same group of physicians and practices.
  • Price Transparency – PAI believes that any information to be made public should first be shared with physicians and others to ensure that it is accurate, and that physicians have appropriate time to review and correct the information.

In addition to the above, PAI also provided comments on additional technical changes proposed in the rule.

http://www.mssnyenews.org/wp-content/uploads/2020/01/PAI-2019-AKS-Proposed-Rule-Comment-Letter.pdf

http://www.mssnyenews.org/wp-content/uploads/2020/01/PAI-2019-AKS-Proposed-Rule-Comment-Letter.pdf


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Practice Coach AdThe Practice Coach –  We Help Physicians Help More Patients
We improve the employee and patient experience to help you achieve your goals and grow your practice. How? With strategic processes that support you, your staff, and your patients! We integrate your values into all areas of your practice including hiring, training, communication and operational strategies. Whether you’re independent or part of a group, we have an approach that will work for you. If you’re ready to strengthen your practice, we can help. smays@thepractice.coach https://www.thepractice.coach/  https://www.instagram.com/practicecoach/ https://twitter.com/coach_practice


RENTAL/LEASING SPACE


Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032


PHYSICIAN OPPORTUNITIES

Pediatric Board Tutor
Looking for a tutor for Initial Pediatric Board Exam
Flexible hours, Negotiable rate. If interested please email at: pedboardhelp@gmail.com


 

NYS Corrections Logo

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

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

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

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

NYS Corrections Personnel Ad

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



 

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

 

MSSNYeNews: Iceberg Right Ahead – January 3, 2020

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
January 3, 2020

Vol. 23  Number 1


MSSNYPAC Seal


Colleagues:

We all remember the scene from Jim Cameron’s Titanic when the lookouts first notice the looming iceberg. Well, that is how I felt when I opened my email before getting ready to celebrate the coming of the New Year. Then, I saw this on my twitter feed:

Doctor's Tweet

That is right— once again, the government’s first solution to a healthcare budget deficit is to cut doctors’ payments. We clearly are regarded as low-hanging fruit here. Imagine the response of say the TWU if the solution to MTA fiscal problems were to first cut the workers’ pay? Right. Well, it’s 2020 and our issue clearly comes into 20-20 focus.

It is as obvious today as it has ever been. Medicine is the only US enterprise that regularly gets to enjoy a Cost of Living DECREASE. While we await further budget details to be hashed out, this is time for real New Year’s resolutions.

Let me be clear – we all need to come together. A House of Medicine divided cannot stand. And so, I call for a gathering – a Summit— if you will. We will put out an invite for our many groups – our ethnic societies, our specialty societies, employed physicians, independent physicians – everyone should be present.

As the Doors put it: “The time to hesitate is through. No time to wallow in the mire.”

Let’s Do It!

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

Arthur Fougner, MD
MSSNY President


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FLU ADVISORY
Due to elevated influenza activity in New York State (NYS), this advisory provides updated influenza prevention, surveillance and control guidance along with links and references to influenza resources.


MSSNY’s Weekly Legislative Podcasts


Governor Vetoes Liability Expansion Bills Opposed by MSSNY
Governor Cuomo has vetoed two bills passed by the State Legislature that had been opposed by MSSNY and MLMIC that, if enacted, could have produced further increases to New York’s already exorbitant medical liability insurance costs.  The bills had also been opposed by many other groups who could have been adversely impacted.

The first bill (S.6081/A.2373) would have forced physician defendants into making a “blind gamble” regarding the selection of how a particular court award should be reduced in cases involving multiple defendants where one of the defendants settles prior to trial.

MSSNY raised concerns that this legislation could create the possibility of a plaintiff being unjustly enriched by collecting more than the jury ultimately determined the award to be.  The second bill (S.6552/A.2373) would have allowed plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question but had been sued by the original defendant.  MSSNY raised concerns that it could encourage those parties who are unable to satisfy their apportioned share of liability to dodge their responsibility, while allowing a plaintiff to target deep-pocketed third parties.

MSSNY thanks Governor Cuomo for vetoing these problematic bills, given the enormous liability exposure physicians already face.


Governor Vetoes Patient Protection Bills
At the end of 2019, Governor Cuomo vetoed two pieces of legislation strongly supported by MSSNY, and other patient advocacy groups, that would have protected patients from harmful business practices by Pharmacy Benefit Manager (PBMS), and health insurers, in New York.

