MSSNY eNews: County Health Officials v. Marijuana

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


MSSNY eNews
January 11, 2019
Volume 22  Number 2

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Colleagues:

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

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

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

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

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

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

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

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

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

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

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

Suus bonus et amicis


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


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

Thomas J. Madejski, MD
MSSNY President


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Capital Update

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

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


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

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

Legislative breakdown:

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

    • 9 new Republicans                                                                        (DIVISION OF GOVERNMENTAL AFFAIRS)

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

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


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

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


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

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


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

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


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

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

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


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

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

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

Join us to urge your legislators to:

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

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


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

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

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

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

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

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

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

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


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

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

For more information, please Click here.


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

Educational Objectives:

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

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

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


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

Educational Objectives:

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

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

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


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


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

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

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


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

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

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

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

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

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


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


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

Webex available (contact sbennett@mssny.org)

*For each CME session

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

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


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

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

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

FOUR TIPS TO GET YOU STARTED

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

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

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


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

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


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


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RENTAL/LEASING SPACE

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



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


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


PHYSICIAN OPPORTUNITIES

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


Physician Insights Wanted to Help Shape the Future of Primary Care
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MSSNY eNews: Visions, Myopia, or Delusions?

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


MSSNY eNews
January 4, 2019
Volume 22  Number 1

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Colleagues:

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

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

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

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

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

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

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

Quod oculus non videre mente id quod non habet

Thomas J. Madejski, MD
MSSNY President


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

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

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

Join us to urge your legislators to:

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

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

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


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

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

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


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

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

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


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

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

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

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


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

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

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

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

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

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

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


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

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


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


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


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

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

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

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

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


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FREE CME PROGRAMS

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

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

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


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

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

Educational Objectives:

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

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

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


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RENTAL/LEASING SPACE

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


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


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


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


PHYSICIAN OPPORTUNITIES

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


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


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


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


December 21, 2018 – Billion Dollar Baby

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


MSSNY eNews
December 21, 2018
Volume 21  Number 46

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Colleagues:

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

Vaping-the Next Epidemic

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

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

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

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

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

County Health Officials Opposed to Legalization

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

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

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

Altria Nears a Deal to Take 35% Stake in Juul

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

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

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

Thomas J. Madejski, MD
MSSNY President


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

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

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

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

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


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


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

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

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

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

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

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

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


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

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

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


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


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

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

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


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

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



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

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


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

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

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

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


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

Please contact sbennett@mssny.org with any questions.

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


Dr. First Banner


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


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

Topic: E/M

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

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Topic: QPP

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

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

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

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Topic: Changes to MIPS Requirements

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

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


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

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

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

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


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

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

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

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


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


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

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

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

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

AHA scientific statement in Arteriosclerosis, Thrombosis and Vascular Biology

AHA/ACC 10-year CV risk calculator


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

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

More detailed recommendations include:

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

CME WEBINARS

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

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

Educational Objectives:

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

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

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


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RENTAL/LEASING SPACE

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


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


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


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


PHYSICIAN OPPORTUNITIES

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


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


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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

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


MSSNY eNews
December 14, 2018
Volume 21  Number 45

MSSNYPAC Seal

Colleagues:

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

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

Medicare and You

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

Incentives Are Wrong

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

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

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

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

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

Thomas J. Madejski, MD
MSSNY President


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eNews

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Garfunkel Ad


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


Dr. First Banner


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

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

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

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

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

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

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

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

Submit your abstract in one of two categories:

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

*research and non-research workshops considered

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

CME WEBINARS

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

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

Educational Objectives:

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

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

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


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DISABILITY

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


CMS

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

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


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

 


Classified

RENTAL/LEASING SPACE

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


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


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

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


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


PHYSICIAN OPPORTUNITIES

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


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


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


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: Marijuana: Right or Wrong?

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


MSSNY eNews
December 7, 2018
Volume 21  Number 44

MSSNYPAC Seal

Colleagues:

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

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

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

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

What Are Our Concerns?

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

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

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

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

Stay tuned for further details.

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

Thomas J. Madejski, MD
MSSNY President


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eNews

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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


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


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CME WEBINARS

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

In response to the recent and expanding measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 roster.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program.  Registration is now open for this program here.

Educational Objectives:

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

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

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


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Residents, Fellows, Students

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


New York Medicaid

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

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

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

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

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


CMS

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

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

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

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

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


Classified

RENTAL/LEASING SPACE

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


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


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

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


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


PHYSICIAN OPPORTUNITIES

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


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


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


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


November 30, 2018 – Single Payor Update!

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
November 30, 2018
Volume 21  Number 43

MSSNYPAC Seal

Colleagues:

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

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

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

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

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

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

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

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

Excelsior!

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance for Doctors


eNews

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

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

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

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

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

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

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

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

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

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



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

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

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

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

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

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


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

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

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

 


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

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

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

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

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

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


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

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


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

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


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

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

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

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

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

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

The Procedure Price Lookup tool is available here.


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

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

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

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

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

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


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

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

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

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


Romaine Lettuce

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

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

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

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

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


CME WEBINARS

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

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

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

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

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

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

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


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

In response to the recent and expanding measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 roster.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program.  Registration is now open for this program here.

Educational Objectives:

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

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

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


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RENTAL/LEASING SPACE

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


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


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

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


PHYSICIAN OPPORTUNITIES

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


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


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


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November 16, 2018 – WSJ, AMA and Wild Fires

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
November 16, 2018
Volume 21  Number 42

MSSNYPAC Seal

Colleagues:

I spent last weekend in National Harbor, Maryland, at the Interim AMA Meeting with our hard working delegation. I am a member of the Council on Medical Service and at our meeting, the following item was discussed:

AMA’s CMS Report 4 addresses Site of Service Differential. The AMA supports Medicare payment for the same service routinely and safely provided in multiple outpatient settings (Office, HOPDs and ASCs) that are based on sufficient data regarding the actual cost in each setting. The AMA approved an amendment to its existing policy so that outpatient services are site neutral without lowering Medicare payments. 

Other major directives discussed are:

  • Physicians again forcefully spoke out on gun-violence policy as AMA delegates adopted policy calling for a better background-check system for firearms purchases, a ban on 3D-printed firearms, and “gun violence restraining orders” for people arrested or convicted of domestic violence or stalking.

The AMA’s actions stem from comprehensive policy adopted in previous House of Delegates meetings to stem the deadly toll of firearm violence.

  • Better data needed to guide suicide prevention efforts among physicians and medical students. Citing the high rate of suicide completion among medical professionals when compared with the general population and work-related stress as a risk factor for doctors, delegates want a better understanding of patterns linked to physician and medical student suicide. Long work hours are commonly cited as a reason for the prevalence of mental illness and burnout among physicians and medical students, but additional institutional factors can contribute to suicide.

  • Sex education should include age-appropriate content on bullying, consent. More than 11 percent of high-school girls are victims of forced sex, along with 3.5 percent of high-school boys, says a 2017 Centers for Disease Control and Prevention survey. To encourage this approach, delegates directed the AMA to “support state legislation mandating that public middle and high school health education programs include age-appropriate information on sexual assault education and prevention, including but not limited to topics of consent and sexual bullying.”

  • Help homeless people get the government ID cards often needed to access medical care. More than 3.5 million Americans will experience homelessness at some point in a given year—and nearly 80,000 are chronically homeless. Lack of government-issued identification remains a major barrier to seeking medical care. Delegates adopted new policy to: Recognize that among the homeless population, lack of identification serves as a barrier to accessing medical care and fundamental services that support health. Support legislative and policy changes that streamline, simplify and reduce or eliminate the cost of obtaining identification cards for the homeless population.

Other important issues:

  • Prescription-drug importation from Canada.
  • Improved access to preventive care.
  • Rural health disparities.

California Doctors

Our hearts go out to all those who have suffered tremendous losses in the California wild fires. Past President of the California Medical Association President Dick Thorpe, lost his house in Paradise, where his internal medicine practice is also located. They have kept their doors open by temporarily moving it to Chico. You can help our friends in California at their website.

Wall Street Journal and Marijuana

Finally, I made it into the Wall Street Journal. It was not for the usual reasons, but they actually published my letter to the editor regarding MSSNY’s stance on marijuana in response to an editorial from former Speaker of the House of Representatives, John Boehner, a consultant to the marijuana industry.

Contact me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance for Doctors


 

eNews

NYU Langone to Open New Medical School on Long Island by September 2019
NYU Langone plans to open a new medical school on Long Island by September 2019 that would exclusively train primary care physicians, NYU President Andrew Hamilton announced at a University Senate meeting on Thursday.

