March 15, 2019 – Say NO! to Recreational Marijuana NOW

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


MSSNY eNews
March 15, 2019
Volume 22  Number 11

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Colleagues:

MSSNY and our County Societies, along with a coalition of other interested groups have been successful in slowing the expansion of marijuana availability in New York State.  I was told when I came into the Presidency that marijuana was a done deal.  MSSNY and the AMA have excellent policy on a rational approach to dealing with marijuana.

Raising Questions

I asked our County leaders to attend listening sessions across the state this past spring and summer. We often were alone voice against anecdotal reports of the benefit with medicinal and recreational use.  Through those efforts, we have been successful in raising significant questions about the effect of legalization on overall use and significant harms with regards to impaired driving and accidents, creation and worsening of severe mental health issues, and negative impacts on developing minds.  I am very sympathetic to our governmental leaders who are concerned about the effects of legalization in Massachusetts and Canada and the effect on our citizens and potential lost tax revenue.  Having said that, I believe it would be pennywise and pound foolish to follow a path to legalization based on the emerging harms associated with increased use of marijuana in states that have legalized non medicinal use.

Other States Concerned

Our colleagues in New Jersey face similar issues and their situation is accelerating. Seeing the rush by Big Marijuana and Big Tobacco to push their product before it has appropriate vetting,

I have discussed coordinating a campaign to stop the expansion until we have sufficient data on the efficacy and long term implications of use for medicinal marijuana. I have had discussions with leaders from Connecticut, Pennsylvania, and New Jersey about coordinating campaigns to slow the descent towards marijuana induced psychosis. They are reviewing policy and we hope to expand our voice by adding additional physician and community groups who share our concerns.  I look forward to updating you on developments as they occur.

In addition, we have been working proactively with many groups who raised similar concerns, including county health officials, PTAs, school administrators, police, and various think tanks ( i.e. SAM, the Schuyler Center.)

I am quite thankful for the activities of our County Medical Societies in this battle for public health and improvement in the practice of medicine. I am arranging a meeting of the County Presidents and their Executive Staffs with MSSNY to enlist them again in reaching out to their legislators and other decision makers at home to promote the MSSNY prescription for the proper use of marijuana in New York State.

Our three major points are:

  1. To review and address issues with criminal justice, disparate enforcement, and stigmatization associated with low level users.
  2. To reschedule marijuana to Schedule II based on some promising, but still largely anecdotal reports on its utility for certain conditions. If rescheduling can be attained, well-funded research can educate us as to the utility and harms of this complicated product.
  3. To oppose further expansion of non-medical use until the effects of long term use are clarified, States that have legalized should collect data on long term efficacy and side effects. States with legalization can provide further data that develops over the next few years.

You can help. Send a letter to your representatives here. Encourage your colleagues and staff who share our concerns to do likewise.

Cum potestate magna venit magnus responsibilitate

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

Thomas J. Madejski, MD
MSSNY President


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Capital Update

Assembly and Senate Advance Their Own Budget Proposals-Intense Budget Negotiations Underway
This week, the New York State Senate and Assembly each passed their respective “one-House” Budget proposals in response to the Governor’s Executive Budget proposal released in January, and amended in February.  They will now enter a period of intense negotiations to achieve an agreed upon final Budget by April 1, the start of New York’s fiscal year.  Here is a brief summary of the actions taken on key items of concern to physicians and patients that were proposed in the Governor’s Budget, both positive and negative.

MEDICAID – Both the Assembly and Senate rejected the proposed $80/patient Medicaid cut for deductibles for patients covered by Medicare and Medicaid.  Moreover, the Assembly and Senate both rejected the 0.8% across the Board Medicaid payment cut.

Both the Assembly and Senate also rejected the proposed repeal of the “prescriber prevails” protections for prescriptions for patients covered by Medicaid.  The Assembly also included a proposal to have a uniform formulary for Medicaid prescriptions, including for Medicaid Managed Care plans, keeping prescriber prevails protections.

MSSNY President Dr. Thomas Madejski issued a statement praising the Assembly and Senate for taking these actions.  Read his statement here.

Please click here to send a letter to your legislators and the Governor urging that they continue the fight to prevent these cuts.

LEGALIZING RECREATIONAL MARIJUANA – The Assembly and Senate did not include the Governor’s proposal to legalize “adult use” or recreational marijuana in its Budgets, though leadership in both Houses have publicly stated their desire to continue working with the Governor on legislation to enable such use.  Several county Executives announced this week that they would seek to opt their counties out of permitting recreational marijuana use if it is to be legalized in New York.

Please urge your legislators to continue to oppose so-called “adult use” marijuana here.

EXCESS – Both the Assembly and Senate supported the continued historical funding amount for the Excess Medical Malpractice Insurance Program that had been proposed in the Governor’s Budget.

PBMs – The Senate accepted the Governor’s recommendation to license PBMs, and included provisions to enhance penalties for non-compliance.  The Assembly rejected the provision, indicating that it will pursue “stand alone” legislation to regulate PBMs in New York State.

PUBLIC HEALTH – The Senate accepted the Governor’s recommendation to raise the age of tobacco/e-cigarette sales from 18-21 that was supported by MSSNY. The Assembly did not, but because they already passed “stand-alone” legislation on this issue (A.558, Rosenthal).

The Senate accepted the Governor’s recommendation to create a Maternal Mortality Review Board that was supported by MSSNY.  The Assembly did not, but could likely pass their own legislation (both the Assembly and Senate have legislation on the floor of each of their respective Houses-A.3276, Joyner/S.1819, Rivera).

The Senate accepted the Governor’s proposal to remove prior authorization requirements for Medication Assisted Treatment (MAT) that was supported by MSSNY and the AMA.  The Assembly took it out, but is pursuing their own legislation (see related article).

WORKERS’ COMP – The Assembly rejected the Governor’s proposal to significantly expand the use of non-physician use in Workers’ Compensation that has been opposed by MSSNY (due to the lack of provisions regarding how such practitioners would coordinate with physicians to manage the patients’ care and complete the necessary paperwork).  However, the Senate accepted the approach.

Please urge your legislators to continue to oppose this proposal here                 (DIVISION OF GOVERNMENTAL AFFAIRS)


Assembly Advances Legislation to Ensure Better Care for Those Suffering from Mental Health and Substance Abuse Disorders
The Assembly Insurance Committee has advanced two bills that would help to ensure availability of better treatment for mental health and substance abuse disorders. Both have moved on to the Codes Committee for review.

Assemblymember Dan Quart’s A.2904 would prohibit certain insurance policies from requiring prior authorization for buprenorphine products, methadone and long acting injectable naltrexone for detoxification or maintenance treatment of substance use disorders. This bill would allow physicians to better care for those suffering from opioid addiction via easing restrictions on medication-assisted treatment (MAT).

Assemblymember Aileen Gunther’s A.6186A would require insurers and health plans to submit data to the Department of Financial Services which would be used to measure compliance with federal and state mental health and substance abuse parity laws. It provides clarifications to the law enacted last year supported by MSSNY.  While parity laws currently exist both federally and at the state level, in the past few years the NYS Attorney General has reached multiple settlements for noncompliance with behavioral health companies and subcontractors. Greater data collection is clearly needed for proactive monitoring of denial rates and network adequacy, among other standards.

MSSNY supports these bills as they would increase patient access to needed medication and treatment by eliminating barriers and would ensure that treatment may be provided in a timelier manner.  (AVELLA)


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Senator Rivera Introduces Bill to Exempt Nursing Homes from E-prescription Requirement
Senator Gustavo Rivera’s bill S.4183 has passed through the Senate Health Committee and is now eligible for a vote in the Senate. The bill is a companion of Assembly bill A.1034-A which passed the Assembly on February 28. If enacted, this legislation would exempt nursing homes’ prescription of oral medication from the state requirement that all prescriptions be electronically submitted. This bill is of particular interest to MSSNY’s Long-Term Care subcommittee.

Nursing homes present unique circumstances that make compliance with the current e-prescription mandate impractical and this legislation would allow for time to rectify the situation. Physicians are not physically present 24 hours a day, so RNs are allowed to take orders for medication safely and without delay for the residents who need them. The physician would then sign the oral order within 48 hours. This legislation would extend to March 2021 an already existing exemption established by the NYS Department of Health that is due to expire later this year. (AVELLA)


Expedited Partner Therapy Nears Passage
Legislation passed the Senate this week to allow physicians to prescribe antibiotics to the partner of an individual diagnosed with a sexually transmitted infection (STI) without examining the partner.  It has also advanced to the Assembly calendar. Senator Gustavo Rivera’s S.1799 and Assemblymember Rodneyse Bichotte’s A.2998, which is supported by MSSNY, would expand expedited partner therapy from Chlamydia to include other STIs. Expedited partner therapy helps physicians and other health care providers to decrease rates of STI.  While it is not intended to replace face to face interaction with a health care provider, it can help patients who otherwise would not reach out for treatment.    (AVELLA)    


Governor Releases Report on Maternal Mortality
Governor Andrew Cuomo released a report on the status of maternal mortality in NYS this week.  According to the report, “In NYS, the maternal mortality rate for black women was 51.6 deaths per 100,000 live births, compared to 15.9 deaths per 100,000 live births for white women in 2014-2016. Black women are approximately three times more likely to die than white women”.  The task force recommendations include:

  • Establish a statewide maternal mortality board
  • Design and implement a training program for hospitals on implicit racial bias
  • Create Competency-Based Curricula for Providers as well as Medical and Nursing Schools
  • Establish an Educational Loan Forgiveness Program for Providers who are Underrepresented in Medicine (URIM) and who Intend to Practice Women’s Health Care Services
  • Convene Statewide Expert Work Group to Optimize Postpartum Care in NYS
  • Promote Universal Birth Preparedness and Postpartum Continuity of Care

A copy of the report can be found here. (CLANCY)    


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Registration Now Open for Medical Matters: Disaster Medicine: Every Physician’s Second Specialty
The Medical Society of the State of New York will conduct a webinar entitled Disaster Medicine: Every Physician’s Second Specialty on March 27, 2019 at 7:30am.

Medical Matters: Disaster Medicine: Every Physician’s Second Specialty – Register here.

When:  Wednesday, March 27th @ 7:30am
Faculty: Lorraine Giordano, MD, FACEP, FAADM

Educational Objectives:

Identify core preparedness competencies every physician should know

Explore essential elements of preparedness plans for staff, patients, and family

Describe available courses, resources and organizations to obtain disaster preparedness education and training 

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

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


Register Now for CME Seminars at the 2019 MSSNY House of Delegates
Physicians are encouraged to pre-register for the many educational programs for physicians offered at the MSSNY House of Delegates.

Medical Matters: What’s Your Diagnosis? Infectious Diseases – Register here

When: Thursday April 11th at 1:00pm
Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers

Veterans Matters: The Special Mental Health Needs of Women Veterans – Register here

When: Thursday April 11th at 2:00pm

Faculty: Malene Ingram, MD, Colonel, US Army Reserves

Educational Objectives:

Review how the increased role of women in the military has impacted their mental health.

Describe mental health concerns unique to women veterans and how to identify and treat them.

Identify the barriers that women veterans face in getting the specific care they need.

Health Matters for Women: Fibromyalgia & Myalgic Encephalomyelitis – Register here

When: Friday April 12th at 1:00pm
Faculty: Florence Shum, DO

Educational Objectives:

Review potential causes of chronic diffused pain and fatigue

Discuss how to accurately diagnose fibromyalgia and myalgic encephalomyelitis

Discuss treatment options for fibromyalgia and myalgic encephalomyelitis

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.

Improving Maternal Mortality Trends in New York State (Live Seminar and Panel Discussion) – Register here.

When: Friday April 12th from 2:00-4:00pm

Faculty: Linda Clark, MD, Lisa Eng, MD, Kenyani Davis, MD & Lauren Tobias, Director, Division of Family Health, NYS DOH (Invited)

Educational Objectives:

Review maternal mortality trends in NYS

Examine racial disparities around maternal morbidity and mortality

Identify potential practice models to improve patient outcomes

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.  Physician should only claim credit commensurate with the extent of their participation in the activity.

Register Now for Veterans Matters: PTSD & TBI in Veterans Webinar

There is a direct connection between traumatic brain injury (TBI) and PTSD.  Learn more about signs and symptoms at MSSNY’s April 4th webinar.

Veterans Matters: PTSD & TBI in Veterans. Register for this webinar here

When:  Thursday, April 4th at 7:30am
Faculty: Thomas Madejski, MD

Educational Objectives:

Identify signs and symptoms of PTSD & TBI

Examine evidence-based treatment modalities for PTSD & TBI

Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture

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 CME Webinars Registration Now Open
The Medical Society of the State of New York is proud to announce two live continuing medical education (CME) webinars on women’s health topics entitled:

“Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis” on Thursday, March 21st, 2019 from 7:30 AM to 8:30 AM and “Health Matters for Women: Endometriosis” on Tuesday, April 23rd, 2019 from 7:30 AM to 8:30 AM for all physicians and other health care providers. Registration for the webinars is now open.

Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis – Register here

When: Thursday, March 21st from 7:30-8:30pm
Faculty: Florence Shum, DO

Educational Objectives:

Review potential causes of chronic diffused pain and fatigue

Discuss how to accurately diagnose fibromyalgia and myalgic encephalomyelitis

Discuss treatment options for fibromyalgia and myalgic encephalomyelitis

Health Matters for Women: Endometriosis – Register here

When:  Tuesday, April 23rd from 7:30-8:30pm
Faculty: Lisa Eng, DO

Educational Objectives:

Review potential causes of pelvic pain and discuss how to identify endometriosis

Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis

Discuss implementation of individualized endometriosis treatment plans and options

The Medical Society for 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 creditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. (ULUKAYA)


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

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

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eNews

Update on ZocDoc Pricing Change
As you are aware, MSSNY and its General Counsel are still awaiting clarification from the DOH on a variety of issues being proposed by ZocDoc. We anticipate getting the clarification prior to the ZocDoc roll out in April. MSSNY will advise our members of any changes as we get closer to the implementation date.


Hospitals, Insurers Ready To Resist Medical Service Price Disclosure Mandate
The Wall Street Journal (3/11) reports that hospitals and insurers plan to argue against a Trump Administration proposal that may mandate the public disclosure of medical services’ negotiated prices. Healthcare industry groups are questioning the government’s legal authority to require public disclosure, and asserting that such a requirement would be too complex to carry out.


Fidelis Remains Dominant in New York’s Individual Insurance Market
Fidelis Care maintained its dominance in the state’s individual insurance marketplace, with its market share holding steady in the first open enrollment cycle since it was bought by Centene. Nearly 40 percent of New Yorkers purchasing an individual plan chose Fidelis — virtually unchanged from last year, according to state data released today. The insurer operates in 56 counties, far more than any of its competitors. (Politico 3/15)


AMA Urges Tech Giants to Combat Vaccine Misinformation
As some technology companies have announced steps to combat the spread of vaccine misinformation, the American Medical Association (AMA) issued a letter to the CEOs of six of the country’s leading social media and technology companies urging them to ensure their users have access to accurate, timely, scientifically-sound information on vaccines. The following letter was sent to the CEOs of Amazon, Facebook, Google, Pinterest, Twitter and YouTube.


NYSDOH FLU Report


Sexual Harassment Train the Trainer FREE Webinar on March 20 at 12
March 20, 2019
12:00pm-1:00pm

REGISTER HERE

The issue of sexual harassment in the workplace has been the center of a staggering amount of media attention and of a surge in litigation activity. Consistent with this momentum, New York State recently mandated that all employers are required to have a sexual harassment policy containing specified criteria in place by October 9, 2018, and to conduct sexual harassment prevention training by October 2019. (New York City requirements are slated to take effect in April 2019.)

The issue of sexual harassment takes on particular significance for the healthcare industry, because there is an established nexus between disruptive behavior, which includes sexual harassment, and adverse patient outcomes and medical errors.

The live webinar will be presented on March 20, 2019, from 12 noon to 1:00pm.  For those individuals who are unable to participate in the webinar at that time, MSSNY will be placing a recorded version of that webinar on the MSSNY website to facilitate access to the webinar for MSSNY members.

By the conclusion of the “Train the Trainers” webinar, you will know how to teach your employees:

  • How to identify the more subtle forms of sexual harassment.
  • The impact of sexual harassment on the quality of care and the victim.
  • Practical advice on how to diminish and prevent sexual harassment at your practice.
  • How to respond to sexual harassment in the workplace.
  • Guidelines on how to comply with statutory mandates relating to sexual harassment.

Garfunkel Wild offers individual or group training, on-site or off-site training, as well as webinar modules that can serve to satisfy this new statutory mandate for your employees. If you would like to set up a personal training, please contact Andrew L. Zwerling at 516-393-2581 or azwerling@garfunkelwild.com.


Continuous Recruitment for NYS DUR Board Membership
Federal legislation requires States to maintain a DUR program and establish a Drug Utilization Review (DUR) Board. The NYS Medicaid DUR Board provides recommendations to the Health Department 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 General Operating Procedures:

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 mail-box 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 go here.


CME Programs

Two CME Programs at the HOD: Protect Your Patients and Women in Medicine
You don’t want to miss these! REGISTER NOW at sbennett@mssny.org

Thursday, April 11, 2019, 3:00 – 4:00 pm, Grand Ballroom D/E, Westchester Marriott, Tarrytown

Protect Your Patients, Your Practice, and You!*

Join us at the OMSS Annual Meeting for an interactive presentation by Garfunkel Wild on MEDICAL RECORDS, including the impact on records of the controlled substances “epidemic,” what to consider when emailing and texting, dealing with non-compliant patients, additional areas of exposure from EMRs, and what to include in a telemedicine record.

Business meeting to follow, 4:00 – 6:00, Putnam Room

Friday, April 12, 2019, 5:00 – 6:30 pm, Grand Ballroom B, Westchester Marriott, Tarrytown

Women in Medicine: Reaching Your Potential Now!**

A panel presentation at the Women Physicians Caucus on PAY, PROMOTIONS and CAREER ADVANCEMENT in Academic Medicine, Private Practice and Organized Medicine

Gender imbalance in medicine and academic sciences still exists. Hear three women physicians who have achieved significant leadership positions describe their own pathways, provide advice on how to achieve success, and show how to overcome gender bias, gender pay gaps and system-wide barriers to career advancement. Learn how to achieve success in your career!

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

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

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

The Medical Society of the State of New York designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


CMS

2019 MAC Satisfaction Indicator (MSI) Survey – JK Now Available
Evaluate Our Services in Ten Minutes

The MAC Satisfaction Indicator (MSI) Survey is the best way to share your opinions of our service directly with the Centers for Medicare & Medicaid Services (CMS). This survey should only take ten minutes of your time and helps us understand how we can better serve you. To take the survey, click on the URL below:

Jurisdiction K providers may access the survey at 2019 Jurisdiction K MSI Survey.


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RENTAL/LEASING SPACE

Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/


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


5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464


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


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


PHYSICIAN OPPORTUNITIES

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


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


Physician Wanted to Help Shape the Future of Primary Care
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Interested? Learn more and apply today at www.98point6.com/pcc



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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


March 8, 2019 – Physicians and Politicians Have Their Say!

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


MSSNY eNews
March 8, 2019
Volume 22  Number 10

MSSNYPAC Seal

Colleagues:

Medical students posing at I Love NY sign Medical students at MSSNY Lobby Day event

Wednesday March 6th in Albany was a great day to be a MSSNY member.  I want to thank each and every one of the hundreds of physicians, medical students, and MSSNY, county medical society and specialty society staff who took the time to participate in this week’s Albany Physician Advocacy Day.

Your MSSNY leaders very much understand the challenges with taking a day away from your patients.  I hope your colleagues appreciate your efforts on their behalf.

And please ask them to pencil in March 4, 2020 so they can plan to join you for next year’s Albany Physician Advocacy Day.

MSSNY is the big tent which brings all New York physicians together.  I was honored to have four of our specialty societies join us and participate in our advocacy efforts.  A special thank you to Dr. Vilma Joseph from the New York State Anesthesia  Association, Dr. Louis Snitkoff from the American College of Physicians,  Dr. Iffath Hoskins from ACOG District 2 and  Dr. Michael Delman from NYSAM.  I appreciate very much their updates in specialty-specific concerns that are part of our overall MSSNY program and the attendance of their staff and members to raise our voice on behalf of our patients.

Together we ARE stronger!

Panel of Leaders

I was very impressed by the thoughtful questions raised by our physicians and the detailed responses they received from our Wednesday morning panelists.   The physicians heard from Assembly Health Committee Chair Gottfried, Senate Health Committee Chair Rivera, Assembly Insurance Committee Chair Cahill and Senate Insurance Committee Chair Breslin.  We also heard from Senate Republican leader John Flanagan, and Troy Oechsner, who oversees the regulation of the health insurance industry for the New York Department of Financial Services.

MSSNY leadership and some of our specialty society colleagues subsequently met with new Senate Majority Leader Andrea Stewart Cousins, and the top healthcare policy staff to Assembly Speaker Carl Heastie.  Moreover, many physicians and county society executives held meetings with their local Senators and Assembly members.

While many topics were discussed relative to patient care delivery, the most extensive discussion was regarding the proposed “New York Health Act,” recreational marijuana legalization, and policy responses to the increasing consolidation in the health care and health insurance industries.

Single Payer

Assemblyman Gottfried saluted MSSNY for our discussion and engagement with regards to crafting the New York Health Act.  I thanked him for some of the changes to his single payor bill as a result of concerns raised by MSSNY and the New York County Medical Society.  Assemblyman Cahill and Senator Breslin emphasized the very careful review that is being brought to this legislation because it so far-reaching and disruptive if not done right.  In afternoon meetings we were advised that the Senate would likely be organizing hearings on this legislation in different parts of the State after the Budget was completed.

I was particularly pleased by the strong support among the Committee Chairs for the physician collective negotiation legislation that has been a consistent MSSNY priority.  Assemblyman Gottfried noted that the bill has repeatedly been passed by the Health Committee, but then gets stalled.  While the bill sponsored by Assemblyman Gottfried has 56 co-sponsors including Cahill and Assembly Majority Leader Crystal People-Stokes, it would be helpful to have many more Assemblymembers join as co-sponsors.  And in the Senate, there have not been any co-sponsors listed yet.

We Are All Elements of Change

This is where I need you to be a change agent for your patients and the practice of medicine.  Our Albany Advocacy day is one among many steps physicians can collectively take to achieve our public health goals.  Equally important is your advocacy in the district.  Make phone calls.  Send letters.  Schedule a meeting with your Senators and Assemblymembers.

What to request?

  1. Urge your Senator and Assemblymember to support the collective negotiation legislation and ask them to join on as a co-sponsor.  You can send a letter from here.
  1. Urge them to move very cautiously on any legislation to permit the use of recreational marijuana, including requesting that it be removed from consideration from the State Budget due in a few weeks.  I want to thank Dr. Frank Dowling, MSSNY Secretary, and addiction treatment expert, for participating in a press conference with the group Smart Approaches to Marijuana (SAM) as well as the NYS PTA this week raising concerns with marijuana legalization.  You can send a letter to your legislators here.
  1. Urge them to continue to oppose Medicaid cuts for your dual eligible patients proposed in the Budget, which we estimate to be about $80 per dual eligible patient.  You can send a letter here.

Join PAL

Want to be even more involved?  Join our Physician Advocacy Liaison (PAL) program and commit to working with your local legislators on an ongoing basis. The new Assembly and Senate are still maturing in their organizational structure. Your action now is critical for us to have input into the legislative decisions that affect your patients and your practice.  Join MSSNYPAC and help to elect physician friendly candidates to office and help to develop and expand existing working relationships with key legislators.

Again, I want to thank all who took the time to make our Annual Physician Advocacy Day a success, especially Moe Auster, Pat Clancy and the rest of our outstanding MSSNY staff.  Now let’s keep up the momentum with continued local contact with our legislators, and help New York lead the country in improving the health of our citizens, and the practice of medicine.

Excelsior!

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

Thomas J. Madejski, MD
MSSNY President

P.S. Regarding my patient and the difficulties encountered in obtaining a prior authorization, I finally spoke to the Medical Director of the health plan involved and the issue has been resolved! 



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Capital Update

Physicians Come to Albany To Advocate for Their Patients and Stability in Care Delivery in Their Communities
Over 200 physicians, medical students and other physician advocates converged on Albany this week to participate in MSSNY’s Annual Physician Advocacy Day, and meet with their local legislators.

