November 4, 2016 – “Fail First” Is a Total Failure

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
November 4, 2016
Volume 16, Number 39

MLMIC Insurance

Dear Colleagues:

The following Letter to the Editor was printed in the Albany Times Union on Oct. 31, 2016.

New York’s physicians are proud to partner with patients and patient advocacy groups to support legislation to strongly regulate health insurance company prescription “fail first” protocols. Unsurprisingly, insurers oppose it (“Patients benefit from step therapy,” Oct. 20).

While these protocols are often medically appropriate, legislation is necessary due to many instances where patients’ health has been adversely impacted by overly strict application of these protocols.

Patients most affected by these “fail first” practices have serious medical conditions such as mental illness, arthritis and cancer. Many physicians report policies requiring their patients to switch blood pressure or cholesterol maintenance medications even though they had been stabilized.

This legislation would simply assure greater specificity in New York’s laws when a health insurer must approve coverage for the medication recommended by the patient’s doctor. Circumstances include where the insurer’s preferred medication is contraindicated, where the insurer’s preferred medication has already proven ineffective, or when the patient has already been stabilized on a medication that is not the insurer’s preferred one.

Importantly, a physician would have the burden of proof as to why the insurer’s “preferred” medication would not be as beneficial. The insurer could still limit coverage to the insurer’s “preferred” medication if the physician does not meet this burden.

Insurance companies seek to deflect the need for these imperative reforms with inflammatory rhetoric about drug company spending. This is nothing more than a distraction from the real issue – removing harmful insurance company roadblocks to patients getting the medications they need.

Gov. Andrew Cuomo needs to sign this important bill into law.

P.S. We have almost 400 responses to our Value-Based Survey. This topic concerns ALL physicians. Please give it two minutes of your time.   https://www.surveymonkey.com/results/SM-2N6FZBDN/

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Council Notes of November 3 Meeting in Westbury

  • Resolutions that were referred to Council by the House of Delegates were approved. They topics involved: expansion of the Independent Dispute resolution process to address claims denied by insurers if existing statutory remedies do not timely address the problem; continue to examine the feasibility of a No-Fault system for resolving medical liability claims and support such system if there can be significant premium savings; MSSNY should form an Employed Physician Section and explore legal avenues to becoming a negotiating agent for these physicians; re-affirm existing policy calling on all healthcare providers to wear ID tags with big bold letters stating their professional designation
  • Resolutions deadline for the 2016 House of Delegates in March 17 at 5pm. Early submission is February 17. After March 17, resolutions will be considered late. In that case, the resolution is forwarded to the Rules Committee that decides whether or not the late resolution can be moved forward.
  • Don Fager, VP of MLMIC reported that regarding the Berkshire-Hathaway partnership, the Insurance Department examination is the longest process and should be completed by March of 2017. Mr. Fager also reported that frequency of claims has leveled off, but severity of claims has increased.
  • MSSNY Leadership Conference for young physicians in Syracuse was fully subscribed. Dr. Thomas Madejski, MSSNY Councilor and one of the conference speakers, said “It was an excellent opportunity for young doctors to network and discuss and develop leadership skills. The presentations on burnout and empathy were particularly well received. Hopefully it will improved our agenda for practice sustainability.”
  • Immediate Past President Dr. Joseph Maldonado, who sits on a FAIR HEALTH Committee, reported that there is a pilot program that will target the top 100 procedures performed in NY and that the physicians’ fees will be reported. The four communities targeted in 2017 are: Buffalo, Syracuse, Albany and Westchester.
  • Cynthia Brown, VP Government Affairs, AMA presented a comprehensive report on MACRA and the two Medicare payment model pathways for physicians. “MACRA is more “than a replacement for SGR,” she said.


CMS Releases Finalized Medicare Payment Rule for 2017
This week CMS finalized the Medicare payment rule for 2017.  To read the CMS fact sheet summarizing major changes in the proposed rule, click here.

To read the entire 1,400 page rule, click here.

Table 52 on pp.1329-1330 highlighted the anticipated specialty by specialty impact of the payment rule.  The chart notes that CMS anticipates that most specialties will see a 0% impact as a result of these changes.  However, they also anticipate that allergists, family practice physicians, internists and geriatricians will see a 1% increase in allowed charges, that ENTs, gastroenterologists, neurosurgeons, radiologists, and vascular surgeons will see a 1% decrease in allowed charges, and ophthalmologists and urologists will see a 2% decrease in allowed charges.

The fact sheet also notes that CMS finalized misvalued code changes that achieve 0.32 % in net expenditure reductions.  Since these changes do not fully meet the statutorily required misvalued code target of 0.5 %, it requires an adjustment to the 2017 overall physician update.   Therefore, the 2017 Part B conversion factor is $35.89, an increase to the 2016 PFS conversion factor of $35.80.

Among the changes highlighted by CMS include:

  • Primary Care and Care Coordination: The rule finalizes revisions to payment for chronic care management, including payment for new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health: CMS is finalizing payments for codes that describe specific behavioral health services furnished using the psychiatric Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also finalizing payment for a new code that broadly describes behavioral health integration services, including payments for other approaches and for practices that are not yet prepared to implement the Collaborative Care Model.
  • Cognitive Impairment Care Assessment and Planning: CMS finalizes payment to physicians to perform cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s)
  • Data Collection for Global Services: The 2017 payment rule also finalizes a data collection strategy for global services with significantly reduced burden for practitioners compared to the proposal. Required reporting will be limited to a sample of practitioners for selected services, and those practitioners who do report will report less information.

Review of the Final rule is ongoing.

MIPs Quality Measures
Based on MSSNY’s Council meeting of November 3, 2016, some of our members might like some help in finding their specialty specific quality measures for MIPs reporting.  Please see these links https://qpp.cms.gov/and https://qpp.cms.gov/measures/quality If you have questions, send an email to rmcnally@mssny.org .  Remember, MSSNY email is not HIPAA-secure, so please do NOT include any PHI!

Register Now for NY eHealth Collaborative on December 6-7
The New York eHealth Collaborative’s Digital Health Conference (DHC) on December 6-7 at New World Stages in Manhattan brings together 500 senior-level healthcare industry leaders to learn about new innovations and to foster dynamic conversation addressing how healthcare is being redefined through technology. This year, the conference is a Who’s Who of New York’s healthcare and health tech community gather for two days of networking, lively intellectual exchange, and exploration to see what’s new, what’s cutting edge, and what will shape the future of healthcare. Join your peers and register today!

MSSNY Colleagues: Receive a 10% registration discount. Use code MSSNY when registering at www.DigitalHealthConference.com.

Physicians Vote 9% Less than General Population
Despite the government’s huge influence on health care, doctors vote 9% less than the general population. They’re 22% less likely to cast ballots than lawyers, another group of highly educated professionals.

“If you look back at the history of the medical profession, there’s the sense that physicians are leaders in their community, and people historically looked up to doctors around broad community issues,” says Dr. David Grande, assistant professor of medicine at the University of Pennsylvania and co-author of the article. But that’s not the case anymore. Their reputation eroded, many experts believe, as they got less time with patients and more and more burned out. (Annals of Internal Medicine 11/1/16 Commentary).

“When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with When Is the Flu Not the Flu? on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!

Patient Survey On Pain Should Be Adjusted Physicians Are Pressured To Prescribe Unnecessary
The Buffalo (NY) News (10/31) editorialized that a patient survey on pain management that affects hospital funding “needs to be adjusted,” if it is putting pressure on physicians to prescribe opioids more often than is necessary. The editorial quotes Dr. Timothy Gabryel, the president of the Medical Society of Erie County, who said that treating pain as “the fifth vital sign” created “an expectation that there should be a pill for every problem and there should be no discomfort at all.”


Retired Physicians Can Get a Waiver for License Registration Fee
A point of information for those physicians who have retired and are no longer compensated for medical care provided – a waiver of the fee for the registration of your license as a physician in the State of New York is allowed under the provisions of Section 6524(10) of the New York State Education Law.  This law allows a waiver of the registration fee requirement for physicians who certify to the State Education Department that, for the period of their registration, they will only practice medicine without compensation or the expectation or promise of compensation. The waiver of the registration fee is limited to the duration of the registration period indicated of the affidavit. Affidavit of Non-Compensation.The American Medical Association (AMA) is offering several educational opportunities to help physicians understand the requirements of the new Quality Payment Program (QPP) that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).   The sessions have been scheduled to give physicians an understanding of what the final rule means for their practice and what they need to do as part of the QPP.

All of the sessions, except the November 29th, are open to physicians and medical society staff. We hope you will take advantage and register for these opportunities to learn what you need to know and pass along the registration information to your physician members. 

The November 29th session will be focused on helping medical society staff to gain a better understanding of the new regulations so you will be prepared to answer your members’ questions. 

30 Days Remaining to Submit an Informal Review for 2017 PQRS Results
In 2017, CMS will apply a downward payment adjustment to those who did not satisfactorily report PQRS in 2015 including:

·        Individual eligible professionals (EPs)
·        Comprehensive Primary Care (CPC) practice sites
·        PQRS group practices
·        Accountable Care Organizations (ACOs)

If you have any questions regarding the status of your 2015 PQRS reporting or are concerned about potentially receiving the PQRS downward payment adjustment in 2017, please do not hesitate to submit an informal review request. CMS will be in contact with every individual EP or PQRS group practice that submits a request for an informal review of their 2015 PQRS data.

If you believe you have been incorrectly assessed the 2017 PQRS payment adjustment, submit an informal review between September 26, 2016 and November 30, 2016 requesting CMS investigate your payment adjustment determination. All informal review requestors will be notified via email of a final decision by CMS within 90 days of the original request for an informal review. All decisions will be final and there will be no further review.

Follow these steps to submit an informal review request:

·        Go to the Quality Reporting Communication Support Page (CSP)
·        In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
·        Select “Informal Review Request”
·        Select “PQRS Informal Review”
·        A new page will open

Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”

Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

Please see the PQRS informal review fact sheet for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 6:00 p.m.

CME on Waterborne Diseases Available at MSSNY CME Site
There’s been a recent outbreak of Legionnaires’ Disease in the Saratoga area of upstate New York.  Go to http://cme.mssny.org/index.jsp  to view our Medical Matters program Waterborne Diseases and learn more about this devastating illness and how it’s spread.  The educational objectives for this program are:

  • Describe how waterborne diseases occur and the national surveillance system for waterborne diseases
  • Identify possible symptoms of waterborne diseases that could occur in the US
  • Understand the prevention and treatment methodology for outbreaks 

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. 

AMA: Educational Opportunities to Fully Understand QPP Created by MACRA
The AMA is offering several educational opportunities to help physicians understand the requirements of the new Quality Payment Program (QPP) that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).   The sessions have been scheduled to give physicians an understanding of what the final rule means for their practice and what they need to do as part of the QPP. All of the sessions are open to physicians and medical society staff. We hope you will take advantage and register for these opportunities to learn what you need to know and pass along the registration information to your physician members.

  • Monday,  Nov. 21, 7 pm – 8:30 pm EST  Physician/Staff  webinar

Registration: https://cc.readytalk.com/r/y70aavsqh5g0&eom

  • Thursday,  Dec. 1 – 6:30 pm – 9 pm EST

Atlanta regional seminar (streaming and webinar)

Cobb Galleria Center

Atlanta Georgia

Registration:   https://www.eventbrite.com/e/macra-regional-seminar-atlanta-tickets-28840143646

  • Tuesday,  Dec. 6, 8:00 pm – 9:30 pm EST Physician/staff  webinar

Registration: https://cc.readytalk.com/r/j8d0v8kh1qr3&eom

  • Saturday,  Dec. 10, 9 am -11:30 PST

San Francisco regional seminar (streaming and webinar)

Marriot Marquis

San Francisco, CA

Registration:  https://www.eventbrite.com/e/macra-regional-seminar-san-francisco-tickets-28863673023

Physicians Feel Pressure to Prescribe Opioids for Pain
In an over 2,200 word article, the Buffalo (NY) News (10/30, Becker) reports that physicians feel pressure to prescribe opioids for pain from hospital administrators, patients, and pharmaceutical companies. The article highlights two sources of such pressure: the patient survey on pain treatment used by the Centers for Medicare and Medicaid Services as part of its formula for calculating hospital reimbursements, and the Joint Commission on Accreditation of Healthcare Organizations’ “Pain Management Standards.” The article mentions that earlier this year, CMS announced that it is considering alternatives to the patient surveys in its formula, but it will continue using the survey results in the meantime. It goes back to the 1990s, when there was a call for pain to be treated as “the fifth vital sign,” said Dr. Timothy Gabryel, president of the Medical Society of Erie County and medical director of Mercy Hospital.

“That set an expectation that there should be a pill for every problem and there should be no discomfort at all,” Gabryel said. “Doctors have been caught in the middle of this,” said Dr. Nancy H. Nielsen, former president of the American Medical Association. 

CMS Releases Finalized Medicare Payment Rule for 2017
This week CMS finalized the Medicare payment rule for 2017.  To read the CMS fact sheet summarizing major changes in the proposed rule, click here.

To read the entire 1,400 page rule, click here.

Table 52 on pp.1329-1330 highlighted the anticipated specialty by specialty impact of the payment rule.  The chart notes that CMS anticipates that most specialties will see a 0% impact as a result of these changes.  However, they also anticipate that allergists, family practice physicians, internists and geriatricians will see a 1% increase in allowed charges, that ENTs, gastroenterologists, neurosurgeons, radiologists, and vascular surgeons will see a 1% decrease in allowed charges, and ophthalmologists and urologists will see a 2% decrease in allowed charges.

The fact sheet also notes that CMS finalized misvalued code changes that achieve 0.32 % in net expenditure reductions.  Since these changes do not fully meet the statutorily required misvalued code target of 0.5 %, it requires an adjustment to the 2017 overall physician update.   Therefore, the 2017 Part B conversion factor is $35.89, an increase to the 2016 PFS conversion factor of $35.80.

Among the changes highlighted by CMS include:

  • Primary Care and Care Coordination: The rule finalizes revisions to payment for chronic care management, including payment for new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.
  • Mental and Behavioral Health: CMS is finalizing payments for codes that describe specific behavioral health services furnished using the psychiatric Collaborative Care Model, which has demonstrated benefits in a variety of settings. In this model, patients are cared for through a team approach, involving a primary care practitioner, behavioral health care manager, and psychiatric consultant. CMS is also finalizing payment for a new code that broadly describes behavioral health integration services, including payments for other approaches and for practices that are not yet prepared to implement the Collaborative Care Model.
  • Cognitive Impairment Care Assessment and Planning: CMS finalizes payment to physicians to perform cognitive and functional assessment and care planning for patients with cognitive impairment (e.g., for patients with Alzheimer’s)
  • Data Collection for Global Services: The 2017 payment rule also finalizes a data collection strategy for global services with significantly reduced burden for practitioners compared to the proposal. Required reporting will be limited to a sample of practitioners for selected services, and those practitioners who do report will report less information.

Review of the Final rule is ongoing.

AMA Perspective on Reduction Opioid Abuse
This week, in a presentation to MSSNY, Patrice A. Harris, MD, MA, Chair of the American Medical Association’s (AMA) Board of Trustees provided the national and AMA perspective to physicians of the Medical Society of the State of New York on how to reduce opioid abuse.

“Since 2012, there has been an 81% increase in physicians nationally who have trained to provide Medication Assisted Therapy (MAT) to patients and a 1,170% increase during 2013-15 in physicians who are co-prescribing naloxone, said Dr. Harris.  “Additionally, physicians are taking more education on the prescribing of opioid and there are over 50,000 courses that are available.”

Dr. Harris also noted that New York State will now hold insurers accountable and has reached a settlement agreement with Cigna to halt pre-authorization for opioid addiction drugs and to remove barriers to other potential life-saving treatments.

MSSNY is one of eight state medical society members of the AMA’s Task Force to Reduce Opioid Abuse.


CLASSIFIEDS


State of the Art Midtown Medical Office for Rent
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: hefderm@outlook.com for details. No Brokers.


Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Want to rent your medical office? Need to lease space to expand your practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities


A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

October 28, 2016 – Snapshot Survey-Do You Know What Value Based Pay Is?

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
October 28, 2016
Volume 16, Number 38

mlmichereforyou_enews_102016

Dear Colleagues:

Federal and state policymakers are increasingly leaning on public and commercial payers to increase the use of so-called value-based payments in Medicare, Medicaid and commercial health coverage.

MSSNY has created a survey to assess to what extent physicians are already participating in such value-based payment structures.  We also would like to obtain your perspective regarding the sufficiency of health insurer networks to be sure your patients can receive the care they need. The purpose of this survey is to assess to what extent physicians are already participating in such value-based payment structures.

I am hoping it will give us a “snapshot” and some “conversational data” regarding each of these topics that we can use in our advocacy.

Please take a few minutes to help us to help you.