“We have the opportunity to create a new medical school that would focus exclusively on primary care physicians,” Hamilton said. “It will be a three-year program focused on training physicians to become practicing doctors in primary care in communities.”

Over the last two years, Langone has merged with Winthrop Hospital on Long Island, and this would be the site of the new medical school. Hamilton mentioned an existing infrastructure of dormitories and educational facilities at Winthrop Hospital, which would make a transition into a full-blown medical school easier. There are several steps still to go before the medical school could be deemed official, such as receiving state approval. If approved, the school would enroll 40 students per semester, potentially by as early as September 2019 according to Hamilton.


FDA Increasing Scrutiny of Drug Manufacturing Processes In Light of Recalls
FDA Commissioner Scott Gottlieb, M.D., announced “the agency is increasing its focus on drug quality to guard against impurities such as the potentially cancer-causing chemicals that have been found in three commonly prescribed blood pressure medications.” Following the recall of valsartan, irbesartan, and losartan, Dr. Gottlieb said the FDA has recruited “dozens of chemists to review pharmaceutical companies and monitor for any changes in manufacturing techniques” to help “prevent drug impurities that may be harmful to consumers.” The article points out that the agency is currently “investigating the scope of the manufacturing problem that led to the recalls.” USA Today (11/14)


Older Age and Lack of Experience with Transgender May Hinder Caring
Findings published in the Annals of Family Medicine.(11/12,Subscription Publication) reports, “Older age and lack of personal experience with transgender individuals may correlate inversely with a clinician’s willingness to care for transgender patients,” The authors of an accompanying editorial write that transgender people often report feeling stigmatized or misunderstood by healthcare” professionals. The editorialists “use a hypothetical case scenario to show how physicians and their office staff can communicate with transgender patients in sensitive and respectful ways.”


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Workers with Highest Suicide Rates Have Construction, Mining, and Drilling Jobs
On November 16, The Centers for Disease Control and Prevention published in their Morbidity and Mortality Weekly Report that “workers with the highest suicide rates have construction, mining and drilling jobs.”  The findings corrected “an earlier study that mistakenly said farmers, lumberjacks and fishermen killed themselves most often.” In arriving at these conclusions, investigators examined data on “22,000 people who died of suicide in 2012 and 2015, and what jobs they held.”


SAVE THE DATE for the MSSNY Sections Annual Meeting: Young Physicians, Residents and Fellows, and Medical Students. Saturday, February 9, 2019. Contact sbennett@mssny.org

SYMPOSIUM/CME

Cybersecurity: A Daily Threat for Healthcare” CME webinar RESCHEDULED

November 28, 2018 at 7:30am Registration now openThe originally scheduled Medical Matters free CME webinar: Cybersecurity: A Daily Threat for Healthcare was unexpectedly cancelled owing to insurmountable weather and traffic conditions in the Capital District on November 14, 2018.

There were multiple road closures leading into Albany from every direction, preventing MSSNY staff and program faculty from reaching the MSSNY offices.  This was additionally compounded by technical difficulties that prevented MSSNY staff from accessing email remotely.

MSSNY has rescheduled this program for November 28th at 7:30am.  Register here for Medical Matters: Cybersecurity: A Daily Threat for Healthcare.  Mahesh Nattanmai, Deborah Sottolano, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program.

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

Educational objectives are:

  • Describe vulnerabilities within medical practices, hospitals and daily life
  • Identify methods to increase protection from cyberattacks
  • Review methods for reporting and responding to a cybersecurity incident

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. 


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

In lieu of the recent measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 schedule.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program.  Registration is now open for this program here.

Educational Objectives:

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

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

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


Alzheimer’s Disease Research Symposium at Stonybrook on November 19
Learn from key experts about the important research being conducted at Stony Brook Medicine in the field of Alzheimer’s disease. The Stony Brook Center of Excellence for Alzheimer’s Disease will present a symposium on Monday, November 19, from 12 pm to 2 pm in the Health Sciences Tower, Galleria, Level 3.

No registration is required. For more information, email Daphne.Perry@stonybrookmedicine.edu or call (631) 632-3074.


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FDA

FDA Approved Supplemental Application for Gardasil 9
The US Food and Drug Administration (FDA) has approved a supplemental application for Merck’s 9-valent human papillomavirus vaccine (Gardasil 9) to include women and men aged 27 through 45 years.

The CDC has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90% of these cancers, or 31,200 cases every year, from ever developing. The CDC estimates that every year about 14 million Americans become infected with HPV. About 12,000 women are diagnosed with cervical cancer and about 4000 women die from cervical cancer caused by certain HPV viruses. HPV is also associated with several other forms of cancer affecting men and women.

In 2014, the FDA approved Gardasil 9, which covers the same four HPV types as Gardasil as well as five additional types (31, 33, 45, 52, and 58). Gardasil 9 was first approved for use in males and females aged 9 through 26 years.

According to the FDA, in a study in roughly 3200 women aged between 27 and 45 years followed for an average of 3.5 years, Gardasil was 88% effective in preventing the combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine.

The safety of Gardasil 9 was evaluated in a total of about 13,000 males and females. The most commonly reported adverse reactions were injection-site pain, swelling, redness, and headaches.

The FDA granted the Gardasil 9 application priority review status, a program that facilitates and expedites the review of medical products that address a serious or life-threatening condition.


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NYS Mediciad

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.


 


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RENTAL/LEASING SPACE


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


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

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


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


PHYSICIAN OPPORTUNITIES

Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and

community partners, Send resume to neurosciencesgroup@gmail.com


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November 9, 2018 – Winners and Losers

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
November 9, 2018
Volume 20  Number 42

MSSNYPAC

Colleagues:

The Arena

Apart from personal thoughts, beliefs and policy implications, I was fascinated and intrigued by the run up to the elections Tuesday night. I was encouraged, and my faith in our system was strengthened by the level of participation and engagement of all of us in the electoral process.  Democracy is a terribly inefficient system of government, but there is none better.

Then national, and importantly for MSSNY and our members, New York State political landscapes have changed (See article below). Subsequent to this, I had an email chat with some of our members on the importance of political activity and participation in MSSNYPAC. (Please see my contribution to the discussion below.)

The President of MSSNY is responsible for executing the MSSNY agenda (which changes depending on our members’ thoughts and desires) and, with the direction of the HOD and Council, the operation of the organization to attempt to achieve that agenda. Part of that Presidential responsibility is to try and get us to all pull together and craft a team of physician leaders to have the best chance of achieving our goals.

The PAC

PAC activity was created by our broader society as a mechanism for advocacy, and former wise leaders created MSSNYPAC to complete our advocacy efforts. It is a helpful tool; it would be more helpful if it was if better funded. When I came into the Presidency, one of my goals was to make us as effective as possible, building on the work of my predecessors. I asked staff to provide me data on PAC participation. We have excellent, but not uniform participation within leadership and committees. I also want to be sure that our committee members are committed to success for their efforts by participating personally and financially in our advocacy efforts.  While everyone’s personal circumstances differ, it should be a rare exception to not participate at all. There are a few instances that I can contemplate for not participating. Having said that it does raise a question of cognitive dissonance for achieving our mission.

Part of leadership is to lead by doing. We will reach out to every member, especially our new members who are becoming engaged (For example, I spoke with a new member who is excited to join us and will participate on our Legislative and CME committees) and ask them to participate in MSSNYPAC and the MSSNY Physicians Advocacy Liaison (PAL) Network.

You look for inspiration when you participate in an organization. I think that is one of the hardest things for a President to do. I felt honored to be able to have my Presidential Reception at the Theodore Roosevelt inaugural site. TR spoke about the responsibilities of citizenship in Paris in 1910:

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.

As physicians, we have a responsibility to the profession.  I’d like all members to dare greatly, inspire other non-members to join us as we try and make the practice of medicine, and the arena we live in—a better place.

Dare greatly!

Join MSSNYPAC http://www.mssnypac.org/contribute.

Contact me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance for Doctors


 

eNews

Election Results Could Bring Major Change to Albany
This week’s election will bring many familiar faces back to Albany in 2019 but many new ones as well.  Overall, there will be nearly 40 new state legislators come 2019.

Democratic Governor Andrew Cuomo, Lieutenant Governor Kathy Hochul and Comptroller Tom DiNapoli were all re-elected for new four year terms. In the race for Attorney General, Democrat Letitia James defeated Republican Keith Wofford, to succeed current interim AG Barbara Underwood.