The assembled physicians heard from the Assembly Health Committee Chair Richard Gottfried, Senate Health Committee Chair Gustavo Rivera, Assembly Insurance Committee Chair Kevin Cahill and Senate Insurance Committee Chair Neil Breslin regarding their priorities for 2019, and to answer questions from physicians.  They also heard from Senate Republican leader John Flanagan, and Troy Oechsner, who oversees the regulation of the health insurance industry for the New York Department of Financial Services.

While many topics were discussed with these legislative leaders relative to patient care delivery, the most extensive discussion centered on the potential benefits and significant concerns with the proposed “New York Health Act”, concerns with legislation to permit “adult use” or “recreational” marijuana use, and the strong support for physician collective negotiation legislation (A.2393, Gottfried/S.3462, Rivera) that would enable physicians to better advocate for their patients in response to the increasing consolidation in the health care and health insurance industries.

Other key issues physicians raised throughout the day included:

  • Support for important public health initiatives contained in the Governor’s Budget including licensing PBMs, raising the tobacco/e-cigarette purchase age from 18-21, creating a Maternal Mortality Review Board, and eliminating pre-authorization for Medication Assisted Treatment (MAT).
  • Opposing the estimated $80/patient cut to deductible payments for patients covered by both Medicare and Medicaid proposed in the Governor’s Budget
  • Opposing the repeal of “prescriber prevails” for Medicaid FFS and certain Medicaid Managed Care prescriptions proposed in the Governor’s Budget
  • Concerns with provisions that would permit Nurse Practitioners and licensed social workers to treat injured workers and be directly reimbursed under Workers Compensation without coordination with a physician, as proposed in the Governor’s Budget.         (DIVISION OF GOVERNMENTAL AFFAIRS)

NYS Assembly Passes Increase in Purchase Age for Tobacco Products
By a margin of 120-26, the NYS Assembly passed legislation that would increase the purchasing age for tobacco products from 18 to 21 years of age.  A.558-A S.2833, sponsored by Assemblymember Linda Rosenthal and Senator Diane Savino, is now before the Senate Finance Committee for its consideration. A March 2015 report by the Institute of Medicine concluded that raising the purchase price to 21 will have a substantial positive impact on public health and will significantly reduce the number of adolescents and young adults who start smoking, reduce smoking-caused deaths, and immediately improve the health of adolescents, young adults and young mothers who should be deterred from smoking.

Working together with other patient advocacy organizations, MSSNY has strongly supported this measure and urges members of the NYS Senate to also pass this bill. (CLANCY)


Senator Rivera Introduces Bill to Exempt Nursing Homes from E-prescription Requirement
Legislation (S.4183, Rivera) is before the Senate Health Committee next week which would exempt nursing homes’ prescription of oral medication from the state requirement that all prescriptions be electronically submitted. It is a “same as” to Assembly bill A1034-A which passed the Assembly on February 28. This bill is of particular interest to MSSNY’s Long-Term Care subcommittee. Nursing homes present unique circumstances that make compliance with the current e-prescription mandate impractical and this legislation would allow for time to rectify the situation. Physicians are not physically present 24 hours a day, so RNs are allowed to take orders for medication safely and without delay for the residents who need them. The physician would then sign the oral order within 48 hours. This legislation would extend to March 2021 an already existing exemption established by the NYS Department of Health that is due to expire on 3/24/19.               (AVELLA)



ONC Proposes Rules to Limit EHR Information Blocking and Promoting Interoperability
The Office of the National Coordinator for Health IT (ONC) released a proposed rule implementing provisions of the 21st Century Cures Act enacted by Congress in 2017 related to electronic health information blocking, interoperability and the ONC Health IT Certification Program.  At the same time, he Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on patient access to data and interoperability.

According to an overview by the American Medical Association (AMA), provisions in these rules regarding information blocking and application program interfaces (APIs) will impact interoperability and the way data is exchanged between patients, health providers, payers, technology developers, health information exchanges, and other health care stakeholders. The proposed rules also promote laudable goals, such as patient access and price transparency.

The AMA summary notes that the proposals are complex and interwoven with an array of newly defined terms. While most of ONC’s focus is on HIT developers, the information blocking proposals significantly impact physicians. There is presumption that all patient information must be shared for a large variety of purposes. The Office of Civil Rights’ (OCR) HIPAA regulation is a permissive rule, meaning that physicians and other covered entities are allowed but not required to share health information with anyone but the patient. The interaction between what must be shared and what can be shared will present a significant challenge for physicians. There is also a lack of discussion around patients’ awareness and understanding of how these rules permit other parties to obtain and use their data.

Among the positive aspects include components to expand the amount of data EHRs must provide to physicians and patients; introduce a vendor information blocking condition of certification; increase ONC’s direct oversight of vendors; limit the fees vendors can charge physicians; require real-world testing of EHRs; adopt modern interoperability standards; remove vendor “gag clauses” that limit physicians from sharing health IT safety concerns; and create exceptions for information blocking rules, such as when disclosing a patient’s information could cause harm or pose a security risk to a health IT system.

However, the AMA also notes that, due to the sheer number and complexity of proposals, physicians may find it difficult to understand many of these rules, and compliance could prove burdensome.

The AMA further notes that the ONC (1) defines key terms, including electronic health information (EHI); (2) provides an illustrative list of activities that would be likely to interfere with access, exchange, or use of EHI; (3) codifies compliance with the information blocking provisions as a Condition of Certification; (4) introduces seven exceptions to the general prohibition on information blocking; and (5) issues a Request for Information on disincentives for health care providers.

The summary further notes that the HHS Office of the Inspector General (OIG)  may issue civil money penalties ($1,000,000 per incident) for information blocking conducted by health IT developers of certified health IT, health information networks, and health information exchanges. The OIG may also investigate health care providers for information blocking for which health care providers could be subject to disincentives. Health care provider penalties will be established in future rulemaking.

Comments on the rules are due on May 3, 2019.   MSSNY will be continuing to review these rules and will be coordinating any response through the AMA and other state medical associations.

For more information from the AMA regarding these new proposed rules, click here: CMS-NPRM-Summary.pdf  and here: ONC-NPRM-Summary.pdf (AUSTER)     


NY SED Working With Physicians To Develop Format on School Health Form; Announces that Schools Should Accept Any Health Form
The NY State Education Department (SED) is working with the Medical Society of the State of New York, the American Academy Pediatrics-NYS Chapter II and other organizations to ensure that the school health exam form completed by physicians is compatible to electronic health records systems commonly used by physician offices. SED has issued a letter to all school districts that until further notice that the school should continue to accept any health exam form received from a provider.  A copy of the letter that was sent to school districts is here: view letter SED will disseminate information in the coming months regarding any of the changes to the health form. (CLANCY)


Legislation to Provide for Transfer of Medicals Records upon Retirement Passes through Assembly Health Committee
Assemblyman Nick Perry recently introduced legislation (A2349) that would require medical practitioners to provide a plan for transferring patient records to another facility at least 30 days prior to closing or transferring ownership. It requires that when a physician closes their office, their patients be notified of the pending closure and their rights regarding the transfer of their medical information. MSSNY had worked with sponsors of previous iterations of this legislation to assure it did not apply to circumstances when the physicians practice is purchased or merged. The bill has passed out of the Health Committee and is on the agenda of the Codes Committee for next week. While the bill is an improvement over the earlier version, concerns include defining which cohort of patients should receive this notice.  MSSNY staff has engaged in dialogue with the Assembly to ensure that if implemented, it is done in a clear sensible manner. (AVELLA) 


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MSSNY Live Webinar Fibromyalgia and Myalgic Encephalomyelitis
The Medical Society of the State of New York will hold a live continuing medical education (CME) webinar entitled Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis on Thursday, March 21st, 2019 from 7:30 AM to 8:30 AM for all physicians and other health care providers. Registration for the webinar is now open.

To pre-register, please click here. A copy of the flyer can be accessed from here.

Faculty: Florence Shum, DO

  • Review potential causes of chronic diffused pain and fatigue
  • Discuss how to accurately diagnose fibromyalgia and myalgic encephalomyelitis
  • Discuss treatment options for fibromyalgia and myalgic encephalomyelitis

For assistance in registering or any other questions, please contact Ayse Ulukaya at aulukaya@mssny.org or call (518) 465-8085.

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 credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.                                                                                                                                                   (ULUKAYA)


Registration Now Open for New Veterans Matters CME Webinar March 14th
The Medical Society of the State of New York is proud to announce our newest Veterans Matters webinar scheduled for March 14th at 7:30am. This webinar is entitled Military Culture: Everything Physicians Need to Know About Veterans as Patients.  Register for this program here.

Veterans Matters: Military Culture: Everything Physicians Need to Know About Veterans as Patients

When: Thursday, March 14 2019 at 7:30am – Register here

Faculty: Lt. Col Lance Allen Wang, & Marcelle Leis, CM Sgt. (Ret)

Educational Objectives:

  • Describe the unique aspects of military culture and how they impact patients who are veterans.
  • Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality.
  • Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back into civilian life.

Additional information or assistance with registration can be obtained by contacting Melissa Hoffman at mhoffman@mssny.org or (518)465-8085.

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 creditsä.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.                                                          (HOFFMAN)



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Register Now for CME Seminars at the 2019 MSSNY House of Delegates
Physicians are encouraged to pre-register for the educational programs offered at the MSSNY House of Delegates.

Medical Matters: What’s Your Diagnosis? Infectious Diseases – Register here

When: Thursday April 11th at 1:00pm
Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers

Veterans Matters: The Special Mental Health Needs of Women Veterans – Register here

When: Thursday April 11th at 2:00pm
Faculty: Malene Ingram, MD, Colonel, US Army Reserves

Educational Objectives:

Review how the increased role of women in the military has impacted their mental health.

Describe mental health concerns unique to women veterans and how to identify and treat them.

Identify the barriers that women veterans face in getting the specific care they need.

Health Matters for Women: Fibromyalgia & Myalgic Encephalomyelitis – Register here

When: Friday April 12th at 1:00pm
Faculty: Florence Shum, DO

Educational Objectives:

Review potential causes of chronic diffused pain and fatigue

Discuss how to accurately diagnose fibromyalgia and myalgic encephalomyelitis

Discuss treatment options for fibromyalgia and myalgic encephalomyelitis

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. 

Improving Maternal Mortality Trends in New York State (Live Seminar and Panel Discussion) – Register here

When: Friday April 12th from 2:00-4:00pm

Faculty: Linda Clark, MD, Lisa Eng, MD, Kenyani Davis, MD & Lauren Tobias, Director, Division of Family Health, NYS DOH (Invited)

Educational Objectives:

Review maternal mortality trends in NYS

Examine racial disparities around maternal morbidity and mortality

Identify potential practice models to improve patient outcomes

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.  Physician should only claim credit commensurate with the extent of their participation in the activity.


Register Now for Veterans Matters: PTSD & TBI in Veterans on
There is a direct connection between traumatic brain injury (TBI) and PTSD.  Learn more about signs and symptoms at MSSNY’s April 4th webinar Veterans Matters: PTSD & TBI in Veterans at 7:30am. Register for this webinar here.

Faculty: Thomas Madejski, MD

Educational Objectives:

Identify signs and symptoms of PTSD & TBI

Examine evidence-based treatment modalities for PTSD & TBI

Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture

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)


 


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

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

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eNews

MSSNY Lobby Day. March 6, 2019, Albany 

Moe Auster speaking at Lobby Day event

Update on ZocDoc Pricing Change
MSSNY was instrumental in getting the pricing change delayed from their original implementation in October 2018. 

Updates on our ZocDoc activities have been in our weekly e-News publication.  Our general counsel, Garfunkel Wild, recently met with NYS DOH on this matter.  NYS DOH is reviewing MSSNY’s concerns on behalf of our members and any update will be in a future e-news. 


Council Notes from March 5 Meeting in Albany

  • Representatives from OPMC and the Board of Medicine led a discussion on “Physician Wellness.” Presenters were Arthur Hengerer, MD, Chair, OPMC;  Robert Catalano, MD, MBA, Executive Secretary, OPMC;  Keith Servis, OPMC Director; and Stephen Boese, Executive Secretary, NYS Board of Medicine.  They stressed that the discussion was about burnout, not misconduct, and provided a roadmap to burnout awareness efforts and physician wellness support.  Following a summary of the OPMC Workgroup Discussion on Burnout, they looked at the potential for collaborative efforts with MSSNY going forward and the next steps to address Physician Wellness.
  • Kevin Sabet, Ph.D, president and CEO of Smart Approaches to Marijuana (SAM) presented “Efforts to Stop Legalization of Marijuana in New York State.” He warned of the perils of opening up marijuana shops in the middle of a drug epidemic and stressed that the effort is to prevent another “big tobacco” situation. He also noted that medical use should be determined by science, not popular vote.  Following Dr. Sabet’s presentation, a counterpoint to the discussion was presented by representatives from Governor Cuomo’s office.  Axel Bernabe, Associate Counsel for Health, Office of Governor Cuomo, and Jason Starr, Assistant Counsel, Office of Governor Cuomo, presented “Overview of the Proposal to Legalize Marijuana in New York State.”
  • Council approved the following amended substitute resolution, which was referred by the 2018 House of Delegates: MSSNY will correspond with the state Office of Mental Health, the Office of Alcoholism and Substance Abuse Services and the Department of Health to determine the mechanism for primary care physicians to access records of mental health and substance use disorders to afford those patients the best medical care. MSSNY will educate its members on what options are available and will transmit a copy of the resolution to the AMA to work towards federal regulations on the matter.

AMA, Planned Parenthood File Lawsuit over Abortion “Gag Rule”
The AP (3/5) reports the rule’s requirement that abortion providers not share office space with Title X clinics “would in many cases boost costs for providers like Planned Parenthood that offer abortions and other services, including family planning.” Planned Parenthood previously said it would forgo Title X funding if the rule is not overturned, “forgoing an estimated $60 million in annual funding” and potentially impacting the “1.6 million of the 4 million women who get care through Title X.”

The Washington Post (3/5) reports the American Medical Association and the Planned Parenthood Federation of America have filed a lawsuit over the new rule from HHS that prevents clinics receiving Title X funding from making referrals for abortion, referred to as the “gag rule.” Barbara L. McAneny, the AMA’s president, said in a statement, “Because of the administration’s overreach and interference in health-care decision-making, physicians will be prohibited from having open, frank conversations with their patients about all their health care options.” Meanwhile, HHS maintains the rule will prevent “‘co-mingling’ of funds that are used for abortion and those that are used for other types of reproductive care.” The rule also prevents clinics from sharing physical space and finances with abortion providers.


New York Hospitals Rank 50th in CMS Star Ratings
The Albany (NY) Times Union (3/4, Bump) reports that New York’s “Capital Region hospitals earned mixed reviews in the latest and long-awaited update to the federal government’s controversial star hospital rating system.” CMS “has published hospital ratings since 2005 in an effort to give the public a way to compare hospitals on measures such as patient experience, timely and effective care, complications and death rates, readmission rates and payments, among other things.” Out of “all 50 states, New York hospitals rank 50th in star ratings.”


HHS To Air Secret Hospitals/Physicians Negotiate With Carriers?
On its front page, the Wall Street Journal (3/7) reports HHS is mulling whether to mandate that hospitals, physicians and others in the healthcare industry publicize the prices they negotiate with insurers for services, which could provide more transparency regarding the true cost of care. The department is seeking public input about whether patients are entitled to this information prior to receiving care.


Medical Groups Want Adolescents to Be Able to Meet with Physicians Individually
The Wall Street Journal (3/6) reports physicians and other experts are pushing for teenagers to be able to speak individually with their doctors. The American Academy of Pediatrics and other groups have long advocated for adolescents to be able to spend time alone with their physicians. The article quotes physicians, parents, and adolescents discussing the potential value of such time as well as some of the barriers to it.


CMS Revises Immediate Jeopardy Guidance
Modern Healthcare (3/6) reports that the Centers for Medicare & Medicaid Services Administrator Seema Verma announced in a blog post “revisions to the guidance surveyors use to spot immediate jeopardy, requiring them to fill out a three-question template that describes the incident.” Verma explained that the changes are due to recent media attention focused on harm at facilities, saying, “Despite stringent safeguards, alarming stories continue to be reported about people, including some of our most vulnerable individuals, who have experienced harm in healthcare settings.” CMS also removed “culpability” as one required component of immediate jeopardy,  and adds psychological harm as a component.


Register Today for MLMIC’s Free Risk Management Program
April 11, 2019 at 9:00am
Westchester Marriott Hotel
670 White Plains Road
Tarrytown, NY 10591

MLMIC is pleased to invite you to attend its Risk Management Program on Thursday morning, April 11, 2019, at the Westchester Marriott Hotel in Tarrytown, New York. The program will run from 9:00 a.m. to 12:45 p.m.  This year’s program will address several topics including Top Risks of the Office Practice Setting, Effective Coordination of Hospitalist Care, and High Exposure Liability Cases. 

Attendance at this complimentary educational event will enable physicians to earn 3.75 AMA PRA Category 1 CME Credits™ and provide the opportunity to complete a second component of the program online, at their convenience, to:

Earn additional CME credits; secure a 5% premium credit on their primary insurance policy, and

Qualify for participation in the “free” Section 18 excess medical malpractice insurance program.

There is no charge to attend however, pre-registration is required.

REGISTER ONLINE TODAY at www.mlmic.com/2019RMProgram


Sexual Harassment “Train the Trainers” Webinar:
The Impact on the Healthcare System and the Medical Profession
When: March 20, 2019
Time: 12:00pm-1:00pm
REGISTER HERE

The issue of sexual harassment in the workplace has been the center of a staggering amount of media attention and of a surge in litigation activity. Consistent with this momentum, New York State recently mandated that all employers are required to have a sexual harassment policy containing specified criteria in place by October 9, 2018, and to conduct sexual harassment prevention training by October 2019. (New York City requirements are slated to take effect in April 2019.)

The issue of sexual harassment takes on particular significance for the healthcare industry, because there is an established nexus between disruptive behavior, which includes sexual harassment, and adverse patient outcomes and medical errors.

At this time, Garfunkel Wild will be offering a complimentary “Train the Trainers” webinar on the issue of sexual harassment.  The live webinar will be presented on March 20, 2019, from 12 noon to 1:00pm.  For those individuals who are unable to participate in the webinar at that time, MSSNY will be placing a recorded version of that webinar on the MSSNY website to facilitate access to the webinar for MSSNY members.

By the conclusion of the “Train the Trainers” webinar, you will know how to teach your employees:

  • How to identify the more subtle forms of sexual harassment.
  • The impact of sexual harassment on the quality of care and the victim.
  • Practical advice on how to diminish and prevent sexual harassment at your practice.
  • How to respond to sexual harassment in the workplace.
  • Guidelines on how to comply with statutory mandates relating to sexual harassment.

Garfunkel Wild offers individual or group training, on-site or off-site training, as well as webinar modules that can serve to satisfy this new statutory mandate for your employees. If you would like to set up a personal training, please contact Andrew L. Zwerling at 516-393-2581 or azwerling@garfunkelwild.com.


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RENTAL/LEASING SPACE

Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/


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


5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464


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


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


PHYSICIAN OPPORTUNITIES

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


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


Physician 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, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year.

Interested? Learn more and apply today at www.98point6.com/pcc



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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


March 1, 2019- What We Got Here is a Failure to Communicate

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


MSSNY eNews
March 1, 2019
Volume 22  Number 9

MSSNYPAC Seal

Colleagues:

My wife Sandra and I have been blessed with five wonderful children.  The Madejski children are a combination of scientists and thespians.  My oldest son, Greg, is the other Doctor in the family— a PhD in Biomedical Engineering at the University of Rochester.  His youngest brother, Joe, is following in his footsteps as a sophomore at the U of R.  Giovanni, our middle child, is an industrial engineer in Colorado.  My daughter Jacqueline is an actress, currently performing in Key West, and my son James is a writer, currently in London working on a film.  The engineers, but especially the artists are all film buffs and we have ongoing discussions about a number of family favorite movies.

I missed the Oscars on Sunday, but am always amused, and sometimes dismayed, when life imitates art.

The quote at the top of the page is from the movie Cool Hand Luke.  Our children didn’t require a lot of guidance growing up, but when they did I would often joke that I felt we had difficulty with communication.  I felt somewhat like Paul Newman this past week in my efforts to give care to one of my patients in a Medicare Advantage Plan.

Rationing by Inconvenience

My patient, Mr.  X., had a CT of his abdomen and pelvis to assess some abdominal symptoms.  He was found to have an incidental abnormality in one of his kidneys, and my colleague in radiology recommended an ultrasound for further delineation. The ultrasound did not provide enough information and the radiologist recommended a dedicated CT of the kidney to complete the evaluation.  My office reviewed with the radiologist the need for repeat imaging.  The patient’s Medicare Advantage insurance plan required prior authorization for non-emergent imaging studies. We submitted the request and copy of the radiology report and recommendation and were denied the additional study.  I reviewed the denial, and felt that the initial reviewer had erred and submitted an appeal, indicating that my colleague in radiology recommended additional imaging.

Second Denial

Monday, I received another denial and reviewed the rationale.  The denial letter indicated that the test was denied because the patient had a CT done recently—the initial CT that incompletely identified the abnormality.  It was not clear to me who reviewed the information (a physician— it appeared) and whether they had the full clinical picture when they refused to authorize the study.  If they did have the full picture, and denied the study, I had serious concerns about the quality of care that I could deliver to my patients enrolled in this plan.  I called the 1-800 number on the denial and was connected immediately to a very friendly woman who accepted the patient identification information and then, because I was a provider, transferred me to the provider 800 number. The phone rang, and then I received frequent, repeated messages indicating that due to high call volume, there would be a delay in response.  I left the phone on speaker and completed some of my other post clinical work.  After 10- 15 minutes I was still on hold.  I hung up and went home.

Different Day, Same Response

The next morning,   I asked my assistant to contact the plan and find a medical director to discuss the case with.  In my previous experiences with other health plans, I’ve had good success in discussing a case with a physician colleague and moving forward on behalf of the patient in a mutually satisfactory way.  The plan responded that the medical director could not override a determination of the external reviewer and would not arrange for me to discuss the situation with an in- house medical director.  I was intrigued, and dismayed.   There appeared to be a problem in this system in which a physician, advocating for the proper care of their patient, could not discuss with a physician involved in the administration of the plan, concerns regarding the care of an individual patient and the quality of the plans administration of benefits for their insured. I dialed up the pleasant supervisor of appeals who dutifully took down my concern.  I did question whether the supervisor understood my concern was not just the individual patient, but a potentially flawed process that could harm other patients.  She indicated she would review it further with one of their medical directors and get back to me.  I received a call back the next morning.  The appeals supervisor told me they had reviewed my concerns, but no physician was available to speak to me.

Pulling Rank?

 Metaphorically, there was some blood on my forehead, and some puffiness to the bridge of my nose.  We had some back and forth and I was informed my only option would be to speak to her supervisor.  Trying to maintain some humor, I indicated that I thought she was the supervisor, but found that there were a number of levels of supervisors.  In these types of situations, my inclination is to work through the system, but clearly the system was not working for my patient, and not for me.  My sense of humor was failing, and I indicated that I did not wish to speak to another supervisor, but wanted to speak with a physician working for the plan.  It appeared that we were at an impasse.  Bloodied, but unbowed, I related my displeasure and indicated that I would now pursue the matter outside of the plans process.  I mentioned that I had 20,000 or so colleagues in New York who were going to hear about my experience, and indicated that if there was a medical director who wished to call me to discuss my concerns further, it might be worth their while.

I received a call back from the Medical Director of the plan within the hour.  We agreed to speak at the end of the day.  We had a pleasant conversation about my individual patient’s situation and his explanation (and to some extent an apology) about the frustrating rules imposed on the plan and their participating physicians and patients due to Medicare regulations.  He agreed to review my concern about the quality of the review and we agreed to have further discussions about the process for appeals and to review communications policies with our MSSNY VP for Socioeconomics Regina McNally.  I look forward to further discussions to improve the care of our patients and the satisfaction of our physician members.  Hopefully, this will be to the benefit of all concerned, and I won’t end up like Luke.

P.S. Just yesterday, I did have a conversation with a medical director and I think the long story will have a satisfactory (not happy because of the hours expended) ending.

This story has a number of lessons which I think are instructive to some of the discussions we will be having over the next few months in Albany and Washington.

Medicare for All?