Click here the survey.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Physicians Urged to Familiarize Themselves with Medicare Quality Payment Program Rules Effective for 2017
As previously reported, CMS has issued its final rule implementing the Medicare Quality Payment Program that starts in 2017.   The American Medical Association (AMA) has prepared two summaries that you can review from MSSNY’s website to familiarize yourself with the important provisions of this rule.  You can access these documents by clicking HERE and HERE.

Among the positive changes contained in the final rule that provide some flexibility to physicians in complying with new Medicare Merit Based Incentive Payment System (MIPS) include:

  • increasing from $10,000 to $30,000 the annual Medicare revenue threshold requiring participation in the MIPS program;
  • enabling physicians who report on one quality measure or one quality improvement activity for 2017 to avoid a 2019 Medicare payment penalty;
  • enabling physicians who report 90 continuous days (instead of the entire year) of quality data to be eligible for a 2019 Medicare payment bonus;
  • reducing from 90% to 50%  the percentage of patients of which a physician has to report quality measures;
  • Reducing from 11 to 5 the number of measures to be reported in the Advancing Care Information category (which replaces Meaningful Use) and permitting 90-day rather than full year reporting;
  • Enabling physicians practices recognized as a “Patient Centered Medical Home” to receive full credit in the “Clinical Practice Improvement” Category (15% of your MIPS score); and
  • Eliminating the “Cost” component in the 2017 MIPS evaluations.


Weekly Charting Tip: Prescribing Medical Marijuana
In New York, if you are registered, you may provide a prescription for your patient to receive an acceptable form of medical marijuana if they have one of the following diagnoses: Cancer, HIV Infection or AIDS, ALS, Epilepsy, Inflammatory Bowel Disease, Neuropathy, or Huntington’s Disease. Here is the catch: You patient MUST have associated or complicating conditions that ONLY include: cachexia (wasting syndrome), severe or chronic pain, severe nausea, seizures, or severe of persistent muscle spasms.

CAUTION: It is NOT sufficient to have a diagnosis JUST of severe or chronic pain! It must be associated with one of the listed diagnoses. Additionally, the diagnosis MUST be severe, debilitating or life threatening that is also accompanied by one of the acceptable diagnoses. For example, somebody diagnosed with Basal Cell Carcinoma probably would not qualify. A neuropathy MUST have notations in your chart that specifies how and where the neuropathy is causing severe pain or is debilitating. The nature of the pain? What the patient can do, or no longer do must be charted as well. It is not enough just to list a diagnosis and some symptoms. Go into detail. This is another example of how to avoid a problem; have a complete and accurate chart!  If you have any questions, please contact Kern Augustine, P.C. at 1-800-445-0954 or via email at info@DrLaw.com. 

“When Is the Flu Not the Flu?” Nov. 16 CME Webinar Registration Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.

Webinar: Learn More about the New Medicare Quality Payment Program
CMS invites you to join webinar on November 15 on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule with comment period. The webinars will provide an overview of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program.

Quality Payment Program Final Rule MLN Connects® Call — November 15

  • Date: Tuesday, November 15, 2016
  • Time: 1:30 to 3:00 PM ET
  • Register MLN Connects Event Registration.
  • Target Audience: Medicare Part B Fee-For-Service clinicians, office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders.

During these calls, participants will learn about the provisions in the recently released final rule; participants should review the rule prior to the call. A question and answer session will follow the presentation.

Space for these webinars is limited. Register now to secure your spot. After you register, you will receive an email message with a dial-in number and webinar link. Please note, you will not be able to share your participant information because it will be unique to you.

For More Information

To learn more about the final rule and the Quality Payment Program, view the following resources:


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


AMA Webinar on How Final Rule Affects Your Practice
On November 21 and December 6, the AMA will host educational webinar sessions to help physicians prepare and understand what the final rule means for their practice.

Register for November 21
Register for December 6

Review of all the provisions of the final rule is ongoing.  Medical societies across the country including the AMA and MSSNY had advocated for additional flexibility, particularly for smaller practices that may not have the infrastructure necessary to be successful in these value-based payment programs.

LI Pharmacist Gets Up To 24 Years for Selling Black-Market HIV Meds
Attorney General Eric T. Schneiderman announced that pharmacist Ira Gross, 63, of Babylon, was sentenced to 8 to 24 years in state prison for his role in selling over $274M dollars of diverted, medically worthless HIV medication. Gross was also ordered to pay back the amount he pocketed as a result of the scheme, which totaled $25.2M.

The evidence at trial revealed that from 2008 to 2012, Gross and others sold the diverted medications, mostly expensive HIV antiretroviral medications purchased off the street, to MOMS Pharmacy in Melville. MOMS Pharmacy then dispensed the diverted medications to thousands of its unsuspecting patients, many of whom were Medicaid recipients, throughout New York and other states.  Ultimately, the New York Medicaid program paid $124M for those tainted medications distributed to New York Medicaid patients.

Gross organized the scheme and coordinated the sale of the diverted street medication to MOMS Pharmacy. Evidence at trial showed that Gross paid Glenn Schabel, the supervising pharmacist and compliance officer for MOMS Pharmacy, over $5 million to buy medication that he knew or should have known were diverted. Schabel, 55, of Melville, was also arrested and pleaded guilty in September 2016 to Criminal Diversion of Prescription Medications and Prescriptions in the First Degree and Commercial Bribe Receiving in the First Degree.  Schabel was sentenced to two to six years in state prison and has paid $5.45M in restitution.

Free DOH Posters Educate Patients re Appropriate Antibiotic Prescribing
The NYS Department of Health and the NY “Get Smart Campaign” are pleased to share brand new “Get Smart Guaranteeposters to demonstrate healthcare professionals’ commitment to appropriate antibiotic prescribing. 

The posters can be personalized with a provider’s photo and signed. When displayed, they not only enhance provider “buy-in” to appropriate antibiotic prescribing but are also a way to educate patients about appropriate antibiotic prescribing and use.  CDC-sponsored “Get Smart Week” is November 14-20 (but the DOH would appreciate displaying these posters year-round!) The posters may be downloaded via this link.

Simpler yet, the NY Get Smart Campaign can mail you limited copies of 11”  X 17” Get Smart Guarantee posters. The poster is available at no cost to you and may be ordered by contacting the NYSDOH Get Smart Program Coordinator, Mary Beth Wenger, at marybeth.wenger@health.ny.gov Additionally, there are patient Palm Cards carrying the same message, which can be handed out to patients, explaining why antibiotics aren’t always the answer.

Healthcare providers may be pressured by patients to prescribe antibiotics even when they have a viral infection. Displaying this poster in waiting or examination rooms sends a message to patients that antibiotics aren’t always appropriate. We hope the posters will help facilitate conversations with patients on the appropriate use of antibiotics.

New Diabetes Guidelines Recommend that Patients Move Every 30 Minutes
The American Diabetes Association now recommends that patients with diabetes take a break from prolonged sitting every 30 minutes, citing blood glucose benefits. This could mean 3 or more minutes of standing, walking, or doing light-intensity activities like office chair swivels. Previously, the group recommended movement breaks every 90 minutes.

The group’s first comprehensive physical activity guidelines, published in Diabetes Care, also make the following recommendations:

  • Physical activity should be prescribed to all patients with diabetes.
  • Patients should aim to get at least 150 minutes of physical activity every week. Both resistance and aerobic training are encouraged. Patients should go no more than 2 consecutive days without activity.
  • Older adults with diabetes should aim for 2–3 days a week of flexibility or balance training, such as tai chi or yoga.

The document also provides guidance for youth, pregnant patients, physical activity considerations with various diabetes complications, and suggested carbohydrate intake before exercise.

American Diabetes Association news release

CMS: New Ops for Clinicians to Join Advanced Alternative Pay Models
CMS announced new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) developed by the CMS Innovation Center to improve care and potentially earn an incentive payment under the Quality Payment Program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program rewards clinicians with sufficient participation in Advanced APMs that align incentives for high-quality, patient-centered care. By giving more clinicians the opportunity to participate in these models, today’s announcement will extend the benefits of high-quality, coordinated care to more Medicare beneficiaries.

CMS is announcing that it expects to re-open applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year. In addition, CMS is announcing that the Innovation Center’s Oncology Care Model with two-sided risk will now be available in 2017, which will qualify the model as an Advanced APM beginning in the 2017 performance year.

In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through sufficient participation in the following Advanced APMs:

  • Comprehensive ESRD Care Model (Large Dialysis Organization (LDO) arrangement)
  • Comprehensive ESRD Care Model (non-LDO arrangement)
  • CPC+
  • Medicare Shared Savings Program ACOs – Track 2
  • Medicare Shared Savings Program ACOs – Track 3
  • Next Generation ACO Model
  • Oncology Care Model (two-sided risk arrangement)

In 2018, we anticipate that clinicians may also earn the incentive payment through sufficient participation in the following models:

  • ACO Track 1+
  • New voluntary bundled payment model
  • Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology (CEHRT) track)
  • Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT track)

These lists will continue to change and grow as more models are proposed and developed in partnership with the clinician community and the Physician-Focused Payment Model Technical Advisory Committee.

For more information, please click here.

Insurers Must Be Up to Date on Physician Participation Info for MA Plans
Starting next year, the federal government will require health insurers to give patients enrolled in  Medicare Advantage plans or in policies sold in the federally run health exchange up-to-date details about which doctors are in their plans and taking new patients.

Under a rule published last month by CMS, Medicare Advantage plans must contact doctors and other providers every three months and update their online directories in “real time.” Online directories for policies sold through healthcare.gov, the health law exchange run by the federal government in 37 states, must be updated monthly, CMS announced in a separate rule.

Inaccuracies in the Medicare Advantage directories may trigger penalties of up to $25,000 a day per beneficiary or bans on new enrollment and marketing. CMS will also use the directories to help determine whether insurers have enough doctors to meet beneficiaries’ needs.

The administration last year announced rules designed to make sure those networks have adequate numbers of providers. The newest rules will help guarantee that consumers get good information on those networks.

Nearly 9 million people have enrolled in plans on the federal marketplace for 2015, according to officials.

Incorrect information was found for almost half of the 5,832 doctors listed in directories for 54 Medicare Advantage plans checked last fall, they said. Only online directories were examined.

CDPHP and Capital Care Create Acuitas Health for Value-Based Pay Success
For nearly a decade, CDPHP and CapitalCare have partnered to achieve a shared mission of improving the quality and affordability of health care for residents in and around the Capital Region. The organizations – which are philosophically aligned around the goals of value-based care – have taken that partnership to the next level, creating an organization which will allow physicians to remain independent, while offering patients access to better health, better care, and lower costs.

Acuitas Health provides practices with a turn-key solution needed to succeed in a value-based payment environment. This includes a comprehensive readiness assessment, realignment of staff and workflows, and oftentimes, a total transformation in the way the practice delivers care.

Acuitas Health will embed care managers within physician practices and use sophisticated population health management tools to identify patients with gaps in care or are at high-risk, or rising risk, clinically. Care managers will work with the practice to engage with patients, ensuring that individuals receive the right care, at the right time.  For more information on Acuitas Health, please visit www.acuitashealth.com.

Established in 1984, CDPHP is a physician-founded, member-focused and community-based not-for-profit health plan that offers high-quality affordable health insurance plans to members in 24 counties throughout New York.

CapitalCare Medical Group is a physician-owned medical practice with over 650 employees including more than 230 healthcare professionals.  The group offers primary care services in Family Practice, Pediatrics and Internal Medicine throughout the Capital Region. CapitalCare also provides services in Endocrinology, Pulmonary and Sleep Medicine, Developmental-Behavioral Pediatrics, Nephrology, adult and pediatric Neurology, medical nutrition therapy, comprehensive diabetes education and operates a state-of-the-art clinical laboratory.

Children with Persistent Post-Concussion Symptoms May Have Lower Quality of Life Than Youngsters Who Have Recovered
Research Indicates that children “with persistent symptoms months after a concussion have lower quality of life than kids who have recovered, but even kids who recovered quickly may still struggle,” researchers found after assessing “quality of life factors for about 2,000 kids aged five to 18 years who had presented to an emergency department within two days of suffering an acute concussion.” The findings were published online in JAMA Pediatrics.

RFP for Office of Temporary and Disability Assistance

REQUEST FOR PROPOSALS


The New York State Office of Temporary and Disability Assistance (OTDA), Division of Disability Determinations is issuing a Request for Proposal (RFP) to solicit proposals from qualified vendors for the establishment of one contract medical provider to establish a site in the upstate area of the Capital District, NY (including the cities of Albany, Schenectady, and Troy and the immediate geographic area) to perform medical examinations and ancillary testing of claimants applying for Social Security disability benefits. If your organization is capable of performing a high volume of medical examinations and diagnostic tests, the Capital District Consultative Examination RFP can be found on the OTDA website at https://otda.ny.gov/contracts/procurement-bid.asp.  If your organization wishes to receive a hard copy of the RFP, please send your request immediately by Certified Mail to:


Mr. Lawrence Rockefeller
NYS Office of Temporary and Disability Assistance
Division of Disability Determinations
One Commerce Plaza, 10th Floor
99 Washington Avenue
Albany, New York 12210


The RFP release date is September 14, 2016 with proposals due no later than November 2, 2016 at 3:00 p.m. EST.  If you have any questions, you may contact Melinda Kuiken at (518) 626-3042.


CLASSIFIEDS


State of the Art Midtown Medical Office for Rent
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: hefderm@outlook.com for details. No Brokers.


Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Want to rent your medical office? Need to lease space to expand your practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

County Executive
The Suffolk County Medical Society, a 501C-6 corporation, recognized as the premier professional medical association for the physicians of Suffolk County, is seeking to fill the position of Executive Director.  Successful candidates will possess a Bachelor Degree, (Masters Degree preferred in a healthcare-related field and/or Business/Finance).  Should have minimum of five years experience in healthcare or association management .  Must possess the following abilities: have a thorough working knowledge of the health care industry;  serve as a strong physician and patient advocate; be able to successfully balance multiple demands; possess strong leadership skills with excellent oral and written communications.For more information and a complete job description, visit www.scms-sam.org.  Please forward a resume with a cover letter outlining how you meet the parameters of the position, including salary requirements, to stuscms@optonline.net.  Position scheduled to begin February, 2017.



A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

October 21, 2016 – MACRA Rules Final!

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
October 21, 2016
Volume 16, Number 37

mlmichereforyou_enews_102016

Dear Colleagues:

This week, CMS issued a final rule outlining the requirements of the new Quality Payment Program for physicians that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).

As has been widely reported, there were positive changes contained in the final rule that provide some flexibility to physicians in complying with new Medicare Merit Based Incentive Payment System (MIPS).  These include:

  • enabling physicians who report at least some 2017 data before March 31, 2018 to avoid a 2019 Medicare payment penalty;
  • increasing from $10,000 to $30,000 the annual Medicare revenue threshold requiring participation in the MIPS program;
  • reducing from 90% to 50%  the percentage of Medicare patients of which a physician has to report quality measures;
  • Reducing from 11 to 5 the number of measures to be reported in the Advancing Care Information category (which replaces Meaningful Use) and
  • Eliminating the Value based component in the 2017 MIPS evaluations.

Summaries, fact sheets and other CMS resources are available on the agency’s web site.  In the coming days, the AMA will make additional resources available on its own MACRA web page.  To access the Quality Payment Program Overview Fact Sheet, click here.

While the AMA is in the process of fully analyzing the regulations, a first review reveals that CMS responded to many of the concerns expressed by physicians about the proposed rule issued last spring.  On November 21 and December 6, the AMA will host educational webinar sessions to help physicians prepare and understand what the final rule means for their practice.

Register for November 21
Register for December 6

Review of all the provisions of the final rule is ongoing.  Medical societies across the country including the AMA and MSSNY had advocated for additional flexibility, particularly for smaller practices that may not have the infrastructure necessary to be successful in these value-based payment programs.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Webinar: An Overview of MACRA (Quality Payment Program)
CMS invites physicians to join a webinar on October 26 at 2:00 PM ET, on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule with comment period. The webinar will provide an overview of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program.

Webinar Details

Quality Payment Program Overview

  • Date: Wednesday, October 26, 2016
  • Time: 2:00 to 3:00 PM ET
  • Register Here.

Space for this webinar is limited. Register now to secure your spot. After you register, you will receive an email message with a dial-in number and webinar link. Please note, you will not be able to share your participant information because it will be unique to you. 

Please Review Comprehensive Medicare Quality Payment Program Summaries
The American Medical Association (AMA) has prepared two summaries that you can review from MSSNY’s website to familiarize yourself with the important provisions of this rule.  You can access these documents by clicking HERE and HERE.