  • Cracking Down on PBMs

The first bill, S.6531, would have increased the oversight, transparency and accountability of Pharmacy Benefit Managers (PBMS).

Although, similar protections in the 2019 budget were agreed to for Medicaid beneficiaries, and Governor Cuomo had proposed additional requirements for PBMs used by commercial plans, he vetoed the bill because of concerns that provisions could be pre-empted by ERISA, and invite scrutiny from the FTC and DOJ and “sweep in plans that are not true PBMs, but rather health benefit funds only.”

  • Ending Plans’ Ability to Make Mid-Year Changes to Drug Formularies

A second bill, S.2849, would have created a list of safeguards designed to protect patients with private, commercial health insurance plans seeking to remove drugs from their pharmacy benefit formularies, in the middle of a contract year. New York’s current law puts thousands of patients at risk of losing access to therapies for such chronic and life-threatening diseases as epilepsy, rheumatoid arthritis, multiple sclerosis, among many others. It also usurps decisions by physicians as to what the most effective therapy is to treat a patient’s condition.

The Governor vetoed the bill because of concerns that “Insurers would have to anticipate and set rates for hypothetical future drug price increases, causing higher premiums for everyone, while pharmaceutical companies would be able to raise their prices with impunity”.

MSSNY pushed hard for passage of both these bills and will continue to advocate for these patient protections in the new legislative session.


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Governor Signs MAT Access Bill for Commercial Insurers and Vetoes MAT Access Bill for Medicaid
As the year came to an end Governor Cuomo signed and vetoed bills that would expand access for patients to Medication Assisted Treatment (MAT), both bills that had been strongly supported by MSSNY and the American Medical Association.

The first bill (A.2904/S.4808) that was signed into law requires commercial health insurance companies to eliminate prior authorization requirements for all MAT.  A provision enacted earlier in the year removed prior auth requirements for formulary approved MAT, but not all forms of MAT.  This gap was particularly problematic if a patient was stabilized on a particular form of MAT, but switched insurance company coverage.  Medical evidence shows that MAT promotes recovery from opioid use disorders, saves the health care system money. Prior authorization requirements for MAT delay access to evidence-based care.

However, the Governor vetoed similar legislation (A.7246/S.5935) that would have required Medicaid and Medicaid Managed Care plans to cover all MAT without prior authorization requirements. The lengthy veto message noted concerns that  the bill would “provide  a  statutorily-authorized  unfair  competitive advantage to one pharmaceutical manufacturer” which failed to “offer  sufficient  competitive  pricing  to be included on the preferred drug list or on many  managed  care  organization  formularies,  and  in lobbying  for this legislation to eliminate prior authorization requirements, requires Medicaid plans and the State to pay whatever price  this manufacturer charges.”


MSSNY’s Lobby Day – Wednesday, March 4th, 2020
Please plan to join your colleagues in Albany for MSSNY’s ‘Physician Advocacy Day’, which will take place at the Lewis Swyer Theater at The Egg in Albany on Wednesday, March 4, 2020.

Physician participation in this event is critical.  With a $6 billion Budget deficit likely to produce a swath of adverse proposals in the name of achieving “savings”, it is imperative that physicians let their legislators know of the potential adverse consequences to patient care in their communities. As with past years, the morning program will provide 3.0 Continuing Medical Education hours for physicians. To learn more about MSSNY’s Lobby Day click here and to sign up for the event click here.


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Gov. Cuomo Proposes to Ban Flavored Nicotine Vaping Products in State of State
Governor Andrew Cuomo has proposed in his State of the State agenda to ban all flavored nicotine vaping product, including menthol flavors.  The governor has also proposed banning vaping advertisements aimed and youth and authorized the NYS Department of Health to regulate the sale of chemicals used in vaping-related products and ban the sale of vaping product carrier oils deemed a hazard to public health. His proposal also includes legislation that would prohibit the online, phone and mail order sale of e-cigarettes and would require that only registered retailers be allowed to purchase e-cigarettes using these methods.

On the federal level, the Trump Administration and the FDA announced a limited ban of flavored e-cigarettes and the sale of all sweet and fruity flavored vape pods and cartridges, but allows gas stations and convenience stores to continue to sells menthol cartridges and vapes.