There are ongoing discussions about single payer in New York, and Medicare for All in Washington.  Without the ability to discuss clinical concerns with administrative physicians (who also will need to be protected from reprisal when they act on behalf of a patient) in a timely, easily accessible, collegial fashion, care will be even more disrupted than it is now. Patients and physicians will have no recourse or alternative pathway in the face of an adverse determination.   If New York is going to move towards single payer, we need to have Senator Rivera and Assemblyman Gottfried pass our Collective Negotiation Bill now, as a bridge to the future, to ensure patients can get the care they require.

Physician Wellness

Physician wellness will also be further eroded due to increasing frustration with a bureaucratic, Medicare Disadvantage for all type system.  Health plans need to review the quadruple aim and pay attention to physician satisfaction as a key quality indicator.  We need to continue to work with the AMA and our State representatives to Fix Prior Auth

All healthcare financing systems have limited resources.  Patients, their physicians and other providers have ever increasing desires for care.  This constant dynamic within the system determines what actual care occurs.  Which is worse, a bureaucratic system which rations by inconvenience and can be subverted by advocacy, or an overt system with price transparency and determination of value by the purchaser?  Which is more ethical?

It is humbling, and exciting, for each of us, to have the power of this fully operational Medical Society.  Our collective voice opens doors, and our members provide valuable input on crafting the best solutions for healthcare across the state.  Many of our patients are great, articulate advocates for their interests and problems.  MSSNY physicians can complement them well, and we are acting as our best selves when we advocate on behalf of our patients who, for many reasons (illness, stigma, impairment, and developmental issues) cannot advocate on their own behalf.

Come to Albany on Wednesday

I again invite you to join me in Albany March 6th to meet with our elected representatives and share your personal story to inform them about the issues critical to you and your patients. www.mssny.org.  We have physicians and students joining us from all corners of our great state.   It should be educational (CME provided) and fun.

Our incoming President Dr. Art Fougner has agreed to try and exceed the record number of hard boiled eggs consumed in one sitting by Cool Hand Luke!

Quod si veru est per se evident, non est opus facundia

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

Thomas J. Madejski, MD
MSSNY President



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Capital Update

Will You Be Joining Us in Albany Next Wednesday?
Hundreds of physician leaders from across New York State are coming to Albany next Wednesday, March 6, to advocate for their profession and their patients. Will you be joining them?

These physicians will be meeting with their local legislators, and hearing from key health care policy leaders including the Chairs of the Health and Insurance committees in the New York State Senate and New York State Assembly.  Physicians will also be given the opportunity to ask questions of these legislators.

Please join us in Albany so that together we can advocate that the Legislature:

  • Reject State Budget proposals that would impose significant cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject State Budget proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support State Budget proposals to improve public health including raising the age for tobacco purchase, regulating Pharmaceutical Benefit managers, and enable the creation of a Maternal Mortality Review Committee;
  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana and creating a single payor health insurance structure.
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms; and
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

Advocacy Day reading materials can be found: here.

To view MSSNY’s Physicians Advocacy Webinar, please click here.

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

(DIVISION OF GOVERNMENTAL AFFAIRS)


Physicians Urged to Oppose $80/Dual Eligible Patient Cut
Physicians are urged to continue to contact their state legislators to oppose a proposal in the 2019-20 Executive Budget that would significantly cut payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their patients covered by both Medicare and Medicaid.

You can send a letter in opposition to this harmful proposal by clicking: here

You can read MSSNY’s memo of opposition to the Legislature here: memo

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, for practices that see a large number of dual eligible patients, this will have a profound impact.  For example, if a physician’s patient mix includes 500 such dual eligible patients, which could certainly be the case for many types of specialty physicians, it would cut payments by $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment.

In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care. Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the state budget on the backs of dedicated community physicians seeking to deliver quality care to their patient.                                                                              (AUSTER)


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Measures Enacting Tighter Restrictions on Tobacco and E-Cigarettes Moves Forward in NYS Legislature
A series of bills to limit youth tobacco use moved out of the Assembly and Senate Health Committees this week including one that would raise the age of tobacco purchase to 21.  A.558/S.2833, sponsored by Assemblywoman Linda Rosenthal and Senator Diane Savino raises the purchase age of tobacco products from 18 to 21.  Also moving from the Health Committees was A.47/S.428, sponsored by Assemblymember Linda Rosenthal and Senator Brad Hoylman.

This measure prohibits the sale and distribution of flavored “e-liquids” for use in electronic cigarettes and electronic cigarettes containing such flavoring.  A.389/S.592, sponsored by Assemblymember Sandra Galef and Senator David Carlucci, would enact the “Tobacco-Free Pharmacies Act”, which would prohibit the sale of tobacco products in pharmacies. This measure was moved from the Assembly Health Committee; action is still pending in the Senate Health Committee. The Medical Society of the Society of the State of New York supports these measures. MSSNY also supports similar proposals that have been advanced in the Executive budget.  (CLANCY)


New York Health Act Reported from Assembly Health Committee
This week legislation to create a single payor system in New York (The New York Health Act A.5248, Gottfried) was reported from the Assembly Health committee to the Codes Committee. The bill passed the Health Committee by a vote of 17-8, with Democrat Robin Schimminger and all seven Republicans on the committee voting against the measure.

During the committee meeting there was extensive debate, including questions related to private insurance, out of state injuries, effects on Medicare recipients and costs of the bill related to a variety of factors such as pharmaceuticals and unemployment insurance. Gottfried estimated that it would take two years to start paying out claims. The current iteration of the bill adds long-term care insurance for New York State residents in addition to its goal of providing taxpayer-funded insurance coverage without premium or co-pays for all New Yorkers.

The bill has passed the Assembly four years in a row and is carried in the Senate by Health Chair Committee Gustavo Rivera. MSSNY continues to have a long standing policy position in support of a multi-payor system to achieve universal coverage and in opposition to a single payor system, but also recognizes that there is a wide array of physician perspectives on this issue.  MSSNY looks forward to continued open and honest dialogue and careful evaluation of the nuances such a far-reaching proposal related to our healthcare and insurance system to ensure that New York moves forward in a manner that assures that patients access to needed care from the physician of their choice is not impaired.

When the legislation was re-introduced a few weeks back, MSSNY President Dr. Thomas Madejski issued the following statement (Statement by Thomas Madejski, MD) that highlighted improvements to the legislation to place parameters around prior authorization requirements and provide a fairer process to negotiate payments for patient care, but also MSSNY’s ongoing strong concerns with moving away from a multi-payor insurance system. (AVELLA, AUSTER)


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Governor Signs Into Law “Red Flag” Law
Governor Andrew Cuomo this week signed into law S.2451/A. 2689, sponsored by Senator Brian Kavanagh and Assemblymember JoAnne Simon, which allows law enforcement officials, family and household members, and certain school officials to seek a court order requiring a person likely to harm themselves or others to surrender any firearms in their possession. This bill, commonly referred to as a “red flag” law, would establish an Extreme Risk Protection Orders (ERPO) which is an order of protection prohibiting a person from purchasing, possessing or attempting to purchase or possess a firearm, rifle or shotgun.    Under the measure, a police officer, a family or household member, a school administrator or his/her designee, can request a court-issued order of protection.  The bill provides grounds for the request and surrendering of the firearm.  MSSNY’s Taskforce on Firearm Safety recently recommended (and the MSSNY Council agreed) that MSSNY support the concept of “red flag” provisions.

Still awaiting the governor’s signature are a series of bills that would help ensure firearm safety.  S.2374/A.2690, sponsored by Senator Michael Gianaris and Assemblymember Amy Paulin, would establish a background check waiting period of up to 30 days.  S.2248/A.2448, sponsored by Senator Luis Sepulveda and Assemblymember Patricia Fahy, would prohibit the possession of a device (bump stock) that accelerates the rate of fire of a firearm.

Also passed by the Legislature was S.101A/A.1715, sponsored by Senator Todd Kaminsky and Assemblymember Judy Griffin that prevents K-12 schools from authorizing anyone other than a security officer, a school resource officer or a law enforcement officer from carrying a firearm on school grounds.  Senator Shelley Mayer and Assemblymember Linda Rosenthal sponsored legislation that directs the state police to devise regulations for gun buyback programs to ensure that such programs are operated consistently throughout the state.  Senator Anna Kaplan and Assemblymember Pamela Hunter were the sponsors of S.2438/A.1213, which would require out of state applicants for gun permits to allow NY permitting authorities to review out-of-state mental health records.

In March 2018, the MSSNY House of Delegates took action to support legislation that requires a waiting period and background checks prior to the purchase of all firearms, including person-to-person transfer, internet sales and interstate transactions for all firearms.  The MSSNY HOD also supported legislation that blocks the sale of any device or modification – including but not limited to bump stocks, which convert a firearm into a weapon that mimics fully-automatic operation.  MSSNY supports legislation that would ban the sale and/or ownership of high-capacity magazines or clips and high-speed, high-destruction rounds. (MSSNY Policy 260.898 and Policy 260.899). (CLANCY)


NY Health Foundation Issues Report Promoting NY’s Successful Law to Limit Patient Surprise Bills
With the United States Congress looking at legislation to address the issue of patients facing “surprise” out of network medical bills across the country, the New York State Health Foundation issued a report this week highlighting the success that New York’s 2014 law has had in reducing such bills.

While New York’s law contains a number of different components to expand network adequacy and comprehensive out of network coverage, its most notable component assures that patients are not financially responsible for medical bills for “surprise” Emergency Department and hospital out-of-network services that are above the patient’s standard in-network copayment, deductible, or coinsurance amount.  Physician payments for these services are determined through informal negotiation between the insurer and physician, with either party having the right to go to a simplified expedited independent dispute resolution (IDR) process if such negotiations for fair payment are not successful (for more information about the law, click here).  The report noted that the percent of out-of-network emergency department services that were billed decreased from 20.1% in 2013, before the law was passed, to 6.4% in 2015, after its implementation.

As Congress debates this issue, MSSNY has written to the New York Congressional delegation, urging that any legislation to be considered is consistent with New York’s comprehensive law (see MSSNY’s letter here).   New York’s comprehensive law addressing this issue has been hailed as a model for the rest of the country because of the delicate balance it struck among key health care stakeholders (such as physicians, hospitals and health insurers) to protect patients from large “surprise” medical bills, while at the same time being constructed in such a way that it did not adversely affect the ability of hospital emergency departments to have adequate on-call specialty physician care.

The NYS Health Foundation report also included some recommendations for improving New York’s law, including stronger insurer network adequacy requirements, enhanced insurer and provider disclosure of network participation, further limiting balance billing in ER out of network situations, and extending applicability to air ambulance services.  MSSNY is continuing to review the feasibility of these recommendations. (AUSTER)



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Assembly Passes Legislation to Exempt Nursing Home from E-Prescription Requirement
This week the Assembly passed Assemblyman Richard Gottfried’s bill (A1034-A) that would exempt nursing homes’ prescription of oral medication from the state requirement that all prescriptions be electronically submitted.   As was recently discussed at MSSNY’s Long-Term Care subcommittee meeting, nursing homes present unique circumstances that make compliance with the current mandate impractical. Physicians are not physically present 24 hours a day, so RNs are allowed to take orders for medication safely and without delay for the residents who need them. The physician would then sign the oral order within 48 hours. This is an extension of an already existing exemption established by the NYS Department of Health that is set to expire on 3/24/19. It would set forth in statute that a waiver from this requirement would be extended to March 2021. The bill does not yet have a Senate sponsor. (AVELLA)


DOH Announces Prevention Agenda 2019-2024 at 6th Annual Population Health Summit
On February 2nd, MSSNY staff and Dr. Geoffrey Moore (Tompkins County) participated in the 6th Annual Population Health Summit: “Becoming the Healthiest State for People of All Ages – Incorporating Health Across all Policies and Age Friendly Principles into the Prevention Agenda 2019-2024” hosted by the NYS Department of Health. The Summit sought to deepen and extend the understanding of ongoing efforts in New York State and nationally that demonstrate effective collaboration between public health, health care, and other sectors to advance population health.

The Prevention Agenda 2019-2024 will focus on preventing chronic diseases; promoting a healthy and safe environment; promoting healthy women, infants, and children; preventing mental and substance use disorders; and preventing communicable diseases. To learn more about the Prevention Agenda 2019-2024 click on this link (HARRING)


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Legislation to Help Prevent Sudden Cardiac Arrest in Student Athletes Moving in NYS Assembly
Legislation to create an educational program on sudden cardiac arrest moved out of the Assembly Health Committee this week.  A.4892/S.3269, sponsored by Assemblymember Michael Cusick and Senator Andrew Lanza, would add the development of an educational and outreach program preventing sudden cardiac arrest among student athletes to the Health Care and Wellness Education and Outreach Program that currently exists in the New York State Department of Health.

The Medical Society of the State of New York supports this measure.  Under the bill’s provisions, DOH will provide educational materials regarding sudden cardiac arrest to students and their parents and guardians. The materials would be developed in conjunction with the Commissioner of Education, the Medical Society of the State of New York, the New York Chapter of the American Academy of Pediatrics, and the American Heart Association.  They would include an explanation of sudden cardiac arrest, a description of early warning signs and an overview of options that are privately available for screening. This legislation would establish a program similar to one being used in New Jersey that requires the development of brochures that could be given to parents as well as pediatricians. (CLANCY)


Registration now open for Medical Matters: Disaster Medicine: Every Physician’s Second Specialty on March 27th at 7:30 AM
The Medical Society of the State of New York will conduct a webinar entitled Disaster Medicine: Every Physician’s Second Specialty on March 27, 2019 @ 7:30am.

Register now for:

Medical Matters: Disaster Medicine: Every Physician’s Second Specialty

Wednesday, March 27th @ 7:30am
Register here.
Faculty: Lorraine Giordano, MD, FACEP, FAADM

Educational Objectives:

Identify core preparedness competencies every physician should know

Explore essential elements of preparedness plans for staff, patients, and family

Describe available courses, resources and organizations to obtain disaster preparedness education and training. 

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

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


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Registration Now Open for New Veterans Matters CME Webinar March 14th
The Medical Society of the State of New York is proud to announce our newest Veterans Matters webinar scheduled for March 14th at 7:30am. This webinar is entitled Military Culture: Everything Physicians Need to Know About Veterans as Patients.  Register for this program here.

Veterans Matters: Military Culture: Everything Physicians Need to Know About Veterans as Patients

When: Thursday, March 14 2019 at 7:30am – Register here.

Faculty: Lt. Col Lance Allen Wang, & Marcelle Leis, CM Sgt. (Ret)

Educational Objectives:

  1. Describe the unique aspects of military culture and how they impact patients who are veterans.
  2. Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality.
  3. Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back into civilian life.

Additional information or assistance with registration can be obtained by contacting Melissa Hoffman at mhoffman@mssny.org or (518)465-8085                                 (HOFFMAN)

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 creditsä.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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

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

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MSSNY Member Event at the Westbury Manor: “Is Single Payer Legislation Coming to New York? 

Moe Auster MSSNY, Single Payer Seminar, Westbury David Podwell, MD, Single Payer Seminar, Westbury
Single Payer Seminar, Westbury Single Payer Seminar, Westbury

Response to Claim that Majority Legalization of Assisted Suicide
Dr. Thomas Madejski, the president of the Medical Society of the State of New York (MSSNY), wrote in a letter to the editor of the Albany (NY) Times Union (2/22) that MSSNY “has strong concerns with the articulation in the article ‘State’s physicians support aid in dying,’ Jan. 29, that a majority of New York doctors are in favor of physician assisted suicide.” Madejski says that “the survey from Compassion & Choices that was referenced in the article, like the 2017 Medical Society survey, is not a scientific sample representative of the nearly 100,000 New York-licensed physicians as a whole.” Madejski adds that MSSNY’s “Task Force on End of Life continues to discuss many matters related to end-of-life care and whether Medical Society’s long-standing position on physician assisted suicide should be re-evaluated.”


NY Services for Senior Citizens Strained by Record High Elderly Population
The Wall Street Journal (2/27, King, Subscription Publication) reports a study published by the Center for an Urban Future indicates that people aged 65 and older now make up 16 percent of New York’s population, a record high. This in turn is straining state and county services for senior citizens, such as home-care aides and meal delivery.


A Patient Just Sexually Harassed An Employee of My Practice: What Can I Do?
By Andrew Zwerlingftnref1″>[1]

It seems like a normal day at your medical practice until one of your female physician-employees informs you that a male patient grabbed and tried to kiss her when she was conducting a routine examination.  The patient fled the practice immediately after this event.

Putting aside the issue of whether your employee may file criminal charges against the patient – she can – an issue confronting you as the physician-owner of the practice is whether it is appropriate to discharge the offender as a patient of your practice.   As the owner of the practice, under New York law you are required to intervene when put on notice of acts of sexual harassment and assault in your workplace and may be held accountable if you fail to do so.  Here, in order to ensure the safety of your staff, one measure you can take is to discharge or terminate the patient.

Significantly, however, there are myriad components to the termination process that should be undertaken in the effort to insulate you and your practice from a claim of patient abandonment.  You should inform the patient of the termination in writing and through a method of delivery that allows you to track and confirm receipt by the patient, and also send the letter by first class mail.

In the letter you should advise the patient 1) of the reason for the termination; 2) that your practice will be available to him for urgent or emergent care only for a period of thirty (30) days while he transitions his medical care to another qualified provider; 3) that he should contact his insurance provider to assist him in identifying local medical providers to manage or arrange for any ongoing treatment he may need; and 4) that when he finds another provider, that provider may contact your practice to arrange for the transfer of the patient’s clinical records.  You may, but are not required to, provide the patient with a list of other similar providers in the area that he can contact to arrange for ongoing treatment, but cannot recommend any particular provider.  Finally, you should maintain a copy of the termination letter in your files.

[1] Andrew L. Zwerling is a Partner-Director at Garfunkel Wild P.C. with over 36 years as a trial and appellate lawyer in State and Federal courts, including his successful argument before the United States Supreme Court.  He specializes in employment law, and conducts internal investigations for clients relating to sexual harassment and other personnel issues.   His may be reached at 516-393-2581 and by email at azwerling@garfunkelwild.com.


Physicians Accepted $40M in Kickbacks from Texas Hospital, Feds Say
The federal trial for 10 defendants, including four surgeons and a pain physician, accused of participating in a $200 million healthcare fraud scheme kicked off last week, according to The Dallas Morning News.

Five things to know:

  1. The trial, which is expected to last up to two months, centers on bribes and kickbacks now-defunct Forest Park Medical Center in Dallas allegedly paid to physicians and surgeons to steer surgeries to the hospital.
  2. The scheme, which began in 2009 and ran through 2013, involved paying surgeons for referring patients to FPMC, which was out of network with payers. Instead of billing patients for out-of-network copayments, hospital executives and physicians allegedly assured patients they would pay in-network prices. Those involved in the scheme allegedly concealed the patient discounts and wrote off the difference as uncollected bad debt.
  3. There were 21 defendants charged in the scheme in 2016, 11 of whom have pleaded guilty and are expected to testify on behalf of the government at trial, according to The Dallas Morning News.
  4. The $200 million healthcare fraud scheme allegedly involved FPMC officials making $40 million in illegal payouts to surgeons and others in exchange for referrals. Although the $40 million in payments looked legitimate, they were really “bribes and kickbacks,” a government lawyer told the jury during opening arguments on Feb. 21, according to Law360.
  5. Several of the defendants have denied any wrongdoing. They claim healthcare attorneys told them the marketing agreements they entered into, which are at the center of the kickback allegations, were not illegal, according to The Dallas Morning News. (Becker’s Hospital Review, Feb. 27)

More Independent Hospitals Joining Systems Amid Financial Struggles
Modern Healthcare (2/23) reported “stand-alone hospitals’ financial situations are increasingly tenuous,” with 53.2 percent operating at a loss “for each of the past five years, which is more than twice the share of system-owned hospitals, according to an analysis of Modern Healthcare Metrics.” Among rural standalone hospital, the number increases to 60.5 percent. Meanwhile, “independent government-owned hospitals, many of them in rural areas, had an average annual operating margin of negative 16.6% and a $15.8 million operating loss in 2016 compared with a negative 7.9% operating margin and $8.4 million operating loss for their system-owned peers, according to a white paper from Healthcare Management Partners, Waller Lansden Dortch & Davis, and Taggart, Rimes & Graham.” Such financial struggles are leading independent hospitals to join larger health systems; “nearly three-quarters of all hospitals were part of multihospital systems in 2017, up from 70.4% in 2012, according to Metrics data.” (Becker’s Hospital Review, Feb. 27)


As Congress Looks at ‘Surprise’ Billing, a Review of NY’s Law
The New York State Health Foundation on Monday published a review of the state’s law regarding surprise bills, implemented in 2015, to highlight its successes and limitations.

Under the law, patients are responsible for their in-network payment only in cases when they did not give written consent to be treated by an out-of-network provider, including in emergencies. The law also created a dispute-resolution process for providers and insurers to enter binding arbitration over bills.

The law seems to have had its intended effect. The percentage of out-of-network emergency department services billed dropped from 20.1% in 2013 to 6.4% in 2015, according to a study from researchers at Yale University cited in the report.

“We found with our review that the law is working quite well,” said Sharrie McIntosh, vice president for programs at NYSHealth.


Study Underscores Cost Implications of Trend on Taxpayers and Beneficiaries
This study demonstrates that the overall trend continues and is dramatically reshaping the landscape for physicians by creating an increasingly concentrated health care system that costs more.  This is because the same services performed in the hospital outpatient setting are reimbursed by Medicare at higher rates compared to the independent physician office setting. Previous PAI-Avalere research underscored the impact of this policy as it relates to health care spending by taxpayers and patients:

  • Medicare paid $2.7 billion more for four specific cardiology, orthopedic, and gastroenterology services performed in the hospital outpatient setting than if the same services were delivered in the physician office setting from 2012 to 2015.
  • For these same services, Medicare beneficiaries faced $411 million more in out-of-pocket costs due to higher cost-sharing.

Sexual Harassment Webinar
Train the Trainers”: Impact on Healthcare System and Medical Profession

March 20, 2019
12:00pm-1:00pm

REGISTER HERE

 The issue of sexual harassment in the workplace has been the center of a staggering amount of media attention and of a surge in litigation activity. Consistent with this momentum, New York State recently mandated that all employers are required to have a sexual harassment policy containing specified criteria in place by October 9, 2018, and to conduct sexual harassment prevention training by October 2019. (New York City requirements are slated to take effect in April 2019.)

The issue of sexual harassment takes on particular significance for the healthcare industry, because there is an established nexus between disruptive behavior, which includes sexual harassment, and adverse patient outcomes and medical errors.

Sexual Harassment Train the Trainer FREE Webinar on March 20 12 noon

At this time, Garfunkel Wild will be offering a complimentary “Train the Trainers” webinar on the issue of sexual harassment.  The live webinar will be presented on March 20, 2019, from 12 noon to 1:00pm.  For those individuals who are unable to participate in the webinar at that time, MSSNY will be placing a recorded version of that webinar on the MSSNY website to facilitate access to the webinar for MSSNY members.

By the conclusion of the “Train the Trainers” webinar, you will know how to teach your employees:

  • How to identify the more subtle forms of sexual harassment.
  • The impact of sexual harassment on the quality of care and the victim.
  • Practical advice on how to diminish and prevent sexual harassment at your practice.
  • How to respond to sexual harassment in the workplace.
  • Guidelines on how to comply with statutory mandates relating to sexual harassment.

Garfunkel Wild offers individual or group training, on-site or off-site training, as well as webinar modules that can serve to satisfy this new statutory mandate for your employees. If you would like to set up a personal training, please contact Andrew L. Zwerling at 516-393-2581 or azwerling@garfunkelwild.com.


CME PROGRAMS

Two CME Programs at the HOD: Protect Your Patients and Women in Medicine
You don’t want to miss these! REGISTER NOW at sbennett@mssny.org

Thursday, April 11, 2019, 3:00 – 4:00 pm, Grand Ballroom D/E, Westchester Marriott, Tarrytown

Protect Your Patients, Your Practice, and You!*

Join us at the OMSS Annual Meeting for an interactive presentation by Garfunkel Wild on MEDICAL RECORDS, including the impact on records of the controlled substances “epidemic,” what to consider when emailing and texting, dealing with non-compliant patients, additional areas of exposure from EMRs, and what to include in a telemedicine record.

Business meeting to follow, 4:00 – 6:00, Putnam Room


Friday, April 12, 2019, 5:00 – 6:30 pm, Grand Ballroom B, Westchester Marriott, Tarrytown 

Women in Medicine: Reaching Your Potential Now!**

A panel presentation at the Women Physicians Caucus on PAY, PROMOTIONS and CAREER ADVANCEMENT in Academic Medicine, Private Practice and Organized Medicine

Gender imbalance in medicine and academic sciences still exists. Hear three women physicians who have achieved significant leadership positions describe their own pathways, provide advice on how to achieve success, and show how to overcome gender bias, gender pay gaps and system-wide barriers to career advancement. Learn how to achieve success in your career!