More MACRA  Help from the AMA
|Two documents prepared by the AMA’s Washington Office, outlining major provisions of Medicare’s new Quality Payment Program (QPP) for physicians that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).  The longer summary document provides some detail of the various components of the final rule that was issued last week, and notes where key improvements were made to the policies set forth in the original proposed rule.  The second is a chart with more abbreviated descriptions of changes to the original proposed rule that were secured. These documents will be posted on the AMA’s MACRA web page, www.ama-assn.org/go/medicarepayment.  Additional material is in the process of being developed.

  • The AMA Payment Model Evaluator is an innovative tool offering initial assessments to physicians so they can determine how their practices will be impacted by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Developed with the expertise of physicians and input from partners, the tool will give physicians and their staff a brief assessment, as well as relevant educational and actionable resources. Once physicians and medical practice administrators fill out the online questionnaire, they will receive guidance for participating in the MACRA payment model that is best for them. The AMA will continually update the Payment Model Evaluator to respond to regulatory changes and to keep practices up to date throughout the new payment and care delivery reform process. The tool is free to all physicians and their practice administrators.
  • The AMA STEPS Forward™ collection of practice improvement strategies has new MACRA-specific tools. Accurate and successful reporting on quality metrics is crucial to the new Medicare payment system, both in the current Physician Quality Reporting System program and under MACRA’s new Quality Payment Programs. Each STEPS Forward module focuses on a specific challenge and offers real-world solutions, steps for implementation,, case studies, continuing medical education, and downloadable tools and resources. Physicians and their practice staff can use these to help improve practice efficiency and ultimately enhance patient care, physician satisfaction and practice sustainability. The full collection, which now includes 42 modules, has a variety of tools that will help physicians and their practices, including:

The AMA launched a ReachMD podcast series titled Inside Medicare’s New Payment System. Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS), Dr. Gurman, AMA staff experts, and others are featured on the series, which will include five episodes to help physicians be informed on upcoming Medicare changes.

Learn more on AMA Wire® about these tools or check out other key changes to the Medicare payment system.

Attached are two documents prepared by the AMA’s Washington Office, outlining major provisions of Medicare’s new Quality Payment Program (QPP) for physicians that was created by the Medicare Access and CHIP Reauthorization Act (MACRA).  The longer summary document provides some detail of the various components of the final rule that was issued last week, and notes where key improvements were made to the policies set forth in the original proposed rule.  The second is a chart with more abbreviated descriptions of changes to the original proposed rule that were secured.

These documents are posted on the AMA’s MACRA web page, www.ama-assn.org/go/medicarepayment.

DOH Commissioner’s Grand Rounds on Dietary Supplements on Nov. 29
New York State Department of Health Commissioner Howard Zucker, MD, will host a medical grand rounds on Tuesday, November 29, 2016, 7:30 – 9:00 am at The Wadsworth Center – David Axelrod Institute, 120 New Scotland Avenue, Albany, NY 12208.   The topic will be:  “Dietary Supplements: Buyer Beware, Provider Be Wary”.

Faculty for the event will be Pieter A. Cohen, MD, Assistant Professor of Medicine, Harvard Medical School Internist, Cambridge Health Alliance; Nina Ahmad, MD, Medical Director, Division of Epidemiology, New York State Department of Health and Nathan Graber, MD, MPH, Director, Center for Environmental Health, New York State Department of Health. Registration for this session is required and a copy of the flyer can be found here.

Nov. 17 Webinar Best Practices for Palliative Care in Primary Care
This program will address best practices for integrating palliative care services into the primary care and/or PCMH settings. This webinar will cover the evidence and business case for this approach, strategies for patient acceptance, and examples of successful implementation.

Webinar Details

Date: November 17

Time: 1 p.m.
Featured Speaker: Joan Dacher, Ph.D., R.N., N.P., Professor of Nursing, The Sage Colleges; and Co-Chair, New York State Palliative Care Education and Training Council

Registration: Register online. 

DFS: Guidance to Insurers New Substance Abuse Coverage Requirement
The New York Department of Financial Services has issued a 9-page guidance to health insurance companies reminding them of new requirements enacted earlier this year to expand coverage for substance use disorder treatments.   This includes expanded prescription drug coverage, and expanded inpatient and outpatient coverage, coverage for naloxone, and expedited pre-authorization requirements.  To read the guidance, click here.

When Is the Flu Not the Flu?” CME Webinar Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


Billing for Influenza Correctly
NGS published CMS article titled, “Billing for Influenza: New CPT Code 90674” on 9/30/2016. The article advises that MACs may direct use of an NOC code to allow billing for the vaccine for dates of service on or after 8/1/2016 and before 1/1/2017; however, NGS is not allowing an NOC code and your claims will deny as an invalid code. CPT Code 90674 will be added with the January 2017 release. Please hold your claims until the January release is implemented; Additionally, Part A MACs will be holding claims from 1/1/2017 to 2/20/2017. At this time, any claims received on and after 1/1/2017 will be released for payment beginning 2/20/2017.The Seasonal Influenza Vaccines Pricing on the CMS website shows the CPT 90674 payment allowance is $22.93 effective for dates 8/1/2016-7/31/2017.

Fentanyl the Cause of 16% of All NYC Overdose Deaths
In 2015, 146 overdose deaths in New York City involved fentanyl, 16 percent of all overdose deaths, according to the city health department. Never before had fentanyl accounted for more than 3 percent of overdose deaths in the city. On Monday, the city’s health department reported that since July 1, 47 percent of confirmed drug overdose deaths involved fentanyl. That’s up from 39 percent through the first six months of the year, according to provisional data. That data also shows there have been 725 confirmed overdose deaths to date in New York City and that 581 of these deaths occurred during the first six months of 2016.

Adults Stressed out Due to Presidential Election
According to an online survey conducted by the American Psychological Association (APA). Some 52% of U.S. adults find the 2016 presidential election to be a “very or somewhat significant source of stress,” Over 3500 adults aged 18 and older completed the survey in August 2016. Among the other findings:

  • Rates of stress were similar among Democrats and Republicans, and among women and men.
  • Those over age 70 were most likely to feel election stress (59%), while those aged 38 to 51 were least likely (45%).
  • Some 60% of Americans with disabilities found the election stressful, versus 48% of those without disabilities.
  • Stress was more common among adults who used social media (54%) than among those who did not (45%).

The APA offers these tips for coping:

  • “Limit your media consumption. Read just enough to stay informed.”
  • Don’t talk politics if you think the discussion could “escalate to conflict.”
  • “Whatever happens on Nov. 8, life will go on. … Avoid catastrophizing.”


REQUEST FOR PROPOSALS

The New York State Office of Temporary and Disability Assistance (OTDA), Division of Disability Determinations is issuing a Request for Proposal (RFP) to solicit proposals from qualified vendors for the establishment of one contract medical provider to establish a site in the upstate area of the Capital District, NY (including the cities of Albany, Schenectady, and Troy and the immediate geographic area) to perform medical examinations and ancillary testing of claimants applying for Social Security disability benefits. If your organization is capable of performing a high volume of medical examinations and diagnostic tests, the Capital District Consultative Examination RFP can be found on the OTDA website at https://otda.ny.gov/contracts/procurement-bid.asp.  If your organization wishes to receive a hard copy of the RFP, please send your request immediately by Certified Mail to:

Mr. Lawrence Rockefeller
NYS Office of Temporary and Disability Assistance
Division of Disability Determinations
One Commerce Plaza, 10th Floor
99 Washington Avenue
Albany, New York 12210

The RFP release date is September 14, 2016 with proposals due no later than November 2, 2016 at 3:00 p.m. EST.  If you have any questions, you may contact Melinda Kuiken at (518) 626-3042.


CLASSIFIEDS


State of the Art Midtown Medical Office for Rent
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: hefderm@outlook.com for details. No Brokers.


Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Want to rent your medical office? Need to lease space to expand your practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

County Executive
The Suffolk County Medical Society, a 501C-6 corporation, recognized as the premier professional medical association for the physicians of Suffolk County, is seeking to fill the position of Executive Director.  Successful candidates will possess a Bachelor Degree, (Masters Degree preferred in a healthcare-related field and/or Business/Finance).  Should have minimum of five years experience in healthcare or association management .  Must possess the following abilities: have a thorough working knowledge of the health care industry;  serve as a strong physician and patient advocate; be able to successfully balance multiple demands; possess strong leadership skills with excellent oral and written communications.For more information and a complete job description, visit www.scms-sam.org.  Please forward a resume with a cover letter outlining how you meet the parameters of the position, including salary requirements, to stuscms@optonline.net.  Position scheduled to begin February, 2017.



A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

October 14, 2016 – Get Your CME Here!

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
October 14, 2016
Volume 16, Number 36

MLMIC

Dear Colleagues:

On Friday, September 30, I had the pleasure of meeting with MSSNY’s Committee on Continuing Medical Education, chaired by E. Kenneth Freiberg, DO.  The CME Committee oversees MSSNY’s dual role as both a Recognized Accreditor of 33 CME providers in New York State and an Accredited Provider of CME activities.

In order to support these two roles, there are two CME subcommittees:  the Subcommittee on Surveys (chaired by Pauline Hecht, MD) and the Subcommittee on Educational Programs (chaired by Sheldon Putterman, MD).  MSSNY couldn’t ask for a more dedicated, passionate, and hard-working group.  The Subcommittee on Surveys and the full CME Committee meet quarterly (in March, June, September, and December), while the Subcommittee on Educational Programs meets monthly to approve both directly and jointly provided activities and analyze the results of activities that have occurred.

MSSNY is in the process of revising its CME website http://cme.mssny.org  to incorporate all of MSSNY CME programming.  It is anticipated that the revisions will be completed early in 2017.   In the meantime, the cme.mssny.org site offers over 50 CME programs, which include the Opioid Webinar series, public health topics such as Zika, Ebola, influenza, and pertussis, and others.  Additionally, there are courses related to bioterrorism, emergency preparedness, and mental health.

If you are new to the site, you will have to register as a new user with a log on and password.   Please go here to see the array of programs MSSNY has to offer.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Physicians Required to Comply with “Non-Discrimination” Reporting
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which include most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.

According to the AMA, the rule does not apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court.

Covered physicians must comply with the following requirements:

  • Post a notice of nondiscrimination and taglines in multiple languages
  • Develop and implement a language access plan
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)

To help reduce burden and costs, the HHS Office of Civil Rights (OCR) has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rulefactsheets on key provisions and a list of frequently asked questions.

To read a comprehensive summary prepared by Donald Moy, Esq. from the firm of MSSNY’s General Counsel, Kern Augustine P.C., click here. 

CMS Finalizes the New Medicare Quality Payment Program
Today, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program.

While the program begins January 1, 2017, CMS has laid out different time frames for when physicians can begin to participate to avoid penalties in Medicare payment in 2019. CMS also raised to $30,000 the Medicare revenue threshold that enables a physician to be exempted from the MIPS program.

The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.

Accompanying today’s announcement is a new Quality Payment Program website, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.

To see the press release and obtain more information about today’s announcement, including a fact sheet, please click here.

To learn more about the rule, click here.

AMA and MSSNY evaluation of the final rule is ongoing and further updates will be provided.

ICD-10 Updates for 10-01-16
In reference to the ICD-10 diagnosis code updates that were scheduled to be effective on October 1, 2016, Excellus has advised us that the ICD-10 codes are in their claim processing system.  However, Excellus is currently updating their clearinghouse to accept these codes electronically. Excellus expects that the clearinghouse will be updated by 10/19/16.  These delays will cause rejections/denials if you are submitting with the updated ICD-10 diagnosis codes. Since the claims will be rejected from the Clearinghouse, the claims would not have entered the Excellus system so you will have to resubmit the claims for payment.
Other payers might be experiencing some delays with their ICD-10 updates, as well.

OSCAR Health Insurance Narrowing Physician and Hospital Network
Oscar Health Insurance has begun to notify its participating provider network physicians that their contract participation will be amended effective January 1, 2017.  Please see the attached communications. As you should know, Oscar Health Insurance began their services utilizing the Magna Care network of physicians.  Now, Oscar plans to reduce its network and contract directly with their own network of physicians.

Two letters are attached.  One letter was sent out to providers who will continue to be in network, by direct contract, with Oscar in 2017, and the other letter was sent out to providers who will not be participating in the Oscar 2017 network. Both letters have information on Oscar’s continuity of care policy.  Both letters advise the physicians that their Magna Care contract remains intact and unaffected by this change.

http://www.mssnyenews.org/wp-content/uploads/2016/10/MagnaCare-Letter-1.pdf

http://www.mssnyenews.org/wp-content/uploads/2016/10/MagnaCare-Letter-2.pdf

Based on additional contact with Oscar Health Insurance, MSSNY has been advised that Oscar is conducting a comprehensive outreach to all Oscar members/patients impacted by the network change. Oscar has processes in place to support their members in continuity of care as well as finding in network providers.

Informed sources report that Oscar will reduce its provider network in New York, by half.  This may impact 20,000 doctors.  Its hospital network will decrease from 77 facilities to just 31.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


Beware of “Seamless Conversion” for Your Medicare Patients
A policy known as seamless conversion allows insurance companies to move members of their commercial or Medicaid managed-care plans over to Medicare Advantage plans if they first ask permission from the CMS. The Medicare Advantage plans mean more revenue for insurers, but it often means patients’ doctors will be considered out of network. The CMS believes the transition to Medicare Advantage should be implemented to ensure continuity of care and recently issued a memo to insurers reminding them about seamless conversion as a way to transition enrollees.

The concern among many physicians is that the CMS’ seamless conversion is not as advantageous to patients as it is to its insurers and financial interests. Physicians nationwide have been critical of the secrecy of the plan as well and some groups are pushing for the CMS to publicly release information on which Medicare Advantage plans have been approved.

The goal of assuring a continuity of care seems contradicted when a patient’s non-Medicare insurance has been covering their care at a practice but the practice is not in the Medicare Advantage plan’s network. It has been rumored that Aetna, Humana and UnitedHealthcare have asked for permission to participate in seamless conversion. Patient advocacy groups are also pushing against this policy and requesting that the CMS require insurers to get confirmation from a beneficiary that they understand their network may have changed and allow for a special enrollment period in case their doctors are not in network.

In response to the criticism, the CMS countered that beneficiaries should be more vigilant in opening and reviewing all mail from their current insurer. The CMS further shifted the onus on enrollees to make sure to ask about provider and pharmacy networks and noted that patients can opt out of Medicare Advantage plans. The CMS has also said that it will make public which insurers use seamless conversion later this year.

Click here to download a MSSNY flyer for your patients to inform them that they may be switched into a Medicare Advantage Plan without their knowledge.

“When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.

Democrat (Psychiatrists 76%) or Republican (Surgeons 67%)?Physicians in certain specialties are much more likely to be registered as Democrats or Republicans, according to analysis by the New York Times’ “The Upshot.” For instance, the analysis found that 67 percent of surgeons in the study sample identified as Republican, while 76 percent of psychiatrists were registered as Democrats. (New York Times’ “The Upshot,” (10/6).

PQRS Negative Payment Adjustment Notification
PQRS participants are now being notified by letter regarding the 2017 negative payment adjustments. If you did not participate in PQRS in 2015, or did not satisfactorily participate in 2015, all of your 2017 Medicare Part B reimbursement will be subject to a -2.0% adjustment.

If you think that this negative payment adjustment has been applied incorrectly, you can request an informal review — but you must request a review on or before November 30, 2016 at 11:59 pm. CMS will investigate the merits of your request and issue a decision within 90 days of receipt.

Start with these steps:

Review your Feedback Report and 2015 AQRUR

Request an informal review (note: there are no hardship exemptions for the PQRS negative payment adjustment)

Register for the live CSMS AQRUR webinars

Download the CSMS on-demand PQRS webinars

Questions? Please contact theQualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or qnetsupport@hcqis.org. They are available from 7 am – 7 pm Central Time, Monday through Friday. 

RFP for Office of Temporary and Disability Assistance

The New York State Office of Temporary and Disability Assistance (OTDA), Division of Disability Determinations is issuing a Request for Proposal (RFP) to solicit proposals from qualified vendors for the establishment of one contract medical provider to establish a site in the upstate area of the Capital District, NY (including the cities of Albany, Schenectady, and Troy and the immediate geographic area) to perform medical examinations and ancillary testing of claimants applying for Social Security disability benefits. If your organization is capable of performing a high volume of medical examinations and diagnostic tests, the Capital District Consultative Examination RFP can be found on the OTDA website here.  If your organization wishes to receive a hard copy of the RFP,  please send your request immediately by Certified Mail to:

Mr. Lawrence Rockefeller
NYS Office of Temporary and Disability Assistance
Division of Disability Determinations
One Commerce Plaza, 10th Floor
99 Washington Avenue
Albany, New York 12210

The RFP release date is September 14, 2016 with proposals due no later than November 2, 2016 at 3:00 p.m. EST.  If you have any questions, you may contact Melinda Kuiken at (518) 626-3042. 