MSSNY supports banning all flavored e-cigarettes, including menthol and supports legislation that would also ban all flavored tobacco products, such as chewing tobacco and cigarillos. In December, MSSNY has joined with other public health organizations that called upon the Governor, the Senate and Assembly leaders, and members to pass legislation that would prohibiting the sale of flavored nicotine and tobacco products which will protect our young people from the scourge of the myriad health problems and addictions caused by flavored tobacco products and e-cigarettes. Physicians are encouraged to send a letter through MSSNY Grassroots Action Center (GAC) at: https://p2a.co/hn9SSVu

Additionally, MSSNY supported legislative efforts to increase the legal purchase age for tobacco and e-cigarette products and in November 2019, Governor Cuomo signed into law legislation that accomplished this goal.  In December, Congress passed the Federal Food, Drug and Cosmetic Act that raised the federal minimum age to purchase tobacco products from 18-19; President Trump signed the measure on December 20, 2019.  According to a statement on the FDA’s website, “it is now illegal for a retailor to sell any tobacco product—including cigarettes, cigars and e-cigarettes—to anyone under 21”.


Albany Memorial and Samaritan Hospitals Merge Albany Memorial Hospital and Samaritan Hospital in Troy, N.Y., merged Jan. 1.
Albany Memorial is now a third campus of Samaritan Hospital and has been renamed Samaritan Hospital-Albany Memorial Campus. The hospitals are part of Albany-based St. Peter’s Health Partners, which is a member of Livonia, Mich.-based Trinity Health. “The long-planned and previously announced merger of Samaritan and Albany Memorial represents the fulfillment of our always top-of-mind goal, which is to provide the highest quality, most compassionate, and most accessible care, to all who need it, in Albany, Troy and across the Capital Region,” Michael Finegan, president of acute care at SPHP, said in a news release.


Female Surgeons Face Fertility Issues; Radiation, Surgical Smoke, Exposures
The Telegraph (UK) (1/2) reports research suggests “female surgeons are more than twice as likely to suffer fertility problems due to radiation and the other hazards of operating theatres.”

The study published in JAMA Surgery indicates “there are direct medical risks from working as a surgeon, including from radiation, surgical smoke, anaesthetic gases and other toxic substances.” The researchers point “to a survey of 1,021 US females surgeons across different specialisms that found 32 per cent of respondents reporting difficulty with fertility, compared to 10.9 per cent in the general population,” and “the same study saw a pregnancy complication rate of 35.3 per cent, compared to 14.5 per cent generally.”


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Mysterious Pneumonia Cases in China Prompt International Concern
Infectious disease experts are keeping a close eye on a mysterious outbreak of pneumonia in central China that has sickened more than three dozen people, reports Bloomberg.

As of Jan. 3, 44 pneumonia cases have been confirmed in Wuhan, China, according to a statement from the city’s health agency cited by the publication.

The World Health Organization is working with the Chinese government to investigate the outbreak. Health officials have ruled out common respiratory illnesses like the flu, but the exact cause of the illness is still unknown.

Several of the sickened individuals worked at a local market that sold animals like birds and pheasants. This detail is prompting concerns that an unknown animal virus may have spread to humans, reminiscent of the 2003 SARS outbreak, which killed nearly 800 people.


WEBINAR

“Doctor Are You Ready?” CME Webinar on January 15; Registration Now Open
Disasters big and small happen every day.  Be sure to find out how best to be prepared at MSSNY’s next Medical Matters webinar: Doctor Are You Ready? on January 15th at 7:30am.  Kira Geraci-Ciardullo, MD, MPH immediate past speaker of the house and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Explore core preparedness competencies every physician should possess
  • Describe emergency situations that arise on a regular basis
  • Identify resources to acquire preparedness training

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

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

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


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Practice Coach AdThe Practice Coach –  We Help Physicians Help More Patients
We improve the employee and patient experience to help you achieve your goals and grow your practice. How? With strategic processes that support you, your staff, and your patients! We integrate your values into all areas of your practice including hiring, training, communication and operational strategies. Whether you’re independent or part of a group, we have an approach that will work for you. If you’re ready to strengthen your practice, we can help. smays@thepractice.coach https://www.thepractice.coach/  https://www.instagram.com/practicecoach/ https://twitter.com/coach_practice