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

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

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

The Medical Society of the State of New York designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Classified

RENTAL/LEASING SPACE

 

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


5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464


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


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


PHYSICIAN OPPORTUNITIES

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


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


Physician 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, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year.

Interested? Learn more and apply today at www.98point6.com/pcc



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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Council – March 5, 2019

AGENDA
MSSNY Council Meeting
Tuesday, March 5, 2019, 1:00 p.m.
Albany Renaissance Hotel
144 State Street
Albany, NY  12207

 

A. Call to Order and Roll Call

B. APPROVAL of the Minutes of January 24, 2019

C. New Business (Informational/Action Items)

1. President’s Report:
Introduction to the New MSSNY Mobile App for the House of Delegates (verbal)
Presented by:
Mr. Stephen Sachs, MSSNY’s Website Administrator

2. Board of Trustees Report – Dr. Robert Hughes will present the report  (handout)

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

4. MLMIC Update – Mr. Marc Craw will present the report (verbal) 

5. AMA Delegation Report – Dr. John Kennedy will present the report (verbal)

6. MSSNYPAC Report – Dr. Joseph Sellers will present the report (handout)

7. MESF Update – No written report submitted

8. Commissioners (Action Items – For Council Approval)
    Commissioner of Science & Public Health, Joshua M. Cohen, MD

  1. Resolution 2018-63 – Integrating Medical Records
  2. Resolution 2018-150 – Common Sense Prostate Cancer Screening
  3. Revisions to MSSNY Policy 125.996 Screening Programs and Interventions Most Beneficial in Improving the Overall Public Health

DReports of Officers

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

E.  Presentations

2:00 p.m.
PowerPoint – “Physician Wellness” (handout)
Presented by:
Arthur Hengerer, MD, Chair BPMC
Robert Catalano, MD, MBA Executive Secretary, OPMC
Mr. Keith Servis, OPMC Director
Mr. Stephen Boese, Executive Secretary, Board of Medicine


2:45 p.m.
PowerPoint – “Efforts to Stop Legalization of Marijuana in New York State” (handout)

Presented by:
Kevin A. Sabet, PhD. President & CEO
Smart Approaches to Marijuana (SAM)


3:45 p.m
Discussion – “Overview of the Proposal to Legalize Marijuana in New York State” (verbal)
Presented by:
Mr. Axel Bernabe, Associate Counsel for Health
Office of  New York Governor Andrew Cuomo
Mr. Jason Starr, Assistant Counsel
Office of  New York Governor Andrew Cuomo


F.
  Reports of Councilors (Informational Items)

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

G.  Commissioners (Informational Items)

1. Commissioner of Communications, Maria A. Basile, MD, MBA
  a.  Report from the Division of Communications 

2. Commissioner of Governmental Relations, Gregory Pinto, MD
  a. HIT Committee Minutes, February 1, 2019

3. Commissioner of Membership, Parag H. Mehta, MD
    a. Membership Committee Report

4.  Commissioner of Science & Public Health, Joshua M. Cohen, MD 
  1. Addiction & Psychiatric Medicine Committee Minutes, January 18, 2019
  2. Bioethics Committee Minutes, February 8, 2019
  3. Health Care Disparities Minutes, January 25, 2019
  4. HLC Committee Minutes, October 17, 2018
  5. Infectious Diseases Committee Minutes, January 17, 2019
  6.  PMFH Committee Minutes, February 7, 2019
  5. Commissioner of Socio Medical Economics, Howard H. Huang, MD
  (No written report submitted)

H. Report of the Executive Vice President, Philip Schuh, CPA, MS

I. Report of the General Counsel, Garfunkel Wild, P.C., James Derling, Esq.
   (No written report submitted)

J. Report of the Alliance, Barbara Ellman
   (No written report submitted)

K. Other Information/Announcements 

  1. AMA Surprise Bill Sign-On Letter
  2. MSSNY Surprise Bill Letter to Senator Schumer
  3. PAI Comments on HIPAA RFI
  4. MSSNY Statement on Legalization of Cannabis Public Hearing
        http://www.mssnyenews.org/press-releases/legalcannabis/#can
  5. MSSNY Statement on Revised New York Health Act Legislation
        http://www.mssnyenews.org/press-releases/health-act-  legislation/#leg   
  6. Poughkeepsie Journal Article    https://www.poughkeepsiejournal.com/story/news/2019/02/20/marijuana-legalization-ny-under-attack-cops-educators-docs/2905268002/

L. Adjournment

 

 

 

 

 

February 22, 2019 – Federal and State Issues

 

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


MSSNY eNews
February 22, 2019
Volume 22  Number 8

MSSNYPAC Seal

Colleagues:

Last week your MSSNY leadership and staff attended the AMA National Advocacy Conference in Washington, D.C.  We enjoyed presentations from a number of elected officials, HHS Secretary Alex Azar, various media personalities and AMA content experts about the many issues affecting our patients and our practices.  The highlight of the meeting was the Nathan Davis Awards dinner, Tuesday night.  Nathan Davis, a MSSNY member from Broome County helped to found the AMA in 1857.  I was proud to accept an award for our longstanding MSSNY member Dr. Richard Izquierdo for his work to improve the healthcare of his patients in his underserved community.

Doc Izquierdo is a trailblazer whose efforts have resulted in the creation of a healthcare system that focuses on treatment of the underserved, and was a pioneer in improving the educational system to improve recruitment of minority students into healthcare fields.

On the Hill

 Tuesday and Wednesday were spent on the Hill meeting with our elected representatives and staff to discuss the many current issues under discussion.  We were happy to visit the offices of Senate Majority Leader Schumer, Senator Gillibrand, Rep. Elise Stefanik, Rep. Paul Tonko, Rep. Brian Higgins, Rep. Elliott Engel, and Rep. Joe Morelle among others.  We reviewed legislative proposals for fixing some of the flaws in the ACA, Medicare funding, current activities to combat the opiate crisis, and challenges related to marijuana.  There was uniform support to changing marijuana from Schedule I to Schedule II, to support high quality research to address the many questions regarding its medicinal use and safety concerns with expanding access to marijuana in some of the states.  MSSNY is very supportive of efforts to better define the medicinal properties of various cannabis derived products for treatment of various conditions.  That research should also answer the many questions about safety and consequences of chronic use for patients, and inform decisions on non-medicinal use.

Expanded Marijuana Use for Recreational Purposes

Subsequently, Governor Cuomo’s Council and other staff briefed the New York State Legislature on their proposal to expand medicinal and adult recreational use.  Many questions remain in regard to promoting increased use of marijuana and related hemp products both medicinally, and as a lifestyle choice.  MSSNYs concern relates to a paucity of data on long term efficacy and risks associated with chronic use.  Last week JAMA Psychiatry published a meta-analysis raising concerns about increased depression and suicide rates in association with marijuana use.

Societal mental health issues and teenage and young adult suicide is a major issue throughout the country.  Emerging concerns regarding increasing marijuana usage among youth should give us pause before making it more accessible to society in general, even with the protections in the Governor’s proposal.  States with adult use programs have higher rates of child and adolescent use.

We should work with the Governor’s Office and the Legislature to address any disparities in the application of the law to minor users of marijuana.  We should urge our Federal representatives to reschedule marijuana to allow high quality, large population studies of this complex moiety to inform us on its proper place in the compendium of treatments available for our patients.  That research should also help to determine whether it is safe for long term use and made available more widely for non-medicinal purposes.  Federal action would also help to protect our children, teens, and young adults from the effect of legalization in neighboring states and countries.

Join me in Albany March 6th to help your fellow physicians inform our representatives on these many important topics.

Primum, non nocere!

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

Thomas J. Madejski, MD
MSSNY President



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Capital Update

Join Us For: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
Physician leaders from across New York State will be coming to Albany on March 6, to advocate for their profession and their patients. Will you be joining them?

With nearly 40 newly elected legislators in Albany, the need for physician advocacy and grassroots involvement is greater than ever. It’s vital for physicians to forge new relationships, as well as strengthen existing relationships to ensure the physician community’s message is heard about policies that could impact patient care.

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

Join Us To Urge Your Legislators To:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure.
  • Reject proposed unfair cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

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


Physicians Urged to Oppose $80/Dual Eligible Patient Cut 
Physicians are urged to continue to contact their state legislators to oppose a proposal in the 2019-20 Executive Budget that would significantly cut payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their patients covered by both Medicare and Medicaid.  You can send a letter in opposition to this harmful proposal by clicking here.  You can read MSSNY’s memo of opposition to the Legislature here.

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, for practices that see a large number of dual eligible patients, this will have a profound impact.  For example, if a physician’s patient mix includes 500 such dual eligible patients, which could certainly be the case for many types of specialty physicians, it would cut payments by $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment.

In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care. Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the state budget on the backs of dedicated community physicians seeking to deliver quality care to their patient.         (AUSTER)


 

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Governor Releases “30-Day” Budget Amendments That Could Cause Significant Medicaid Cut
Late last week, Governor Cuomo provided the State Legislature with his “30-day amendments” to the Executive Budget proposal that was formally introduced on January 15. While staff is continuing to review the entire proposal, there are major implications for the health care sector that are designed to close a $2.3 Billion budget gap for FY 2019-20.  Of significant concern is a proposal that would impose an across the board Medicaid cut to all covered Medicaid providers totaling $190 million.  This could translate to a per service cut to physicians and other health care providers of approximately 0.8%.

Moreover, there were significant cuts to hospitals and nursing homes announced including the proposed elimination of a scheduled $550 million increase in Medicaid payments that had been announced in late 2018.  Furthermore, the Governor proposed a revised version of an “opioid tax” on manufactures and distributors that had been approved by the State Legislature as part of last year’s Budget, but had been struck down by the courts.  The governor has also proposed re-convening the Medicaid Redesign Team (MRT) that had met in the early years of the Cuomo Administration to arrive at ways to increase quality care delivery and produce savings for the system.  Please remain alert for further updates on these issues. (AUSTER)


NYS DOH Sends Letter To Physician Regarding Opioid Prescribing
The New York State Department of Health, Bureau of Narcotic Enforcement, has sent a letter to physicians and institutions apprising them that, effective April 1, 2018, legislation was enacted that  no opioids shall be prescribed to a patient initiating or being maintained on opioid treatment for pain which has lasted more than three months or past the time of normal tissue healing, unless the medical records contains a written treatment plan that follows generally accepted national professional or governmental guidelines.

This requirement does not apply for patients who are being treated for cancer that is not in remission, in hospice or end of life care, or whose pain is being treated as part of palliative care practices. MSSNY took no position on this measure as it was consistent with the CDC’s Chronic Pain guidelines, and was an improvement from an earlier version that would have required a written treatment plan for pain lasting longer than 30 days. A copy of the letter from BNE is here. Information on the CDC’s Chronic Pain Guidelines is here. (CLANCY)


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NYS DOH Issues Emergency Regulations On PTSD, Substance Abuse And Opioid Use Disorder
This week the NYS DOH re-issued emergency regulations adding PTSD, substance abuse and opioid use disorder to the list of conditions to be treated by marijuana consistent with statutes enacted in 2018 authorizing medical marijuana to treat these conditions. DOH had previously issued an emergency regulation on this subject last October.

MSSNY has opposed adding these conditions to the list of medical conditions that a physician and/or other health care provider can certify a patient for use of marijuana.  However, importantly, these updated emergency regulations now require that any provider making a recommendation for marijuana for the treatment of opioid use disorder must have a DATA 2000 waiver. This regulation appears to limit when marijuana can be used and assures that only those who have appropriate training can make the decision.  A copy of the emergency regulations can be found on pages 7-9 at the NYS State Register 

MSSNY remains concerned about using marijuana for substance or opioid use disorders.  A recent JAMA article highlights the concern of substituting marijuana in place of buprenorphine. The Jama article concluded “For the opioid addiction crisis, clearly efficacious medications such as methadone and buprenorphine are under prescribed. Without convincing evidence of efficacy of cannabis for this indication, it would be irresponsible for medicine to exacerbate this problem by encouraging patients with opioid addiction to stop taking these medications and to rely instead on unproven cannabis treatment.  (CLANCY)


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Galef Introduces Legislation To Enable Greater Communication Between Physicians & Patients
Assemblywoman Sandy Galef has introduced legislation (A5909) that would exclude a statement by a physician indicating apology or regret as an admission of liability in malpractice lawsuits. Under current law, physicians open themselves up to malpractice liability if and when they express their condolences to patients and/or their families when there is a negative medical outcome – even if there has been absolutely no wrongdoing on the physician’s behalf.

At least thirty-six states have passed similar legislation. Enactment of this measure would allow physicians to provide the apology or validation that families and patients often state they hope for by preventing these statements from being used as admissions of guilt in legal proceedings. Further, research has shown that in those states with apology laws, malpractice cases are solved 20% faster and average claims payment amounts are lower.  (AVELLA)


Registration Now Open For Veterans Matters CME Webinars February 28th and March 14th
The Medical Society of the State of New York is proud to announce two NEW Veterans Matters webinars scheduled for February and March 2019. These webinars are: The Special Mental Health Needs of Women Veterans on Thursday, February 28th at 7:30am and Military Culture: Everything Physicians Need to Know About Veterans as Patients on March 14th at 7:30am.

Veterans Matters: The Special Mental Health Needs of Women Veterans
When:  Thursday February 28, 2019 at 7:30am – Register here
Faculty: Col. Malene Ingram, MD (US Army Reserves)

Educational Objectives: 

  1. Review how the increased role of women in the military has impacted their mental health.
  2. Describe mental health concerns unique to women veterans and how to identify and treat them.
  3. Identify the barriers that women veterans face in getting the specific care they need.

Veterans Matters: Military Culture: Everything Physicians Need to Know About Veterans as Patients
When: Thursday, March 14 2019 at 7:30am – Register here
Faculty: Lt. Col Lance Allen Wang, & Marcelle Leis, CM Sgt (Ret)

Educational Objectives 

  1. Describe the unique aspects of military culture and how they impact patients who are veterans.
  2. Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality.
  3. Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back into civilian life.

Additional information or assistance with registration can be obtained by contacting Sarah Humes at shumes@mssny.org or (518)465-8085

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. (HUMES, HOFFMAN)


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Registration Now Open For Medical Matters: Disaster Medicine: Every Physician’s Second Specialty on March 27th at 7:30 am

The Medical Society of the State of New York will conduct a webinar entitled, “Disaster Medicine: Every Physician’s Second Specialty” on March 27, 2019 @ 7:30am.

Register now for:

Medical Matters: Disaster Medicine: Every Physician’s Second Specialty
Wednesday, March 27th @ 7:30am
Register Here
Faculty: Lorraine Giordano, MD, FACEP, FAADM

Educational Objectives:

  • Identify core preparedness competencies every physician should know
  • Explore essential elements of preparedness plans for staff, patients, and family
  • Describe available courses, resources and organizations to obtain disaster preparedness education and training

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

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


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

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

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eNews

Dr. Ardis Hoven’s Two Grandchildren Killed in Car Accident in Lexington KY
Dr. Ardis D. Hoven, an AMA Past President and Chair of the Board, a friend of MSSNY and a friend of Dr. Madejski, lost her two grandchildren, 17 year-old Neo and 15 year-old Roan, in a car accident on Sunday morning in Lexington, Kentucky, Ardis’ hometown.  Please keep Dr. Hoven and her family in your thoughts and prayers.


FDA Head Warns Feds May Intervene if States Don’t Strengthen Vaccine Laws
FDA commissioner Scott Gottlieb said that the federal government may have to take action if states don’t strengthen their laws on vaccine exemptions, CNN reports.

Seventeen states allow families to choose not to vaccinate their children based on personal beliefs. Forty-seven states allow religious exemptions.

Measles outbreaks in the U.S. have infected 127 people so far in 2019; most were unvaccinated.


NYU to Offer Free Tuition to NYU Winthrop, a LI Medical School
New York University said Tuesday that its new three-year medical school on the campus of NYU Winthrop Hospital in Mineola will offer free tuition, matching the commitment made at its Manhattan campus. The university said it received preliminary accreditation from the Liaison Committee on Medical Education on Feb. 12 and plans to recruit its first students, to start in July.

The timing differs from most medical schools, which already may be delivering decisions to applicants. But Dr. Steven Shelov, dean of the NYU Long Island School of Medicine, said he still expects the school’s tuition-free program to draw thousands of applicants for its 24 initial slots. That number eventually will rise to 40 students per class.

For students to graduate in three years, the medical school will cut certain activities, such as weeks-long periods that allow students to travel to interview for residency programs and independently study for board exams. Instead, students will have conditional acceptance to primary care residency programs at NYU Winthrop, and group study for licensure exams will be part of the curriculum.

Preference for admission will be given to students who say they will train and practice in the New York metro area, the school said. Students who want to apply to residencies in other locations will be allowed to do so, but Shelov said he expects those students to be exceptions. The school tailored the curriculum for a career in primary care, with less focus on topics that would be applicable to future physician scientists and subspecialists. (Crains, 2/20)


Have You Seen an Increase in Automatic Down Coding of Your Visit Codes?
MSSNY has heard from a few members that they have been subjected to automatic down coding of their evaluation and management visit codes.  Has this affected you or your practice?  If so, please send an email to Regina McNally.  Please use DOWN CODING in the subject line.  Do not include any patient information; but do include the plan name, the code you billed and the code the plan reduced it to.  In addition, please let us know if you filed an appeal with a copy of the medical record and what the result was, if any.  Send your email to at rmcnally@mssny.org.


Physicians Have Concerns about Legalized Recreational Marijuana
New York physicians still have “significant concerns” with the executive budget proposal to legalize recreational marijuana, says Dr. Thomas Madejski, president of the Medical Society of the State of New York.

In a statement released Feb. 15, Madejski said that although a recent legislative public hearing “provided valuable insight,” there are several questions that need to be answered to alleviate physicians’ concerns, including how to keep marijuana out of children’s hands, especially as youth are using e-cigarettes are at an unprecedented pace. “The recently announced report from the CDC that 2018 saw the largest single-year increase in youth tobacco ever recorded—driven by adolescents who reported using e-cigarettes—is alarming,” Madejski said. “How will we ensure that legally purchased cannabis doesn’t get into the hands of children, similar to e-cigarettes?”

He said physicians also are concerned about a possible increase in drugged driving as a danger to pedestrians and other drivers. Madejski called for the continued review of data on public health implications from other states that have legalized marijuana and more research on the efficacy of marijuana for treating a range of health conditions. “We look forward to continued constructive discussion with the Legislature and the governor’s office on this issue,” he said. —Crains 2/19.


Sexual Harassment “Train the Trainer” FREE Webinar on March 20 at 12 noon
The Impact on the Healthcare System and the Medical Profession

When: March 20, 2019
Time:  12:00pm-1:00pm

REGISTER HERE

The issue of sexual harassment in the workplace has been the center of a staggering amount of media attention and of a surge in litigation activity. Consistent with this momentum, New York State recently mandated that all employers are required to have a sexual harassment policy containing specified criteria in place by October 9, 2018, and to conduct sexual harassment prevention training by October 2019. (New York City requirements are slated to take effect in April 2019.)

The issue of sexual harassment takes on particular significance for the healthcare industry, because there is an established nexus between disruptive behavior, which includes sexual harassment, and adverse patient outcomes and medical errors. For those individuals who are unable to participate in the webinar at that time, MSSNY will be placing a recorded version of that webinar on the MSSNY website to facilitate access to the webinar for MSSNY members.

By the conclusion of the “Train the Trainers” webinar, you will know how to teach your employees:

  • How to identify the more subtle forms of sexual harassment.
  • The impact of sexual harassment on the quality of care and the victim.
  • Practical advice on how to diminish and prevent sexual harassment at your practice.
  • How to respond to sexual harassment in the workplace.
  • Guidelines on how to comply with statutory mandates relating to sexual harassment.

Garfunkel Wild offers individual or group training, on-site or off-site training, as well as webinar modules that can serve to satisfy this new statutory mandate for your employees. If you would like to set up a personal training, please contact Andrew L. Zwerling at 516-393-2581 or azwerling@garfunkelwild.com.


Extortion Scam Targeting DEA Registrants
DEA is aware that registrants are receiving telephone calls and emails by criminals identifying themselves as DEA employees or other law enforcement personnel.  The criminals have masked their telephone number on caller ID by showing the DEA Registration Support 800 number.  Please be aware that a DEA employee would not contact a registrant and demand money or threaten to suspend a registrant’s DEA registration.

If you are contacted by a person purporting to work for DEA and seeking money or threatening to suspend your DEA registration, submit the information through “Extortion Scam Online Reporting” posted on the DEA Diversion Control Division’s website, Extortion Scam Online Reporting

For more information contact:
Locate DEA Field Office for your area – https://apps.deadiversion.usdoj.gov/contactDea/spring/fullSearch
Registration Service Center – 1-800-882-9539
Email – DEA.Registration.Help@usdoj.gov


Physician Employment, Acquisition of Physician Practices Continue to Increase
A new study by PAI analyzes eighteen months of data – between July 2016 and January 2018 – during which hospitals acquired 8,000 medical practices, and an additional 14,000 physicians left private practice in favor of employment. This continued an ongoing trend that earlier PAI-Avalere research documented for the period between July 2012-July 2016, which witnessed an intense increase in hospital acquisitions and growth in physician employment.

The cumulative study period – from July 2012 through January 2018 – saw a dramatic, sustained trend of physicians leaving independent practice to enter into employment arrangements with hospitals and health systems. Over the full 5 ½- year study period, the number of hospital-acquired physician practices increased from 35,700 in 2012 to more than 80,000 in 2018. Forty-four percent of U.S. physicians were employed by hospitals or health systems by January 2018, compared to just one in four in July 2012.

These latest cumulative findings highlight striking changes in health care delivery, marked by consolidation between the hospital and physician sectors in every region of the country.

  • Throughout this period, hospitals aggressively pursued acquisitions of physician practices, growing from 35,700 hospital-owned practices in July 2012 to 80,000 in January 2018. This 128 percent growth represents more than doubling in the number of hospital-owned practices nationwide.
  • Physician employment increased overall by more than 70 percent, growing from 94,700 employed physicians in mid-2012 to 168,800 employed physicians in January 2018, with increases in every six-month time period measured over five-and-a-half years.
  • All regions of the United States saw an increase in hospital-owned practices, with a range of total increase from 91 percent to 303 percent by region.

New Resources for 2019 Program Year for Promoting Interoperability Programs
CMS is currently updating the Promoting Interoperability Programs website to include new resources for the 2019 program year. Below are resources that are now available online:

For More Information

For more information on the Promoting Interoperability Program reporting requirements for 2019, please visit the Promoting Interoperability Programs website. Additional information for the Medicare and Medicaid Promoting Interoperability Programs for 2019 will be posted on the Promoting Interoperability Programs website in the coming weeks.


Two Programs at the HOD You Don’t Want to Miss!
Protect Your Patients, Your Practice, and You!

Thursday, April 11, 2019, 3:00 – 4:00 pm, Grand Ballroom D/E, Westchester Marriott, Tarrytown

Join us at the OMSS Annual Meeting for an interactive presentation by Garfunkel Wild on Medical Records, including the impact on records of the controlled substances “epidemic,” what to consider when emailing and texting, dealing with non-compliant patients, additional areas of exposure from EMRs, and what to include in a telemedicine record.

Business meeting to follow, 4:00 – 6:00, Putnam Room

Click here to view flyer.

Women in Medicine: Reaching Your Potential Now!

Friday, April 12, 2019, 5:00 – 6:30 pm, Grand Ballroom B, Westchester Marriott, Tarrytown

A panel presentation at the Women Physicians Caucus on Pay, Promotions and Career Advancement in Academic Medicine, Private Practice and Organized Medicine. Gender imbalance in medicine and academic sciences still exists. Hear three women physicians who have achieved significant leadership positions describe their own pathways, provide advice on how to achieve success, and show how to overcome gender bias, gender pay gaps and system-wide barriers to career advancement. Learn how to achieve success in your career!

Click here to view flyer.

Register for one or both programs at sbennett@mssny.org.


Doctors Without Borders: Put Your Ideals into Practice!
On Thursday, March 14th, 2019 you are invited to join Doctors Without Borders/Médecins Sans Frontières (MSF) for a recruitment information session in the Bronx, NY. This is your opportunity to meet our recruitment team and learn about how you can join our pool of dedicated aid workers. We’re currently recruiting for a variety of medical and non-medical positions. Register here.