Perhaps the most significant aspect of this week’s elections is that Democrats will now have control of the New York State Senate for the first time in a decade and for only the second time in the last 50 years. Democrats appear to have picked up 8 new seats in the State Senate that had previously been held by Republicans, though ballots from some of these races are still being counted.  If the numbers hold as they are now, Democrats will outnumber Republicans 39-24.  These potential pick-ups include:

  • SD-3 (Suffolk): Monica Martinez (D) defeating Dean Murray (R) to replace Sen. Tom Croci (R)
  • SD-5 (Nassau/Suffolk): James Gaughran defeating Sen. Carl Marcellino (R)
  • SD-6 (Nassau): Kevin Thomas (D) defeating Senate Health Committee Chair Kemp Hannon (R)
  • SD-7 (Nassau): Anna Kaplan (D) defeating Sen. Elaine Phillips (R)
  • SD-22 (Kings): Andrew Gournardes (D) defeating Sen. Martin Golden (R)
  • SD-39 (Orange/Ulster): James Skoufis (D) defeating Tom Basile to replace Sen. Bill Larkin (R)
  • SD-40 (Putnam/Westchester): Peter Harckham (D) defeating Sen. Terence Murphy (R)
  • SD-42 (Orange/Sullivan/Ulster): Jen Metzger (D) defeating Anne Rabbit (D) to replace Sen. John Bonancic (R)

For more information about the still contested races, click here.

In the State Assembly, Democrats held their wide majority, 106-44. Three incumbent Democrats (Pellegrino, Jenne, and Magee) lost their seats to Republican challengers (LiPetri, Walczyk, and Salka). Two Republican incumbents (Curran, Walter) were defeated by Democratic challengers (Griffin and McMahon).

With so many new Assemblymembers and Senators coming to Albany next year, the need for physician grassroots involvement is greater than ever.

With the Democrats taking control of both the New York Senate in addition to the Assembly, there could be significant change in the approach to health care legislation. For example, many Democrats in their campaigns pushed for many progressive changes, including single payer healthcare. While that bill has overwhelmingly passed the Assembly multiple times, those votes were taken when it was likely the legislation would not be approved by the Senate.  Other health care issues likely to be acted upon include legalizing recreational marijuana, and expanding access to contraception.

There has never been a greater need for MSSNY members to become active both politically and at the grassroots level. It cannot just be left to a relative few individuals to participate and be active in MSSNYPAC and the MSSNYPAL. Many are part of our efforts but we need far more. We must broaden our network of active physicians. If you are not a member of MSSNYPAC, or would like to increase your contribution, you can do so at www.mssnypac.org/contribute.

Moreover, with some new faces in the Legislature, it is a perfect time to join MSSNY’s Physician Advocacy Liaison (PAL) program to commit to engaging with your local legislators on an ongoing basis to assure they are familiar with the concerns of physicians and their patients.  For more information about the PAL, contact Carrie Harring at charring@mssny.org, or join today at PAL Sign Up.


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Federal Elections Bring Change to Washington for New York House Seats
At the federal level, party control of the U.S. House of Representatives switched from Republican to Democrat as Democrats across the country won at least 30 seats. However, the Republicans increased their majority in the U.S. Senate, defeating Democratic incumbents in Florida, Indiana and North Dakota.

In New York’s House races, 22 of its 27 incumbent Representatives won re-election.  However, two incumbent Republican Congressmen, Dan Donovan and John Faso, lost their re-election bids to Democrat challengers Max Rose and Antonio Delgado, while a third, Democrat Anthony Brindisi, appeared to have defeated Republican incumbent Claudia Tenney with ballots still to be counted.   Also of note, current Assembly Democratic Majority Leader Joe Morelle defeated Republican Dr. Jim Maxwell to become Representative for the 25th Congressional District which is presently vacant following the death of Congresswoman Louise Slaughter (D).

New York’s U.S. Senator Kirsten Gillibrand was easily re-elected to another 6-year term, defeating Republican Chele Farley.


NYC Marathon Hero!
MSSNY Member and NYC Marathoner Theodore Strange MD, Stopped at Mile 16 to Save a Life

Dr. Theodore Strange, an IM from Richmond County (Staten Island), was running his 25th NYC Marathon last Sunday. At mile 16, Dr. Strange answered a call for help for a downed female runner. She was not breathing; he started performing CPR and called for an officer to bring him a defibrillator. On the fourth shock, the woman breathed and was finally taken to the hospital. “People have been calling me a hero, but I was doing what I was trained to do,” he said. Read the full story here.


Garfunkel Ad


Gov. Raises Medicaid Rates for Hospitals and Nursing Homes before Election
Gov. Andrew Cuomo “quietly increased Medicaid rates to hospitals and nursing homes” just a few days before the election. In the New York State Register, “the state Health Department notified the public of a two percent hike for hospitals and 1.5 percent nursing homes on page 90.”


Gov. Signs Measure to Eliminate Patient Cost-Sharing for Prostate Cancer Screening
Governor Cuomo signed into law this week legislation passed earlier in the year (S.6882-A, Tedisco/A.8683-A, Gottfried) and supported by MSSNY to ensure that health insurers provide coverage for diagnostic testing for prostate cancer for men 40 and over with a family history, and men 50 and over who are asymptomatic, without such care being subject to annual deductibles or coinsurance.

The bill would also require the inclusion of information regarding the availability of insurance coverage for prostate cancer screening without cost sharing in the standardized written summary prepared by the Commissioner of Health.  New York has for many years required insurance coverage for these tests, but were subject to patient cost-sharing.  The new law, effective for insurance policies initiated or modified after January 1, 2019, would provide coverage without patient cost-sharing to a greater cohort of men for necessary prostate cancer screening than what has been recommended by the US Preventative Services Task Force. 


Would You Like to Share MSSNY’s The Daily  with Other Professionals in your Practice?
MSSNY is ready to extend this popular member benefit to the PAs and NPs on your staff. If you’re interested, please send the email addresses of the appropriate professionals in your office to rraia@mssny.org so they can begin to enjoy this daily sweep of healthcare news.


Medical Society of NY Classifieds


The Best Test is the One That Gets Done: Colorectal Cancer Screening
“How to Save Lives and Resources by Matching the Test with the Patient,” featuring Dr. Dorado Brooks, VP Cancer Control Interventions, American Cancer Society; and Dr. Heather Dacus, Director, Bureau of Cancer Prevention and Control, NYS Department of Health.

WHEN: November 13th, 2018, from Noon to 1:00 pm. To register click or copy this link. Register today while lines are still available!


Nine Cases of Flaccid Myelitis Suspected in New York
New York health officials say there are now nine suspected cases of acute flaccid myelitis in the state, a mysterious condition that’s paralyzing children nationwide.

The last known report from state Department of Health officials put the number of suspected cases at five in late October. On Wednesday, they confirmed four additional cases are under investigation. They declined to say where the suspected cases originated, other than outside of New York City, citing patient confidentiality laws.

None of the nine cases have been confirmed yet, said spokesman Jeffrey Hammond. So far this year, the CDC has confirmed   80 out of 219 suspected cases of acute flaccid myelitis. The cases have been reported across 25 states, with an increase occurring in August and continuing through September and October — similar to other spike years.


Big Employers Will Use Online Startup To Save On Medicine Costs 
A group of large employers plans to use a new online prescription-savings tool as they confront high drug costs and try to steer patients to the most cost-effective medicines. The Health Transformation Alliance, a coalition of more than 40 big companies that includes IBM Corp., Verizon Communications Inc. and American Express Co., has agreed to use a new online tool from startup Rx Savings Solutions to help the millions of people who work for the group’s members get better deals on their medications. (Bloomberg, 11/1)


CVS to Test Stores with More Health Services after Aetna Deal Closes
Consumers will soon start to see CVS Health’s vision for the future of health care. CVS expects its roughly $69 billion acquisition of health insurer Aetna to close before Thanksgiving, the company said Tuesday when announcing third-quarter financial results. The combined company has pledged to improve health services and outcomes and lower costs. CVS plans to open its first concept stores early next year, CEO Larry Merlo told Wall Street analysts Tuesday. (CNBC, 11/6)

As previously reported, MSSNY Past-President Dr. Charles Rothberg testified at a NY Department of Financial Services hearing expressing MSSNY’s opposition to this acquisition.  NYDFS Superintendent Mario Vullo expressed many concerns about this transaction at the hearing.


Dr. First Banner


CMS

Review Comprehensive 2019 Summary of Medicare/MIPS Physician Payment Rule
As reported last week, CMS finalized its Medicare physician payment rule for 2019.  Please click here for a comprehensive summary of the rule by the American Medical Association.