RENTAL/LEASING SPACE


Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032


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


PHYSICIAN OPPORTUNITIES

Pediatric Board Tutor
Looking for a tutor for Initial Pediatric Board Exam
Flexible hours, Negotiable rate. If interested please email at: pedboardhelp@gmail.com


 

NYS Corrections Logo

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

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

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

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

NYS Corrections Personnel Ad

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


Physician Insights Wanted to Help Shape the Future of Primary Care
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CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
December 20, 2019

Vol. 22  Number 47


MSSNYPAC Seal


Colleagues:

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

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

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

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

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

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

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

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

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

Arthur Fougner, MD
MSSNY President


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

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

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

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

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


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

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

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

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

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

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

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


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

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

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

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

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


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

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


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

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

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

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

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


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

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

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


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

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

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

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

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


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


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


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WORKERS COMP

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

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

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

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

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


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

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

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


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

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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Technical support questions:

WCBCustomerSupport@wcb.ny.gov

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

Review Now

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

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

·       Questions – Contact Live Help Desk

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


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RENTAL/LEASING SPACE


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

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

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


PHYSICIAN OPPORTUNITIES

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


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

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

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

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

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


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


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
December 13, 2019

Vol. 22  Number 46


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Colleagues:

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

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

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

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

Make no mistake; it could still be Merry Grinchmas.

For this session, it’s The Final Countdown.

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

Arthur Fougner, MD
MSSNY President


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

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

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

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

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

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


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

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

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

The law takes effect in March.


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

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

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

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

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


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

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

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


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

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


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

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

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

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


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


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

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

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

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

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


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

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

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

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

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


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

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

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

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

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

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


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


MEDICARE/MEDICAID

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


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


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

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

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

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

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

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

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RENTAL/LEASING SPACE

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Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties. Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032


  

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


PHYSICIAN OPPORTUNITIES

 


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

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

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

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

NYS Corrections Personnel Ad

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


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


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: December 6, 2019 – Progressive or Regressive

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
December 6, 2019

Vol. 22  Number 45


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Colleagues:

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

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

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

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

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

Arthur Fougner, MD
MSSNY President


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

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

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

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

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

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

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


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

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


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

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

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

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


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


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

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

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

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


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


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

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

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

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

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


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

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


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

Applications can be submitted online here.

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

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

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

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


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

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

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

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

Subject: Continuous Recruitment for NYS DUR Board Membership


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

Responsibilities of the DURB include:

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

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

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


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WORKERS COMP

Important News About WC Authorization/Re-Registration

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

New Health Care Provider Registration Coming Soon

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

Registering

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

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

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

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

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

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

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

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

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


CME

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

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RENTAL/LEASING SPACE


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

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
_______________________________________


Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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


PHYSICIAN OPPORTUNITIES

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


NYS Corrections Logo

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

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

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

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

NYS Corrections Personnel Ad

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


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


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: November 22, 2019 – California Dreamin’

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 22, 2019

Vol. 22  Number 44


MSSNYPAC Seal


Colleagues:

The AMA Interim Meeting in San Diego was interesting. A major issue discussed concerned Scope – NOT the mouthwash. The meeting highlighted the confusion that often arises among patients as to the credentials of the person who is treating them.

Table of doctorshttps://www.ama-assn.org/media/26936/download

For example, 88% of those surveyed were clear that an Obstetrician-Gynecologist is a physician, 12% either thought an Ob-Gyn was not a physician or were unsure. About one in five thought a Nurse Anesthetist was a physician. More folks than not thought Optometrists were physicians.

Therefore, in NY, we have the requirement to wear identifiers to reduce the confusion. However, there are Doctors of Nursing with PhD degrees. Therefore, they are doctors but not physicians. No wonder patients get confused.

To be clear, we all need each other. Patients clearly fare best when their care is team-based. There should be no room for either – or. No remonstration, no finger pointing allowed. However, when I learn that a physician is being bullied so as not to give a vanilla presentation on the differences in education and training among the various healthcare professionals who treat patients in the area, I am deeply troubled.

To that end, MSSNY has set up an ad hoc Scope of Practice committee.

In the end, it’s the patient who counts.

Please let us end the confusion.

There is a “physician” and then there is “not exactly”.