Study: Lower Mortality Rates Associated With Greater Number of Physicians
Reuters (2/18) reports that “mortality rates are lower in American communities with more primary care physicians than in areas of the country with fewer doctors, a study suggests.

The “number of primary care physicians rose from 196,014 in 2005 to 204,419 in 2015, the study found.” However, “because of disproportionate losses of providers in rural areas, the average number of primary care physicians for every 100,000 people in the population declined from 46.6 to 41.1 during the same period.” Further, “each 10 additional primary care physician per 100,000 people was associated with a 51.5 day increase in life expectancy, the study also found.” The study was published in JAMA Internal Medicine.


September 11th Compensation Fund Running Low on Money
The AP (2/16) reported that “the compensation fund for victims of 9/11 is running out of money and will cut future payments by 50 to 70 percent, officials announced Friday.” Almost “40,000 people have applied to” the September 11th Victim Compensation Fund, a “federal fund for people with illnesses potentially related to being at the World Trade Center site, the Pentagon or Shanksville, Pennsylvania, after the 2001 terror attacks there, and about 19,000 of those claims are pending.” Almost $5 billion of the $7.3 billion fund has already been awarded, but “fund officials estimate it would take another $5 billion to pay pending claims and the claims that officials anticipate will be submitted before the fund’s December 2020 deadline.


“Im/Migrant Workers Conference: Health Barriers and Solutions” at University of Rochester
University of Rochester School of Medicine, Flaum Auditorium
This Saturday 2/23/19, 9am-3pm

Ticket Pricing
Student Registration: Free
General Public: $5.00
CME credit (4.5 credits): $13.00

Register herehttps://urmcimmigrantworkerconference.brownpapertickets.com

Registration fee inclusive of breakfast & lunch.

Conference Website: https://ursmdmwc.wordpress.com


 

Classified

RENTAL/LEASING SPACE

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


5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464


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


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


PHYSICIAN OPPORTUNITIES

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


Physician 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, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year.

Interested? Learn more and apply today at www.98point6.com/pcc



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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


February 15, 2019 – Common & Uncommon Denominators

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


MSSNY eNews
February 15, 2019
Volume 22  Number 7

MSSNYPAC Seal

Colleagues:

I have alluded to the confluence of information streams and activities that surrounds and runs through all of our lives. Last Saturday, I was honored to join our students, residents, fellows and MSSNY Young Physician members.  Immediate Past President Charles Rothberg, President Elect Art Fougner, and Vice President Bonnie Litvack also participated enthusiastically in discussions.  We were impressed by the thoughtfulness and maturity of our younger colleagues—they seemed to be smarter, better organized, and more committed to improving the lives of our patients and the practice of medicine than either of us were at a comparable age.  That should give us encouragement and great optimism for the care of our patients and the future of our profession!

Within 60-90 minutes, a number of data points swirled around me:

  • Joe Sellers, our MSSNYPAC Chair, gave a presentation on advocacy and the political process. He used the current measles outbreak in multiple areas in New York and 9 other states to demonstrate the importance of our policy development and advocacy activity to protect our citizens and improve the public health.
  • A number of resolutions were discussed for submission to the MSSNY House of Delegates. Second year medical student, Connor Sholtis, worked with University of Rochester MSS representatives Shireen Saxena, Randall Porter and other U of R students created a resolution that looks to reduce barriers to mental health care for medical students.  I believe this has the potential to begin to change our approach to student and physician stressors and improve physician wellness.
  • Carlos Zapata, YPS Councilor, moderated a social media discussion/ work session.
  • While participating in the social media workshop, I received a tweet that Ron Wyden (D-Ore.) had introduced legislation that would legalize marijuana at the federal level, designating the measure S. 420 in a nod to cannabis culture. The proposal, identical to a bill in the House, aims to ease the longstanding conflict between states where cannabis is legal in some form and the U.S. government, which categorizes marijuana as a dangerous illegal drug, similar to LSD or heroin.

I have to say the MSSNY presidency forces you to look for themes and common denominators that bring policy together to make our advocacy more effective.  The common denominator in all of this is what we in medicine do best— apply the science informing an issue to our patients and our communities.  The students gathered evidence relating to effective interventions for depression and applied it to their particular community.   Dr. Sellers reviewed the evidence for interventions to increase vaccinations and MSSNYs approach to counter pseudoscience that has caused a drop off in vaccination rates and immunity leading to a recrudescence of a preventable, potentially eradicable disease.

Personally, I look forward to discussing movement of marijuana to Schedule II with our federal representatives to allow the research needed to clear the smoky haze surrounding a complex psychoactive substance and define its proper place in the pharmacopoeia.

Our legislators have impressed me over many years with their knowledge of the many different subjects under legislative consideration. They rely on us to give them specific, evidence-based information about how legislative proposals effect our patients and their constituents. As Adam Smith opined, “Science is the great antidote to the poison of enthusiasm and superstition.”

Are You Coming or Not?

Come with me to Albany March 6th to help provide crucial information about the many issues effecting the citizens of New York State.  A few counties are providing bus transportation—call your county executive for information! Your colleagues, your patients, and our fellow citizens are depending on us.

Never be afraid to raise your voice for honesty and truth and compassion against injustice and lying and greed- William Faulkner

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

Thomas J. Madejski, MD
MSSNY President



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Capital Update

SAVE THE DATE: MSSNY’s Annual “Physician Advocacy Day” (3/6)!
With nearly 40 newly elected legislators in Albany, the need for physician advocacy and grassroots involvement is greater than ever. With so much new representation, it’s vital for physicians to forge new relationships, and to strengthen existing relationships to ensure the physician community’s message about policies that could impact patient care is heard.

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

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

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure;
  • Reject the $80/per patient cut to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care;
  • Reduce the high cost of medical liability insurance through comprehensive reforms;
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

The morning program will be followed by a brief and informal luncheon to which members of each House are invited to speak with their constituents.  County medical societies will be scheduling afternoon appointments for physicians to meet with their elected representatives.

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


MSSNY Physician Leaders Advocate for Their Profession and Their Patients in the Nation’s Capitol
Several MSSNY physician leaders and staff members traveled to Washington, DC this week for meetings with many New York Congressional representatives.  Physicians advocated for several measures to improve and preserve patient access to needed physician care, including:

  • Assuring that any “surprise medical bill” law enacted on the federal level is consistent with New York’s comprehensive law which has become a model for the country;
  • Preserving seniors’ access to needed care through increases to the Medicare fee schedule to keep up with practice cost inflation;
  • Reducing the hassle factor associated with participation in the Medicare MIPS program and assuring EHR interoperability;
  • Lifting the DEA Schedule 1 classification of marijuana so that necessary research can be performed on potential medicinal benefits.

Among the attendees were the following: MSSNY President and Medina internist Dr. Tom Madejski; MSSNY Immediate Past-President and Long Island ophthalmologist Dr. Charles Rothberg; former MSSNY Councilor and Schenectady ophthalmologist Dr. John Kennedy; Erie County Medical Society Past-President, AMA Council on Legislation Chair and Roswell Park urologist Dr. Willie Underwood;  MSSNY Councilor and Queens Emergency Department Physician Dr. Carlos Zapata; MSSNY Legislative & Physician Advocacy Committee Vice-Chair Dr. Rose Berkun, Oswego Family practice physician Dr. Corliss Varnum; medical student Usman Aslam; and MSSNY staff.

The meetings occurred in conjunction with the American Medical Association’s annual National Advocacy Conference, where physicians across the country go to Washington to meet with their respective members of Congress.                                                                                 (AUSTER)


 

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Governor Releases Budget Amendments that Includes Across the Board Medicaid Payment Cut
Today Governor Cuomo gave to the Legislature his “30-day amendments” to his Executive Budget proposal that was formally introduced on January 15. While staff is continuing to review the entire proposal, of concern is a proposal that would impose an across the Board Medicaid cut to all covered Medicaid providers totaling $190 million.  Spending under the Medicaid global cap for FY 2020 is expected to be $19.4 billion. This could translate to a material per service cut (exact amount to be determined) to physicians and other health care providers.  Please remain alert for further update on this issue.                                                      (AUSTER)


Legislators Advance Legislation Aimed at Preventing Maternal Deaths
Legislation (S.1819, Rivera/A.3276, Joyner) advanced this week from the Senate Women’s Issues Committee, and from the Assembly Health and Codes Committees, that would establish maternal mortality review boards and the maternal mortality and morbidity advisory councils for New York State and New York City.  The goal of S1819/A3276 is to gather and review information related to maternal deaths and illness, to disseminate their findings and to develop recommendations and best practices to improve maternal health in New York.

The legislation also provides needed confidentiality protections regarding the board’s proceedings and requires the Board to report on its aggregate finding and recommendations.  MSSNY working together with the American College of Obstetricians & Gynecologists (ACOG) is in support of this legislation and strongly backs its goal of improving health outcomes in New York.      (AVELLA, CLANCY)


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Physicians Urged to Oppose $80/Dual Eligible Patient Cut
All physicians are urged to contact their state legislators to urge that they reject a proposal contained in the 2019-20 Executive Budget that would significantly cut the payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their “dually eligible” patients.   You can send a letter in opposition by clicking here.

You can read MSSNY’s memo of opposition to the Legislature here.

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, practices that see a large number of dual eligible patients be profoundly impacted.  For example, if a physician’s patient mix includes 500 such dual eligible patients – which could certainly be the case for many types of specialty physicians – that amounts to a decrease of over $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment. In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care. Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the state budget on the backs of dedicated community physicians seeking to deliver quality care to their patient.        (AUSTER)


Governor’s Staff Testifies Before Legislative Body Regarding Cannabis Regulation and Taxation Act
On Wednesday 2/13, Governor Cuomo’s staff testified to members of the Senate and Assembly at a public hearing regarding the legalization of adult-use of cannabis. The governor’s administration was represented by Alphonso David, Counsel to the Governor; Axel Bernabe, Associate Counsel for Health; Jason Starr, Assistant Counsel; Jen McCormick, First Deputy Commissioner of the Department of Agriculture and Markets; and Dr. Chinazo Cunningham, member of faculty at the Albert Einstein College of Medicine and a member of the Governor’s Workgroup on Cannabis Regulation.

Mr. David, supported by his staff, provided an outline of the plan in this year’s budget proposal and addressed a large list of questions and concerns raised by members of the legislature. He described their approach as “integrated” and discussed the three separate markets (adult-use, medical and hemp).

Questions from state representatives focused on how regulation would be structured, how communities would be impacted, how law enforcement officials would manage driving, use, sale, etc. and what the economic implications would be. Of note were questions about the ability to test for impaired driving and how to prevent legally purchased cannabis from getting into the hands of minors. Mr. David and staff acknowledged that some of the aspects of this program are still being worked out and would require further research and discussion.

A copy of David’s testimony can be found here.

The hearing can be watched here.      

This week MSSNY President Dr. Tom Madejski was quoted in an article that highlighted the diverse array of groups – Doctors, Parents, Mental Health Advocates and Police – that have raised concerns with proposals to legalize “adult use” or recreational marijuana use.  A copy of the article can be found here.

Dr. Madejski also issued the following statement which can be found here regarding the discussion at the Cannabis hearing that praised the efforts of the Administration proposal to assure necessary public education regarding cannabis use, but continuing to raise concerns about diversion to youth and the potential increase in drugged driving.                                                              (AVELLA, CLANCY)


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Your Help is Requested to Complete the SHIN-NY Customer Satisfaction and Usage Survey
NORC at the University of Chicago, an independent non-profit research organization, is administering a web survey designed to assess user experiences with health information exchange services offered by New York’s Qualified Entities (QEs).  The results of this survey will be used to improve health information exchange services provided by New York’s Qualified Entities and the Statewide Health Information Network of New York (SHIN-NY).

The survey asks about how an organization uses specific clinical data exchange services provided by New York’s eight QEs in care delivery. Questions also focus on the level of satisfaction with the different QE services as well as any challenges around the use of the services.

The New York eHealth Collaborative (NYeC) is asking physicians that receive a mail or email invitation to participate in the survey as soon as possible. After completing this brief online survey, respondents will receive a gift code or can donate their gift to a charitable organization.

For more information or if you have any questions, please contact the NORC at the University of Chicago team at SHIN-NY@norc.org or call them at 1-800-975-2754.  (AUSTER)


NYS Senate and NYS Assembly Advance Bill Mandating Patient Education for C-Section; Physician Action Urged
Senate Bill 2888/A.318, sponsored by Senator Julia Salazar and Assemblymember Amy Paulin, has advanced to the Senate calendar after being reported from the Senate Women’s Issues Committee this week by a 4-2 vote with one additional Senator voting without recommendation. 

The measure would require all physicians and other health care providers to provide all maternity patients with written information as to the risks associated with Cesarean section. This measure has already passed the NY State Assembly. The Medical Society of the State of New York & ACOG are opposed to this measure as it interferes with the physician patient relationship by requiring a written communication to every single pregnant women whom the physician recommends a  C-Section. MSSNY, the NYS Academy of Family Physicians & ACOG are concerned that an individual patient may have different risk factors and health needs.  Furthermore, the terminology of the bill is not consistent with the typical medical practice. 

The Medical Society is also troubled by the proliferation here in New York State, and nationally, calling for legislation requiring educational information that physicians will need to cite that pertains to women’s health issues.  Nationally, a disproportionate number of these bills apply only to physicians when they are treating pregnant women.  Furthermore, states have gagged or coerced physician communications for politicized public health issues.   This measure mandates physicians to provide “a script” that may not comply with the latest medical evidence on Cesarean section.  Physicians are urged to contact their Senate members and urge defeat of the bill.  Senate members can be reached through the main senate switchboard at (518) 455-2800 or by sending a letter through the MSSNY Grassroots Action Center here.                     (CLANCY)   


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MSSNY Seeking Information on NYS Physicians Having Difficulties with Walmart on Prescribing Practices
The Medical Society of the State of New York is interested in hearing from physicians who may have received a letter from Walmart in regards to the prescribing practices for controlled substances.   Walmart, Walgreens, and CVS pharmacies have implemented the CDC Guidelines for Prescribing Opioids for Chronic Pain as corporate policy.  MSSNY has learned that Walmart has sent letters to physicians throughout the country about their prescribing practices.   In the letters, Walmart indicated that it will no longer be accepting physicians’ prescriptions for Controlled Substances II-V after Walmart’s review of a physician’s prescribing practice.

MSSNY is extremely concerned about corporate policies that could result in refusal to fill prescriptions above certain doses and to refuse to fill prescriptions from certain physicians based on the corporation’s arbitrary definitions of questionable prescribing patterns.  MSSNY is aware that a few NYS physicians have received this letter and several physicians have been told by Walmart that it will not honor any prescription for Controlled Substance II-V.   MSSNY has brought this matter to the attention of the NYS DOH Bureau of Narcotics and is awaiting further information from them.   In particular, we have raised concerns that such policies could result in patients unfairly being denied access to needed medication.  Any physician who may have received this letter, please contact Pat Clancy, Sr. Vice President, Public Health and Education/Managing Director, at pclancy@mssny.org or by phone at 518-465-8085.            (CLANCY)


Physician’s Electronic Emergency Preparedness Toolkit Updated
Be sure to check out MSSNY’s newly updated Physician’s Electronic Emergency Preparedness Toolkit at the MSSNY CME website.  This essential toolkit is set up in four modules and provides participants with a total of 15 free CME credits.  Each module offers a comprehensive selection of resources on everything from legal protections and best practices to go-bag and office checklists.  MSSNY designed this resource to assist medical professionals in becoming fully prepared and ready for the next public health emergency.  MSSNY has also created a new podcast to accompany the updated toolkit, be sure to listen to it here.                 (HOFFMAN, CLANCY)


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

Educational Objectives:

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

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

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

(HOFFMAN, CLANCY)


Registration Now Open for New Veterans Matters CME Webinars
The Medical Society of the State of New York is proud to announce two NEW Veterans Matters webinars scheduled for February and March 2019. These webinars are:

Veterans Matters: The Special Mental Health Needs of Women Veterans

When:  Thursday February 28, 2019 at 7:30am – Register here.

Faculty: Colonel Malene Ingram, MD, US Army Reserves

Educational Objectives:

  • Review how the increased role of women in the military has impacted their mental health.
  • Describe mental health concerns unique to women veterans and how to identify and treat them.
  • Identify the barriers that women veterans face in getting the specific care they need

Veterans Matters: Military Culture: Everything Physicians Need to Know About Veterans as Patients

When: Thursday, March 14 2019 at 7:30am – Register here.

Faculty: Lt. Col Lance Allen Wang, & Marcelle Leis, CM Sgt. (Ret)

Educational Objectives

  • Describe the unique aspects of military culture and how they impact patients who are veterans.
  • Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality.
  • Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back into civilian life.

Additional information or assistance with registration can be obtained by contacting Sarah Humes at shumes@mssny.org or (518)465-8085

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 creditsä.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 (HUMES, HOFFMAN)


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

pschuh@mssny.org mauster@mssny.org  pclancy@mssny.org  mavella@mssny.org
charring@mssny.org
eNews
MSSNY Physician leaders meet in Washington, DC with New York legislators to support efforts to assure patient access to care.

Senator Schumer

Dr. Willie Underwood; Dr. Corliss Varnum; Dr. Charles Rothberg; MSSNY President Dr. Tom Madejski; Senator Schumer; Dr. Carlos Zapata;  Medical Student Usman Aslam; and MSSNY Sr. VP Of Legislative Affairs Moe Auster

Dr. Corliss Varnum; Dr. Charles Rothberg; US Rep. Paul Tonko (20th Cong. District); MSSNY President Tom Madejski; MSSNY Senior VP Legislative Affairs Moe Auster; and Medical Student Usman Aslam

MSSNY EVP Phil Schuh  (second from left) joins the MSSNY contingency at US Rep. Morelle’s (25th District) office.

Dr. Rose Berkun (first on left) joined the group at US Rep. Elise Stefanik (21st District).

Update on ZocDoc Pricing Change
MSSNY and its General Counsel, Garfunkel Wild, P.C., met with representatives of Zocdoc to better understand the planned change in its pricing model, and to discuss concerns raised by MSSNY’s members. Zocdoc currently charges its customers a flat annual fee (with no booking fee), and is now moving to a substantially reduced annual fee, with an additional per new patient booking fee based on the physician specialty.

The new policy is effective April 1, 2019.  Zocdoc has received a legal opinion from the New York State Department of Health (based upon information provided by and a request from ZocDoc) advising that its new pricing model does not constitute an illegal referral business or fee splitting under New York law.  They are currently pursuing guidance from the federal government prior to implementing this new pricing plan for Medicaid and Medicare patients. MSSNY and Garfunkel Wild will continue to monitor the situation and keep all members appraised of any new developments. Members with questions can reach out to MSSNY ‘s Legal Counsel Garfunkel Wild, PC: Barry Cepelewicz (516-393-2725); Hayden Wool (516-393-2232); or James Dering (518-560-4021).


Recreational Marijuana: NY Police, Doctors and Educators Fight Legalization
New York’s recreational marijuana battle sits on the frontline of a generational war over American cannabis laws. As debate heats up, USA TODAY Network New York is compiling answers to key questions about legalized cannabis. The findings will be updated each Monday as New York considers joining the 10 states that allow adults to use marijuana.

A growing opposition movement across law enforcement, education and public health is attacking the politically charged push to legalize recreational marijuana in New York.

Many of the powerful advocacy groups suggest passage could lead to spikes in drugged driving and marijuana-related health risks ranging from smoking hazards to psychotic episodes.

LEGAL POT: Northeast states grapple with recreational marijuana bills in 2019 legislative sessions. Some warn New York’s sudden rush towards legal marijuana ignores how profit-driven corporations hooked generations of Americans on alcohol, cigarettes and opioids, killing millions and straining public resources.

“We have many different intoxicants in our society, none of them are particularly helpful, and I think adding one more is not in society’s interest,” said Dr. Thomas Madejski, president of the Medical Society of The State of New York. (Feb 15 Lohud Rockland/Westchester Journal News)


AMA Presented Prestigious Dr. Nathan Davis Award to MSSNY Member Richard “Doc” Izquierdo, M.D., for Outstanding Public Service
Dr. Izquierdo has served his Bronx community for nearly six decades as a physician, health care innovator, community leader and Medical Society advocate. Dr. Izquierdo was chosen for the AMA’s top public service award for his lifetime of work, serving generations of Bronx residents. The award was presented to Dr. Izquierdo at a ceremony in Washington, D.C. as part of the AMA’s National Advocacy Conference.

Dr. Izquierdo’s daughter, Paloma Izquierdo-Hernandez, was scheduled to accept the award on her father’s behalf but her flight was canceled due to inclement weather in New York. MSSNY President Dr. Madejski stepped in to accept the award on behalf of Dr. Izquierdo. Click here to view a video of Dr. Madejski accepting the award.



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Women Are Overlooked, Undervalued in Healthcare, Research Suggests
A study by The Lancet publishing on Feb. 9 stated, “Women are overlooked by medical researchers and undervalued in health-related careers, a series of reports in the British medical journal the Lancet has found.”

The reports’ authors “found medical research was skewed toward the needs of men, with almost three quarters of biomedical research papers failing to consider differences in outcome according to sex.” One report indicated that “women outnumbered men at junior levels, but their numbers dwindled in senior posts.” A separate report “found women suffered from bias when applying for research funding.” he studies can be found here, here, and here.


CVS Unveils New HealthHub Store to “Manage” Chronic Conditions and Test Blood
CVS Health has unveiled three redesigned health-focused concept stores in the Houston market, according to CNBC. The pilot stores, called HealthHubs, have space for services to help customers manage such chronic conditions as diabetes, hypertension and asthma. Each store also has an expanded health clinic with a lab for blood testing and health screenings. Beyond those services, there are also wellness rooms equipped to handle yoga classes and seminars.

While the new stores have less space for greeting cards, seasonal items and general merchandise, consumers can still find toys, candy. In addition, consumers can buy more health-focused products, such as medical equipment and supplies for diabetes care and sleep apnea.

After acquiring Aetna in November, CVS promised to transform its stores to improve the health of its customers and lower healthcare costs. (Feb 13 Beckers)


Dr. Millar Appears on Local TV Health Show
Onondaga Medical Society President Dr. MaryAnn Millar appeared as a guest on a local TV show Bridge Street; Your Health to talk about the Onondaga County Medical Society and their mission to help their community.

DFS Emergency Adoption Calling for 18 Month Delay of WC Fee Schedules
Please see the following regarding Department of Financial Services’ (DFS) emergency adoption calling for an 18-month delay of the WC medical fee schedules for NYS No-Fault Auto cases-

Charges for Professional Health Services

Date Published in State Register: February 27, 2019

Contact: Camielle Barclay

The notice of proposed rule for No-Fault Auto will be published in the NY State Register on February 20, 2019 with a public comment period, open until April 22, 2019.  Based on this proposed rule, DFS is delaying adoption of the update WC medical fee schedules until October 1, 2020.  Therefore, physicians who treat NYS auto accident victims will need to use the current/existing WCB fee schedule which became effective on June 1, 2012.  This is the link for the NY State Register:  https://www.dos.ny.gov/info/register/2019.htmlOnce the February 20, 2019 notice is published, you will be able to submit your comments to DFS regarding the delayed adoption.


Medicine Innovation & Entrepreneurship Conference Saturday April 27th, 8-5 pm
We invite Physicians interested in innovation & entrepreneurship to join fellow physician innovators at the first start up conference for doctors by doctors. The MIE physician speakers, who have a proven track record of successfully starting their own endeavors, have volunteered their time to help doctors in the healthcare innovation space. A complete list of speakers can be found on the website. We also will be featuring an investor / venture capitalist panel for any physicians who are looking for funding for their innovative idea. Only 50 spots remaining.

Healthcare innovation is not just for tech giants and we want to help our fellow physicians bring their ideas to life. Come join us for this transformative event!

RSVP at www.medicineandtech.com with discount code MSSNY for 15% off all registration categories.


Universal Healthcare in CA Would Cost $17 Billion Annually, Analysis Suggests
The San Francisco Chronicle (2/8) reported, “Universal health care in California could cost $17.3 billion a year,” according to a proposal put forward by health policy researchers at UC Berkeley. Under the plan, some 3 million uninsured Californians would gain access to healthcare coverage.