According to the AMA summary, the 2019 PFS conversion factor will be $36.0391. The Anesthesia conversion factor is $22.2730. The 2019 conversion factors reflect a statutory update of .25%, (as required by MACRA), offset by a budget neutrality adjustment of -0.14%, resulting in a 0.11% update.

According to the summary, it was noted that CMS has postponed any coding and payment-related changes for E/M office visit services until CY2021.   But CMS will be implementing new documentation policies for E&M claims which will significantly reduce administrative burden.   These include:

  • The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.
  • Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated.
  • Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.

It was also noted that the following policies opposed by the AMA will not be implemented by CMS:

  • Payment reductions by 50% for office visits that occur on the same date as procedures (or a physician in the same group practice); and
  • Condensed practice expense payment for the E/M office visits, by creating a new indirect practice expense category solely for office visits, overriding the current methodology for these services by treating Office E/M as a separate Medicare Designated Specialty.

It was also noted that CMS is expanding access to medical care using telecommunications technology by finalizing coverage of several new services, including three new CMS-created HCPCS codes for: brief, non-face-to-face appointments via communications technology (virtual check-ins); evaluation of patient-submitted photos; and the foregoing codes bundled together for use by federally qualified health centers and rural health clinics.

It was also noted that CMS reduces reimbursements for new Part B drugs. Currently paid with an add-on payment of 6% (before sequester), CMS will reduce the add-on payment to 3% (before sequester) for all drugs with Wholesale Acquisition Cost (WAC)-based payment rates.

The AMA summary also includes an extensive summary of changes to the MIPS program for 2019, which will effect Medicare payment for 2021. The Quality category will now comprise 45% of the score.   The promoting interoperability category (formerly Advancing Care Information) will now comprise 25%.  The performance improvement category will now comprise 15%, as will the cost efficiency category.  Performance on these measures will effect Medicare physician payment in 2021.

CMS projects that 97.8% of MIPS eligible clinicians will submit performance data in 2019. Of those submitting data, 91.2% are projected to receive a positive or neutral payment adjustment in 2021, with the remaining 8.8% receiving a penalty in 2021. Nearly two-thirds of those projected to receive a positive or neutral payment adjustment are projected to score high enough for an “exceptional” payment adjustment.


CMS: Most Physicians Will Receive Positive Medicare MIPS Payment Adjustment; Still Concerns for Smaller Practices

CMS Administrator Seema Verma announced this week that 93% of clinicians eligible for the Merit-based Incentive Payment System (MIPS) received a positive payment adjustment for their performance in 2017.  Moreover, she announced that 95% overall avoided a negative payment adjustment while nearly 100,000 eligible clinicians earned Qualifying APM Participant status under the Advanced Alternative Payment Model track.

However, the press release also noted that only 73% of “small practices” received a positive payment adjustment, while 19% received a negative payment adjustment.

The 2017 performance will affect Medicare payments for 2019.

The press release further noted Administrator Verma acknowledged that the MIPS “positive payment adjustments are modest,” while noting that 2017 was a transition year.  She indicated that CMS expects that gradual increases in performance thresholds in the future “will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries.”  She also pledged customized technical assistance, at no-cost, for clinicians who received a negative payment adjustment,” and to continue assistance to providers in solo, small and rural practices.


CME WEBINAR

Cybersecurity: A Daily Threat for Healthcare” CME Webinar
November 14 @7:30am_ Registration Now Open

It’s not too late to register! Do you know how best to protect your office against a cyberattack?  Are you aware of your vulnerabilities?  Learn how to protect yourself, your patients and your workplace on November 14 at 7:30am.  Register here for Medical Matters: Cybersecurity: A Daily Threat for Healthcare.  Mahesh Nattanmai, Deborah Sottolano, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program.

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

Educational objectives are:

  • Describe vulnerabilities within medical practices, hospitals and daily life
  • Identify methods to increase protection from cyberattacks
  • Review methods for reporting and responding to a cybersecurity incident

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. 


Join MSSNY Banner


Classified

RENTAL/LEASING SPACE


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

Contact Kendra at Kendra@drmadnani.com or 516-226-1080


All-Inclusive Medical Office Space for Rent-5 Locations: Elmhurst, Ozone Park, Lawrence, Lindenhurst & East Setauket
Starting up, slowing down or growing your practice? Interested in trying out
a new town or opening a satellite site, with no long term commitment? Come
look into one of our 5 locations throughout Queens and Long Island.

MedPlex is an all-inclusive medical office rental company dedicated to the medical
field. We offer low daily rates ($106-$191 per room, per day), with over 100
customizable rooms available for rent. You have the freedom to choose the days,
times & locations that best suite you and your practice.

We are open 24/7 and offer individual rooms or private suites to rent, with
leasing options as little as 1 year. Each option includes all utilities, exam room set up
with furniture & a list of medical equipment, medical waste pick-up, office cleaning,
common areas, basic consumables, a fully stocked reception station (equipped with
computer, phone, fax and copier) and lockable storage.

For more information please log on to www.MedPlexLLC.com, Loop-Net/Co-Star, or call Carla Scalici, Operations manager, @ 516-797-7735, cscalici@MedPlexLLC.com

ozone park room1 ozone

ozone


Magnificent Medical Suites for Lease 184 East 70th St. New York, NY
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital, Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A: one consultation room plus 2 exam rooms. $6000 per month
Space B: One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500. other combination may work as well. Available for sharing For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.comnyc nyc room2

nyc room3 nyc room4


West 57 St. – Shared Office Space to Rent
Lovely Garden view office with natural light. Located near Columbus Circle in a beautiful Art Deco building. Recently renovated office with additional exam room/ room with a sink. Wi-Fi, medical waste pickup and cleaning included.  Ideal location in desirable neighborhood. Contact Jason Faller 914-393-6583 goutmd@aol.com

West 57th St. Office West 57th Doctors Office

West 57th St Doctors Lobby


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

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

 


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


PHYSICIAN OPPORTUNITIES

Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and

community partners, Send resume to neurosciencesgroup@gmail.com


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nov. 2, 2018 – Leading & Learning

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
November 2, 2018
Volume 20  Number 41

MSSNYPAC

Colleagues:

Meeting the Presidents

I experienced a fortuitous concatenation of meetings recently.   The common theme- Current and Former Presidents of the AMA and State Medical Societies.

Last Thursday evening I had dinner with AMA Past President Nancy Nielsen (and MSSNY Past Speaker) and two other friends at my home.  Friday afternoon, I saw my good friend and AMA Past President Andy Gurman.  Saturday morning, Dr. Barbara McAneny, current AMA President, treated me to breakfast while we were attending the Pennsylvania Medical Society House of Delegates Annual Meeting.  My wife Sandra and I were there to represent New York at the meeting.

Attending other states’ HODs allows me to see different approaches to problems, brainstorm with other leaders of the House of Medicine, and share our successes and challenges with colleagues from other states.  Pennsylvania is fortunate to have a number of great leaders at the local and national level.  Incoming president Danae Powers shared with me some of the opportunities and potential problems for physicians in the PAMED society. We have similar challenges and I was pleased to see that they have begun a successful marketing campaign and had substantial membership growth last year, particularly in some under-represented demographic groups.

Some of this was due to the activity and leadership of their outgoing President, Ted Christopher.  He has been a tireless advocate for patients and physicians this last year, crisscrossing the state and engaging with members and non-members.  Ted also focused on bringing to light issues with social determinants of health.  He transformed his personal experience as an emergency room physician into policy and advocacy that will improve the health and lives of his patients, and the joy of medicine for his colleagues.  I was also fortunate to meet new Indiana Medical Society President, Dr. Stacie Wenk, and Massachusetts President Alain Chaoui.

Listening, Learning, Leading

Dr. Christopher’s farewell address to the Pennsylvania House of Delegates emphasized his goals of listening, learning and leading.  That is a common theme of this group.  Dr. Nielsen had periods during which her family was uninsured and struggled with healthcare and economic insecurity.  Dr. McAneny continues to fight against consolidation of insurers and healthcare institutions and their unfair business practices that harm physicians and make care more expensive for her patients.  Dr. Chaoui is fighting the same battle with his practice against health systems and insurers in Massachusetts.

Their personal experiences and challenges are the crucible that helped to form these leaders.  They channeled their passion with the help of likeminded physicians, local medical students from their state, specialty or national medical societies to focus their energies for the good of their patients and our profession.  I’m grateful to them for sharing their time, talent, treasure and passion. I’m hopeful they inspire all of us to stand firm with our loins girt with truth, staff in hand, ready to battle for the health of our patients and improving the practice of medicine.