All the leaves are brown and the sky is gray
I’ve been for a walk on a winter’s day
If I didn’t go, I could leave today
California dreamin’ on such a winter’s day

-John and Michelle Phillips

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

Arthur Fougner, MD
MSSNY President


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Please Take Our Survey Re Prior Authorization —A Major Physician Concern
MSSNY has worked together with numerous physicians and patient advocacy groups in support of multiple pieces of legislation to reduce physicians’ administrative burden to ensure that their patients can receive the medications they need. Please click here to complete the survey.

Our success includes a recent law that gives physicians greater authority to override a health insurer “step therapy” or “fail first” prescription medication protocol in certain circumstances.

However, MSSNY continues to work for additional laws that reduce the need for unnecessary and repetitive prior authorizations that take time away from patient care delivery.

Please take just a few minutes to complete the survey.


Physicians: Urge Governor to Sign Legislation to Permit Partial Filling of Opioid Prescriptions
Please urge Governor Cuomo to sign into law legislation (A.3918/S.1813) presented for his consideration this week that would permit a physician to stagger a patient’s short-term opioid prescription, so as to prevent the accumulation of unused opioids in patient medicine cabinets.  You can send a letter from here: https://p2a.co/YRf6CsU.  Specifically, the legislation would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each “partial fill” would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households.

The Governor has until November 30 to decide whether to veto or sign. MSSNY President Dr. Art Fougner issued a statement this week calling on the Governor to sign this bill into law, noting that “We know that one way opioid abuse starts is by persons other than the patient accessing unused medications left in medicine cabinets or other parts of a patient’s home.  By enabling the staggered filling of the prescription, this measure will help to reduce the amount of pain medicines left unused. This will limit the risk of these medications being diverted.”


New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
As recently reported, Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted.   The law was designed to respond to reports of medical students being asked to perform such exams, without express patient consent, as part of their medical training in teaching hospitals. Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance  of  a  pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized  to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

·   the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;

·   the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has  already given oral or written consent; or

·   the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

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


It’s Crunch Time – Please Make Sure Congress Doesn’t Let the Insurance Industry Write the “Surprise Bill” Solution
With just a few weeks left in the year, Congress is continuing to have extensive discussions about legislation to address “surprise” out of network medical bills.  It is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution to this issue that protects patients’ access to needed care, and does not grant huge new powers to the health insurance industry.  By clicking here https://p2a.co/klWfpHT, you can send a letter, and tweet at your legislators.

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

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

Large market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not let Congress make this worse.  Please contact your Senators and Representatives today!  https://p2a.co/klWfpHT


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NYDOHMH Confirms Second Vaping-Related Death
The AP (11/20) reports New York’s Department of Health “has declared the state’s second death linked to a vaping-associated illness.” Gov. Andrew Cuomo “said on Wednesday that the person who died was a man in his 30′s from Manhattan with a reported history of using e-cigarettes and vapor products.” The first death, on Oct. 4, “was of a 17-year-old boy from the Bronx.”

New York AG files suit against Juul

New York Attorney General Tish James filed suit against e-cigarette maker Juul Tuesday alleging the company marketed to underage users and misrepresented the product as a healthier alternative to traditional cigarettes. In the 38-page complaint, the AG’s office says that Juul engaged in “deceptive business practices when marketing and advertising its products, and illegally sold its products to minors through its websites and in third-party retail stores throughout the state.”

“There can be no doubt that JUUL’s aggressive advertising has significantly contributed to the public health crisis that has left youth in New York and across the country addicted to its products,” James said in a statement. “By glamorizing vaping, while at the same time downplaying the nicotine found in vaping products, JUUL is putting countless New Yorkers at risk.”

The suit makes it illegal to sell nicotine products to minors. About 220,000 of the 1 million e-cigarette users across the state are under the age of 18, according to an estimate from the state health department. The federal government has reported 2,172 cases of vaping-related illness — though many cases have been tied to vitamin E acetate found in THC cartridges — and 42 deaths as of Nov. 13.


Canada May Have Found New Vaping Complication: Popcorn Lung
Canadian physicians may have identified a new type of lung injury linked to vaping. In CMAJ, they report a potential case of vaping-associated bronchiolitis obliterans, a form of which is known as “popcorn lung.”

Previously, a number of workers in factories making microwave popcorn developed “popcorn lung” after inhaling the flavoring chemical diacetyl, which is also used in e-liquids.