Nursing Home Residents: Ventilators Not Increasing Life Expectancy
The “number of nursing home residents with advanced dementia” connected to ventilators has increased significantly in recent years although it “doesn’t appear to help them live longer,” according to a new study published in JAMA Internal Medicine, researchers found that in 2000 only 39 of every 1,000 nursing home residents with dementia who were hospitalized were connected to ventilators, but in 2013 that had increased to 78 of every 1,000.

CMS Website to Review Resources on 2016 Program Requirements
The Centers for Medicare & Medicaid Services (CMS) has created the following materials to help providers attest successfully to the Medicare and Medicaid EHR Incentive Programs in 2016.

CMS is encouraging EPs, eligible hospitals, and CAHs to use the relevant resources to prepare for attestation.

For More Information
Visit the EHR Events page and listen to previous webinars for EPs and eligible hospitals/CAHs to learn more about the EHR Incentive Programs in 2016.

Price of Insulin Increases, Along With Rebates to PBMs
The Wall Street Journal (10/7) reported that while the list price of top-selling insulins have doubled since 2011, most of the revenue has gone to pharmacy-benefit managers (PBM), rather than drugmakers. Experts say that PBMs have demanded higher rebates to include the drugs on their preferred lists.


CLASSIFIEDS



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Well-Established Nassau County Internal Medicine Practice Available for Acquisition
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to surendralal1@yahoo.com


Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
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Want to rent your medical office? Need to lease space to expand your practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

County Executive
The Suffolk County Medical Society, a 501C-6 corporation, recognized as the premier professional medical association for the physicians of Suffolk County, is seeking to fill the position of Executive Director.  Successful candidates will possess a Bachelor Degree, (Masters Degree preferred in a healthcare-related field and/or Business/Finance).  Should have minimum of five years experience in healthcare or association management .  Must possess the following abilities: have a thorough working knowledge of the health care industry;  serve as a strong physician and patient advocate; be able to successfully balance multiple demands; possess strong leadership skills with excellent oral and written communications.For more information and a complete job description, visit www.scms-sam.org.  Please forward a resume with a cover letter outlining how you meet the parameters of the position, including salary requirements, to stuscms@optonline.net.  Position scheduled to begin February, 2017.



A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777

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

 

 

 

 

 

 

 

 

 

 

 

 

 

October 7, 2016 – Should Medicare Negotiate Drug Prices?

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
October 7, 2016
Volume 16, Number 35

MLMIC

Dear Colleagues:

Our successes at MSSNY are achieved as a result of the combined efforts of many energetic physicians across the State along with the efforts of our talented staff.

Today is the last day of one of our leading staff members, Senior Vice President and Chief Legislative Counsel Elizabeth Dears Kent.  After dedicating 22 years of her professional life to advocating on our behalf, Liz is moving on to an amazing opportunity to be the Governmental Affairs Director for EHR vendor Dr. First.

Her legislative accomplishments for us are enormous, from efforts to enact the Managed Care Bill of Rights in the 1990s, to our most recent successes in providing needed flexibility for physicians in complying with the e-prescribing mandate.  She has been extensively involved in efforts to prevent the enactment of literally hundreds of adverse bills, including bills that would have increased your liability premiums, inappropriately expanded the scope of practice of numerous non-physicians, and have required overbroad and costly state regulation of private physician offices.  She has also helped steer MSSNY through some of the most difficult issues facing our profession, including the transition to value-based payments across public and private payors, and the increased demand for public information regarding the quality of care of physicians and other health care providers.

All physicians across the State of New York owe Liz a big thank you for all of her efforts.

As part of her diligence, Liz trained her successor well, long time MSSNY lobbyist, Morris (Moe) Auster, who ably will take the reins of our Government Affairs division.  We wish Moe the best of luck.  With all the challenges we face, we know he’s got his work cut out for him.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


enews large

If You Have Not Revalidated with Medicaid, You Will Not Be Paid after October 27
Effective for eMedNY claims processing starting October 27, 2016, all claims from non-revalidating billing providers will be pended until the provider’s revalidation package is received. To avoid interruption of claims payment, providers must revalidate immediately.

The federal regulation 42 CFR 455.414 requires providers to revalidate their enrollment with the New York State Medicaid Program. Providers have already received individual written reminders to revalidate, although thousands of providers have not done so. The deadline for submission of revalidation packages was September 25, 2016.

To revalidate:

  1. Visit the Provider Enrollment page at www.emedny.org/revalidation,

locate your enrollment form and additional required documentation, and determine whether an enrollment fee is required. There is a slide presentation, step-by-step processes, and an FAQ section. These resources provide important information on the revalidation process.

  1. Complete and mail the appropriate form(s) with all required documentation to the address provided. Keep a copy of the forms and documentation.

Next steps:

  1. Allow 2 to 3 weeks for the receipt and processing of the revalidation packet by eMedNY.  Once your completed revalidation is received and processed, all claims that have been held due to missing or late revalidation will be released for processing during that cycle.
  2. If more than 3 weeks have passed since sending the revalidation to eMedNY, please contact providerenrollment@health.ny.govwith the subject “FINAL REVALIDATION NOTICE” and provide all pertinent information regarding your submission, such as the date you sent it, and the address you sent it to so that we can research it.
  3. The remittance message for these pended claims is: Health Claim Status Code: 46 INTERNAL REVIEW/AUDIT

If you have additional questions about revalidation, please contact us at providerenrollment@health.ny.gov with the subject “FINAL REVALIDATION NOTICE”, or call the eMedNY Call Center at 800-343-9000 Option 2.

Physicians Required to Comply with “Non-Discrimination” Reporting Provisions by Mid-October
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which include most physicians) must post and publish new mandatory nondiscrimination statements and taglines in the 15 most popular languages for the State by October 16, 2016. This is CMS’ list of the top 15 languages spoken in New York: Spanish; Chinese; Russian; French Creole; Korean; Italian; Yiddish; Bengali; Polish; Arabic; French; Urdu;  Tagalog; Greek and Albanian.

To read a comprehensive summary prepared by Donald Moy, Esq. from the firm of MSSNY’s General Counsel, Kern Augustine PC, to assist physicians with compliance, click here.

At this time, MSSNY is exploring some vendors that should be able to help our members deal with real-time translation services to comply with both the LEP (language) and the ADA (hearing impaired/blind) requirements.  Until we have completed our research, you should contact your local hospital since they subscribe to the translation services and the hospital may be able to make a referral for use in your office, at the present time.  As soon as our research is completed, we will get back to you.

KFF Poll: 88% Said Medicare Should Be Able to Negotiate Drug Prices
An overwhelming majority of Americans favor government action to restrain prescription drug prices, according to a poll released by the Kaiser Family Foundation on September 29.

Eighty-two percent of those polled said they want Medicare to negotiate prices with the companies, which Congress does not allow. Seventy-eight percent favored limiting the amount companies can charge for high-cost drugs, such as those that fight cancer or hepatitis, according to the poll from the Kaiser Family Foundation. And more than two-thirds want to let Americans buy drugs imported from Canada. Support is strong no matter the political party. The poll found that while a majority of Americans still believed prescription drugs developed over the past two decades have improved lives, respect is dwindling. In 2008, 73 percent of Americans said the medicines had this positive effect, but that number dropped to 62 percent in August 2015.

The poll found that three-quarters of Americans considered drug costs unreasonable. Despite the perceived burden, the poll also discovered that 73 percent of people taking prescription medicines said it had been easy to afford their drugs. People in fair or poor health and those taking four or more drugs were more likely to say they were having trouble affording prescriptions than more healthy people.

Other ideas were less popular, including two restricting consumers. A minority of those polled favored eliminating prescription drug advertisements, which has been suggested to quell the aggressive marketing companies do directly to consumers. Only 4 in 10 Americans favored requiring people to pay more if they don’t choose the least expensive version of a drug to treat their illness.

The survey was conducted between Sept. 14 and 20 among 1,204 people, using both land lines and cell phones. The margin of error was +/- 3 percent.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


Reports Show 2017 Medicare Payment Adjustments
As reported in the September 29 AMA Advocacy Update, Medicare has made available two new reports with information on 2015 cost and quality data that indicate which physicians or practices will see related Medicare payment adjustments in 2017.

The 2015 Physician Quality Reporting System (PQRS) Feedback Reports and 2015 Annual Quality and Resource Use Reports (QRUR) were released on September 26, and CMS is mailing letters to physicians beginning September 26 if they will have a penalty.

The payment adjustments detailed in these reports are NOT the result of MACRA legislation passed by Congress in 2015.  They are associated with current federal statutory pay for performance programs that are being replaced in 2019 with the new MIPS system created under MACRA.

2015 PQRS penalty letters notify physicians and groups who are scheduled to receive a 2% penalty in 2017 based on 2015 PQRS reporting. The PQRS feedback report allows physicians to look up whether they will receive the 2% 2017 PQRS penalty, and contains detailed information on program year 2015 PQRS reporting results.

The 2015 Annual QRURs provide information on how practices performed on quality and cost measures used in the Value Modifier (VM) and whether their VM payment adjustment will be positive, negative or neutral and the specific amount. VM penalties can range from -1% to -4% depending on practice size and performance. Bonus payments depend on how much money is collected from penalties and to date the 2017 bonus size has not been publically announced by CMS.

Practices that believe there are errors in the report or calculation of the payment adjustment should file for an informal review by the end of November.

How to access the reports:

  • An Enterprise Identity Management (EIDM) account with the appropriate role is required for participants to obtain 2015 PQRS feedback reports and 2015 Annual QRURs.
  • If you already have an EIDM account, visit the CMS websiteto sign up for the appropriate EIDM role or contact QualityNet Help Desk to determine if someone in the practice already has that role.
  • To sign up for an EIDM account, visit the CMS Enterprise Portaland click “New User Registration” under “Login to CMS Secure Portal.”
  • For more information on viewing the reports, view the PQRS Analysis and Payment webpageand How to Obtain a QRUR webpage.

Information on the informal review process:

  • To request an informal review of a 2017 PQRS negative payment adjustment, view the “2015 Physician Quality Reporting System (PQRS): 2017 Negative Payment Adjustment – Informal Review Made Simple” guide on the PQRS Analysis and Payment webpage.
  • To request an informal review of the 2015 QRURs or the 2017 Value Modifier calculation, see the 2015 QRUR and 2017 Value Modifier webpage.

WCB Proposes a Drug Formulary for Injured Workers
The New York State Workers Compensation Board is inviting public comment on a Discussion Document available from its website that proposes the creation of a Workers Compensation pharmacy benefit plan.

In releasing the Discussion Document the Board noted: “The rapid pace of change in the pharmaceutical industry over the last few years has rendered the Board’s pharmacy benefit structure inadequate to address the overwhelming number of new medications that have been introduced to the medical community. The Board’s current pharmacy benefit describes reimbursement levels for brand, generic and compounded products, but otherwise provides little structure or guidance to prescribers. There is no drug formulary in place; no requirement for pre-approval/prior authorization; no process to ensure the appropriateness of prescribed medications.”

The deadline for receiving comments is November 14.  MSSNY will work with affected specialty societies and groups representing injured workers to review the document and will provide comments as necessary.

MSSNY-Home Care Workgroup Seeks to Reduce Administrative Burdens
As directed at this year’s House of Delegates, MSSNY has established a work group with the Home Care Association of New York State (HCA) to collaborate on efforts to address overbearing administrative burdens that stand in the way of patients receiving, and physicians ordering, needed home care services.  The first meeting of the group took place in September and another is scheduled for the end of October.

One of the most important issues under discussion is how best to reduce the burden of the so-called “Face to Face” requirement included in the ACA.  This provision requires a certifying physician to document that he or she, or a non-physician practitioner (NP or PA) working with the physician, has seen the patient, as a precondition of eligibility for Medicare and Medicaid coverage for home health services.  Many home care agencies and physicians have noted that the CMS regulations implementing this provision have created unnecessary and overly burdensome documentation requirements that are delaying or denying coverage for needed home care services.  One home care provider shared an example of a CMS review agent denying the patient’s coverage for services based on his assessment of the physician’s documentation, despite concurring that the patient met the requisite eligibility criteria and indeed needed the services.

On the federal level, New York Representatives Tom Reed (R-Southern Tier) and Paul Tonko (D-Capital District) initiated a sign on letter to CMS with over 70 other members of Congress to urge simplification of the Face to Face requirement.  Specifically, the letter noted that “the current regulations contain complicated, confusing, and overlapping documentation requirements that exceed the intent of the law passed by Congress. These requirements have imposed a significant burden on home health providers and physicians in our districts”.

On the state level, as the state has now moved (as of July 1) to implement Face-to-Face for Medicaid,  HCA and MSSNY, the Healthcare Association of New York State (HANYS) and the Iroquois Healthcare Alliance have met with the New York DOH to urge mitigation of such an added layer of burden for Medicaid.  These groups have also suggested areas where the Face to Face requirement could be eliminated entirely for Medicaid, such as within the context care delivered under managed care, or other “managed care-like” models, such as within a regional Performing Provider System (PPS) established under DSRIP, or an ACO, health home or other integrated model.

The work group has also discussed the importance of assuring physicians are properly educated regarding these federal requirements, including the importance of completing certification in a timely and comprehensive manner.

MSSNY Representatives for this work group include Dr. Evelyn Dooley-Seidman, Chair of MSSNY’s Long-Term Care Committee; MSSNY Board of Trustees Member Dr. Andrew Kleinman; Dr. Ruth Kleinman; Dr. Eugene Kalmut; and Dr. Jay Slotkin.

To view a brief CMS power point presentation regarding these Face to Face rules, go here.  To read a detailed FAQ document prepared by CMS, go here.

For more information about the activities of the Task Force, please contact mauster@mssny.org.

Most Children Who Contract Zika after Birth Only Fall Mildly Ill, Study Suggests
The New York Times (9/30) reported that a study published in The Lancet Infectious Diseases suggests that “serious complications are rare among children infected with the Zika virus after birth.” Researchers used data reported to the Centers for Disease Control and Prevention since 2015, including “about 160 teenagers and toddlers” aged 1 month to 17 years. In general, “these children got only mildly ill: 129 had a rash, C.D.C. researchers found, while half were feverish and a quarter had red eyes or joint pain.”

AMA: “CMS Listened about MACRA Reporting”
Recently, the AMA saw evidence that CMS has been listening to physician concerns, when CMS Acting Administrator Andrew Slavitt announced that physicians can choose among four options to avoid payment penalties in 2019. Medicine welcomed CMS’ decision to allow physicians to pick their own pace for the initial MACRA reporting period in 2017 as a positive step toward giving all physicians a fair opportunity to succeed.

Although details on MACRA implementation will not be available until the final rule is released later this fall, we have developed a number of resources to help physician practices begin to prepare for the transition to the new payment system:

  • MACRA website – Includes a checklist with steps practices can take now to prepare, an action kit and slideshow with information about what is in the proposed rule, an outline of advocacy efforts, a “Guide to physician-focused payment models,” and additional resources
  • AMA STEPS Forward® module, “Preparing your practice for value-based care – CME-accredited activity provides steps to take, answers to common questions and case vignettes
  • New podcast series “Inside Medicare’s new payment system” (available here) – Produced by ReachMD, these downloadable audio stories feature interviews with industry experts and physician leaders (including CMS’ Andy Slavitt, AMA President Andrew Gurman, MD, and the AMA’s Richard Deem and Michael Tutty)
  • AMA Wire® stories – Ongoing articles on the latest MACRA developments, how physicians are participating in new models of care, and more

The AMA will soon release a new web-based tool to help physicians understand which MACRA pathway is best for them and assess its impact on their practice. The AMA is planning regional seminars on MACRA, as well as webinars for physicians and “train the trainer” webinars.


RFP for Office of Temporary and Disability Assistance


REQUEST FOR PROPOSALS

The New York State Office of Temporary and Disability Assistance (OTDA), Division of Disability Determinations is issuing a Request for Proposal (RFP) to solicit proposals from qualified vendors for the establishment of one contract medical provider to establish a site in the upstate area of the Capital District, NY (including the cities of Albany, Schenectady, and Troy and the immediate geographic area) to perform medical examinations and ancillary testing of claimants applying for Social Security disability benefits. If your organization is capable of performing a high volume of medical examinations and diagnostic tests, the Capital District Consultative Examination RFP can be found on the OTDA website at https://otda.ny.gov/contracts/procurement-bid.asp.  If your organization wishes to receive a hard copy of the RFP, please send your request immediately by Certified Mail to:

Mr. Lawrence Rockefeller
NYS Office of Temporary and Disability Assistance
Division of Disability Determinations
One Commerce Plaza, 10th Floor
99 Washington Avenue
Albany, New York 12210

The RFP release date is September 14, 2016 with proposals due no later than November 2, 2016 at 3:00 p.m. EST.  If you have any questions, you may contact Melinda Kuiken at (518) 626-3042.