MSSNY, the AMA, and our County and Specialty Societies are the forge that created these great leaders.  Your involvement in creating policy and advocating for it is essential for your patients and your ability to care for them properly.  MSSNY has a strong focus on developing leaders (Physician Leadership Program on November 30-Dec.1 in Syracuse).

Let MSSNY help you forge your leadership skills.  Contact me at comments@mssny.org.

Ductus exemplo!

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance Banner


Legislator Scorecard Now Available
Before you vote next week, take a moment to view the MSSNYPAC Legislator Scorecard to see how your elected representatives have voted on issues that are of importance to physicians and feel free to share with your colleagues.  We’ve received such positive response from physicians who wish to access MSSNYPAC’s Legislator Scorecard that we are now offering it to all MSSNY members for free even if you are not yet a supporter of MSSNYPAC.  Please use this tool to make your best choices at the polls!

Click here to view the Legislator Scorecard now.  

eNews

MSSNY Seeking Info: Have You Received Letter from Walmart Re Prescribing Practices?
The Medical Society of the State of New York and the American Medical Association Task Force on Opioids 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 has implemented the CDC Guidelines for Prescribing Opioids for Chronic Pain as corporate policy.  MSSNY and the AMA 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 where it believes it is warranted based upon Walmart’s review of a physician’s prescribing practice. MSSNY and the AMA Task Force on Opioids are 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 nationally there have been physicians who have received this letter; an example of the letters can be found here. MSSNY will meet with state officials from the NYS Bureau of Narcotic Enforcement within the next few weeks to discuss this corporate policy and its impact on NYS physicians and patients.  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.

Physicians may also ask the NYS Office of Professional Discipline (OPD) to review this matter. To file a complaint, please complete the OPD complaint form and list the contact information for the New York pharmacy(s) that is involved along with the details of the complaint. This completed form along with any additional information may be emailed to the OPD directly at conduct@nysed.gov   Please copy Pat Clancy when filing the complaint.


Contraction of Medicare E&M Payments Will Not Be Implemented in 2019
Among the many highlights of the final 2019 Medicare physician payment rule released this week is that CMS will not be implementing a proposal that had been opposed by MSSNY, the AMA and many other state and specialty medical associations to condense E&M payments for Level 2-5 visits.

According to an initial summary from the AMA of the 2,300 page payment rule, it noted that CMS will be implementing new documentation policies for E&M claims which will significantly reduce administrative burden.  Importantly, however, the CMS has acknowledged the work of the AMA’s CPT/RUC Workgroup on E/M by postponing any coding and payment-related changes for E/M office visit services until CY2021.  

The changes to E/M documentation guidelines for 2019 which were strongly supported by the AMA and other members of the Federation include:

  • The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.

  • Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated.

  • Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.

It was also noted that the following policies opposed by the AMA and will not be implemented by CMS:

  • Payment reductions by 50% for office visits that occur on the same date as procedures (or a physician in the same group practice). The AMA brought attention to the fact that duplicative resources have already been removed from the underlying procedure through the current valuation process; and

  • Condensed practice expense payment for the E/M office visits, by creating a new indirect practice expense category solely for office visits, overriding the current methodology for these services by treating Office E/M as a separate Medicare Designated Specialty. This change would also have resulted in the exclusion of the indirect practice costs for office visits when deriving every other specialty’s indirect practice expense amount for all other services that they perform, which would have resulted in large changes in payment for many specialties (such as a greater than 10% payment reduction for chemotherapy services).

However, of concern, the final Medicare payment rule did include a reduction of the “add-on” amount for the wholesale acquisition cost (WAC)-based payment for Part B drugs.  Effective January 1, 2019, WAC-based payments for Part B drugs – during the first quarter of sales when ASP is unavailable – will be “subject to a 3 percent add-on in place of the 6 percent add-on that is currently being used.”  CMS stated that this “change in policy will help curb excessive spending, especially for new drugs with high launch prices, and will also decrease beneficiary cost sharing.”

Review of the final payment rule is ongoing and further updates will be provided.  To read the CMS press discussing highlights of the final 2019 Medicare payment rule, click here.


NY Rx Card Banner


November Council Meeting Voted on 2019 Legislative Program
At the meeting on November 1, Council approved the following:

  • MSSNY will support and co-sponsor the Gay and Lesbian Medical Association (GLMA) resolution regarding an amendment to the AMA policy on Medical Spectrum of Gender. The resolution calls for the AMA to work with appropriate medical organizations and community based organizations to inform and educate the medical community and public on the medical spectrum of gender identity; educate state and federal legislators on the medical spectrum of gender identity to ensure access to quality health care; and affirm that gender is not fixed and may differ from the sex assigned at birth.
  • MSSNY’s 2019 Legislative Program

  • MSSNY will advocate for legislation, regulation or other appropriate means to assure that needle electromyography and nerve conduction studies are performed by licensed physicians only, or those who are directly supervised by a physician.

  • MSSNY will work with the NYS Society of Orthopedic Surgeons to educate physicians regarding existing clinical data registries that collect data regarding poorly performing cobalt/chromium metal-on-hip implants to better assure physicians have necessary information to inform their patients. MSSNY will urge the AMA to work with the American Academy of Orthopedic Surgeons (AAOS) to increase the adoption of musculoskeletal registries so as to aid early detection capabilities of poorly performing implants and report to the public on clinical statistics, and inform quality improvement and educational activities.

Speaker of the House Dr. Kira Geraci announced the following important dates regarding the 2019 House of Delegates at the Tarrytown Marriot:

  • April 11-CMS Programs

  • April 12-14-House of Delegates

  • Resolution submissions: February 8-March 8 @ 5 pm

Mark your Calendars! The 3rd and 4th District Retreat will be held on January 26, 2019 at the Mirror Lake Inn in Lake Placid.


Garfunkel Ad


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, www.DEADiversion.usdoj.gov.

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


Three-Year-Old State Billing Law Leads to Fewer Surprises for New Yorkers
Three years after New York implemented a landmark law to prevent patients from getting surprise bills, many consumers have been shielded from disputes between doctors and insurers. The out-of-network consumer protection law holds patients harmless in emergency cases when they are treated by out-of-network physicians, except for any in-network payment responsibility. It also removes patient liability in cases when a person attempts to use an in network provider but still receives an out-of-network bill from an anesthesiologist or pathologist, for example.

The New York State Health Foundation hosted a panel Monday to review the law’s successes and shortcomings. Troy Oechsner, deputy superintendent for health at the state Department of Financial Services, shared data about outcomes in the independent dispute-resolution process. In emergency cases, health plans were more likely to prevail than providers by a margin of 534 to 289. Plastic surgeons represented about one-quarter of the 2,104 cases that have gone through the resolution process, followed by emergency medicine physicians and orthopedic surgeons. Meanwhile, in cases of non-emergency, surprise bills, providers won the disputes more often, by a margin of 272 to 84, in cases where decisions were rendered. Those disputes most often involved neurosurgeons and anesthesiologists.

The law does have limitations, though. About half of New York’s commercially insured population is covered by self-insured employer health plans regulated by federal law, Oechsner said. “As a result, all these great protections that we’re working on for the state don’t apply to nearly half the commercial market,” he said. “That’s a huge problem.” He said the state is working to improve its enforcement of standards around the type and quantity of providers insurers must include in their networks. (Crains NY Business Oct 3).


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Urge Gov. to Sign Legislation to Expand Access to Prostate Cancer Screening
Physicians are urged to contact Governor Cuomo to encourage him to sign into law legislation (S.6882/A.8683­) that would ensure that health insurers provide coverage for diagnostic testing for prostate cancer without such care being subject to annual deductibles or coinsurance. In particular, men over 40 with family history and men over 50 who are asymptomatic would be enabled to receive this care without being subject to annual deductibles or coinsurance. Additionally, the bill would require the information regarding the availability of insurance coverage for prostate cancer screenings without cost sharing, to also be included in the standardized written summary prepared by the Commissioner of Health. New York has for many years required insurance coverage for these tests, but were subject to cost-sharing. This undoubtedly will encourage even more men to have this often life-saving test. You can send a letter in support here.


Life Expectancy in New York Lowered: Obesity and Opioids Are Factors
Life expectancy in New York State is going in the wrong direction, an alarming reversal after years of steady increases. A report produced by the NYS Health Foundation’s internal policy and research department shows that, after peaking in 2014 at 80.7 years, life expectancy decreased in both 2015 and 2016 https://bit.ly/2Jz8bjf. The report found that a combination of factors–including the growing obesity epidemic and the opioid crisis–is likely contributing to declining life expectancy.