An otherwise healthy, 17-year-old male with a history of heavy, daily vaping presented with cough, dyspnea, and fever. Tests for infectious agents were negative. Computed tomography revealed a diffuse tree-in-bud pattern, which differs from what has been observed in patients with e-cigarette, or vaping, product use associated lung injury (EVALI).

The patient developed refractory hypercapnia and required extracorporeal membrane oxygenation, but he improved with corticosteroids. He was hospitalized for 47 days and still had impaired lung function at 4 months.

Separately, a correspondence in the New England Journal of Medicine describes autopsy findings from a young man who died from untreated EVALI.

CMAJ article https://www.cmaj.ca/content/early/2019/11/20/cmaj.191402CMAJ editorial (https://www.cmaj.ca/content/cmaj/early/2019/11/20/cmaj.191503.full.pdf

NEJM correspondence on pathology of vaping-related lung illness https://www.nejm.org/doi/full/10.1056/NEJMc1914980?query=pfw&jwd=000012759862&jspc=%20


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Three LI Children Contract Polio-Like Disease Acute Flaccid Myelitis
Newsday (NY) (11/17) reports on the “rare polio-like disease” acute flaccid myelitis “that has struck at least three Long Island children since a nationwide outbreak began in 2014.” The CDC “has confirmed nearly 600 cases of the disease – mostly in young children – since it began tracking cases in 2014.”


Survey: Women More Likely to be Warned Away from Surgery Careers
Findings were published in Annals of Surgery regarding a recent survey that “punishing hours and concerns about having little time to marry and have children deter both male and female medical students from choosing careers in surgery, but more women say they’ve been warned away from the field because of their gender.” Researchers “sent surveys to roughly 720 students at Harvard Medical School.” Among the 261 who responded, “similar proportions of both genders intended to become surgeons – roughly one in four men and one in five women.”


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Plan Legal Challenge against Health-Pricing Disclosure Rule
The Wall Street Journal (11/20) reports that the hospital industry is planning a legal challenge to block the Trump Administration’s new health-pricing disclosure rule, which would require the disclosure of secret rates negotiated by hospitals with insurers for all services.


CMS Flags Nursing Home Citations
CMS on its Nursing Home Compare website has added a new icon—a red circle with a white stop hand in the center—to ratings for 760 facilities, indicating that the facilities have been cited for an incident of abuse, neglect, or exploitation. Consumer advocates have applauded the move, but some in the nursing home industry say the alerts are misleading. (Wall Street Journal, 11/19)


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Incontinence is Increasingly Common Though Few Seek Care
The Wall Street Journal (11/17, Subscription Publication) reported on incontinence and efforts to improve bladder health, adding that according to the Urology Care Foundation one-third of Americans 40 or over have urinary incontinence at least some of the time, though many do not seek care.


Hard-to-Use EHRs Tied to Physician Burnout
Physicians who find their electronic health records (EHRs) difficult to use are more likely to report symptoms of burnout, according to a study in Mayo Clinic Proceedings.

Nearly 900 physicians answered a questionnaire about burnout and completed the System Usability Scale (SUS), a 10-item survey assessing how usable they found their EHR (see second link below). SUS scores range from 0 to 100, with higher scores denoting better usability.

Overall, the mean SUS score was 45.9, which is considered “not acceptable.” Additionally, nearly half the cohort reported at least one burnout symptom. SUS scores were associated with burnout in a dose-dependent manner. After multivariable adjustment, the odds of burnout were 3% lower with each 1-point increase in SUS score.

Dr. Patrice Harris, president of the American Medical Association, said in a statement: “The findings will not come as a surprise to anyone who practices medicine. … It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function — helping physicians care for their patients.” Mayo Clinic Proceedings article; System Usability Scale;


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Survey: Practices Spend One Staff Day Each Week on Provider Directory Upkeep
Modern Healthcare (11/14) reports a new Council for Affordable Quality Healthcare survey reveals “maintaining provider directories is an expensive, time-consuming task that takes up the equivalent of one staff day per week for physician practices.” The not-for-profit health plan alliance “found directory maintenance costs practices nationwide $2.76 billion annually, or $999 per practice per month.”

Additionally, “the cost to practices rises in accordance with the number of providers and plan contracts,” and “practices with more than 25 providers spent an average of about $2,500 per month maintaining provider directories, while those with fewer than five providers spent $319 per month on average.” In its report of the results, CAQH suggests “a seemingly simple solution: health plans adopting a single, streamlined platform where practices can enter, update and review their practice information and share it with multiple plans at once.”