New Law Reduces Physician Reporting Burdens for Paper Prescriptions
As reported last week, Governor Cuomo has signed into law legislation (S.6779, Hannon)/A.9335,Gottfried) strongly supported and advocated for by MSSNY which eliminates the requirement for a physician to report a litany of information to the New York DOH when he/she must issue a paper prescription in lieu of an e-prescription.  Instead, the new law requires that the physician make a notation in the patient’s medical record that a paper/oral/fax prescription was issued in those circumstances, articulated in the statute, that are excepted from the general e-prescribing requirement.  These circumstances include:

  • Temporary technological or electrical failure;
  • When the prescription will be dispensed by a pharmacy located outside the state;
  • When the physician reasonably determines that an e-prescription would be impractical for the patient to obtain the medication in a timely manner, and such delay would adversely impact the patient’s medical condition.

MSSNY thanks the many physicians across New York who responded to our call to contact their legislators and the Governor to express their support for this legislation.  MSSNY worked closely with the Healthcare Association of New York State (HANYS) and numerous specialty societies to advocate for this important change to the law.

Upon learning that the bill was signed into law, MSSNY President, Malcolm Reid, MD issued the following statement. “We are pleased that Governor Cuomo has signed into law legislation to reduce the reporting burdens in those situations when a physician must issue a paper prescription.  We thank Senator Hannon and Assemblyman Gottfried for championing this legislation.  We look forward to working with the Governor and the Legislature to address other obstacles related to e-prescribing that interfere with patients timely receiving needed medications”.


Millennials Don’t Plan on Getting Flu Shot
 A survey conducted in September by Harris Poll on behalf of CityMD, an urgent-care-center network, found that 52 percent of millennials don’t plan on getting the flu shot during this year’s influenza season. Of those, 49 percent said they don’t trust that the vaccine will prevent them from getting the flu. An additional 29 percent worried that getting the shot will actually make them catch the virus. Citing recent studies, the CDC says the vaccine “reduces the risk of flu illness by about 50 percent to 60 percent.” Last season, 43.6 percent of Americans got the vaccine, according to CDC data.


CLASSIFIEDS



Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.


Well-Established Nassau County Internal Medicine Practice Available for Acquisition
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to surendralal1@yahoo.com


Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

Want to rent your medical office? Need to lease space to expand your practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

County Executive
The Suffolk County Medical Society, a 501C-6 corporation, recognized as the premier professional medical association for the physicians of Suffolk County, is seeking to fill the position of Executive Director.  Successful candidates will possess a Bachelor Degree, (Masters Degree preferred in a healthcare-related field and/or Business/Finance).  Should have minimum of five years experience in healthcare or association management .  Must possess the following abilities: have a thorough working knowledge of the health care industry;  serve as a strong physician and patient advocate; be able to successfully balance multiple demands; possess strong leadership skills with excellent oral and written communications.For more information and a complete job description, visit www.scms-sam.org.  Please forward a resume with a cover letter outlining how you meet the parameters of the position, including salary requirements, to stuscms@optonline.net.  Position scheduled to begin February, 2017.



A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777

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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 30, 2016 – Best of the Best Member Benefits

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
September 30, 2016
Volume 16, Number 34

MLMIC

Dear Colleagues:

MSSNY membership is not just about our hardworking Government Affairs Division. One of the many perks of being a MSSNY member is our Member Benefits program. The companies we have chosen are carefully vetted to enhance your practices and your lives. In addition to screening each firm for you, MSSNY monitors member satisfaction to ensure that you are receiving quality services.

I would like to highlight a few that might be of assistance to you and your practice:

  • MLMIC- Medical liability insurer that offers superior protection with at-cost rates at www.MLMIC.com or call 888-782-3821
  • Division of Socio-Economics Ombudsman Program- this program intervenes on behalf of the physician when an insurance claim is in dispute, is reduced or is denied. MSSNY staff has been often able to recoup payments or clarify policy to correct plan indiscretions. For information, call Regina McNally at 516-488-6100 ext. 332.
  • Athenahealth– MSSNY members receive a 6% discount on an integrated suite of practice management services. Our ONLY approved EHR and billing company can be reached at www.athenahealth.com or call 866.927.2843
  • Bank of America– cash reward credit cards at
    personalize.bankofamerica.com/mssny
  • DrFirst– e-prescribing solutions at a discounted price for members at www.DrFirst.com
  • Jerome Associates/Hilb Group-life insurance, long term care, primary healthcare for large and small employers, and disability insurance at http://www.eaijjj.com
  • Kern Augustine Law Firm– attorneys specializing in health law matters offer a free consult and reduced hourly rates for practice- or employment-related matters. Take advantage of a FREE coding and documentation review under attorney-client privilege – avert compliance violations AND correct undercoding mistakes that leave money on the table http://www.drlaw.com/
  • Liberty Mutual– Reduced insurance rates for auto and home exclusively for MSSNY physicians at www.libertymutual.com/mssny
  • Mercer– Data breach insurance and Workers’ Compensation, to cover a wide range of risks that you face as a physician with a practice. Call 800-626-9063 or visit www.MSSNYMemberInsurance.com
  • Merrill Lynch– Mortgage point discounts at http://www.merrillhomeloans.com/mlhl/pages/home.aspx?corpurl=mssny or email dennis.singh@ml.com
  • NYrx Card– for your patients, a discounted prescription card for you to distribute to patients that have no insurance; it also can be used when insurance companies will not pay for a specific drug.  Call Roseann Raia at 516-488-6100 ext 302 for cards to distribute to your patients.

This is just a sample of what MSSNY membership has to offer physicians.

If you have any ideas or suggestions for a member benefit that you think would enhance our current program, please contact Christina Southard at csouthard@mssny.org 516-488-6100 ext 355.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Governor Signs Bill to Reduce Reporting Burdens When A Physician Issues Paper Prescription
Governor Cuomo has signed legislation (S.6779, Hannon/A.9335,Gottfried) strongly supported by MSSNY which eliminates the requirement for a physician to report a litany of information to a DOH website when he/she issues a paper prescription.  Instead, effective immediately, the physician must make a notation in the patient’s medical record that a paper/oral/fax prescription was issued. Upon learning that the bill was signed into law, MSSNY President, Malcolm Reid, MD issued the following statement: “We are pleased that Governor Cuomo has signed into law legislation to reduce the reporting burdens in those situations when a physician must issue a paper prescription. We thank Senator Hannon and Assemblyman Gottfried for championing this legislation. We look forward to working with the Governor and the Legislature to address other obstacles related to e-prescribing that interfere with patients timely receiving needed medications.”

At the same time, the Governor vetoed two other bills also designed to address burdens associated with e-prescribing:

  • 9334/S.6778 – would have continued to permit oral prescriptions for nursing home residents.  The Governor’s veto message noted that a waiver had previously been granted to permit such oral prescriptions, and that this waiver will now be extended until October 31, 2017.
  • 9837/S.7334 – to permit sending of an e-prescription to a secure centralized site that can be downloaded by the pharmacy filling the prescription.  The Governor’s veto message noted that the bill would “create significant risk of data breaches and unauthorized access to confidential information”.  Instead, the Governor noted that he “is looking closely at a separate bill” (supported by MSSNY) that would permit a pharmacy to transfer an e-prescription to another pharmacy, which “would more directly and safely address the concern addressed by this bill”.

Healthcare Providers Required to Comply with “Non-Discrimination” Reporting Provisions by Mid-October
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which including most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.

To read a comprehensive summary prepared by Donald Moy, Esq. from the firm of MSSNY’s General Counsel, Kern Augustine P.C, to assist physicians with compliance, click here.

According to the AMA, the rule does not apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court.

Covered physicians must comply with the following requirements:

  • Submit an assurance of compliance form to OCR
  • Post a notice of nondiscrimination and taglines in multiple languages
  • Develop and implement a language access plan
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)

To help reduce burden and costs, the HHS Office of Civil Rights (OCR) has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rule, factsheets on key provisions and a list of frequently asked questions.


Patients Fill Out MOLST Forms Incorrectly, Often Countermanding Wishes
University at Buffalo researchers, writing in the Journal of the American Medical Directors Association, say that end-of-life forms are too often ambiguous. Patients often leave forms, which are supposed to specify their requests, blank and that means they will receive the most aggressive form of treatment. Sixty-nine percent of forms reviewed had at least one section left blank. Inconsistencies were found in patient wishes among a subset (14%) of patients, wherein their desire for “comfort measures only” seemed contradicted by a desire to be sent to the hospital, receive IV fluids, and/or receive antibiotics. The conclusion was that patients and proxies may believe that making choices and documenting some, but not all, of their wishes on the MOLST form is sufficient for directing their end-of-life care. The result of making some, but not all, choices may result in patients receiving undesired, extraordinary, or invasive care. http://bit.ly/2dB37Lk


NY Medicaid Statewide Patient Centered Medical Home Program Incentive Payment Program Policy: Update on Retroactive Incentive Payments
The New York State Medicaid Statewide Patient Centered Medical Home (PCMH) Incentive Payment Program provides financial incentives to primary care practices who achieve PCMH recognition from the National Committee for Quality Assurance (NCQA). Payments are given as either per-member-per-month (PMPM) capitation payments for Medicaid Managed Care (MMC) members or as an add-on payment for eligible claims billed for services provided to Medicaid Fee-For-Service (FFS) members. Rates for both PMPM payments and add-ons depend on a provider’s NCQA recognition standard and level. For more information on the current established rates, please see the November 2015 Medicaid Update.

During the first week of each month, the New York State Department of Health’s Office of Health Insurance Programs (OHIP) posts the most recent list of PCMH-recognized practices and their providers to the Health Commerce System (HCS). The list contains the most recent PCMH recognition information the Department has on file from NCQA at that time. MMC plans to  use this list to identify which practices and providers in their networks are eligible to receive the PCMH incentive payments and the rate they should receive.

Due to the monthly schedule of data transmissions from NCQA to the Department of Health and from the Department of Health to HCS, it takes approximately 60 to 90 days after recognition is awarded for health plans to be notified of a new or changed recognition status. This lag has historically caused a two to three month delay in practices receiving PCMH incentive payments.

Policy Change:

Effective January 1, 2017, all MMC plans will be required to pay incentives for the New York State Medicaid Statewide PCMH Incentive Payment Program as of the month of PCMH recognition. This ensures incentives will be paid for every month of PCMH eligibility to practices and their providers. This may require plans to process retroactive payments to recognized practices and providers in their network when affected by this initial lag of information. Regardless of the NCQA recognition effective date, payments due to practices must account for the entire first month of their recognition, and should not be prorated.

MMC plans are required to distribute PCMH incentive payments to practices at least bi-annually, and MMC plans are encouraged to process on a more frequent basis if possible. Providers with questions regarding the frequency of payment for individual plans should contact their MMC plan representatives directly.

Finally, to ensure accurate incentive payments from both MMC plans and FFS Medicaid, providers must supply NCQA with the full address of the site’s physical location, not a billing site address. The National Provider Identifier (NPI) for the group and the individual NPIs of practitioners working at the practice should be provided to NCQA to ensure payments are made accurately.

Questions regarding this policy change may be directed to pcmh@health.ny.gov. Questions regarding claim eligibility and/or billing guidance for Medicaid FFS claims should be directed to the eMedNY call center at 1-800-343-9000. For more information on how to achieve NCQA PCMH recognition, providers may contact NCQA at 1-888-275-7585 or visit the NCQA website at www.ncqa.org.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


New Fact Sheet Details Physician Efforts to Address Nation’s Opioid Epidemic
The AMA Task Force to Reduce Opioid Abuse has released the attached fact sheet that details the extensive efforts that physicians across the country have taken recently to reverse the nation’s opioid epidemic.  Specifically, the fact sheet notes the following:

.        Every state in the nation saw a reduction in opioid prescribing in 2015—an overall 10.6 percent decrease nationally.

·        State-based prescription drug monitoring programs (PDMPs) were checked nearly 85 million times in 2015—a 40 percent increase over 2014

·        From 2012 to 2016 there has been an 81 percent increase in physicians certified to treat substance use disorders—more than 33,000 across all 50 states.

While not noted specifically in the fact sheet, here in New York State there have been over 50 million searches to New York’s PDMP, with a resulting 90% decrease in so-called “doctor shopping” (patients who visit multiple doctors and pharmacies to get multiple prescriptions for controlled substances)

MSSNY is one of the 25 state medical and national specialty associations represented on this AMA Task Force.  MSSNY Assistant Treasurer Dr. Frank Dowling and MSSNY VP for Public Health Pat Clancy have made extensive efforts to support the work of this group.


Handwriting on Claims Submitted to Medicare
Beginning 10/1/2016, NGS will return to the provider any paper claim submitted with handwriting on the face of the claim that does not meet the criteria of being a signature field for Items 12, 13, or 31. You will receive a notice attached to the front of the claim when it is returned notating this as well. NGS continues to receive claims in which providers are inappropriately writing information on the claim by hand. Some claims are typed or computer generated, then revised with handwritten information prior to submission.

The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 26, Section 30, “Printing Standards and Print File Specifications Form CMS-1500” (596 KB) contains the printing specifications for the CMS-1500 claim form. These printing specifications do not provide instructions to submit handwritten claims.

The only fields on the CMS-1500 claim form that have space and allows for any type of handwriting for signatures of the beneficiary or provider are Items 12, 13, and 31. Other than the signatures, handwriting should not appear on any claim submitted to Medicare. Please refer to CMS IOM 100-04, Chapter 26, Section 30 (596 KB) to make sure you are completing paper claims correctly.


Correction
In last week’s Enews, it was incorrectly stated that MSSNY signed a letter along with the Pennsylvania Medical Society regarding “no confidence” in ABIM (American Board of Internal Medicine). The “no confidence” letter was referencing ABMS (American Board of Medical Specialties) NOT ABIM. Councilor Dr. Parag Mehta, who presented a comprehensive Power Point at the Council Meeting regarding ABMS, wrote to us about the error.

Physicians Foundation Results
The Physicians Foundation is pleased to reveal the results of its fifth Biennial Physician Survey. They received an overwhelming response with over 17,000 physicians providing a glimpse into their current practice environment and anticipated future of medicine.

The bottom line is that physicians are struggling to maintain morale levels, adapt to changing delivery and payment models, and to provide patients with reasonable access to care. While respondents agreed the most satisfying part of their job is the patient relationship, about two-thirds said third-party intrusions detract from the quality of care they can provide.

Even more striking, nearly half (49 percent) of survey respondents say they are either often or always feeling burnt out. This may lead to shifting practice patterns that could reduce the physician workforce by tens of thousands of full-time equivalents (FTEs).

For a deeper look at the findings, the entire report here.


Screening Colonoscopy Provides Little Benefit to Adults Aged 70–79
Screening colonoscopy appears to offer a modest benefit to adults aged 70–74 and little to no benefit to those aged 75–79, according to a study in the Annals of Internal Medicine. The U.S. Preventive Services Task Force recommends routine colorectal cancer screening for those aged 50–75, and screening on a case-by-case basis for those aged 76–85.

Researchers used Medicare data to follow a large group of older adults who hadn’t undergone colonoscopy in the 5 years before baseline. Among adults aged 70–74, the estimated 8-year risk for colorectal cancer was 2.19% among those who subsequently underwent screening colonoscopy, versus 2.62% among those who did not. Among those aged 75–79, this modest benefit was even smaller: 2.84% versus 2.97%.

Screening colonoscopy was associated with an excess 30-day risk for adverse events requiring hospitalization or an emergency department visit: 5.6 excess events per 1000 adults aged 70–74 and 10.3 per 1000 among those aged 75–79.

Annals of Internal Medicine article

Some Physicians Want to Make More House Calls
The New York Times (9/23) in its “Your Money” blog reported on the efforts of some physicians to revive house calls to care for the sick at home rather than in hospitals. The article points out that many practitioners work exclusively in hospitals, but also points out that house calls for Medicare patients increased from 1.5 million in 1995 to 2.6 million in 2014, according to the Centers for Medicare & Medicaid Services. The article also mentions the Independence at Home Act (S. 3130) http://bit.ly/2cR4SoN a bill with bipartisan support that “would expand a Medicare home care demonstration program.”


Elephant Tranquilizer Implicated in Recent Overdose Deaths
The Drug Enforcement Administration is blaming a spate of recent overdose deaths on carfentanil, a synthetic opioid that is roughly 100 times as potent as fentanyl. Just 2 mg of fentanyl can be fatal, while the lethal dose of carfentanil is unknown.

Carfentanil is estimated to be 5000 times as potent as heroin and 10,000 times as potent as morphine. A Schedule II substance, carfentanil is used to sedate large animals like elephants. It is often sold on the streets as heroin. Like with fentanyl, multiple doses of naloxone may be needed.

DEA news release https://www.dea.gov/divisions/hq/2016/hq092216.shtml


CLASSIFIEDS


Well-Established Nassau County Internal Medicine Practice Available for Acquisition
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to surendralal1@yahoo.com


Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

Office Space – 1185 Park Ave. (94th St.) Full-time
Ideal for busy medical subspecialty.  Exclusive use of consult, exam room. Stress test, echo available.  Beautiful décor.  Public transportation nearby.  Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.