Rockland County: 33 Cases of Measles; Five More Suspected
Rockland County officials confirmed that 33 people have measles and five more suspected cases are under investigation. More than 2,000 people in the county have gotten the measles, mumps, 


Medical Society of NY Classifieds


Nassau County DOH Named Local Health Department of the Year
The Nassau County Department of Health (NCDOH) has been named “Local Health Department of the Year” for 2018 by the National Association of City and County Health Officials. The NACCHO represents the nation’s nearly 3,000 local governmental health departments.

The announcement was made at the NACCHO Annual Conference. NCDOH earned the tile by successfully bringing together providers, hospitals, and community-based organizations to evaluate the needs of residents, and together created a county-wide Community Health Assessment and Community Health Improvement Plan. NCDOH is a founding member of the Long Island Health Collaborative, which has grown from a three-agency online database to a grant-funded health initiative with almost 100 agencies.

In recent years, the County Health Department has created initiatives such as an Office of Minority Health Affairs, participation in the “Cribs for Kids” program, programs that screen infants for developmental delays, sending “Newborn Welcome Mailings” with pertinent newborn health information to the families of all 14,000 babies born in the county each year and serving as the grantee for the Long Island Ryan White HIV Service grant.

The Department’s Public Health Emergency Preparedness unit leads a troop of almost 1,000 volunteer medical professionals in a Medical Reserve Corps who train for emergencies and provide on-site medical coverage for the Games for the Physically Challenged and the Long Island Marathon.


Flu Vaccine: One Year Doesn’t Reduce Effectiveness the Next Year
Getting the flu vaccine every year doesn’t reduce its effectiveness — and might even boost its performance — suggests a study in JAMA Network Open. Researchers examined the vaccination status of nearly 3400 children who presented with acute febrile respiratory illness during one of three successive flu seasons between 2013 and 2016. About one-fourth had flu confirmed on reverse-transcription polymerase chain reaction testing; the rest were considered negative for flu.

The researchers found that while vaccine effectiveness varied by vaccine type (e.g., live attenuated influenza vaccine [LAIV) or inactivated influenza vaccine) and flu virus strain, past-season vaccination did not reduce vaccine effectiveness. In fact, in some cases — for example, the effectiveness of LAIV against influenza A (H3N2) — previous vaccination appeared to improve the vaccine’s effectiveness.

Of note, residual protection from past-season flu vaccine alone was observed only for influenza B.

A commentator writes, “The results thus suggest additional support for the current Advisory Committee on Immunization Practices’ recommendation that children be vaccinated annually against influenza.” article; JAMA (Free)


Dr. First Banner


CME

Cybersecurity: A Daily Threat for Healthcare” CME Webinar
November 14 @7:30am_ Registration Now Open

Do you know how best to protect your office against a cyberattack?  Are you aware of your vulnerabilities?  Learn how to protect yourself, your patients and your workplace on November 14 at 7:30am.  Register here for Medical Matters: Cybersecurity: A Daily Threat for Healthcare.  Mahesh Nattanmai, Deborah Sottolano, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program.

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

Educational objectives are:

  • Describe vulnerabilities within medical practices, hospitals and daily life
  • Identify methods to increase protection from cyberattacks
  • Review methods for reporting and responding to a cybersecurity incident

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. 


Be Sure to Check Out All of MSSNY’s Podcasts and CME Programs
Did you know that MSSNY has created several podcasts and CME programs on current topics such as influenza and measles to name just two?  Click here for MSSNY’s podcast on Measles, Mumps and Rubella and click here to listen to a podcast on Influenza Vaccines.  And you can listen to all of our podcasts here.

MSSNY also has several free CME programs at https://cme.mssny.org concerning influenza, including our most recent Medical Matters: Influenza 2018-19.

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


CMS

The Quality Payment Program Resource Library is Back on QPP.CMS.GOV
CMS has moved Quality Payment Program (QPP) resources from CMS.gov to the newly redesigned Quality Payment Program Resource Library on qpp.cms.gov. Following feedback from clinicians and others in the health care community, we wanted to make Quality Payment Program information and resources available in one place. We’ve also made it easier for you to find the resources you’re looking for by including a search function that allows you to search for resources by year, reporting track, performance category, and by document type (e.g., fact sheet, user guide, measure specifications).

Additional resources including materials from educational webinars will be added to the new Quality Payment Program Resource Library soon. Stay tuned for more information!

For More Information:

Questions? Contact the Quality Payment Program at QPP@cms.hhs.gov or 1-866-288-8292.


Join MSSNY


Classified

RENTAL/LEASING SPACE


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

Contact Kendra at Kendra@drmadnani.com or 516-226-1080


All-Inclusive Medical Office Space for Rent-5 Locations: Elmhurst, Ozone Park, Lawrence, Lindenhurst & East Setauket
Starting up, slowing down or growing your practice? Interested in trying out
a new town or opening a satellite site, with no long term commitment? Come
look into one of our 5 locations throughout Queens and Long Island.

MedPlex is an all-inclusive medical office rental company dedicated to the medical
field. We offer low daily rates ($106-$191 per room, per day), with over 100
customizable rooms available for rent. You have the freedom to choose the days,
times & locations that best suite you and your practice.

We are open 24/7 and offer individual rooms or private suites to rent, with
leasing options as little as 1 year. Each option includes all utilities, exam room set up
with furniture & a list of medical equipment, medical waste pick-up, office cleaning,
common areas, basic consumables, a fully stocked reception station (equipped with
computer, phone, fax and copier) and lockable storage.

For more information please log on to www.MedPlexLLC.com, Loop-Net/Co-Star, or call Carla Scalici, Operations manager, @ 516-797-7735, cscalici@MedPlexLLC.com

ozone park room1 ozone

ozone


Magnificent Medical Suites for Lease 184 East 70th St. New York, NY
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital, Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A: one consultation room plus 2 exam rooms. $6000 per month
Space B: One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500. other combination may work as well. Available for sharing For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.comnyc nyc room2

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West 57 St. – Shared Office Space to Rent
Lovely Garden view office with natural light. Located near Columbus Circle in a beautiful Art Deco building. Recently renovated office with additional exam room/ room with a sink. Wi-Fi, medical waste pickup and cleaning included.  Ideal location in desirable neighborhood. Contact Jason Faller 914-393-6583 goutmd@aol.com

West 57th St. Office West 57th Doctors Office

West 57th St Doctors Lobby


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

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

 


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


PHYSICIAN OPPORTUNITIES

Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and

community partners, Send resume to neurosciencesgroup@gmail.com


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Oct. 26, 2018 – Read MSSNY’s Scorecard Before Voting!

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
October 26, 2018
Volume 20  Number 40

MSSNYPAC

Colleagues:

The MSSNY presidency involves a fair amount of travel.  I’m very thankful for the help of my other MSSNY officers, Vice President Bonnie Litvack, President Elect Art Fougner, and our Immediate Past President Charles Rothberg for their counsel and assistance in meeting some of the demands of the presidency.  It’s hard to be in two places at once!

Recently, traveling upstate, I met with County and District Medical Societies, and other Health system leaders.  I finished up Saturday morning with a conference in Albany.  The New York State Thruway can be a little monotonous at times and I will usually have media content to keep me company while on the road.  The back and forth made me think of an old radio comedy duo, Bob and Ray, who started out in the Mohawk Valley.  They mention a number of real and fictional Upstate towns and had an NPR radio show some years ago which featured a traveling reporter, Farley Gerard.  Here’s a link for, hopefully, your listening pleasure.

The allusion (traveling back and forth, meeting members and nonmembers, considering new information, reporting it to you, and incorporating that into our society’s efforts) came to me upon reflection about some of my weekly activity.

Tuesday

I started out Tuesday with a meeting in Monroe County with MCMS President Surinder  Devgun, and their Executive Director Chris Bell.  We had a general discussion on how the County and State Societies can work together to grow membership.  One of the successful programs that Monroe County has implemented is a social rounds, held periodically at a hot venue in the County.  MCMS is trying to reconnect physicians socially and encourage collegiality and mutual support.  I would encourage other counties to attempt to replicate this outreach effort.