Young Physicians at Interim AMA Meeting

Young Physicians at Interim AMA Meeting. (from left) Charles Lopresto, DO; Ryan Schlobach, MD (in rear); then Ray Lorenzoni, MD (in rear); Carlos Zapata, MD; Anita Ravi, MD; Jocelyn Young, DO; Daniel Choi, MD; and Carlo Milani, MD


WORKERS COMP

Go Live Date Approaching for NY Workers’ Compensation Formulary
The New York Workers’ Compensation Board Drug Formulary (NY WC Formulary) becomes effective on December 5, 2019 for all new prescriptions. Starting that day, all new prescriptions for injured workers in New York State must be listed within the NY WC Formulary unless an alternative medication has been approved through the NYS Workers’ Compensation Board’s new prior authorization process. The new electronic prior authorization process will soon be available through the Board’s Medical Portal; please watch for the notification.

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

  • An overview of the NY WC Formulary and the prior authorization process
  • The latest version of the NY WC Formulary (effective 11/5/19)
  • A video overview for Medical Providers
  • A Quick Guide to the NY WC Formulary
  • An NY WC Formulary Dashboard Guide for Medical Providers

Information and resources related to requesting prior authorization through the Board’s Medical Portal, can be found on the Board’s Medical Portal Overview webpage.

For more information or assistance: http://www.wcb.ny.gov/content/main/hcpp/DrugFormulary/overview.jsp


CMS

The CY 2020 MPFS is Now Available
The CY 2020 Medicare Physician Fee Schedule (MPFS) is now available. You can view the new fees using the Fee Schedule Lookup tool page on the NGSMedicare.com website.


Webinars

MSSNY hosted a webinar, “How to Maximize Success and Maintain Control & Ownership of Your Physician Group,” featuring Roy Bejarano, Co-Founder & CEO of Scale Physician Group, and Andrew Blustein, Partner/Director and Vice Chair of Garfunkel Wild, P.C. on November 12, 2019.

Roy shared the lessons and best practices learned from his experience working with over 1,200 physicians across the country and Andrew facilitated Q&A during the presentation. Listen to the replay for Scale’s insights on the benefits of scale, barriers to building sustainable growth, and how to approach a private equity transaction for physician groups.


Classified

RENTAL/LEASING SPACE


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

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
_______________________________________


Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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


PHYSICIAN OPPORTUNITIES

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


NYS Corrections Logo

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

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

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

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

NYS Corrections Personnel Ad

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


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


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: November 15, 2019 – Collateral Damage

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 15, 2019

Vol. 22  Number 43


MSSNYPAC Seal


Colleagues:

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

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

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

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

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

Arthur Fougner, MD
MSSNY President


MLMIC Insurance Banner Ad


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

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

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


It’s Crunch Time – Please Make Sure Congress Adopts a Fair Solution to Surprise Medical Bills
 With just 6 weeks left in the year, Congress is continuing to have extensive discussions about legislation to address “surprise” out of network medical bills.  It is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution to this issue that protects patients’ access to needed care, and does not grant huge new powers to already market dominant insurers.  By clicking here, you can send a letter, and tweet at your legislators.

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

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

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

Cartoon illustration issues with surprise billing


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

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

  • Protect Against Insurer Mid-year Formulary Changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law.
  • Support Partial Prescription Fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • Oppose Liability Expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills.

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NYeC: Shin-NY Reduced Healthcare Costs by Over $160 Million Annually
According to a recent preliminary analysis conducted by New York eHealth Collaborative (NYeC) use of the Statewide Health Information Network for New York (SHIN-NY) is reducing unnecessary healthcare spending in New York by $160-$195 million annually, which includes significant savings to Medicaid and Medicare.  To see NYEC’s white paper on this analysis click here.

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

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

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

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


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

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

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

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


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


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


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


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


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


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

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

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

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

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


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

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

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

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

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


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

There are several ways to find your revalidation due date:

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

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

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

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

PECOS: View and Manage Reassignments through Group Enrollment

Webinars

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

Educational objectives are:

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

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

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

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


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RENTAL/LEASING SPACE


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

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

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


PHYSICIAN OPPORTUNITIES

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


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

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

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

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

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


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


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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