The article said this is one of several recent analyses. This one differs from the others in that universal healthcare is estimated to cost about twice as much, given that it “builds in the assumption that the uninsured would get on private health insurance plans, whereas other estimates factor in federal funding for getting more people on Medi-Cal, which is jointly paid for by the federal and state governments.”


New WC Medical Fee Schedule
The Chair adopted an updated Workers’ Compensation Medical Fee Schedule on December 26, 2018. The new Medical Fee Schedule will be effective for services provided on or after April 1, 2019. The new WC fee schedule is an increase of 10-37% for physicians.

The Board adopted the use of ICD-10 October 1, 2015, as previously announced in Subject Number 046-785 Chair Announces Adoption of ICD-10. Therefore, effective April 1, 2019, the Board will require full compliance with ICD-10.

The Workers’ Compensation Medical Fee Schedule is published by Optum Insight. Copies may be obtained by mail, telephone, or online.

By mail, write to: Official New York Workers’ Compensation Fee Schedule, PO Box 88050,
Chicago, IL 60680-9920 By phone: Call (800) 464-3649, option 1.

Online: Go to www.optum360coding.com, keyword New York, or https://www.optum360coding.com/Product/40508/.

Clarissa M. Rodriguez
Chair WCB


 

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


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


PHYSICIAN OPPORTUNITIES

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


Physician Wanted to Help Shape the Future of Primary Care
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Interested? Learn more and apply today at www.98point6.com/pcc


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Feb. 8, 2019 – Women and Children First!

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


MSSNY eNews
February 8, 2019
Volume 22  Number 6

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Colleagues:

I need your help.  I need you to join me in Albany March 6th to meet with our elected officials about the health and safety of our patients Click Here to Register! New York Governor Andrew Cuomo @NYGovCuomo has proposed his budget for New York State and the NYS legislature has started budget hearings on a multitude of issues affecting the health and welfare of our patients and our profession.  These issues are currently under discussion and MSSNY has provided testimony on a number of items of concern. I’ve indicated to you in some of my previous communications the importance of building relationships with our elected officials in the markedly changed legislative environment during the new session. Our representatives and their staff need to understand the potential effects of their proposals on our patients and families and their constituents.

Our excellent MSSNY legislative staff does a great job in getting information about our greatest concerns to our elected officials. The most critical part of advancing our goals for the betterment of public health and the proper practice of medicine is direct interaction with your personal representatives.  March 6th is our best opportunity to demonstrate our care of, and care about, our patients. We have an opportunity to weigh in on reducing maternal mortality, advocating for the care of women and their infants, and to reduce the incidence of exposure to psychoactive substances to our children and young adults.  Let me assure you that the situation is fluid, and your individual effort can make a difference in the health of your patients, your satisfaction in your practice, and the health of our communities.

Please sign up to join me in Albany March 6th.  Your patients, and our profession, are counting on us.

P.S. I’d be honored if you would also join me in Albany for our MSSNY Council meeting March 5th.  Let me know if you’re coming, and any other thoughts you have.

You can follow me on twitter@tommadejski

lux, veritas, virtuslegis plenitudo charitas

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

Thomas J. Madejski, MD
MSSNY President



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Capital Update

MSSNY Delivers Testimony Highlighting Positives and Negatives of New York State Budget Proposal
MSSNY Senior Vice President and Chief Legislative Counsel Moe Auster delivered testimony this week to a joint Senate-Assembly Committee regarding the healthcare portion of Governor Cuomo’s proposed 2019-20 budget. MSSNY’s testimony applauded the several positive measures included within the budget that MSSNY believes will help physicians provide better care to New Yorkers, while also highlighting a list of issues deemed problematic to the medical community and their patients.

To view MSSNY’s testimony and the several questions from legislators,  Click here.  To read MSSNY’s written testimony, Click here.

Of note, MSSNY’s testimony noted its support for NYS Executive Budget measures that would: increase the tobacco/e-cigarette purchase age to 21, provide better coverage of care for mental illness and substance abuse treatment, examine ways to prevent maternal mortality, provide stronger regulation of pharmaceutical benefit managers (PBMs) and extend the Excess Medical Malpractice Insurance program to assist physicians in affording extraordinarily expensive but needed liability insurance coverage.

MSSNY’s testimony also expressed strong concerns with proposals that would legalize the non-medicinal use of marijuana, revoking from doctors the final say in coverage for prescribing medications to their Medicaid insured patients and expansion of the types of practitioners who could treat Workers Compensation patients without addressing the numerous factors that are deterring physician participation in this program.  He particularly highlighted the physician community’s strong concerns with a proposal that would significantly cut (an estimate $80 per patient cut) the patient deductible payments that Medicaid makes to physicians who treat patients dually eligible for Medicare and Medicaid.

Mr. Auster answered a variety of questions from the legislative panel, including the physician perspectives on the legalization of non-medicinal marijuana; the regulation of pharmaceutical benefit managers, and perspectives on single payer legislation. (DIVISION OF GOVERNMENTAL AFFAIRS)


Physicians Urged to Oppose Further Dual Eligible Payment Cuts Proposed in State Budget
All physicians are urged to contact their state legislators to urge that they reject a proposal contained in the 2019-20 Executive Budget that would significantly cut the payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their “dually eligible” patients.   You can send a letter in opposition by clicking Here.

You can read MSSNY’s memo of opposition to the Legislature Here.

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, for practices that see a large number of dual eligible patients, this will have a profound impact.  For example, if a physician’s patient mix includes 500 such dual eligible patients, which could certainly be the case for many types of specialty physicians, that amounts to a decrease of over $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment. In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care. Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the state

budget on the backs of dedicated community physicians seeking to deliver quality care to their patient.
(AUSTER)


Medical Liability Reform Bills Introduced in the Assembly
Assemblymembers Robin Schimminger (D-Kenmore) and Peter Abbate (D-Brooklyn) each re-introduced legislation this week aimed at reducing the exorbitant cost of medical liability insurance in New York State, and providing more fairness in the resolution of the cases.

In New York, cumulative medical liability payouts far outpace other states. A recent report by Diederich Healthcare showed that, in 2017, once again New York State had far and away the highest number of cumulative medical liability payouts. Claimants in New York were awarded nearly two times more than the state with the next highest amounts, Pennsylvania, and payments in New York far exceeded states such as California and Florida. Moreover, New York had the dubious distinction of having the highest per capita medical liability payouts in the country, about 500% greater than the State of California, which has enacted meaningful liability reforms.

Assemblyman Schimminger’s Medical Liability Reform Act (A.4897) would work to ease the extraordinary liability burden on physicians in New York through the enactment of a number of policy changes, including the following:

  • Requiring an affidavit of merit from a NY licensed physician to cut down on the filing of non-meritorious claims;
  • Placing a reasonable limit on non-economic damages (there are currently 30 states with some form of a similar cap); and
  • Requiring enhanced disclosure of identity of expert witnesses

Assemblyman Abbate’s legislation (A.5018) would require a particularized affidavit of merit to function as a comprehensive vetting of medical malpractice claims prior to commencing of a legal action. Additionally, it would require full and complete discovery of expert witnesses in medical liability actions.                            (AVELLA, AUSTER)                     


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New York State insurance exchange reports record enrollment numbers
NY State of Health’s open enrollment period ended on January 31, and at that time enrollment in both the Essential Plan and in Qualified Health Plans had increased over last year. Essential Plan enrollment stood at 790,152, up 6.9% over last year meanwhile 271,873 people had purchased Qualified Health Plans, a 7.4% increase compared to the same point last year. In contrast, enrollment dropped by 3.8% in the 39 states that use the federal marketplace. The Essential Plan provides coverage with no deductible and is either free or costs $20 monthly. A family of four earning up to $50,200 qualify and New York and Minnesota are the only two states to offer this option. According to the Kaiser Family Foundation, the monthly premium for the cheapest individual bronze Qualified Health Plan in NY averages $402 without subsidies and the cheapest gold plan averages $638 per month. NYSOH has stated that 58% of people buying plans qualify for financial assistance.      (AVELLA)


Experts Debate New York Health Act
Click here to watch a 2-hour debate of the proposed New York Health Act sponsored by the New York City Bar Association please Click here.  Participants in the program included NYS Assembly Health Committee Chair Richard Gottfried, sponsor of the legislation; Eric Linzer, President of the New York Health Plan Association; Bill Hammond, Director of Health Policy for the Empire Center for Public Policy; Dr. Oliver Fein, Chair of the NY-Metro Chapter of Physicians for a National Health Plan; and Ashley Fox, an Assistant Professor at University at Albany.                       (AUSTER)     


Workers Compensation Board Looks at Improvements to the IME Process
This week the initial meeting of the New York Workers’ Compensation Board IME Advisory Committee took place.   Among the members of the WCB expert panel was MSSNY Past-President Dr. Robert Goldberg.  The group was created pursuant to a provision of the comprehensive Workers Compensation legislation enacted in 2017 that called on the WCB to make recommendations for improving the process by which injured workers receive independent medical examinations.   In particular, the statute calls upon the Board to develop recommendations “that will ensure fairness, and highest medical quality, while improving methods of combatting fraud”For example, one of the major discussion points for the initial meeting this week was examining data that a small number of practitioners had performed an enormous number of IMEs.  The group will be meeting throughout 2019 to develop recommendations for improving the IME process with a report due to the Governor & Legislature by year end. (AUSTER)


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MSSNY Fights for Funding to Attract and Retain Physicians in NYS
This week MSSNY staff joined representatives from a variety of other health care advocacy groups (including HANYS, NYACP, CHCANYS, the Center for Health Workforce Studies & the Upstate NY Physician Recruiter Network) in numerous meetings with key legislative and executive staff to support increased efforts to address the shortage of physicians in underserved regions across New York State. In addition, two physicians who are Doctors Across New York (DANY) awardees joined the group and shared their stories about how DANY positively affected their lives and ability to practice in New York. Among the notable issues was the request of legislative support of funding for DANY.

DANY is a state funded program launched in 2008 that aims to train and place physicians in areas of New York State where that specialty is most needed. The goal is to ensure adequate funding, streamline the application process and to remove barriers to application. The group is also hoping for increased funding for the Empire Clinical Research Investigator Program (ECRIP) which allows doctors to spend additional time training in research.

Other priorities for the group include funding for the Diversity in Medicine Scholarship; the expansion of the Take a Look Program, which introduces medical students and residents practicing in NYC to Upstate New York and the opportunities available in medicine; and statutory implementation of required data collection for allied health workers.                                                                      (HARRING, AVELLA)


Senator Rivera Introduces Legislation to Improve Patient Access to be Treated by the Physician of Their Choice
Senator Gustavo Rivera, Chair of the New York State Senate Health Committee, introduced three bills this week that are strongly supported by MSSNY. The bills in question relate to health insurance networks and the interaction between physicians and insurance companies.

  • S3461 would require that health insurers cover services provided by out-of-network (OON) providers. OON coverage is not mandated in New York and while exchange officials have “strongly encouraged” insurers to offer this coverage, many New Yorkers do not have this option available. Additionally, many patients are restricted to limited physician networks that do not provide adequate choice of physician to receive their care.
  • S3462 would allow in limited instances independently practicing physicians in New York State to conduct some collective negotiations by creating a system under which the state would closely monitor those negotiations, and approve or disapprove such negotiations from going forward. Many areas of New York are dominated by a small number of insurers and this bill would help even the playing field between physicians and insurers.
  • S3463 would provide physicians due process protections when health insurers seek to terminate a physician from its network by failing to renew the physician’s contract. Current law prohibits a health insurance company from terminating a physician’s contract without a written explanation of the reasons for the proposed contract termination and an opportunity for a hearing by a panel comprised by three persons including a clinical peer in the same or similar specialty. These provisions, however, do not apply to situations involving the non-renewal of physician contracts. This bill would correct that disparity.                            (AVELLA)

NYS Senate Commitee to Consider Bill Mandating Patient Education for C-Section; Physician Action Urged
Senate Bill 2888/A.318, sponsored by Senator Julia Salazar and Assemblymember Amy Paulin, would require all physicians and other health care providers to provide all maternity patients with written information as to the risks associated with Cesarean section. This measure is before the Senate Women’s Issues Committee and has already passed the NY State Assembly. The Medical Society of the State of New York & ACOG are opposed to this measure as it interferes with the physician patient relationship by requiring a written communication to every single pregnant women whom the physician recommends a  C-Section. MSSNY & ACOG are concerned that a individual patient may have different risk factors and health needs.

Furthermore, the terminology of the bill is not consistent with the typical medical practice.  The Medical Society is also troubled by the proliferation here in New York State, and nationally, calling for legislation requiring educational information that physicians will need to cite that pertains to women’s health issues.  Nationally, a disproportionate number of these bills apply only to physicians when they are treating pregnant women.  Furthermore, states have gagged or coerced physician communications for politicized public health issues.

This measure mandates physicians to provide “a script” that may not comply with the latest medical evidence on Cesarean section. Physicians are urged to contact members of the Senate Women’s Issue Committee which are:  Senator Julia Salazar, Senator Betty Little, Senator Shelley Mayer, Senator Anna Kaplan, Senator Catherine Young, Senator Jen Metzger, and Senator James Gaughon. They can be reached through the main senate switchboard at (518) 455-2800 or by sending a letter through the MSSNY Grassroots Action Center at this link please Click here.                (CLANCY)   


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NYS Reproductive Health Act; Governor Discusses Aspects of the Law
The New York State Legislature passed the Reproductive Health Act and it was immediately signed into law by Governor Andrew Cuomo as Chapter 1, Laws of 2019.    The law amended the public health law by codifying the abortion procedure within New York State’s public health law and removing it from the penal law.  The same provisions found in Roe v. Wade remain in same.  The law creates a statement of purpose and says that an abortion may be performed by a licensed, certified or authorized practitioner acting within their defined scope of practice under Title 8 of the Education Law. Under the new law, an abortion can be performed:

  1. a) within 24 weeks from the commencement of pregnancy;
  2. b) at any time, where there is an absence of fetal viability; or
  3. c) at any time, when necessary to protect the patient’s life or health.

This is consistent with what previous Supreme Court decisions have held.

Gov. Andrew Cuomo this past week wrote an op-ed about the law in the NY Times including responding to comments misinterpreting what the law does.   His op-ed can be found  Here.

MSSNY has a long standing policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.   Moving the abortion procedure from the State Penal law to the Public Health Law is consistent with this position.   The law does not expand the current scope of practices for health care providers.  It does, however, specify that health care practitioners can perform an abortion if it is otherwise enabled by their current scope of practice as defined under the NYS Education Law. Nurse practitioners are allowed to perform a medicated abortion procedure already under their scope of practice.  However, nurse practitioners’ scope does not include “surgery” and cannot perform a surgical abortion.   The American College of Obstetricians and Gynecologists (ACOG) District II and the NYS Academy of Family Physicians (NYAFP)  supported this measure.  MSSNY will be closely monitoring the implementation of the new law to assure health care practitioners are acting within their scope. (CLANCY) 


Measles Outbreak in New York State Continues to Spread Webinars Available at MSSNY CME Website
The measles outbreak in New York State continues to spread with at least 186 confirmed cases as of last week.  There have been 124 in Rockland County and 62 cases in Brooklyn with one suspected case currently being monitored.  While New York State has a statewide vaccination rate of about 90% for Measles, the communities mainly affected by the current outbreak are only at about 60%.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.  This webinar has now been posted to the MSSNY CME website.

Additionally, be sure to watch The Importance of Herd Immunity, another Medical Matters posting that delves into how herd immunity works and why it is integral to the elimination of vaccine-preventable diseases.  Please check both of these programs out and keep yourself informed about the ongoing measles outbreak throughout New York State and the country.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine please Click here. (HOFFMAN, CLANCY)


“What’s Your Diagnosis? Psychological First Aid” Interactive CME webinar February 20, 2019 @7:30am – Registration now open
Be sure to register for the next Medical Matters interactive webinar, What’s Your Diagnosis? Psychological First Aid.  This program will include interactive components for participants.  You will be asked to answer questions about a case and discussion will follow.  Find out if you’re fully prepared to include psychological first aid during an emergency on February 20th at 7:30am.

Registration is open for this program please click Here.

Faculty will be Craig Katz, MD, co-vice chair of MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.

Educational Objectives:

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

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

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

(DIVISION OF GOVERNMENTAL  AFFAIRS)


Registration Now Open for New Veterans Matters CME Webinars
The Medical Society of the State of New York is proud to announce two NEW Veterans Matters webinars scheduled for February and March 2019. These webinars are: The Special Mental Health Needs of Women Veterans on Thursday, February 28th at 7:30am and Military Culture: Everything Physicians Need to Know About Veterans as Patients on March 14th at 7:30am.  Register Here

for The Special Mental Health Needs of Women Veterans, and Register Here.

for Military Culture: Everything Physicians Need to Know About Veterans as Patients.



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

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

eNews

MSSNY, AMA and Medical Societies Fight to Assure Fair Resolution of Surprise Medical Bills Issue
Led by United States Senator William Cassidy, MD (R-LA), the US Senate has been examining proposals that would address surprise out of network medical bills faced by patients in hospitals, usually the result of being treated by an out of network specialist in the emergency department or other unanticipated care.

Many believe that this is one of the only health care issues in the current Congress that has bipartisan support.

To that end, MSSNY has written to the New York Congressional delegation, urging that any legislation to be considered is consistent with New York’s comprehensive law on the subject enacted in 2014 (see MSSNY’s letter here: http://www.mssnyenews.org/wp-content/uploads/2019/02/0349_001.pdf).   New York’s comprehensive law addressing this issue has been hailed as a model for the rest of the country because of the delicate balance it struck among key health care stakeholders (such as physicians, hospitals and health insurers) to protect patients from large “surprise” medical bills, while at the same time being constructed in such a way that it did not adversely affect the ability of hospital emergency departments to have adequate on-call specialty physician care.

In addition, MSSNY has also joined on to a federation of medicine letter to the US Congress initiated by the American Medical Association along with over 60 other national specialty societies and over 40 other state medical societies urging that the any legislation to be considered by Congress meet a series of key principles.  These principles recognize the multitude of factors that can lead to patients facing unanticipated out of network medical bills: including assuring health insurers maintain robust physician networks, assuring health insurers maintain accurate provider directories; assure patients are kept “out of the middle”, and assure that any guidelines or limits on what out-of-network providers are paid should reflect actual charge data for the same service in the same geographic area from a statistically significant and wholly independent database, and not be based on Medicare or in-network rates.

MSSNY physician leaders will be in Washington DC next week along with physician leaders across the country to visit with their respective Congressional delegations on this critical issue and other key health care issues before Congress.


What’s next for DSRIP?
State Department of Health officials said they plan to pursue an additional five-year federal waiver ahead of the expiration of the $7.4 billion Medicaid Delivery System Reform Incentive Payment program in April 2020. In the meantime, the governor’s fiscal 2020 budget proposal includes several provisions to advance the DSRIP goal of reducing avoidable hospital use by 25% compared to the state’s baseline in 2015.

So far the state’s 25 Performing Provider Systems—groups of hospitals, physicians, health centers and community organizations—have reduced unnecessary hospitalizations by 17%, said Greg Allen, director of program development and management at the state Department of Health, during a webinar budget briefing.

“Many Performing Provider Systems have been engaged in conversations in what a future DSRIP program could look like,” he said. “Clearly there’s an interest by all stakeholders in continuing the best of what’s happened here. Just about everyone agrees we should ask for renewal.”

Allen noted that several other states have had their federal waivers renewed. He said health care providers’ value-based contracts with insurers were “not quite mature enough” to finance the types of programs providers are pursuing. As part of the budget, the state Department of Health plans to promote best practices from providers that have been able to keep their patients out of the hospital, which it estimates will save $10 million for Medicaid next year. The department also plans to lower Medicaid payments to facilities that have high rates of avoidable hospitalizations. It would use the $5 million it expects in savings to invest in primary, maternity and ambulatory care. (Crains)


 


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

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

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

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure.
  • Reject unfair cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Reject burdensome mandates that interfere with patient care delivery.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

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

If you have any questions, please contact Carrie Harring: charring@mssny.org.


NY County President Dr. Van De Walle Welcomes Legislators

Naheed-Van-De-Walle-MDThe President of the New York County Medical Society Naheed Van De Walle MD at the podium at the Legislative Breakfast held on January 27. 

The event featured a lineup of Manhattan legislators including Assembly Health Chair Dick Gottfried, US Representative Carolyn Maloney, Manhattan Borough President Gale Brewer, and Senate Health Chair Gustavo Rivera.  

Other speakers were New York City Councilman and physician Matthieu Eugene, Senator Robert Jackson and Assemblymember Harvey Epstein.  Over 70 physicians from New York County Medical Society and co-sponsoring organizations NY City Psychiatric Society and the New York Council on Child and Adolescent Psychiatry were in attendance to question legislators on everything from single payer, drug formularies, marijuana, and other important physician issues.

Presidents of all three organizations actively participated in the session. According to Dr. Van de Walle, the success of the breakfast was a product of the hard work and dedication of the organizers from all three organizations which included, Cheryl Malone, Meagan O’Tolle, Susan Tucker, Vera Fuer and other dedicated NYCMS staff such as Lisa Joseph. Although representatives from a number of organizations attended the breakfast, the initial feedback was that it was the best Legislative breakfast they had attended to date.


Anthem Tops Fourth Quarter Expectations
The Blue Cross-Blue Shield insurer Anthem topped fourth-quarter earnings expectations and unveiled a better-than-expected 2019 forecast, helped by an early start for its prescription drug coverage business. Shares of the nation’s second-largest health insurer soared after Anthem said Wednesday that it will start moving customers into its new business in this year’s second quarter, several months ahead of schedule.

The insurer has said that it expects to gain annual savings of more than $4 billion by running its own pharmacy benefit management operation, which it calls IngenioRx.

Anthem initially anticipated a 2020 start for its PBM business, which it will run with help from CVS Health Corp. But it said Wednesday that it was ending its deal with Express Scripts on March 1 due to that company’s recently completed acquisition by another insurer, Cigna Corp. Anthem Inc. covers nearly 40 million people, including those who receive private insurance or benefits from the government-run Medicaid and Medicare programs. (AP 2/7)


Determining Whether Older Medical Professionals Can Competently Perform
The New York Times (2/1) reports that some hospitals are using “mandatory screening procedures” to assess whether medical professionals older than 70 can perform competently, with many of those professionals “unenthusiastic about the idea.” The Times says mandatory screening – generally beginning at age 70 –has already begun at “the University of Virginia Health System, Temple University Hospital and UPMC in Pittsburgh.” Screening generally covers physicians as well as physician assistants, nurse practitioners, and other roles.


Researchers Find Increasing Risk of Obesity-Related Cancers
The New York Times (2/4) reports on a study published in Lancet Public Health finding that “the risk of developing obesity-related cancer is increasing in successive generations, along with increasing rates of obesity.” Investigators “studied the incidence of 30 of the most common cancers, including 12 that are obesity related, from 1995 to 2014 in people ages 25 to 84 — more than 14.6 million cases.” The investigators “found that for six of the 12 obesity-related cancers (multiple myeloma, colorectal, uterine, gallbladder, kidney and pancreatic) the risk for disease increased in adults 25 to 49, with the magnitude of the increases steeper with younger age.”


E-Cigarettes Outperform Nicotine Replacement for Smoking Cessation
Adults who smoke conventional cigarettes are more likely to quit smoking successfully when they use electronic cigarettes rather than nicotine replacement therapy (NRT) as a quit aid, according to a randomized trial in the New England Journal of Medicine. Nearly 900 U.K. adults who were looking to stop smoking were randomized to use e-cigarettes or NRT beginning on their quit date. The e-cigarette group was given a starter pack but could then use the product of their choice, while NRT participants could choose their preferred product. All participants also received at least four weekly sessions of behavioral support.

The primary outcome — the rate of abstinence at 1 year confirmed by carbon monoxide levels — favored the e-cigarette group (18% vs. 9.9% in the NRT group).

NEJM article

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Feb. 1, 2019 – Leg 2019: Strong at the Start

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


MSSNY eNews
February 1, 2019
Volume 22  Number 5

MSSNYPAC Seal

Colleagues:

Downhill Racer

Great news!  I finally was able to hit the slopes this season.  I spent the weekend in Lake Placid to meet with members from our 3rd and 4th districts at their Winter Meeting.  I’ve wanted to join them for many years, but circumstances conspired against us. Our MSSNY Vice Speaker Dr. Bill Latreille served as the congenial host and master of ceremonies.