Want to rent your medical office? Need to lease space to expand your practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.


A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice
Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777

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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 23, 2016 – Tell Gov Now: Remove E-Prescribing Hassles

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

September 23, 2016
Volume 16, Number 33

MLMIC

Dear Colleagues:

E-prescribing has become a fact of life. Over the last few years, most of us have accepted and adapted to issuing prescriptions electronically, except for those who have a waiver. However, we all know that there are times when circumstances beyond our control require exceptions to e-prescribing—and it’s time to reduce the hassles associated with those situations.

Legislation advanced by MSSNY to rectify E-Prescribing issues encountered by physicians passed both Houses in June—and has now been delivered to the Governor for his signature.

We need your help in urging the Governor to sign into law this recently passed legislation (A.9335, Gottfried/S.6779, Hannon).

The first bill, (S. 6779, Hannon/A.9335-B,Gottfried) would ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription in lieu of e-prescribing. Presently, the Bureau of Narcotic Enforcement (BNE) requires physicians to electronically submit to the department an onerous amount of information about the issuance of each and every paper prescription. The bill on the Governor’s desk affords a much better alternative by allowing physicians and other prescribers to make a notation in the patient’s chart indicating that they have invoked one of the three statutory exceptions. The letter urging the Governor to sign the bill can be accessed by clicking here.

The second bill (A.10448, Schimel/S. 7537, Martins) would authorize a pharmacy that does not have a particular medication in stock to transfer the prescription to another pharmacy. Currently, e-prescriptions cannot be transferred by one pharmacy to another, thereby requiring the patient to return to or call the prescriber’s office to ask that he/she transmit the e-prescription to another pharmacy. This creates unnecessary burdens on the patient and delays timely access to their medication. The letter urging the Governor to sign the bill can be accessed by clicking here.

The Governor needs to hear from all of us—the New York physicians who take care of our patients every day. Our focus should remain on the patients who depend on us—not on onerous hassles that take us away from patient care. Please take a minute and contact Governor Cuomo now.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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Physicians Must Post Nondiscrimination Statements by Oct. 19
Under new HHS rules implementing the ACA “Nondiscrimination” provision, covered entities (which includes most healthcare providers) must post and publish new mandatory nondiscrimination statements and taglines by October 16, 2016.

According to the AMA, the rule does NOT apply to physicians who participate only in Medicare Part B, though it does apply to physicians who participate in Federal or State Exchange plans, Medicaid or receive meaningful use incentive payments. Physicians should note that in addition to administrative enforcement mechanisms, such as loss of federal financial assistance, individuals are permitted to bring individual or class action violation claims directly against them in federal court. This new rule is the first federal civil rights law to broadly prohibit discrimination on the basis of sex in federally funded health programs. It also includes important protections for individuals with disabilities and enhances language assistance for people with limited English proficiency.

Covered physicians must comply with the following requirements:

  • Post a notice of nondiscrimination and taglines in the top 15 languages spoken by individuals with limited English proficiency
  • Develop and implement a language access plan
  • Designate a compliance coordinator and adopt grievance procedures (applicable to group practices with 15 or more employees)
  • Submit an assurance of compliance form to OCR

To assist with implementation, OCR has translated into 64 languages a sample notice and taglines for use by covered entities. In addition, OCR has published a summary of the rulefactsheets on key provisions and a list of frequently asked questions. 


New Report: New York Leads Nation in Medical Home Adoption
A new report from United Hospital Fund (UHF) titled The Growth of Medical Homes in New York State, 2014 to 2016 examines the continued growth of the medical home model in New York, breaking it out by region, degree of certification, and type of facility. New York State continues to lead the nation in adoption of the medical home model; a notable finding of the report is that much of the overall recent growth of medical homes is occurring in hospital clinics as they expand their primary care programs, the explicit goal of several state initiatives.

The report also explains the number of concurrent and competing medical home models, several of which are being supported by New York State initiatives. The proliferation of models has created some confusion among providers, and raises some logistical questions for the State as it continues to promote primary care: how to align the competing programs, how to encourage multipayer support, how to ensure that medical homes can still start up under value-based payment systems, and how to make sure small practices aren’t left behind in these efforts. 


MSSNY Makes Endorsements for the 2016 November Elections
At the September 15, 2016 meeting of the MSSNY Council, the following legislators/candidates were endorsed for election by the Medical Society of the State of New York.   Each has demonstrated themselves to be champions of issues to preserve the ability of patients to continue to receive needed and timely physician care. 

To see which candidates were endorsed by MSSNY, click here.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


AMA Releases Updated Competition in Health Insurance Report
The AMA released its 2016 Update to its Competition in Health Care Report this week that once again indicated the need for more competition in health insurance markets, and efforts to block the proposed mergers among four of the nation’s biggest health insurance companies.   To read the press release, click here.

MSSNY President Dr. Malcolm Reid recently presented testimony at a New York Department of Financial Services hearing expressing significant concerns about the impact to patient care if the Anthem-Cigna merger to be approved.  The Anthem-Cigna and Aetna-Humana proposed mergers have been challenged by the US Department of Justice.  New York Attorney General Eric Schneiderman joined the action by the DOJ in seeking to block the proposed Anthem-Cigna merger.

The AMA press release noted that, on an individual basis, the Anthem-Cigna proposed merger would diminish competition in 121 metropolitan areas located throughout the 14 states where Anthem is licensed to provide commercial coverage, including: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. The AMA press release also noted that the Aetna-Humana proposed merger would diminish competition in 57 metropolitan areas located throughout 15 states, including: Arizona, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Ohio, Tennessee, Texas, Utah, Wisconsin and West Virginia.

On an individual basis, the Anthem-Cigna merger would diminish competition in 121 metropolitan areas located throughout the 14 states where Anthem is licensed to provide commercial coverage, including: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Nine of these 14 states are working to block the Anthem-Cigna merger. States that have yet to take an antitrust position on the merger include: Indiana, Kentucky, Nevada, Ohio and Wisconsin.


Liquidator’s Adjudication of Policy Claims Against Health Republic Insurance
On September 15, 2016, the Supreme Court for the State of New York signed an order setting October 11, 2016 at 10:00 a.m. as the date and time for any interested parties or their attorneys to appear and show cause why an order approving certain procedures (the “Claims Adjudication Procedure”) for adjudicating claims for payment under Health Republic’s insurance policies should not be entered.

If you are a health care provider and have a Policy Claim against Health Republic, you should have submitted your Policy Claim in accordance with the deadlines and procedures set forth in the contract governing your provision of services to former members of Health Republic (your “Health Republic Contract”). If you already properly submitted a Policy Claim in accordance with the requirements of your Health Republic Contract, you do not need to re-submit it.

It is anticipated that EOBs will begin to be mailed to Providers and Members in the first quarter of 2017. If a Provider accepts the EOB, they are not required to take any further action. If a Provider disagrees with the EOB, they will have the opportunity to appeal any and all determinations set forth in the EOB through Health Republic’s website at www.healthrepublicny.org or by paper copy to the address indicated in the Claims Adjudication Procedure. The written appeal and supporting documentation must be submitted within 60 days of the date of mailing of the EOB. The Liquidator and her agents, utilizing the appropriate resources to investigate the appeal, will review each appeal and, within 60 days, either grant the appeal and issue a revised EOB or deny the appeal and provide the reasons for the denial.

If a Provider objects to the determination of the appeal, the Provider will have 30 days from the date the notice of denial is sent to file an objection to the denial of the appeal. PROVIDERS WHO WOULD LIKE TO RECEIVE A HARD COPY OF THE CLAIMS ADJUDICATION PROCEDURE SHOULD CONTACT THE GARDEN CITY GROUP VIA THE HEALTH REPUBLIC HOTLINE at (866) 680-0893. Requests for further information or questions may be directed to (866) 680-0893 or www.healthrepublicny.org.


 “When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly. 


YP/Resident Leadership Seminar Slated for Syracuse Oct 21-22
Following an exciting Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has now slated a Leadership program for upstate physicians in Syracuse from late afternoon Friday, Oct 21 through Saturday, Oct 22.

The program is scheduled for the Doubletree Inn at Syracuse Thruway exit 36. A renowned faculty from Brandeis and Harvard University will lead the program, which is focused on management techniques needed by physicians in an integrated health care environment.

Attendees at the April downstate Leadership Seminar gave the program rave reviews. The program is limited to 40 physician attendees aged 40 and under with all costs covered under a grant from The Physicians Foundation.  For further information, contact MESF Executive Director at Tom Donoghue tdonoghue@mssny.org. 


Pediatrics Group: “Time to Say ‘No’” to Codeine for Children
The American Academy of Pediatrics is urging clinicians and parents to stop giving codeine to children, citing risks for respiratory depression and death.

Highlights of the clinical report, published in Pediatrics, include:

  • Genetic variation in codeine metabolism can lead to excessive morphine levels in some children, and is a particular concern in those with sleep-disordered breathing. From 1965 to 2015, the FDA Adverse Event Reporting System recorded 64 children with severe respiratory depression and 24 deaths associated with use of codeine.
  • Despite warnings from the FDA and international groups, codeine continues to be used widely for pediatric pain and cough. In 2011, it was prescribed to more than 800,000 U.S. children younger than 11 years. Codeine is available in over-the counter cough medicines in 28 states.
  • Among the limited alternatives for pediatric analgesia, other opioids are not recommended due to similar safety concerns. Nonopioid options, chiefly nonsteroidal anti-inflammatory agents and acetaminophen, may be effective for mild-to-moderate pain.

Pediatrics online-first page

Full NEJM Journal Watch Pediatrics and Adolescent Medicine coverage of AAP clinical report


CLASSIFIEDS


Well-Established Nassau County Internal Medicine Practice Available for Acquisition
After serving the community for 34 years, this well-established internal medicine practice is available for acquisition. The practice is multi-specialty with significant volume of primary care patients. This office is located in Plainview on a major street with excellent visibility and accessibility, with ample parking. For more information please call (516)822-4706 or E-mail to surendralal1@yahoo.com


Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

Office Space – 1185 Park Ave. (94th St.) Full-time
Ideal for busy medical subspecialty.  Exclusive use of consult, exam room. Stress test, echo available.  Beautiful décor.  Public transportation nearby.  Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.

Want to rent your medical office? Need to lease space to expand your practice? Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice
Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777

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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 16, 2016 – What Is Really Discussed at Council?

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

September 16, 2016
Volume 16, Number 32

MLMIC

Dear Colleagues:

Yesterday, the Council meeting to plan for 2016-2017 activities met in Westbury. The six meetings we convene in a year’s time are usually quite lively in spite of the fact we always have an ambitious agenda. Yesterday’s was 127 pages.

The following items were deliberated and voted upon:

  • Council voted to sign-on to the Pennsylvania Medical Society MOC letter making the official declaration of No Confidence in the ABIM. The voting was preceded by an informative presentation by Dr. Parag Mehta outlining the case against the necessity of MOC requirements and highlighting the growing protest over the MOC process.
  • Council approved the following resolution as amended: Whereas CMS is permitting a process of “seamless conversion” wherein seniors are transitioned from traditional MCR insurance products into Medicare Advantage options with seniors having little understanding of the implications, MSSNY will prepare a simple, easy to read modifiable model letter for physician members to provide their Medicare enrollees this month as well as a poster for physicians to post. Additionally, MSSNY will work with appropriate stakeholders to collaborate with senior groups to raise awareness among physicians and seniors on the implications of the practice of seamless conversion and will work with appropriate stakeholders to advocate with legislators and CMS to implement an immediate moratorium on the practice of seamless conversion. MSSNY will bring the resolution to the AMA.
  • Council approved an in-person, rather than a virtual meeting, for the January 2017 Council meeting.
  • Council approved the Congressional, State Senate and State Assembly candidates for MSSNYPAC endorsement http://bit.ly/2cPkoUb
  • The 2017 House of Delegates will be held April 21-23 at the Westchester Marriot in Tarrytown. Speaker of the House Dr. Geraci-Ciardullo announced the Resolution deadlines for the 2017 House of Delegates: February 17, 2017 and March 17, 2017 (final deadline).

Your Councilors make a concerted effort to attend these meetings on their own time and take their posts very seriously. Your interests as a practicing physician are utmost in their minds when issues come up for discussion. You can read your county report that was submitted on behalf of your geographic area. You might want to call your Councilor to discuss your issues and concerns about your practice. You might even want to thank your Councilor for their service to your county and the personal time spent on our pressing issues. They are:

  1. Kings/Richmond Report– Parag H. Mehta, MD
  2. Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
  3.  Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
    (no written report submitted)
  5. Suffolk County Report – Maria A. Basile, MD, MBA
  6. Third District Branch Report – Brian P. Murray, MD
  7. Fourth District Branch Report – John J. Kennedy, MD
  8.  Fifth District Branch Report –Howard H. Huang, MD
  9. Sixth District Branch Report – Robert A. Hesson, MD
  10.  Seventh District Branch Report – Mark J. Adams, MD
  11. Eighth District Branch Report – Edward Kelly Bartels, MD
    (no written report submitted)
  12. Ninth District Branch Report – Thomas T. Lee, MD
  13.  Medical Student Section Report –Christina Kratschmer
  14.  Organized Medical Staff Section Report –Richard A. Ritter, MD (no written report submitted)
  15. Resident & Fellow Section Report – Robert A. Viviano, DO
  16. Young Physician Section Report – L. Carlos Zapata, MD(no written report submitted)
  17. Resident & Fellow Section Report– Robert A. Viviano, DO16.
  18. Young Physician Section Report – L. Carlos Zapata, MD (no written report submitted) 

We are all working hard for you and your practice.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


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MSSNY Makes Endorsements For The November Elections
At the September 15, 2016 meeting of the MSSNY Council, the following legislators/candidates were endorsed for election by the Medical Society of the State of New York.   Each has demonstrated themselves to be champions of issues to preserve the ability of patients to continue to receive needed and timely physician care. 

NEW YORK STATE ASSEMBLY

  • Kevin Cahill (D, 103rdAD – Dutchess and Ulster counties)
  • Michael Cusick (D, 63rd AD- Richmond County)
  • Deborah Glick (D, 66th AD, NY County)
  • Richard Gottfried (D, 75th AD, NY County)
  • Charles Lavine (D, 13th AD, Nassau County)
  • Joseph Morelle (D, 136thAD, Monroe County
  • Robin Schimminger (D, 140th AD, Erie and Niagara counties)

NEW YORK STATE SENATE

  • Tom Croci (R, 3rdSD, Suffolk County
  • Kemp Hannon (R, 6th SD, Nassau County)
  • Robert Ortt (R, 62ndSD, Monroe, Niagara and Orleans Counties)
  • Michael Ranzenhofer (61stSD, Erie, Genesee and Monroe Counties)
  • James Seward (51stSD, Cayuga, Chenango, Cortland, Delaware, Herkimer, Otsego, Schoharie, Tompkins and Ulster counties)
  • James Tedisco (Candidate For 49thSD, Fulton, Hamilton, Herkimer, Saratoga and Schenectady Counties)
  • Catherine Young (57thSD, Allegany, Cattaraugus, Chautauqua and Livingston Counties)

US CONGRESS

  • Chris Collins (R, 27thCD – Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans and Wyoming Counties)
  • Joseph Crowley (D, 14thCD – Bronx and Queens counties)
  • Elise Stefanik (R, 21stCD – Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, St. Lawrence, Saratoga, Warren and Washington counties)
  • Paul Tonko (D, 20thCD – Albany, Montgomery, Rensselaer, Saratoga, and Schenectady counties)  

NEW YORK STATE ASSEMBLY

Assembly Member Kevin Cahill 103rd AD (Ulster and Dutchess counties)  Chairs the Assembly Insurance Committee, and a member of the Health, Higher Education and Ways & Means Committee. Assemblyman Cahill works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.  This past legislative session, he led efforts to assure that the Assembly rejected cuts to the Excess Medical Malpractice program proposed in the Executive Budget, which preserved coverage for 13,000 physicians across New York who otherwise would have been dropped from the program.  He also was a forceful vocal opponent to legislation rejected by the Assembly proposed in the State Budget and on a “stand-alone” basis that would have permitted corporate-owned retail clinics.  Moreover, as Chair of the Assembly Insurance Committee, he was integral in helping to shape legislation supported by MSSNY and passed by the Legislature that provides physicians with a mechanism to override a health insurer step therapy medication protocol.  He is also one of the principal co-sponsors of legislation to permit physicians to collectively negotiate with health insurers.