Wednesday

I met with a friend, Dr. Tom Hughes, Chief Medical Officer, Optimum Physician Alliance (OPA).  OPA is a growing 600+ member physician network in Western New York.  We had a great discussion about our organizations’ mutual goals of improving the care of patients and the well-being and satisfaction of our physician members.  We discussed physicians’ personal health related to loss of a colleague from our area last year, and how our organizations can work together, particularly with the activity of MSSNY’s Physician Wellness and Resilience Committee to improve the practice environment and reach out to physicians who may be struggling for whatever reason.  I look forward to further discussions with Tom, our 8th District Leaders, and other healthcare groups to improve the lives of patients and their physicians in Western New York.

Thursday

Our Committee on Legislation met to review our 2019 Legislative advocacy program for presentation and approval by the MSSNY Council.  Reducing the hassle factor to improve the practice environment and liability reform are high on our priority list.

Friday

Friday evening I met with members from the 3rd and 4th Districts at their Annual Fall retreat.  I gave an informal update of MSSNY’s recent activity on a number of issues.  We had a spirited debate about how MSSNY should prioritize its’ advocacy efforts, and whether we should bother to advocate for, or against, various issues based on a perceived likelihood of success.  Shepherding our limited resources is one of my primary duties, and we do prioritize our efforts. Having said that, to just roll over, because the odds are against us is, in my opinion,an abdication of our responsibility as the major advocacy organization on behalf of physicians and patients in New York State. We also have greater resources than many of our opponents and some of our physicians realize.

Saturday

I participated in the Annual Meeting and Board Training of the Board of Professional Medical Conduct, of the New York State Department of Health.  Dr. Rothberg and I were invited to participate in the training sessions by Dr. Bob Catalano, Executive Secretary of the BPMC, Dr. Art Hengerer, current Board chair, and Keith Servis, Director of the Office of Professional Medical Conduct.  Our invitation was the result of discussion between MSSNY and some of the BPMC members on examining ways that we might be able to help physicians prior to having a situation that requires the OPMC to sanction a physician. MSSNY already does much of this activity through our Committee on Physicians Health.

Physician Wellness

Our Committee on Physician Wellness and Resiliency believes we can create programs such as a Peer to Peer counseling program to reduce the chance of impairment farther upstream and reduce the chances of a physician becoming impaired. I believe Dr. Rothberg and I were effective in convincing the physicians on the Board of the need to identify and intervene for struggling physicians before they become impaired, and to promote programs to address physician burnout.  Our Medical Director for CPH, Dr. Jeff Selzer gave an excellent review of assessment of physician burnout.  Jeff had two particular points that hit home to me:

  • Physicians need to create positive disruption in the healthcare system: Civil disobedience for quality and patient concerns and to promote physician wellness which is associated with better patient care.
  • We need to change a culture which hides defects and promotes isolation for fear of repercussions.

Driving home after the meeting Saturday morning, I tried to synthesize the varied information that came in this week.  We do need to prioritize our activities.  MSSNY and our County Medical Societies are the vehicle to promote positive changes for the physicians and patients of New York State. Our Physician Wellness programs, advocacy for liability reform to change a culture of silence, continued efforts to improve the practice environment, and engagement of fellow physicians at the local level are key to make the practice of medicine a joy for physicians and provide great healthcare for the citizens of New York State. We will continue to engage with interested (as well as adversarial) groups to move forward.

You can help.  Contact me at comments@mssny.org to discuss how.

Excelsior!


Thomas J. Madejski, MD
MSSNY President

 


MLMIC Insurance Banner


eNews

Read the Records of Your Local Legislators!
With the elections coming up in 10 days, MSSNYPAC has created a number of tools to assist physicians in evaluating the records of their local legislators. Please click here to read the list of candidates endorsed by MSSNYPAC and here to view our legislative scorecard evaluating the voting and co-sponsorship records of legislators on several pieces of legislation supported and opposed by the physician community.  


Sexual Harassment Webinar:
The Impact on the Healthcare System and the Medical Profession*
When: November 15, 2018
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.

As general counsel to MSSNY, Garfunkel Wild is offering society members ONLY a complimentary training webinar on November 15th from 12:00pm-1:00pm. This program fully satisfies the New York State requirements, and the individual society member who registers for this program will receive a certificate of completion. 

Garfunkel Wild also offers individual or group training, on-site or off-site training, as well as “train-the-trainers” sessions 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.

By the conclusion you will know:

  • How to identify the more subtle forms of sexual harassment
  • Your responsibilities as an owner of or supervisor at your medical practice.
  • 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.
  • Guidelines on how to comply with statutory mandates relating to sexual harassment.

REGISTER HERE

*In addition, a “Train the Trainer” tutorial will soon be available to members on the MSSNY website www.mssny.org. Learn what the requirements of this mandate are, and then instruct your staff in sexual harassment prevention.  Look for more information on this on-demand program soon. The deadline for providing staff training is October 9, 2019.


NY Workers’ Compensation Board Launches State-Of-The-Art Virtual Hearings
After successful pilot, injured workers and other participants can now choose to attend hearings remotely, avoiding travel burden

This week, New York State Workers’ Compensation Board Chair Clarissa M. Rodriguez announced the Board has launched a first-in-the-nation initiative that allows injured workers and other participants to attend workers’ compensation hearings right from their homes or offices. The Board’s virtual hearings provide injured workers a way to move the claim process forward without the need to travel many miles for a hearing that may last only minutes, which is especially beneficial depending on the extent of their injuries.

The New York State Workers’ Compensation Board developed virtual hearings in partnership with the Office of Information Technology Services to give all parties involved the option of using a smartphone, tablet or computer to attend hearings. This is the first high definition, all access system for legal hearings in the nation, where multiple users in different locations log in once and then move from one hearing to another.

To participate in a virtual hearing, the party of interest needs only a smartphone, tablet or computer with a microphone and video camera, as well as a high-speed internet connection. All participants can see and hear each other on their respective screens. Additionally, workers’ compensation law judges can share claim documents with all involved parties. The system includes security.

The Board is also developing a mobile app, for future release, that parties may download and use to attend hearings.

Many workers’ compensation hearings last less than 10 minutes, but injured workers can still lose time from work and suffer inconvenience traveling to Board offices. Weather-related complications can also make these trips difficult. Virtual hearings are entirely optional though, and parties may now choose them over attending a hearing at a Board office. They 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, then rolled out across the state. Since the beginning of the pilot, more than 33,000 hearings have included at least one party who appeared remotely, successfully connecting injured workers, law judges and representatives from all over New York and nationally. The Board has trained more than 780 participants on the system, including law judges and other staff, attorneys and legal representatives. Feedback has been overwhelmingly positive.

More information on virtual hearings, including instructional videos and other training materials, is at www.wcb.ny.gov/virtual-hearings.


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Nine Physician Specialties See Jump in Compensation
Physicians in nine specialties saw increases in total cash compensation from 2017 to 2018, with those specializing in general cardiology seeing the biggest jump in pay, according to a survey from SullivanCotter.

The survey includes data on nearly 167,000 individual physicians and advanced practice providers, with nearly 750 participating hospitals, health systems and medical groups.

Reported total cash compensation generally increased from 2017-18, averaging 1 percent to 4 percent. Out of 10 specialties listed, surgery (general) was the only specialty that did not see an increase in total cash compensation.

Here is the percent change from 2017-18 in total cash compensation for the nine other specialties in the survey:

  1. Cardiology (general): 4.4 percent increase
    2. Emergency medicine: 4.3 percent increase
    3. Pediatrics (general): 3.7 percent increase
    4. Orthopedic surgery (general): 3.2 percent increase
    5. Hospitalist: 2.2 percent increase
    6. Internal medicine: 2.1 percent increase
    7. Family medicine: 2 percent
    8. Psychiatry (general): 1.4 percent increase
    9. OB-GYN: 1.4 percent increase

Medicare Fraud-Settlement Tops $22M for Vascular Access Centers
The U.S. Attorney’s Office for the Southern District of New York said it reached a settlement with Vascular Access Centers and its related entities in a federal lawsuit alleging Medicare fraud. VAC agreed to pay at least $3.8 million and up to $18.3 million over five years. The settlement was approved Oct. 19 by a federal judge.

The lawsuit had named centers located in several cities in New Jersey, including Jersey City and West Orange, as well as in 11 other states and Washington, D.C., as defendants.

According to a complaint filed in U.S. District Court for the Southern District of New York, VAC Centers provided surgical procedures such as fistula grams and certain types of angioplasties to view patients’ arteries and restore blood flow. Patients had end-stage renal disease and were enrolled in Medicare. The complaint alleged “the VAC Centers routinely performed fistula grams and angioplasties on ESRD patients who did not have the requisite ‘diagnostically specific and appropriate indications,'” and that VAC submitted Medicare claims for those procedures in violation of the False Claims Act.