Day One

Saturday morning began with reports by our 3rd and 4th District Counselors, Greg Pinto and Brian Murray.  They updated the assembly on county activities and the recent Council meeting.  We also had presentations from Moe Auster, our Government Affairs VP, and our MSSNYPAC Chair, Dr. Joe Sellers, on the changing political landscape, the many public health and professional issues under discussion and MSSNYs policies and perspectives. State Senator Betty Little discussed the significant changes in the State Capital, as well as key healthcare issues she is seeing in her district that covers the North Country. She affirmed my observations that we are in a very dynamic environment with regards to legislation and regulation.  She validated the observations of our Government Affairs staff and your leadership— that we are in a critical time of creating new relationships with our elected leaders and new regulators.

You have already seen rapid activity on a number of issues where the new legislature and Gov. Cuomo had consensus and campaigned to achieve.  It’s probably the ambience of Lake Placid, but I feel like we are in a slalom race to passage of the budget sometime around April 1. We need to keep our eyes and weight forward, lean into the gates, and watch for icy patches and cross the finish line on behalf of our citizens and our profession.  Make sure you are signed up as a PAL and join me in Albany for our Council meeting and State Legislative Day March 6. 

We had a number of other excellent presentations. Jim Dering, an attorney from Garfunkel Wild’s Albany office, gave a vitally relevant presentation on employment contracts. GW has great expertise in review and assistance with negotiations on behalf of physicians. They provide an excellent member benefit for contract review as part of their service to MSSNY members. Having negotiated a number of times on behalf of physician employees, GW provides a great value at a substantially lower cost than I have experienced in the past.

MLMIC

Michael Schoppman, President of MLMIC, updated the group on developments after the closing of the sale of MLMIC to Berkshire Hathaway. Over 95% of proceeds have been distributed. Remaining proceeds will be distributed after resolution of disputes. MLMIC has created an in house mediation system to assist policy holders who have had their distribution contested by other parties.  For more information, click here.

After an afternoon break, we met in the early evening to review potential resolutions for our MSSNY HOD April 11-13th. 

One area of concern is continued staffing and viability of small county medical societies.  We had a good discussion about potential opportunities for regionalization through our existing District model.  I related to the group that MSSNY is working on this through our Strategic Planning Committee and our Membership Committee and that MSSNY remains committed to assisting our county and District Societies as they work through these issues.

Covering All Bases

Our MSSNY President Elect, Dr. Art Fougner, and Vice President Bonnie Litvack and MSSNY legislative staff participated in the Legislative Breakfast hosted by New York County Psychiatric Society and the New York Council on Child and Adolescent Psychiatry. They met some of our new Senate members and visited with Senate Health Chair Gustavo Rivera and Assembly Health Committee Chair Richard Gottfried Sunday.

We have follow up meetings scheduled with a number of the new legislators.  We (MSSNY and you) need to engage all our legislators but particularly the new members in their districts and in Albany.  Please register and join me in Albany March 6th!

Medicinae membra movere!

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

Thomas J. Madejski, MD
MSSNY President



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Capital Update

Physicians Urged To Oppose Further Dual Eligible Payment Cuts Proposed In State Budget
All physicians are urged to contact their state legislators to urge that they reject a proposal contained in the 2019-20 Executive Budget that would significantly cut the payments that Medicaid makes to physicians to cover the Medicare Part B deductibles of their “dually eligible” patients. You can send a letter in opposition here.

While the exact cut for each physician would depend on the physician’s patient mix and services provided, we estimate that the cut would be $80 per patient.  That is because the 2019 Medicare Part B deductible is $185, and studies show that on average Medicaid only pays 56% of the Medicare fee schedule in New York.

Given that there are hundreds of thousands of patients in New York who are “dually eligible”, for practices that see a large number of dual eligible patients, this will have a profound impact.  For example, if a physician’s patient mix includes 500 such dual eligible patients, which could certainly be the case for many types of specialty physicians. That amounts to a decrease of over $40,000 per year – funds that could go toward upgrading electronic health records, hiring additional staff to allow for more time with patients, upgrading facilities or other medical equipment.

In past years, physicians have had to absorb significant cuts from Medicaid for the care that they provide to their senior and disabled patients covered by both Medicare and Medicaid, making it much harder for these physicians to deliver community-based care.

Inexplicably, in a time where there is a greater emphasis on assuring patients receive care in the most appropriate care settings, including community physician practices, these cuts could force patients to receive care in more expensive care settings.

Please urge your legislators know how unfair this cut is.  Please urge them to oppose balancing the State Budget on the backs of dedicated community physicians seeking to deliver quality care to their patients.                       (AUSTER, AVELLA)



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Governor Proposes $175 Billion Budget For 2019-20; Many Items Of Impact To Medicine

As previously reported, Governor Andrew Cuomo has formally announced his proposed $175 Billion Budget for the FY 2019-20 Fiscal Year.

Some positive items in the Executive Budget include: 

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

Some items of potentially significant concern include:

  • Cuts Medicaid payments for the deductibles of “dual eligible” patients, which could have a significant adverse impact for those physicians whose patient mix includes a substantial number of Medicare/Medicaid dual eligible patients. (see related article)
  • Legalize the sale of recreational marijuana to those 21 and over (see related article)
  • Expands the existing medical marijuana program to add additional health conditions which would be eligible for “Medical Cannabis”.
  • Permit Nurse Practitioners and licensed social workers to treat injured workers and be directly reimbursed under Workers Compensation without coordination with a physician.
  • Repeal “prescriber prevails” protections for prescriptions for Medicaid FFS patients that are not on the Medicaid formulary. 

Some items of Interest and Further Review Include:

  • Codify New York’s Health Insurance Exchange, and assure NY has continued coverage for pre-existing conditions, Essential Health Benefits and provide physician a clear method to appeal medications not included on insurers’ formulary
  • Expand health insurance coverage for IVF
  • Require ED physicians to check I-STOP database
  • Create a Commission on Universal Access to Health Care comprised of health policy and insurance experts to devise ways to achieve universal access to high quality, affordable health care.


MSSNY will be testifying at a Joint Senate-Assembly Budget Hearing examining these issues next Tuesday Feb. 5. (DIVISION OF GOVERNMENTAL AFFAIRS)


Assemblyman Gottfried Introduces Series of Health Insurance Reform Bills
This week Assembly Health Committee Chair Richard Gottfried reintroduced a number of important health insurance reform bills supported by MSSNY to better enable patients to receive the care they need and better enable physicians to be able to advocate on behalf of their patients to assure they receive the care they need.  These bills include:

  • A2393 – Gives independently practicing physicians the much-needed right to collectively negotiate with insurance companies on patient care issues in certain instances, under close state supervision.
  • A3038 (also carried by Senate Insurance Committee Chair Neil Breslin – S.2847) – Includes many provisions to improve the way that insurance companies operate by speeding up and improving prior authorization requirements and duration; ensuring that authorizations are being reviewed by qualified individuals, using evidence-based criteria; preventing harmful prescription drug formulary changes.
  • A3076 – Requires health insurer medical necessity decisions to be made by a NY licensed physician that is qualified to perform the procedure in question.
  • A2983 – Prohibits the inclusion of onerous clauses in contracts between physicians and HMOs, including those that reduce payment, impose inappropriate mandates on prescriptions and allow changes to prescriptions by those other than the prescribing physician or pharmacist with which they collaborate.
  • A2899 (also carried by Senate Health Chair Gustavo Rivera – S.873) – Prevents insurance companies from using extrapolation (except in certain circumstances) to unfairly assert and attempt to recoup purported overpayments.
  • A2799 – Ensures “prescriber prevails” protection for all prescriptions written for patients covered by Medicaid, giving physicians the final say in prescribing.      (AVELLA, AUSTER)

Senator Breslin Introduces Health Insurance Reform Bills
Senate Insurance Committee Chair Neil Breslin (D-Albany County) introduced this week two bills that are strongly supported by the physician-community to cut down on administrative hassles and to ensure that patients are able to receive the care that they need.

  • Senate Bill S2847, which is also carried by Assemblyman Gottfried (A.3038), would reduce prior authorization hassles by requiring health plan utilization review criteria to be evidence-based and peer reviewed; reducing the time frame for reviewing prior authorization requests from 3 business days to 48 hours (and to 24 hours for urgent situations); assuring that a prior authorization, once given, is enduring for the duration of the medication or treatment; prohibiting mid-year prescription formulary changes; and assuring that once a prior authorization is given, it cannot be withdrawn if eligibility is confirmed on the day of the service.
  • Senate Bill S2849, carried by Assembly Majority Leader Crystal People-Stokes (A.2969) would help to prevent harmful changes to drug formularies mid-year. Patients are not allowed to change insurance plans mid-year and often make selections with formularies in mind, so this bill would ensure that insurance companies are held to their end of the contract. (AVELLA, AUSTER)                    

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NYS Legislature Passes and Governor Signs In to Law the Reproductive Health Act
The New York State Legislature passed the Reproductive Health Act on January 22, 2019 and it was immediately signed into law by Governor Andrew Cuomo as Chapter 1, Laws of 2019.    Assembly Bill 21 and Senate Bill 240, sponsored by Assemblymember Deborah Glick and Senator Liz Krueger, amended the public health law by codifying the abortion procedure within New York State’s public health law and removing it from the penal law.  The bill passed the NYS Senate by a vote of 38-24 and the NYS Assembly by 95-49.  The law creates a statement of purpose and says that an abortion may be performed by a licensed, certified or authorized practitioner acting within their defined scope of practice under Title 8 of the Education Law. Under the new law, an abortion can be performed:

  1. a) within 24 weeks from the commencement of pregnancy;
  2. b) at any time, where there is an absence of fetal viability; or
  3. c) at any time, when necessary to protect the patient’s life or health.

MSSNY has a long standing policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.  Moving the abortion procedure from the State Penal law to the Public Health Law is consistent with this position.

The law does not expand the current scope of practices for health care providers.    It does, however, specify that health care practitioners can perform an abortion if it is otherwise enabled by their current scope of practice as defined under the NYS Education Law.  Nurse practitioners are allowed to perform a medicated abortion procedure already under their scope of practice.  However, Nurse Practitioners’ scope does not include “surgery” and cannot perform a surgical abortion.

The American College of Obstetricians and Gynecologists (ACOG), District II and the NYS Academy of Family Physicians (NYAFP) supported this measure.  MSSNY will be closely monitoring the implementation of the new law to assure health care practitioners are acting within their scope. (CLANCY)


Mental Health Association Joins Lists of Organizations Urging NYS Legislature to Consider Implications of Legalizing Recreational Marijuana
The Mental Health Association of New York State has joined the growing lists of organizations that is urging state officials to proceed cautiously as they consider proposals to legalize recreational marijuana.  The association listed several serious concerns about legalization, such as addiction and the impact marijuana can have on the neurological development of young people.   While the Medical Society has expressed support for efforts to remove the threat of criminal sanction for marijuana possession, it has also expressed concerns with efforts to legalize recreational marijuana use.  Additionally, Assembly Speaker Carl Heastie commented this week that marijuana legalization may not occur as part of the State Budget, noting the significant complications associated with enacting such a change.  The Medical Society is asking for the NYS Legislature to remove this provision from the budget proposal and are urging physicians to send a letter to the NY Legislature and to the governor through its Grassroots Action Center (GAC):  https://cqrcengage.com/mssny/app/write-a-letter?7&engagementId=495697                                        (CLANCY) 


Firearm Safety Measures Pass NYS Legislature; Awaiting Action by Governor

The NYS Legislature this week passed a package of bills that would help combat firearm violence.

  • 2451/A. 2689, sponsored by Senator Brian Kavanagh and Assemblymember JoAnne Simon, allows law enforcement officials, family and household members, and certain school officials to seek a court order requiring a person likely to harm themselves or others to surrender any firearms in their possession.
  • 2374/A.2690, sponsored by Senator Michael Gianaris and Assemblymember Amy Paulin, would establish an extension background check waiting period of up to 30 days.
  • 2248/A.2448, sponsored by Senator Luis Sepulveda and Assemblymember Patricia Fahy, would prohibit the possession of a device (bump stock) that accelerates the rate of fire of a firearm.

Also passed by the Legislature were S.101A/A.1715, sponsored by Senator Todd Kaminsky and Assemblymember Judy Griffin that prevents k-12 schools from authorizing anyone other than a security officer, a school resource officer or a law enforcement officer from carrying a firearm on school grounds.  Senator Shelley Mayer and Assemblymember Linda Rosenthal sponsored legislation (A.2685/S.2449) that directs the state police to devise regulations for gun buyback programs to ensure that such programs are operated consistently throughout the state.  Senator Anna Kaplan and Assemblymember Pamela Hunter sponsored legislation (S.2438/A.1213) which would require out of state applicants for gun permits to allow NY permitting authorities to review out-of-state mental health records.

All of these measures are now before Governor Cuomo for his action.

In March 2018, the MSSNY House of Delegates took action to support legislation that requires a waiting period and background checks prior to the purchase of all firearms, including the person-to-person transfer, internet sales, and interstate transactions for all firearms.  The MSSNY HOD also adopted policy to support legislation that blocks the sale of any device or modification, including but not limited to bump stocks, which convert a firearm into a weapon that mimics fully-automatic operation.  MSSNY supports legislation that would ban the sale and/or ownership of high-capacity magazines or clips and high-speed, high-destruction rounds. (MSSNY Policy 260.898 and Policy 260.899).

Furthermore, MSSNY has adopted a policy statement that states that gun violence in the United States is a public health crisis and supports federal efforts to reverse the ban that prohibits the Center for Disease Control from researching gun-related injuries, deaths, and suicides related to this violence.  In January 2019, the MSSNY Task Force on Firearm Safety also recommended that the Medical Society support the concept of “red flag” provisions.

In a press statement released by the NYS Legislature following the passage of the legislation, it contained a quote from Dr. Thomas Madejski, president of the Medical Society, that “Today’s gun safety package contains a number of important measures supported by the medical community.  Establishing ‘red flag’ laws, prohibiting the sale of so-called ‘bump stocks’ and extending the waiting period to purchase firearms are all common sense reforms that have been supported by MSSNY as ways to reduce the risk of firearms coming into the hands of those who present a risk to themselves or others.  We thank the Senate and Assembly leadership, as well as Governor Cuomo, for advancing these important measures.”                                                       (CLANCY)


Federal Regulators Propose Controls To Reduce Prescription Drug Costs, Create More Transparency
This week, HHS Secretary Alex Azar announced proposals to help lower prescription drug prices, reduce out-of-pocket costs for patients and bring about greater transparency in the pharmaceutical industry. The proposed rule would encourage drug manufacturers to pass discounts directly on to patients.

The proposed rule would exclude rebates on prescription drugs paid by manufacturers to PBMs and insurance companies from “safe harbor” protections under the Anti-Kickback Statute. Further, it would create a new “safe harbor” for discounts that are offered directly to patient, in addition to fixed fee service arrangements between manufacturers and PBMs.

According to HHS, rebates currently amount to an average of 26-30% of a drug’s list price and this proposed rule would require these rebates be passed directly to patients (reflected in what they pay at pharmacies). The proposal would likely provide the greatest savings to seniors with high drug costs and is intended to encourage drug companies to compete for the lowest price and out-of-pocket cost for patients.  For more details, visit https://www.hhs.gov/sites/default/files/20190131-fact-sheet.pdf                                                                (AVELLA, AUSTER)


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

The measles outbreak in New York State continues to spread with at least 186 confirmed cases.  There have been 124 in Rockland County and 62 cases in Brooklyn with one suspected case currently being monitored.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December, 2018.  This webinar has now been posted to the MSSNY CME website. Please check it out and keep yourself informed about the ongoing measles outbreak throughout New York State.  You can also listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine here.                                                                                                                            (HOFFMAN, CLANCY)


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

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

Educational Objectives:

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

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

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


Registration Now Open for New Veterans Matters CME Webinars:
The Medical Society of the State of New York is proud to announce two NEW Veterans Matters webinars scheduled for February and March 2019. These webinars are: The Special Mental Health Needs of Women Veterans on Thursday, February 28th at 7:30am and Military Culture: Everything Physicians Need to Know About Veterans as Patients on March 14th at 7:30am.

Register here for The Special Mental Health Needs of Women Veterans, and here for Military Culture: Everything Physicians Need to Know About Veterans as Patients.

Veterans Matters: The Special Mental Health Needs of Women Veterans

When:  Thursday February 28, 2019 at 7:30am

Faculty: Malene Ingram, MD (Col., US Army Reserves)

Educational Objectives:

Review how the increased role of women in the military has impacted their mental health.

Describe mental health concerns unique to women veterans and how to identify and treat them.

Identify the barriers that women veterans face in getting the specific care they need

Veterans Matters: Military Culture: Everything Physicians Need to Know About Veterans as Patients 

Military Culture: Everything Physicians Need to Know About Veterans as Patients

When: Thursday, March 14 2019 at 7:30am

Faculty: Lt. Col Lance Allen Wang, & Marcelle Leis, CM Sgt (Ret)

Educational Objectives:

Describe the unique aspects of military culture and how they impact patients who are veterans.

Explain the Dwyer Peer-to-Peer program as a resource to assist veteran patients re-acclimating from a group to an individual mentality.

Review and identify resources to improve physician’s ability to fully treat veterans who are transitioning back into civilian life.

Additional information or assistance with registration may be obtained by contacting Sarah Humes at   shumes@mssny.org or (518) 465-8085

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 creditsä.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 



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

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

 

 

eNews

 

MSSNY Statement re ZocDoc’s Amended Pricing Proposal

Last August, we advised the membership that MSSNY, together with its General Counsel, Garfunkel Wild, P.C., had been engaged in lengthy discussions with ZocDoc to better understand ZocDoc’s planned changes to its program. As a result of those meetings, ZocDoc postponed implementation of those pricing changes. ZocDoc recently announced that it is moving forward with its amended pricing proposal effective April 1, 2019.

Under the new pricing, physicians will pay a reduced annual licensing fee and a booking fee based on the physician’s specialty for each new patient making an appointment.

MSSNY is continuing to address the concerns of our members with regard to the proposed pricing methodology and will know more after a meeting, which will be scheduled shortly with Garfunkel Wild and ZocDoc.


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

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

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

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure.
  • Reject unfair cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Reject burdensome mandates that interfere with patient care delivery.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

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

If you have any questions, please contact Carrie Harring: charring@mssny.org.



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Proposed VA Rules Allow More Vets to Seek Private Primary/Mental Healthcare
The New York Times (1/30) reports, “Veterans who live as little as a 30-minute drive from a Veterans Affairs health care facility will instead be able to choose private care, the most significant change in rules released Wednesday as part of the Trump administration’s effort to fix years-old problems with the health system.” This group of veterans “will be allowed to seek primary care and mental health services outside the department’s system.” At present, veterans are allowed to “use a private health care provider if they must travel 40 miles or more to a V.A. clinic.” The Times says using “commuting time rather than distance will greatly open the private sector to veterans in rural and high-traffic urban areas.”


CMS Unveils New Medicare Mobile App
CMS has unveiled a new Medicare information mobile app called “What’s Covered.” The objective is to “help beneficiaries understand what’s covered under Medicare, historically a source of much confusion.” CMS Administrator Seema Verma explained that the free app is part of the agency’s “‘eMedicare’ collection of tools, designed to help beneficiaries search and compare coverage and out-of-pocket costs online.”

“What’s Covered?” released on iOS and Android on January 28, aims to quickly bring such information to users’ mobile devices. The app now provides another solution—users can look up medical devices or services to find out how much Medicare covers and what they’ll have to pay. It also lets users browse preventative health services for which they are already eligible. 


Presentation in Social Media Ad2019 MSSNY Young Physicians Section Annual Meeting and Educational Symposium
Young Physicians, Residents/Fellows, Medical Students: Join us for two top CME* Programs by National Leaders in Medical Toxicology and Social Media in Medicine.

When: Saturday, February 9, 2019 at the Marriott Courtyard in Westbury and MSSNY HQ.

http://www.mssny.org/MSSNY/About_MSSNY/Member_Sections/Young_Physicians/Joint_Edu_Symposium_Welcome.aspx.

Leaders in medical toxicology and social media in medicine. CME* credits provided. We look forward to seeing you! Webex available (Contact sbennett@mssny.org)

*For each CME session

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

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


Electric Scooters Cause Rash of Visits to Hospital EDs, Study Indicates

study published online in JAMA Network Open revealed that “more electric scooter riders showed up with injuries in the emergency” departments “of two hospitals on Los Angeles’ scooter-heavy Westside than either bicyclists or pedestrians.” Among the patients admitted “some 40.2 percent” had “head injuries,” and 31.7 percent had fractures. The Washington Post (1/25) reported, “Although California law required helmet use while operating electric scooters during the entire study period, only 4.4% of injured scooter riders were documented to be wearing a helmet” at the time of their accidents.


CDC: Nearly Two Percent of US High School Students Identify as Transgender

Nearly two percent of high school students in the United States identify as transgender, according to data published January 31 by the US Centers for Disease Control and Prevention” in the CDC’s Morbidity and Mortality Weekly Report. The data were derived from the “2017 Youth Risk Behavior Survey in 10 states and nine large urban school districts.” Reuters (1/24) reports that the CDC found that 35 percent of transgender students “said they had attempted suicide in the previous year, compared with about 7 percent of those who did not see themselves as transgender.”


 

Educational Sessions for Practitioners Interested Learning about Marijuana for Medical Purposes

In service educational programs are being offered by Curaleaf on cannabis use.  Both registered and un-registered practitioners are invited to these educational events. Light refreshments will be provided. Note: These programs have not been accredited by MSSNY.

To RSVP, contact Curaleaf Practitioner Liaison: Stacia Woodcock PharmD swoodcock@curaleaf.com

Practitioner In-Service: Medical Cannabis and Cancer

Date: February 13, 2019

Time: 6-8pm

Leaders: Curaleaf Pharmacists

Description: To help educate practitioners regarding how medical cannabis could benefit cancer patients.

Practitioner In-Service: CBD, Medical Cannabis, and the Illicit Market

Date: March 13, 2019

Time: 6-8pm

Leaders: Curaleaf Pharmacists

Description: To help educate practitioners on the difference between CBD, medical cannabis, and the cannabis obtained on the illicit market.

Practitioner In-Service: Medical Cannabis Journal Club

Date: April 17, 2019

Time: 6-8pm

Leaders: Curaleaf Pharmacists

Description: Reviewing and discussing several recent medical cannabis research papers, and discussing the potential influence on medical cannabis practice they represent.

Practitioner In-Service: Medical Cannabis and Women’s Health

Date: May 15, 2019

Time: 6-8pm

Led by Curaleaf Pharmacists

Description: To help educate practitioners on the use of medical cannabis as it applies to women’s health.

Practitioner In-Service: Medical Cannabis and the Opioid Crisis

Date: June 12, 2019

Time: 6-8pm

Led by Curaleaf Pharmacists

Description: To help educate practitioners on how medical cannabis can be used to reduce opioid usage and to treat opioid addiction.

Locations:

 

  1. Curaleaf Carle Place

255 Glen Cove Road

Carle Place NY 11514

CarlePlace@curaleaf.com1 (516) 534-2872

  1. Curaleaf Newburgh

8 North Plank Road

Newburgh NY 12550

Newburgh@curaleaf.com

  • (845) 762-0110
  1. Curaleaf Plattsburgh

345 Cornelia Street

Plattsburgh NY 12901

Plattsburgh@curaleaf.com

  • (518) 930-4340
  1. Curaleaf Queens

107-18 70th Road

Forest Hills NY 11375

Queens@curaleaf.com

1 (646) 968-2872

 

Joint Commission Pioneers in Quality eCQM Expert to Expert Webinar Series: ED-1 and ED-2 eCQMs

February 12, 2019 – 11 AM – 12 PM CT

Click here to register

If you cannot get the registration page to launch, please cut and paste this Event URL into your browser to register: https://goto.webcasts.com/starthere.jsp?ei=1228586&tp_key=5a5670b731

The Joint Commission and the Centers for Medicare & Medicaid Services (CMS) are committed to supporting hospitals on their journey towards electronic clinical quality measure (eCQM) adoption and transition to the new Clinical Quality Language (CQL) expression language for the 2019 eCQM reporting period. This series, offered in cooperation with and incorporating expert content from The Joint Commission, Centers for Medicare & Medicaid Services’ subcontractors Mathematica, Lantana, and ESAC, provides in-depth CQL coverage.

The February 12 session will address ED-1 and ED-2 eCQMs and will include a review of measure logic, common issues, and a question and answer session. At the end of this session, participants will be able to:

  • Apply concepts learned about the new Clinical Quality Language (CQL) expression language for the ED-1 and ED-2 eCQMs,
  • Identify common issues and questions regarding ED-1 and ED-2 eCQMs, and
  • Prepare to implement the CQL expression language for the 2019 eCQM reporting year (2020 data submission).