Assembly Member Michael Cusick 63rd AD (Richmond County) Sits on the Assembly Higher Education and Ways & Means Committees. Assemblyman Cusick works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.   He was chief sponsor of legislation that passed the Legislature to hasten the time for insurers to complete review of applications for physicians to participate in the insurer’s network.  Despite his sponsorship of the I-STOP legislation, hHis efforts were critical in helping to greatly improve the final version bill of the I-STOP bill over earlier versions, including working to assure a physician could delegate the “duty to consult” to staff.  He also was very helpful in efforts to help shape legislation so as to reduce the hassles to physicians associated with required CME for pain management, and limitations on specific opioid medications. In 2015-16, he supported a number of bills of importance to MSSNY in floor votes, including legislation to require health insurers to use similarly trained physicians before denying patient care, and legislation to assure due process protection for physicians when health plans do not renew physician participation contracts with them.   He is also a co-sponsor of legislation to permit physicians to collectively negotiate with health insurers.

Assembly Member Deborah J. Glick (D) 66th AD New York County) Assemblywoman Glick chairs the Assembly’s Higher Education Committee.   She has been tenacious in opposing legislation to permit corporate owned “retail clinics” and has been a strong advocate in opposition to CME mandates.    She has been a fierce opponent to inappropriate scope of practice expansion bills, including those that the Senate had passed in recent years such as the podiatric, athletic trainer and a bill to allow chiropractors to co-own medical practice in contravention of the corporate practice of medicine doctrine.  She and her staff have an outstanding working relationship with MSSNY.

Assembly Member Richard Gottfried 75th AD (New York County). Chairs Assembly Health Committee and sits on the Assembly Higher Education Committee. In that capacity, Assemblyman Gottfried has introduced and secured passage of legislation to protect physician and patient concerns with e-prescribing.  He also the long time sponsor of numerous MSSNY priority bills, including legislation to provide peer review confidentiality protections and to permit physician collective negotiations. He also opposed changes to the Excess Medical Liability Insurance program. He works closely with MSSNY staff and has a good record of taking action consistent with MSSNY’s positions.

Assembly Member Chuck Lavine 13th AD (Nassau County). Sits on the Assembly Codes, Health, Higher Education, Insurance, and Judiciary Committees. Assemblyman Lavine works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.  In 2015-16, he sponsored multiple bills to address concerns raised by physicians, including legislation (which passed the Assembly) to assure due process protection for physicians when health plans do not renew physician participation contracts with them, and legislation that would prohibit health insurers from using extrapolation when they audit physicians (which also passed the Assembly). In 2015-16, he supported a number of bills of importance to MSSNY in committee and floor votes, including legislation to permit physicians to collectively negotiate with health insurers (he is a co-sponsor), and legislation to require health insurers to use similarly trained physicians before denying patient care.  He also voted against multiple bills opposed by MSSNY, including stand-alone legislation to require physicians to take pain management CME and legislation that would have imposed a 5-day limit on medications to treat acute pain.

Assembly Majority Leader Joseph Morelle 136th AD (Monroe County). Assembly Majority Leader. Assemblyman Morelle was instrumental in efforts to delay passage of an overbroad pain management CME mandate and helped to assure that the final opioid legislation enacted addressed many concerns raised by physicians.  He was also helpful in efforts to prevent passage of legislation to permit corporate owned retail clinics. He is also opposed to most scope of practice changes and supports legislation to provide additional protections for physicians and patients to prevent insurers from denying or delaying necessary medical care. He opposed proposed changes to the Excess program and opposed changes to the workers compensation program that would have added certain non-physician providers to provide care to injured workers and a proposal to eliminate the county medical society role in review of applications to the workers’ compensation program.

Assembly Member Robin Schimminger 140th AD (Erie and Niagara counties) Sits on the Assembly Health, Codes and Ways and Means Committees.  Assemblyman Schimminger works closely with MSSNY staff and has a strong record of taking action consistent with MSSNY’s positions.    He is the long-time sponsor of the Medical Liability Reform Act, legislation which contains a number of provisions to address the high cost of medical liability insurance, including:

  • A cap on non-economic damages
  • Reducing joint and several liability
  • Identification of expert witnesses in medical liability cases
  • Identification of physician providing certification for Certificate of Merit

Assemblyman Schimminger also sponsored legislation to prohibit hospitals from requiring board certification as a condition of staff privileges, and health insurers from requiring board certification as a condition of participation. In 2015-2016, he supported a number of bills of importance to MSSNY in committee and floor votes, including the Collective Negotiation legislation, and legislation to assure due process protection for physicians when health plans do not renew physician participation contracts with them.   He also voted in opposition to a number of bills also opposed by MSSNY, including legislation to extend the medical liability statute of limitations, legislation to require physicians to complete CME for pain management, and legislation that would have imposed a 5-day limit on medications to treat acute pain

NEW YORK STATE SENATE

Senator Tom Croci (R) 3rd SD (Suffolk County). Chairs Senate Ethics, Veterans and Homeland Security & Military Affairs. In his capacity as chairman of the Senate Veterans Committee, Senator Croci worked with the Committee on Mental Hygiene to secure for MSSNY, NYSPA and NASW a grant to assist in the development and presentation of continuing medical education programming on the diagnosis and treatment of PTSD and TBI in returning veterans.

Senator Kemp Hannon (R) 6th SD (Nassau County). Chairs Senate Health Committee. Senator Hannon has, at the request of MSSNY, carried and successfully passed a number of bills including three bills to address issues with e-prescribing, standard prior authorization request forms, physician collective negotiation (2011) and has introduced medical liability reform legislation including a cap on noneconomic loss and peer review confidentiality legislation while advocating within his conference on behalf of MSSNY against the date of discovery bill.

Senator Robert Ortt (R) 62nd SD (Monroe, Niagara, Orleans Counties). Chairs Senate Mental Hygiene & Developmental Disabilities Committee. In his capacity as chair of the Mental Hygiene Committee, Senator Ortt, worked with the Committee on Veterans to secure for MSSNY, NYSPA and NASW a grant to assist in the development and presentation of continuing medical education programs on the diagnosis and treatment of PTSD and TBI in returning veterans.

Senator Michael Ranzenhofer (R) 61st SD (Erie, Genesee, Monroe Counties), is the Deputy Majority Leader for Economic Development and Chairs the Corporations, Authorities & Commissions Committee, and is a member of the Senate Finance Committee.  During the Senate caucus on the Date of Discovery Statute of Limitations bill in the final hours of session, Senator Ranzenhofer is reported to have stridently argued against the bill thereby aiding in its defeat.

Senator James Seward (R) 51st SD (Cayuga, Chenango, Cortland, Delaware, Herkimer, Otsego, Schoharie, Tompkins and Ulster counties), is the Chair of the Senate Insurance Committee, and member of the very powerful Senate Finance, Health and Rules Committees.  Senator Seward has long been a champion of medical liability reform and staunch opponent of liability expansion legislation.   He has also been a regular participant at MSSNY’s Annual Albany Physician Advocacy Day.  This year, as Chair of the Senate Insurance Committee, he was integral in helping to shape legislation supported by MSSNY and passed by the Legislature that provides physicians with a mechanism to override a health insurer step therapy medication protocol.

Jim Tedisco (R) Running to fill vacant 49th SD (Fulton, Hamilton, Herkimer, Saratoga and Schenectady Counties). Assemblyman Tedisco has represented voters in Schenectady and Saratoga Counties since 1982. He is very well known in his District and has been a long-time friend of medicine. He served as Minority Leader of the Assembly from 2005 to 2009. He has had a long and very good working relationship with MSSNY DGA staff and MSSNY physicians. He supported the step therapy override bill and legislation that would eliminate the requirement for physicians to report to the State each time they write a prescription in lieu of an e-prescription.

Senator Catherine Young (R) 57th SD (Allegany, Cattaraugus, Chautauqua, and Livingston Counties). Senator Young chairs the Finance Committee, as well as the Senate Republican Campaign Committee. As Chair of the Senate Finance Committee, working with the Chair of the Senate Health Committee, Senator Young steadfastly opposed the Governor’s proposal to reduce funding of the Excess program substantially reducing the number of physicians eligible for such coverage, opposed the retail clinic proposal and opposed the workers compensation proposal to add certain non-physician providers to provide care to injured workers and a proposal to eliminate the county medical society role in review of applications to the workers’ compensation program. She also sponsored legislation that would empower physicians to override step therapy protocols to assure that their patients have timely access to medically necessary medication.

US CONGRESS

Representative Chris Collins (R) CD 27 (Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Wyoming) Representative Chris Collins is running for his 3rd term.  He serves on the very powerful House Energy & Commerce Health Subcommittee. Representative Collins and his staff work closely with local physicians and MSSNY staff, and he has a strong record of advocating for policies consistent with the concerns of physicians and patients.  He is a co-sponsor of the Fair Medical Audits Act of 2015 which would restore some fairness in the conducting of audits by Medicare Recovery Audit Contractors.  He also signed unto a letter to CMS that expressed strong opposition with a CMS proposal that would significantly cut the payments to physicians for medications administered to patient under Medicare Part B.  Moreover, at a Congressional hearing last December, he aggressively questioned CMS Acting Administrator Slavitt regarding CMS response to the collapse of Health Republic and its impact on local physicians.

Representative Joe Crowley (D) 14th CD (Bronx and Queens Counties) Congressman Crowley is running for his 10th term. He serves on the very powerful House Ways & Means committee, which has jurisdiction over much of the health care policy considered by Congress. Representative Crowley and his staff work closely with local physicians and MSSNY staff, and he has a strong record of advocating for policies consistent with the concerns of physicians and patients. He is lead sponsor of legislation that would significantly increase the number of residency slots to address doctor shortages in New York and across the country. He was also very vocal in support of efforts that ultimately led to a repeal of the flawed Medicare Sustainable Growth Rate formula, including leading a bi-partisan effort to use the Overseas Contingency Operations (OCO) funds to pay for its repeal.  Moreover, he recently signed unto a letter to CMS that expressed strong concerns with a CMS proposal that would significantly cut the payments to physicians for medications administered to patient under Medicare Part B. 

Representative Paul D. Tonko (D) CD 20 (Albany, Schenectady and parts of Montgomery, Rensselaer and Saratoga Counties) He is serving his fourth term, and is one of New Yorkers on the very powerful House Energy and Commerce Committee – one of the Committees with health care jurisdiction.  Congressman Tonko served for over 20 years in NYS Assembly prior to running for Congress, and was the sponsor of the Mental Health Parity bill.    He has carried his advocacy for mental health parity to Congress.  He has also been a strong advocate to expand opioid treatment capacity for community caregivers – legislation that in May, passed the U.S. House of Representatives. Congressman Tonko is the vice co-chair of the Congressional Addiction, Treatment and Recovery Caucus.  He has an excellent working relationship with local physicians and with MSSNY staff.

Representative Elise Stefanik (R) 21st SD (Clinton, Essex, Franklin, Fulton, Hamilton, Herkimer, Jefferson, Lewis, St. Lawrence, Saratoga, Warren, Washington). Running for second term, the Congresswoman serves on the House Armed Services Committee and the Committee on Education and the Workforce.   She authored the Be Open Act – legislation that was signed into law by the President to fix a flaw in ObamaCare by repealing the auto-enrollment mandate that reduces choices in health coverage and has created confusion that can lead to significant tax penalties on both the employer and employee. She also signed onto a House Republican Delegation letter to CMS in opposition to a Medicare Demonstration program that would significantly impair seniors’ access to care by reducing physician reimbursement for injectable medications.   She has worked closely with many local physicians, including several MSSNY leaders.

Urge Governor Cuomo To Sign Step Therapy Override Bill
All physicians are urged to send a letter to Governor Cuomo requesting that he sign into law a bill (A.2834-D/S.3419-C) that would establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health.

The bill has not as of yet been delivered to the Governor.

MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations, specialty societies, hospitals, and pharmaceutical manufacturers to achieve passage of this legislation.      We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

Over the summer, MSSNY representatives and several other patient advocacy groups met with the Governor’s office to urge that this bill be signed into law.  Moreover, in Augusts, dozens of patient advocates rallied at the State Capitol in support of this bill.

The bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

Gov. Signs Laws to Improve Voluntary Organ Donation
New York State has the third highest need for donors – with 10,000 residents currently waiting for organ transplants – but the lowest number of registered donors. Governor Cuomo has now signed three laws that will help improve voluntary organ donation in New York.

  • Lauren’s Law, which requires individuals who apply for a New York State Driver’s License to affirmatively decide whether or not to participate in the state’s organ donor registry, was extended for four years.
  • The Organ Donor Registration Opportunity/Health Benefit Exchange law requires applications for insurance coverage through the State’s Health Benefit Exchange to include an opportunity for individuals to participate in New York’s Donate Life Registry.
  • Another new law lowers the minimum age for organ donation designation to 16 years old. The law, taking effect February 14, 2017, allows individuals age 16 and older to enroll in the New York State Donate for Life Registry and to consent to making lifesaving organ and tissue donations. The vast majority of other states have this law. 


Empire Bluecross/Blueshield to Participate in CMS Multi-Payer Initiative
Empire BlueCross BlueShield has been selected to participate in the Centers for Medicare and Medicaid Services’ Comprehensive Primary Care Plus program, a five-year multi-payer model.

The program, according to CMS, is designed to bolster primary care through regionally-based multi-payer payment reform by bringing different payers, like CMS, commercial insurance plans and state Medicaid agencies, together to make changes to health care delivery.

CPC+ will have two primary care tracks with “incremental advanced care delivery requirements” and payment options, in the hopes each will have better infrastructure to deliver care to patients, according to CMS. Practices will be centered on certain functions, like access and continuity, care management, comprehensiveness and coordination, patient and caregiver engagement and planned care and population health, according to CMS.

Providers that want to participate in CPC+ need to apply through CMS and will be announced later this year.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


NYSDOH Offering “A September 2016 Series of Zika Virus Webinars”

  • Zika Virus: An Update for Obstetric and Neonatal Providers and the Birth Facility Team
    When: Tuesday, September 20, 12 – 1 p.m.
    Speakers: Lou Smith, MD, MPH, Medical Director, Bureau of Communicable Disease                       

Control

  • Zika Virus: An Update for the NYS Healthcare Provider             When: Wednesday, September 21, 12 – 1 p.m.
    Speakers:
    P. Bryon Backenson, MPH, Director of Vector-Borne Diseases and   Elizabeth Dufort, MD, FAAP, Medical Director, Division of Epidemiology, NYSDOH
  • Zika Virus: An Update on Transplant Associated Concerns             When: Thursday, September 22, 12 – 1 p.m.
     Host: NYSDOH and the NYS Transplant Council
    Speakers: Kirsten St. George, MAppSc, PhD, Chief Viral Diseases, Wadsworth Center,                                                                        NYSDOH; Lewis Teperman, MD, FACS, Vice Chair of Surgery & Director of Organ Transplantation at Northwell Health, Manhasset NY and Region 9 Councillor to the United Network for Organ Sharing (UNOS); Marian Michaels, MD, MPH, Professor of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Disease Transmission Advisory Committee (DTAC) Vice Chair, United Network for Organ Sharing (UNOS)
  • Zika Virus: An Update for the Pediatric Provider
    When: Wednesday, September 28th 2016, 12 – 1 p.m.

Please click here for more information and to register.

UnitedHealthcare Physician Advocacy Council: Any Questions to Ask Them?
As part of the last legal settlement with United that was concluded in 2015, United agreed to the formation of a Committee referred to as the PAC – Physician’s Advisory Council.  The Medical Society of the State of New York has 4 physician members who are on the UHC PAC.  The Committee meets 4 times a year with similarly named physicians from United.  One criteria for being on this group is that the physician must be participating with United.

The Committee is charged with addressing any issue of contention, either operational or administrative, that might be encountered in dealing with United. While issues are discussed at length, the agreement stipulates that UHC is there to listen and report back to the UHC leadership on items discussed.  United does not present new policy matters to the PAC.  However, the group could discuss United policy issues that cause concern and these concerns would then be taken back the leadership for their thoughts and/or action.  The spirit of the settlement agreement is that MSSNY could share subject matters at a high level to garner a better relationship with UHC.

In this spirit, MSSNY is asking members if they have specific issues with United that we can address and advocate for your behalf.  If you have a concern, please send an email to Regina McNally, VP, Socio-Medical Economics.  Please state the subject as UHC PAC Item and send your email to rmcnally@mssny.org  MSSNY email is not HIPAA-secure, so please do NOT include any PHI!

Many Seniors Wrongly Denied Medicare Coverage
The New York Times (9/13,) reports that beneficiaries are often told Medicare will no longer cover physical therapy or nursing home stays because they are “stable and chronic,” or have reached “maximum functional capacity,” or they have plateaued.

Seniors “with chronic and progressive diseases – dementia, Parkinson’s, heart failure” – are typically given this incorrect assessment, even though a 2013 settlement of a class-action suit mandated that Medicare “cover skilled care and therapy when they are ‘necessary to maintain the patient’s current condition or prevent or slow further deterioration.’”