“For years, Vascular Access Centers cheated taxpayers out of millions of dollars by billing Medicare for treatments that were clearly non-reimbursable and in some cases by falsifying medical records to make it seem as if its billings were justified,” Manhattan U.S. Attorney Geoffrey Berman said in a statement. “Through this settlement, VAC is being made to account for its misconduct.” (Pulse 10/24)


New Flu Drug Approved for First Time in Twenty Years
On October 24, the FDA for the first time in nearly 20 years, approved a new antiviral influenza drug, Genentech’s Xofluza. The drug is a single-dose treatment intended to treat individuals ages 12 and older with acute uncomplicated influenza who have demonstrated symptoms for no longer than 48 hours.



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CDC: Drug Overdose Deaths Fell Over Last 6 Months
Fatal drug overdoses have fallen nationwide over the last six months, according to a CDC report. However, health experts warn against early claims of the opioid and drug epidemic ending.

Here are four things to know:

  1. In the CDC’s most recent data for the 12-month period ending in March 2018, the agency reported a 2.8 percent decline in overdose deaths — representing an estimated 71,073 people — compared to the 12-month period ending in September 2017.

“After 40 years of this predictable growth pattern, we can hope that the curve is finally bending downward for good,” Donald Burke, MD, dean of University of Pittsburgh’s Graduate School of Public Health, told STAT in an email. “But history tells us to interpret these wobbles cautiously.”

  1. From April 2017 to March 2018, the number of fatal opioid overdoses declined by 2.3 percent compared to the 12 months ending in September 2017. The decline is attributed to a drop in the number of overdose deaths from heroin and prescription opioids.
  2. The CDC’s analysis also shows signs of increased drug deaths not attributed to opioids. Cocaine and stimulants, such as methamphetamine, kill more 10,000 people a year, the agency found.
  3. Researchers do not know what is driving the decrease in overdose deaths, but said policy initiatives at the local, state and federal level might have something to do with it.

Fun Fact: The Most-Googled Health Problems by State
The medical condition U.S. patients Googled most frequently in 2018 was attention deficit hyperactivity disorder, or ADHD, with nine states searching for this condition more than any other health concern, a report from Medicare Health Plans found.

Medicare Health Plans identified the most frequently searched medical conditions over the last year using Google Trends. The report authors then listed each of these conditions and ran them through Google Trends again to determine which states and the District of Columbia had the most searches for each condition.

Here are the most-Googled health problems by state for this year: Alabama — pneumonia; Alaska — UTI; Arizona — Hashimoto’s disease; Arkansas — endometriosis;
California — syphilis; Colorado — syphilis; Connecticut — quarter-life crisis; District of Columbia — HIV/AIDS; Delaware — hypertension; Florida — HIV/AIDS; Georgia — syphilis;
Hawaii — Hashimoto’s disease; Idaho — Escherichia coli; Illinois — syphilis; Indiana — ADHD; Iowa — binge drinking; Kansas — diabetes; Kentucky — hepatitis A; Louisiana — HIV/AIDS; Maine — rabies; Maryland — ADHD; Massachusetts — ADHD; Michigan — endometriosis; Minnesota — hemorrhoids; Mississippi — genital herpes; Missouri — ADHD; Montana — hypertension; Nebraska — anorexia; Nevada — skin cancer; New Hampshire — ADHD; New Jersey — breast cancer; New Mexico — PTSD; New York — breast cancer; North Carolina — ADHD; North Dakota — ear infection; Ohio — syphilis; Oklahoma — diabetes; Oregon — HIV/AIDS; Pennsylvania — syphilis; Rhode Island — lupus; South Carolina — endometriosis; South Dakota — insomnia; Tennessee — strep throat; Texas — ADHD; Utah — Hashimoto’s disease; Vermont — opioid use disorder; Virginia — ADHD; Washington — body dysmorphia; West Virginia — porn addiction; Wisconsin ADHD; Wyoming — flu


Amazon, Apple Opening On-Site Clinics for Employees
More large companies are opening on-site medical clinics for employees as they aim to control their healthcare spending, according to an employer survey conducted by Mercer and the National Association of Worksite Health Centers.

The survey results showed growth in the prevalence of on-site clinics providing health services for employees, particularly among large companies. Thirty-three percent of companies with 5,000 or more employees offer general medical clinics at their worksite, and an additional 11 percent of employers of this size are considering adding a clinic by 2019. That represents a significant increase from 2012, when 24 percent of large companies offered on-site clinics.

Amazon is reportedly launching a primary care clinic for a small number of employees at its headquarters in Seattle. After considering outsourcing clinic operations and hearing proposals from vendors, Amazon decided to develop the clinics internally. Meanwhile, Apple is hiring for AC Wellness, a group of health clinics for its employees and their families. Amazon, Apple and other large companies are opening clinics as a way to control healthcare costs. The majority (89 percent) of those who responded to the Mercer and NAWHC survey said their top objective for their clinics is having better control of their overall healthcare spending. (Becker’s Hospital Review, Sept.)


Medical Society of NY Classifieds


CME

Cybersecurity: A Daily Threat for Healthcare” CME webinar on Nov. 14, 7:30am
Registration now open
Is your office protected against a cybersecurity event?  Studies show that 88% of all ransomware attacks in 2017 occurred within the healthcare industry and 89% of studied healthcare organizations experienced a data breach.  Learn how to protect yourself, your patients and your workplace on November 14th at 7:30am.  Register here for Medical Matters: Cybersecurity: A Daily Threat for Healthcare.  Mahesh Nattanmai, Deborah Sottolano, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program.

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

Educational objectives are:

  • Describe vulnerabilities within medical practices, hospitals and daily life
  • Identify methods to increase protection from cyberattacks
  • Review methods for reporting and responding to a cybersecurity incident

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. 

CMS

Reminder: Register Today for the Physician Compare National Provider Call
CMS will host a MLN Connects® National Provider Call about Physician Compare on October 30, 2018 at 1:30 – 3:00 PM ET. Learn more about Physician Compare and the public reporting of 2017 Quality Payment Program performance information. The Physician Compare preview period allows clinicians and groups to review their performance information before it is publicly reported on the Physician Compare website.

This webinar will describe:

  • What to expect during the upcoming 30-day preview period and
  • How to navigate previewing your performance information

There will be a question and answer session after the presentation, during which attendees will have a chance to ask the Physician Compare team questions about Physician Compare.

Register today

If you have any questions, please contact us at PhysicianCompare@Westat.com

 


Join MSSNY


Classified

RENTAL/LEASING SPACE


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


All-Inclusive Medical Office Space for Rent-5 Locations: Elmhurst, Ozone Park, Lawrence, Lindenhurst & East Setauket
Starting up, slowing down or growing your practice? Interested in trying out
a new town or opening a satellite site, with no long term commitment? Come
look into one of our 5 locations throughout Queens and Long Island.

MedPlex is an all-inclusive medical office rental company dedicated to the medical
field. We offer low daily rates ($106-$191 per room, per day), with over 100
customizable rooms available for rent. You have the freedom to choose the days,
times & locations that best suite you and your practice.

We are open 24/7 and offer individual rooms or private suites to rent, with
leasing options as little as 1 year. Each option includes all utilities, exam room set up
with furniture & a list of medical equipment, medical waste pick-up, office cleaning,
common areas, basic consumables, a fully stocked reception station (equipped with
computer, phone, fax and copier) and lockable storage.

For more information please log on to www.MedPlexLLC.com, Loop-Net/Co-Star, or call Carla Scalici, Operations manager, @ 516-797-7735, cscalici@MedPlexLLC.com

ozone park room1 ozone

ozone


Magnificent Medical Suites for Lease 184 East 70th St. New York, NY
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital, Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A: one consultation room plus 2 exam rooms. $6000 per month
Space B: One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500. other combination may work as well. Available for sharing For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.comnyc nyc room2

nyc room3 nyc room4


West 57 St. – Shared Office Space to Rent
Lovely Garden view office with natural light. Located near Columbus Circle in a beautiful Art Deco building. Recently renovated office with additional exam room/ room with a sink. Wi-Fi, medical waste pickup and cleaning included.  Ideal location in desirable neighborhood. Contact Jason Faller 914-393-6583 goutmd@aol.com

West 57th St. Office West 57th Doctors Office

West 57th St Doctors Lobby


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day (about $180) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

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

 


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


PHYSICIAN OPPORTUNITIES

Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and

community partners, Send resume to neurosciencesgroup@gmail.com


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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