Space for each session is limited to 3000 lines; when all lines have been used, no additional participants can join. If your organization or colleagues use a meeting room and single conference line for this session, please read below about CE requirements. To claim continuing education credits, staff must register individually.

This webinar is approved for 1.0 Continuing Education Credit from: ACCME, ANCC, ACHE, California Board of Registered Nursing, IACET, and CJCP. CE/CME/CEU Credits available for live audio only; credits not offered for webinar replays. To claim credit, you must have:

  1. Individually registered for the webinar.
  2. Listened to the live webinar in its entirety. Only those listening live during the session will be eligible to receive credit.
  3. Completed a post-program evaluation/attestation. The program evaluation/attestation link will be sent to your registered email after the webinar.

Printable certificates will be sent via email 2 weeks after the session; all participant CE certificates will be sent at the same time.

A webinar recording and slides will be posted on the Expert to Expert Series landing page and the CMS’ eCQI Resource Center website within several weeks of each session.

Click here to register


 

 

 

 

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RENTAL/LEASING SPACE


5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464


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


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


PHYSICIAN OPPORTUNITIES

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


Physician 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, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Avoid nuisance lawsuits!! Make sure your website is compliant with the Americans with Disabilities Act! We can do a free audit of your website and let you know if corrections are needed. Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Jan. 25, 2019 – Are YOU for Single Payer?

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


MSSNY eNews
January 25, 2019
Volume 22  Number 4

MSSNYPAC Seal

Colleagues:

We’ve been getting reacquainted with snow and other forms of precipitation in Western New York this week. Water is essential to life, but like so many other substances there can be too much of a good thing, and excess can lead to significant problems.  Indeed, MSSNY and the New York State Academy of Family Physicians suffered from the consequences of Mother Nature’s intemperance.  Travel was challenging over the weekend and the NYAFP leadership thoughtfully curtailed the end of their Scientific Assembly meeting to allow safe travel for their members.

NYSAFP provided an excellent review of many clinical topics.  I provided an update on the changing legislative landscape within New York State.  Subsequently, NYSAFP President Marc Price and I had a fireside chat with the attendees to discuss various items of concern to our memberships.  NYSAFP and MSSNY are in policy agreement with the vast majority of issues.  Our organizations have had a long standing difference in support for a single payer healthcare system.  MSSNY has long standing policy against endorsement of single payer, but in 2017 directed our leadership to engage in discussions that would be beneficial to patients and physicians.  NYSAFP has had policy for single payer for a number of years. Both of us agree that the devil is in the details.  The New York Health Act continues to be modified by its primary sponsors, Assemblyman Richard Gottfried and Senator Gustavo Rivera.  Senator Rivera indicated to me earlier in the week at a public event that he planned on further refinement of the bill to address the concerns of his constituents.

Assemblyman Gottfried indicated earlier this week that he was attempting to address some of MSSNYs concerns based on discussions we had in the fall.  I emphasized to the assembled group the importance of continuing the dialogue to improve policy for our patients and members and to shape the healthcare environment for our patients and our practices.  There are a number of other items under serious discussion with the Governor and Legislature, including the legalization of some hydrophobic substances currently prohibited by law.  NYSAFP and MSSNY are in strong agreement with regards to equity in law enforcement, and high quality research regarding the risks and benefits and long term effects of a certain oily, herbal substance with psychotropic activity before further expansion of its availability.

You can make a difference!

I believe we are at one of those tipping points in our state and country.  We (MSSNY, NYSAFP, our other specialty societies, and you personally) have a professional duty to inform the discussions and decisions of our elected officials during their deliberations.  Join me in Albany March 6th as we meet our elected leaders to share our concerns and policy recommendations for the health and welfare of our patients and fellow citizens with the unique insight we have caring for individual patients and informed by the basic and clinical science we employ on a daily basis.

Your duty doesn’t stop there.  You also need to engage your representatives at home.  Our Physician Advocacy Liaison (PAL) program can help you get there

Some former members have voiced that our efforts are inconsequential, that NY is run by “ three men in a room.”  There may have been some truth to that in the past, but “the times they are a changing.”  The 2018 election has changed the dynamics substantially and as noted above we have substantial input into the discussion.  Our political leaders are now seek our thoughts on how to proceed with these difficult questions.  Our MSSNY Leaders and our excellent Government Affairs staff continue with ongoing discussions with Assembly and Senate leaders and the Governor’s Management Team.  We continue to seek other healthcare allies in our discussion.

You can empower our patients and our profession further with your help in Albany and at home. Remember together we really are stronger!

Excelsior

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

Thomas J. Madejski, MD
MSSNY President



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

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

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

Join us to urge your legislators to:

  • Proceed very cautiously on paradigm shifting proposals such as legalization of recreational marijuana (proposed in the State Budget) and creating a single payor health insurance structure.
  • Reject proposed unfair cuts to physicians treating patients covered by both Medicare and Medicaid;
  • Reject proposals that would add prior authorization burdens for care provided to Medicaid patients;
  • Support legislation to reduce excessive health insurer prior authorization hassles that delay patient care.
  • Reduce the high cost of medical liability insurance through comprehensive reforms.
  • Preserve opportunities for medical students and residents to become New York’s future health care leaders.

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

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


Governor Proposes $175 Billion Budget for 2019-20; Many Items of Impact to Medicine
As reported last week, Governor Andrew Cuomo has formally announced his proposed $175 Billion Budget for the FY 2019-20 Fiscal Year that would close a $3 billion Budget deficit.

Some positive items in the Executive Budget include: 

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

Some items of potentially significant concern include:

  • Cuts Medicaid payments for the deductibles of “dual eligible” patients, which could have a significant adverse impact for those physicians whose patient mix includes a substantial number of Medicare/Medicaid dual eligible patients. Send a letter to your legislator here.
  • Legalize the sale of recreational marijuana to those 21 and over.
  • Expands the existing medical marijuana program to add additional health conditions which would be eligible for “Medical Cannabis”.
  • Permit Nurse Practitioners and licensed social workers to treat injured workers and be directly reimbursed under Workers Compensation without coordination with a physician.
  • Repeal “prescriber prevails” protections for prescriptions for Medicaid FFS patients that are not on the Medicaid formulary. 

Some items of Interest and Further Review Include:

  • Codify New York’s Health Insurance Exchange, and assure NY has continued coverage for pre-existing conditions, Essential Health Benefits and provide physician a clear method to appeal medications not included on insurers’ formulary
  • Expand health insurance coverage for IVF;
  • Require ED physicians to check I-STOP database;
  • Create a Commission on Universal Access to Health Care comprised of health policy and insurance experts to devise ways to achieve universal access to high quality, affordable health care;

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


Governor Proposes “The Cannabis Act” To Legalize Use of Recreational Marijuana
Governor Andrew Cuomo proposed in his New York State Budget legislation a comprehensive component that would provide for the legalization of recreational marijuana.  Contained within the legislation is the existing program on medical marijuana.  The Medical Society is asking for the NYS Legislature to remove this provision form the budget proposal and are asking physicians to send a letter to the NY Legislature and to the governor through its Grassroots Action Center (GAC):

The bill’s components are as follows:

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

Medical Marijuana

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

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


NYS Legislature Passes and Governor Signs in to Law the Reproductive Health Act
The New York State Legislature passed the Reproductive Health Act on January 22, 2019 and it was immediately signed into law by Governor Andrew Cuomo as Chapter 1, Laws of 2019.    Assembly Bill 21 and Senate Bill 240, sponsored by Assemblymember Deborah Glick and Senator Liz Krueger, amended the public health law by codifying the abortion procedure within New York State’s public health law and removing it from the penal law.  The bill passed the NYS Senate by a vote of 38-24 and the NYS Assembly by 95-49.  The law creates a statement of purpose and says that an abortion may be performed a licensed, certified or authorized practitioner acting within their defined scope of practice under Title 8 of the Education Law.   Under the law, an abortion can be performed within 24 weeks from the commencement of pregnancy, an absence of fetal viability or at any time when necessary to protect a patient’s life or health. 

MSSNY has policy that opposes the criminalization of the exercise of clinical judgement in the delivery of medical care.   Moving the abortion procedure from the penal law to the public health law is consistent with this position.   The law does not expand the current scope of practices for health care providers.    It does, however, specify that health care practitioners can perform an abortion if it otherwise enabled by their current scope of practice as defined under the NYS Education Law.  Nurse practitioners are allowed to perform a medicated abortion procedure already under their scope of practice.  Nurse practitioners scope does not include “surgery” and cannot perform a surgical abortion.  The American College of Obstetricians and Gynecologists (ACOG), District II and the NYS Academy of Family Physicians (NYAFP) supported this measure.  (CLANCY) 


Comprehensive Contraception Coverage Act Passed by NYS Legislature; Awaits Governor Action
“The Contraceptive Equity Act” has passed the NYS Legislature.    Assembly Bill 585-A/Senate Bill 659-A, sponsored by Assemblymember Kevin Cahill and Senator Julia Salazar, requires health insurance policies to include coverage of all FDA-approved contraceptive drugs, devices and productions.  The bill also requires insurance coverage for emergency contraception when prescribed or when lawfully provided over the counter and allows for dispensing of up to twelve months of contraception.  The bill would also require coverage of voluntary sterilization procedures for women and men and would require coverage for patient education and counseling about contraception.

The bill would also require that any follow-up care related to the covered contraceptives including management of side-effects, counseling and device insertion and removal be covered.  The legislation also importantly contains a “prescriber prevails” provision.  MSSNY has policy that supports allowing greater access to emergency contraception and supports insurance coverage for contraceptive drugs and devices.  The bill was also supported by COG and NYAFP. (CLANCY)


Conversion Therapy Bill Signed Into Law By Gov. Cuomo; MSSNY Participates In Bill Signing Ceremony
On Friday, January 25, 2019, Governor Andrew Cuomo signed legislation that would prohibit a mental health professional from engaging in sexual orientation change efforts with a patient under 18 years of age.  A. 576/S. 1046, sponsored by Assemblymember Deborah Glick and Senator Brad Hoylman, provides that any sexual orientation change efforts attempted on a patient under 18 years of age by a licensed mental health professional shall be considered unprofessional conduct and shall subject the provider to discipline by the provider’s licensing entity.   Frank Dowling, MD, MSSNY Secretary, participated in the bill signing ceremony.  The Medical Society of the State of New York has supported this measure and it has been part of our legislative program for several years. (CLANCY)


Firearm Safety Package Moving in NYS Legislature
The New York State Legislature will be considering a series of firearm safety measures next week. Senate Bill 2448, sponsored by Senator Luis Sepulveda, would prohibit the possession, manufacture and transport of rapid-fire modification devices which are commonly referred to as a “bump stock” mechanism.  This legislation is on the Senate Codes Committee for its consideration on Monday.  Its companion measure, A.2684, sponsored by Assemblywoman Patricia Fahy is also on the Assembly Codes Committee.   Senate Bill 2374/A.2690 sponsored by Senator Michael Gianaris and Assemblymember Amy Paulin, would establish a waiting period before a firearm, shotgun or rifle can be sold or transferred.  The bill requires either the National Instant Criminal Background Check System (NICS) or its successor to issue a “proceed” response to the licensee or a 30 day waiting period to expire.  The measure is on the Senate and Assembly Codes Committee for action.

At its 2018 House of Delegates, the Medical Society of the State of New York enacted policy that  supports legislation that blocks the sale of any device or modification, not limited to bump stocks, that functionally converts a firearm into a weapon that mimics fully-automatic operations.   MSSNY also supports legislation that requires a waiting period and background checks prior to the purchase of firearms, including person-to-person transfers, internet sales and interstate transactions. Also coming before the Senate Judiciary Committee is S.2451, sponsored by Senator Brian Kavanagh.   Its companion measure Assembly bill 2689, sponsored by Assemblymember JoAnne Simon, is on the Assembly Codes Committee.

This bill, commonly referred to as a “red flag” law, would establish an Extreme Risk Protection Order (ERPO) which is an order of protection prohibiting certain persons from purchasing, possessing or attempting to purchase or possess a firearm, rifle or shotgun.  Under the measure, a police officer, a family or household member, a school administrator or his/her designee, can request a court-issued order of protection when it is believed that a person has threatened or committed an act of violence towards themselves or others, or situations where an order of protection has been violated, or where there is a pending charge or conviction for an offense involving the use of a weapon.  The bill provides grounds for the request and surrendering of the firearm.  MSSNY’s Taskforce on Firearm Safety recently recommended, and the MSSNY Council agreed, that MSSNY support the concept of “red flag” provisions.              (CLANCY)


Empire Center Forum Examines Implication of Proposed New York Health Act
This week the Empire Center for Public Policy held a widely attended seminar in Albany at which legislators and industry experts discussed the provisions and ramifications of the New York Health Act (NYHA), as well as possible alternatives for achieving universal health care.  NYHA bill sponsors Senator Gustavo Rivera and Assemblyman Richard Gottfried presented their case for a single-payer system, including the articulation of their goal to assure coverage for the currently uninsured and underinsured by re-directing the enormous amount of health care dollars that currently goes toward administrative spending. 

In response, representatives of HANYS and the NYS Conference of Blues Plans raised significant concerns with the legislation, including possible ERISA pre-emption and the elimination of employer-funded insurance as an option for patients.  They also noted that, while the goals of expanded coverage are agreed to by many, the “devil is in the details” regarding how such a program would be constructed and implemented.  Assemblyman Gottfried and Senator Rivera indicated a revised NYHA bill would be introduced soon, including provisions to clarify that pre-authorization requirements for needed care would be no more burdensome that what is currently imposed by Medicare (a concern raised by MSSNY).

The Empire Center’s health policy director Bill Hammond noted that the NYHA would require a significant tax increase which could be greater than $139 billion (plus long term care) suggested by a recent Rand study. Hammond also presented information outlining how New Yorkers would be affected financially.   Hammond also noted that, while many people would pay less for health insurance, many from across financial strata, would pay more. In fact, Hammond noted that many of those that would pay more would be low- and middle-income individuals and families.

The second panel, moderated by Hammond, was comprised of Eric Linzer, CEO of the NY Health Plan Association, Michael Sparer, professor and Chair of Health Policy at Columbia University, and Michael Capaldo, a board member of the NYS Association of Health Underwriters.

Sparer advocated for allowing individuals to buy into government programs like Medicaid, the Essential Plan and CHP in order to assist the un- and underinsured in achieving more affordable coverage. He also noted the great difficulties that the federal government’s unwillingness to provide waivers would present. Linzer noted his support for state subsidies for those who qualify for little to no subsidies (ie, 400-600% FPL) in order to expand affordable coverage and help to stabilize the risk pool. He also discussed focusing on transparency within the pharmaceutical industry.  Capaldo advocated to expand the use of New York’s All Payer Database so that individuals can better shop for care. He also proposed innovating network coverage, such as permitting members to go to a non-participating provider if they are cheaper than a participating provider, and possibly allowing the member to share in the savings.  (AVELLA, AUSTER, HARRING)



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

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


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

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

Educational Objectives:

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

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

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


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

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

eNews

New York’s Capital Region Reports Boost in Crucial NIH Funding Last Year
The Albany (NY) Times Union (1/17, Mendoza) reports the Albany, New York area “saw a significant jump in funding for biotech research last year from the National Institutes of Health,” according to the Albany-based Center for Economic Growth. The center found that the NIH “directed $62 million in funding to 20 institutions across an eight-county area,” a sum that “is the most the area has received from the NIH since 2013.” According to the article, “More than half of the Capital Region’s federal life sciences research and development funding comes from the National Institutes of Health,” an infusion that researchers regard as critical to scientific institutions.


JAMA Observational Study on Pharma Marketing v. Opioid Overdose
An observational study published in JAMA Network Open analyzes the link between how much money pharmaceutical companies spend marketing to doctors and opioid overdose death rates a year later. The companies spent nearly $40 million to market their medications to U.S. doctors between 2013 and 2015.

The researchers who conducted the JAMA study looked at more than 2,000 counties across the United States to see whether overdose death rates changed in the year after doctors in the area received payments and/or marketing material from opioid manufacturers. The counties that got more marketing attention did later experience higher overdose death rates.

The study authors point out that prescription opioids account for about 40 percent of all overdose deaths and, more importantly, are the first opioid a person typically encounters. While most overdose deaths are related to illicitly obtained opioids, mainly heroin and fentanyl, the authors say using prescription opioids first may lead to OD deaths from any type of opioid. Although the study did not prove causation, it does show that pharmaceutical companies and doctors may play an unexpected role in the opioid epidemic, and it raises questions about how the U.S. health care system could more effectively address the opioid crisis.

Sourced from: JAMA Network Open


Free Buprenorphine Waiver Training in Albany Feb 22
When:  Fri Feb 22 12-5
Where: Desmond Hotel, Albany

The PCSS-MAT Half-and-Half Medication Assisted Treatment (MAT) waiver training course provides an overview of the FDA-approved medication—buprenorphine—prescribed for the treatment of opioid use disorder (OUD). This course provides the required 8-hour training to prescribe buprenorphine for the treatment of OUD. The course provides an overview of prevention, identification, and treatment of substance use disorders emphasizing OUD.

Tuition: Free

More information/ to register: www.nyacp.org


State Lobby Day Banner

USAF Looking for Medical School Applicants, Med Students, Fellows and Residents

The NY USAF office handles applications for the Office of the Surgeon General’s following programs:

1. Medical Corps Health Professions Scholarships Program
(Up to 100% Tuition & Fees Scholarship for 4 years, with $2,330/month Stipend,   $20K Sign-up bonus, and materials reimbursement quarterly)
     a. Undergraduates and graduates applying to medical school
     b. Current medical school students
     c. Students already enrolled in early assurance programs at the undergrad or       graduate levels
2. Medical Corps Health Professions Financial Assistance Program 
(Earn up to an additional $73K per PGY on top of what their residency program is already paying)
    a. Final year medical school students playing in the match cycle
    b. Final year medical school students already matched
    C. Current Residents
    d. Current Fellows
3. Direct Accessions of BE/BC Physicians
(Initial Sign-on bonuses from $250-400K depending on specialty + competitive pay    and unmatched benefits)
           a. Final year residents and fellows
           b. Practicing Physicians seeking a change, challenge, or privilege to serve
           c. Any ‘a’ or ‘b’ candidate wanting to gain additional training, licensing, and experience as an Aerospace Medicine Doctor (a.k.a. Flight Surgery or Flight Medicine)
           d. A pathway to highly specialized and elite physician programs and teams like Special Operations Surgical Teams (SOST), Critical Care Assessment Teams (CCAT), Ground Surgical Teams (GST), Center for Sustainment of Trauma and Readiness Skills (CSTARS)  and many, many, more growth and career broadening pathways.

MSSNY Past President and Family Physician Ralph Schlossman, MD Died Jan. 17
Dr. SchlossmanMSSNY Past President Ralph Schlossman, MD, 88, died at his home surrounded by his wife of 64 years, Ruth, family and friends on January 17, 2019. Interment was on, January 20 at Mount Hebron Cemetery.

He graduated from New York University School of Medicine in 1955 and joined the Medical Society of the County of Queens in January 27, 1959. Dr. Schlossman became President of Medical Society of the County of Queens in 1970-1971 and President of Medical Society of the State of New York in 1998-1999. He was MSSNY Councilor from 1984-1992. He was elected to the Board of Trustees in 2000 and served on it until 2005 and he was Chair of the Board from 2004-2005. Dr. Schlossman received the Medical Society of the State of New York’s most prestigious award, the Henry I. Feinberg Award for leadership.

Dr. Schlossman served in the United States Air Force from 1956-1958 and was Chief Flight Surgeon 31st Tactical Fighter Wing and Commander of 31st Tactical Hospital. He was proud of his service in the U.S. Air Force, becoming the flight surgeon of a wing of the first generation of supersonic fighter bombers and one of the first physicians to fly faster than the speed of sound.

Dr. Schlossman and his wife Ruth have three children Andrew, Wendy and Marcie. The Family requests contributions may be made to Hadassah or Wounded Warriors Project.


Workers Compensation New Medical Fee Schedule
The new Medical Fee Schedule will be effective for services provided on or after April 1, 2019. The Board adopted the use of ICD-10 October 1, 2015, as previously announced in Subject Number 046-785 Chair Announces Adoption of ICD-10. Therefore, effective April 1, 2019, the Board will require full compliance with ICD-10.

The Workers’ Compensation Medical Fee Schedule is published by Optum Insight. Copies may be obtained by mail, telephone, or online.

By telephone: Call (800) 464-3649, option 1.

Online: Go to www.optum360coding.com, keyword New York, or https://www.optum360coding.com/Product/40508/. 


Erie County Medical Society Physicians Meet with Local Legislative Delegation
On January 4, 2019, physician leaders of the Medical Society of the County of Erie (MSCE) met with several key local legislators representing Western New York in Albany and Washington.  Participating Senators and Assembly Members included Senator Patrick Gallivan, Ranking Member of the Senate Health Committee on Health, and Assembly Members Angelo Morinello, Michael Norris and Monica Wallace.  Also participating were top staff from Senator Michael Ranzenhofer, Senator Tim Kennedy, US Representative Chris Collins and US Representative Brian Higgins.

In anticipation of the 2019 legislative session, two important topics were discussed – physician concerns with proposals to legalize recreational marijuana (proposed in the Governor’s Executive Budget) and legislation to create a statewide single-payer insurance program.

MSCE representatives included: Drs. Robert Armstrong, Secretary/Treasurer MSCE; Rose Berkun, Chair Legislative Committee MSCE (and MSSNY Legislative Committee Vice-Chair); Gale Burstein, Erie County Health Commissioner and Chair of Public Health Committee MSCE; John Gillespie, President MSCE; Kenneth Eckhert III, President-Elect MSCE; Gordon Tussing, Chair Practice Management Committee MSCE; Willie Underwood, Immediate Past President MSCE; Joseph McCarthy, Esq., MSCE Counsel and Jennifer Scharf, Esq., Co-Chair Health Law Committee MSCE.

Have you had a local meeting with your legislators on key legislative issues impacting physicians and their patients?  Please share with us to include in future issues of the MSSNY e-news.


Cost of Insulin for Treating T1D Nearly Doubled Over Five-Year Period
Reuters (1/22)reports, “The cost of insulin for treating type 1 diabetes [T1D] in the United States nearly doubled over a five-year period,” researchers found in “a report due to be released on Tuesday by the nonprofit Health Care Cost Institute (HCCI).” The report revealed that an individual with T1D “incurred annual insulin costs of $5,705, on average, in 2016,” compared to an “average cost” of “$2,864 per patient in 2012.” According to Reuters, these numbers “represent the combined amount paid by a patient and their health plan for the medicine and do not reflect rebates paid at a later date.”


What’s Changed for 2019 E&M Services?
For those of you who bill Medicare for Evaluation and Management and some telehealth services, you will need to know what has changed based on the 2019 Final Rule for Medicare.  You or your staff should review the changes through the following link:
What’s Changed as a Result of CMS Final Rule 2019


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


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


PHYSICIAN OPPORTUNITIES

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


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


Avoid nuisance lawsuits!! Make sure your website is compliant with the Americans with Disabilities Act! We can do a free audit of your website and let you know if corrections are needed. Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: Positive Budget Items!

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


MSSNY eNews
January 18, 2019
Volume 22  Number 3

MSSNYPAC Seal

Colleagues:

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

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

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

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

Honored to Be Honored

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

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

Non ministrari sed ministrare

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

Thomas J. Madejski, MD
MSSNY President


MLMIC Banner

Capital Update

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

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

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

Join us to urge your legislators to:

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

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

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


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

Some positive items include: 

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

Some items of potentially significant concern include:

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

Some items of Interest and further review Include:

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

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

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

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


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

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

    Medical Marijuana

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

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


    NY Rx Card Banner


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

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

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

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

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


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

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


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

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

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


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

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


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

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

    Educational Objectives:

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

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

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


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

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


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

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

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

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

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

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


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

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

    eNews

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

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

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

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

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


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

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

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

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

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

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


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

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

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

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

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


    Garfunkel Ad


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

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


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


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

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

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

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

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


     

    Classified

    RENTAL/LEASING SPACE


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


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


    PHYSICIAN OPPORTUNITIES

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


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


    Avoid nuisance lawsuits!! Make sure your website is compliant with the Americans with Disabilities Act! We can do a free audit of your website and let you know if corrections are needed. Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     


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