In addition, last month, a Federal judge ordered CMS “to do a better job of informing health care providers and Medicare adjudicators that the so-called improvement standard was no longer in effect.” The judge said that while CMS does not have to further update its manuals, it must do a better job of educating the medical community about these changes. 

YP/Resident Leadership Seminar Slated for Syracuse Oct 21-22
Following an exciting Leadership Seminar for downstate physicians in April, MSSNY’s Medical Educational and Scientific Foundation (MESF) has now slated a Leadership program for upstate physicians in Syracuse from late afternoon Friday, Oct 21 through Saturday, Oct 22.

The program is scheduled for the Doubletree Inn at Syracuse Thruway exit 36. A renowned faculty from Brandeis and Harvard University will lead the program, which is focused on management techniques needed by physicians in an integrated health care environment.

Attendees at the April downstate Leadership Seminar gave the program rave reviews. The program is limited to 40 physician attendees aged 40 and under with all costs covered under a grant from The Physicians Foundation.  For further information, contact MESF Executive Director at Tom Donoghue tdonoghue@mssny.org. 

“When Is the Flu Not the Flu?” CME Webinar on Nov. 16; Registration Now Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 at 7:30 a.m.   William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.

22% of Generic Drugs Billed to Part D Had 100% Increase between 2010-2015
About 22 percent of generic drugs billed to Medicare Part D had at least one price increase of 100 percent or more between 2010 and 2015, states a new GAO report titled, “Generic Drugs Under Medicare Part D Generic Drug Prices Declined Overall, but Some Had Extraordinary Price Increases.”  http://www.gao.gov/assets/680/679022.pdf

Exercise in Self-Assessment of Your Orthopaedic Knowledge: Preparation for MOC
The 2016 Annual New York State Society of Orthopaedic Surgeons Symposium will take place on Saturday, September 24, 2016 from 7:00am – 4:30pm at the NYU Langone Medical Center – Hospital for Joint Diseases in the Loeb Auditorium (301 East 17th Street, NY NY 10003).

NYSSOS is committed to designing programs that help orthopaedists achieve and comply with educational requirements. This one-day event features presentations on topics including sports, pediatrics, trauma, adult reconstruction, spine, geriatrics, metabolic bone disease, upper extremity, foot & ankle and hand surgery.

Participants who purchase and pass the AAOS OKU 11 exam will receive up to 20 SAE credits. Participants who review the AAOS OKU 11 educational material and complete and pass the AAOS OKU 11 exam will be eligible to receive up to 70 CME credits. AAOS OKU 11 products will be available for purchase at the time of registration.  Pre-registration is required to attend.

Residents and Fellows are encouraged to attend. Three discounted registration packages are available. Register Online or download the Brochure. 

 “Light the Path” Walk at LI’s Sunken Meadow State on October 6
The Long Island Health Collaborative is hosting a “Light the Path” walk for Behavorial Health Awareness on Thursday, October 6 at 4:00PM at Sunken Meadow State Park, Rte. 25A and Sunken Meadow Parkway, Kings Park, NY 11754. Parking is available in Field 2. Register to receive updates here. For questions or more information visit www.LIHealthCollab.org


CLASSIFIEDS



Considering Outsourcing Your Billing?
Elite Medical Revenue Solutions, LLC specializes in Practice Management.  We can quickly solve your insurance billing problems by filing and following up on your claims and billing. We provide some of the most innovative and powerful solutions in the market today: online, and in real-time. Our CMS provides you with control and gives you and your staff complete access from any computer with Internet access. Services include: Practice Management, Claims Filing & Follow-up, Electronic Health Records (EHR), Online Patient Payment Portal & Collections, Certified Coding Services & Audit Prevention, Paperless Document Filing, HIPPA Compliance Documentation. Call us today at 888 334-6585 or visit us at www.elitemedsolutions.net
emrs

Office Space – 1185 Park Ave. (94th St.) Full-time
Ideal for busy medical subspecialty.  Exclusive use of consult, exam room. Stress test, echo available.  Beautiful décor.  Public transportation nearby.  Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.

Want to rent your medical office? Need to lease space to expand your practice? Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).

If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.



Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice
Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777

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

 

 

 

 

 

 

 

 

 

 

 

 

 

September 9, 2016 – Reject Anthem-Cigna Merger

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
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September 9, 2016
Volume 16, Number 31

MLMIC

Dear Colleagues:

The following is a summary of my testimony at the Department of Financial Services hearing yesterday strongly opposing the proposed Anthem-Cigna merger:

On behalf of our over 20,000 members, I thank you for the opportunity to present our concerns regarding the impact to patient care if Anthem, the parent of Empire Blue Cross/Blue Shield, is permitted to acquire Cigna. The recent litigation initiated by the US Department of Justice to block this proposed merger as well the proposed Aetna-Humana merger validated the very serious concerns held by many physician and patient advocacy groups in New York State and across the country.   Specifically, the DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country were “unprecedented in their scale and in their scope.”

Greatest Impact on Smaller Practices

We agree that this proposed merger could have serious adverse implications for care delivery, with the greatest adverse impact upon smaller physician practices, which are already reeling from the profound changes arising from policy advanced from both the federal and state governments.  Indeed, these concerns regarding insurer market concentration have been made by physicians and physician advocacy groups for years as many insurers have merged or have been purchased, or converted to for-profit status.  More specifically, this concern was expressed by many of our physician members when we sought their feedback on this proposed merger of these two insurance giants.  Many physicians already feel powerless to negotiate for fairer treatment by existing insurance behemoths, and believe that this merger will exacerbate an already extremely difficult practice environment. Many feel they have no choice but to become employees of large systems, which can cause disruptions to existing physician-patient relationships.

Based upon information reported by the American Medical Association within its 2015 Competition in Health Insurance report, this proposed merger would substantially increase the market share of the combined entity in several New York State regions. We believe this would have a serious detrimental impact on patient access to care, as Empire has a mixed record in assuring patients can receive the care they need based upon DFS’ own 2015 Guide to Health Insurers.

Based upon data contained in the AMA’s 2015 Competition report, if Anthem were to purchase Cigna, the market share for Empire could:

  • increase from 17% to 27% in the Lower Hudson Valley and New York City;
  • increase from 21% to 27% in Long Island; and
  • increase from 20% to 26% in the mid-Hudson Valley.

Another AMA report, written specifically to assess the market impact of this proposed merger across the country, notes that the resulting Anthem-Cigna entity “would be presumed to likely enhance the market power” of the combined entity in Long Island, and “raises significant competitive concerns” and “warrants scrutiny” for the combined entity in New York City and the Hudson Valley.  The report makes these determinations using the Horizontal Merger Guidelines developed by the U.S. Department of Justice and Federal Trade Commission.

Merger Would Increase Anthem’s Market Share Considerably 

Additionally, the DFS Superintendent’s letter highlighted the impact of this takeover on the large employer health insurance market. She noted that it would increase Anthem’s market share across commercial products to 31.2% statewide, of which Anthem would command nearly 10% of New York’s fully insured market and nearly 50% of the self-insured market.  The biggest impact would be felt in the New York City metro area, where Anthem would control nearly 70% percent of the commercial self-insured market in the Bronx and Staten Island, 63% in Queens and Brooklyn, and 55% in Putnam County. United, which purchased Oxford, and Emblem, which formed from the merger of HIP and GHI, have been publicly reported in the last few years to have drastically reduced their physician networks, reducing patient access for many.

Moreover, it is important to note that, according to DFS’ public data, Empire has at best a mixed record with regard to addressing the care needs of their insureds. Specifically, the 2015 Consumer Guide to Health Insurance prepared found that in 2014:

  • Empire had the worst overall consumer complaint ratio among HMO products offered in New York State;
  • Empire had the worst overall prompt payment complaint ratio among HMO products offered in New York State; and
  • Empire had the highest number of external appeals taken against it (705) among any health insurer operating in New York State.

It stands to reason that with less competition, there will be less incentive for Empire and the remaining health insurers to have comprehensive physician networks and to fix prior authorization abuses identified by physicians and patients.

In summary, we are very concerned that these problems will only get worse as insurers’ market shares increase. We appreciate that the DOJ, the DFS and the NY AG have recognized these concerns and urge that this proposed merger be rejected on the grounds that it would harm patient access to needed care.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org


enews large

CMS Announces Flexibility Options for MACRA Participation for 2017
This week CMS Acting Administrator Andrew Slavitt  announced in a blog posting its plans to provide some flexibility to physicians complying with the MACRA Medicare value-based payment programs scheduled to begin January 1, 2017.   While the final rule will not be released until later this fall, CMS announced that the final MACRA regulation will exempt physicians from any risk of Medicare payment penalties for 2019 within the Merit Based Incentive Payment System (MIPS) program if they choose one of three distinct reporting options in 2017, in addition to the option of participating in an advanced APM:

  • Full-year reporting that begins on January 1;
  • Partial year reporting for a reduced number of days; and
  • A “test” option under which physicians can report minimal amounts of data.

Physicians who report in 2017 may be eligible for bonus payments in 2019, depending on which option they choose.  According to the blog posting, those who opt for full-year reporting will be eligible to receive a “modest positive payment adjustment;” and those who choose partial year reporting will be eligible for a “small positive payment adjustment.”  Physicians who choose the “test” option will not be eligible for a bonus, but also not subject to any payment penalties.  Qualified participants in advanced APMs will be eligible for 5 percent incentive payments in 2019.

AMA President Dr. Andrew Gurman praised the action taken by the federal government, stating it “strongly applauds Secretary Burwell and Acting Administrator Slavitt – and their teams – for listening to physicians’ concerns about the timeline that was originally proposed for MACRA.  By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA.  This approach better reflects the diversity of medical practices throughout the country.  “The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.” 

CMS Offers Session on PQRS Feedback Reports on September 27 at 1PM
The Centers for Medicare & Medicaid Services (CMS) announced a Virtual Office Hours (VOH) session regarding Physician Quality Reporting System (PQRS) feedback reports for program year 2015 results. This VOH session will include information on the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.

The session, titled “2015 PQRS Feedback Reports,” will take place on Tuesday, September 27, 2016 from 1:00 – 2:00 p.m. ET. Topics to be discussed in this session include information about how the 2017 PQRS negative payment adjustment is assessed and how and where to access 2015 PQRS feedback reports depicting payment adjustment results. Additionally, this PQRS VOH session will allow stakeholders an opportunity to ask a CMS representative questions about the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.

Event Registration:

You must register to participate in this session, and spots are limited. Registration begins on Tuesday, September 13, 2016 at 12:00 p.m. ET. Click here to access the registration page.

A few notes about this VOH session:

  • You will only be able to register on or after 12:00 p.m. ET on September 13, 2016. If you attempt to register before this time you will receive an error message.
  • Only a limited number of participants will be allowed to register.
  • Only questions related to the 2015 PQRS feedback reports and 2017 negative payment adjustment will be addressed on this call. All other questions, including questions regarding program requirements and policy or reporting specifics, should be directed to the QualityNet Help Desk.

Complete information about PQRS is available on the CMS PQRS website.

For questions about PQRS or the VOH registration process, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. – 7:00 p.m. Central Time.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!


Urge Governor Cuomo To Sign Step Therapy Override Bill
All physicians are urged to send a letter to Governor Cuomo requesting that he sign into law a bill (A.2834-D/S.3419-C) that would establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health.

The bill has not as of yet been delivered to the Governor.

MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations, specialty societies, hospitals, and pharmaceutical manufacturers to achieve passage of this legislation. We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.

Over the summer, MSSNY representatives and several other patient advocacy groups met with the Governor’s office to urge that this bill be signed into law.  Moreover, in August, dozens of patient advocates rallied at the State Capitol in support of this bill, which received significant media attention, including from WNYT. TWC’s Capital Tonight and Politico-NY.

The bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.

While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication.  Perhaps most importantly, if the physician’s request for an override is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an external appeal.

Decline In Teenage Pregnancy Due to Use of Contraceptives, Study Suggests.
The New York Times (9/1) reports a new study published in the Journal of Adolescent Health found the “sharp decline in American teenage pregnancy and birthrates in recent years was driven exclusively by the use of contraceptives.” The study of a “nationally representative sample of more than 3,000 women ages 15 to 19” in 2007, 2009 and 2012 concluded “that sexual activity in the last three months of each time period did not vary — about one-third of the young women had had sex during that time.” However, the “percentage of teenagers who reported using contraception increased to 86 percent from 78 percent, and the share using more than one method increased to 37 percent from 26 percent

Zika Virus Commissioner’s Grand Rounds to Be Held on September 29
The 2016-2017 Commissioner’s Medical Grand Rounds series first session will be held Thursday, Sept. 29th from 6-8 p.m.   The program, entitled, “From A to Zika: An Update on Zika Virus for Primary Care Providers” will be presented as a live seminar and webinar at Stony Brook Medicine, Health Science Center, Level 2, Lecture Hall 2, 101 Nicolls Road, Stony Brook NY. The presentation will inform clinicians on current evidence about transmission, best practices for laboratory testing and evaluation, potential health effects and prevention of Zika virus infection. 

Presenters will be Samuel Stanley, MD, president, Stony Brook University and Chair, National Science Advisory Board for Biosecurity; Burton Rochelson, MD, Chief of Maternal Fetal Medicine at Northwell Health, Director of Maternal-Fetal Medicine Fellowship Program, Northwell Health; Philip Kurpiel, PhD, MPH; Program Supervisor, MARO Regional Epidemiology Program, NYS Department of Health; Louis Manganas, MD, PhD, Assistant Professor, Department of Neurology, Stony Brook University Medical Center.   The program is free of charge for all providers in New York State and advance registration is required.  To register, please see the flyer HERE.

The program will be streamed as a live webcast for those unable to attend in-person and will also be archived for future viewing.   Participants are eligible for CME credits whether they view in-person, via the live webcast, or the archived webcast. More Info.

Medicine at the Metropolitan Museum: Art in Clinical Practice
Learn how to use art to enhance your observation and communication skills in order to strengthen your clinical practice! 

When:
September 16, 2016 from 6 to 8.30pm:
Enhancing Observation and Presence
September 18 from 10.30am to 1pm:
Expanding Point of View and Creative Thinking
Location: The Met Museum in NYC

Space is limited! For more information and to register click here.

From the participants:
“Fantastic course. Therapeutic, informative and reformative.”
“Very interesting and I think it’ll make me a better doctor.”

MSSNY in the News

The Buffalo News – 08/27/16
Opinion – Another Voice: I-STOP changes won’t hurt fight against opioid abuse
(Letter to the Editor from MSSNY president Dr. Malcolm Reid, MD & VP, Dr. Thomas Madejski)
Healthcare Business Daily News – 09/07/16
AMA and MSSNY urge New York State officials to reject Anthem-Cigna merger as anticompetitive
(MSSNY President, Dr. Malcolm Reid quoted)
Becker’s Hospital Review – 09/08/16
AMA, physicians press NY state to reject Anthem-Cigna deal
(MSSNY President, Dr. Malcolm Reid quoted)
The Canadian Business Journal – 09/08/16
AMA and MSSNY: Anthem-Cigna Deal Is Bad Medicine For New York State
(MSSNY President, Dr. Malcolm Reid quoted)
Modern Healthcare – 09/08/16
AMA, consumers urge N.Y. regulators to reject Anthem-Cigna merger
(MSSNY President, Dr. Malcolm Reid quoted)


CLASSIFIEDS


Office Space – 1185 Park Ave. (94th St.) Full-time
Ideal for busy medical subspecialty.  Exclusive use of consult, exam room. Stress test, echo available.  Beautiful décor.  Public transportation nearby.  Available immediately. Please call 212-996-2900 or e-mail: robertreichsteinmd@gmail.com

Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.

Want to rent your medical office? Need to lease space to expand your practice? Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty).  Space is located in concierge building on 3rdAvenue (3 blocks to Grand Central Station).2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft).  The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable.  Serious inquiries only, may contact us at 201-615-6963 or email us: cahnmd@gmail.com

Midtown1Midtown2


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777


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

 

 

 

 

 

 

 

 

 

 

 

 

 

August 26, 2016 – DOH:Expand Marijuana Program

Dr. Reid
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
asset.find.us.on.facebook.lgTwitter_logo_blue1

Aug. 26, 2016
Volume 16, Number 30

MLMIC

Dear Colleagues:

The following letter to the editor was sent to the Buffalo News to clarify several misstatements in an article about I-STOP.

The Medical Society of the State of New York (MSSNY) staunchly supports the need to reduce, prevent, and eliminate opioid addiction.

Several points of the Buffalo News article, (“I-STOP Supporters Urge Cuomo to Veto Bills They Say Would Weaken Pill Prescription Legislation”) at http://bit.ly/2bvehjU need clarification. In fact, the efforts of physicians across New York State complying with I-STOP are a major reason for the huge decrease in “doctor-shopping.”

Current law requires prescribers to consult the State’s prescription medication registry before they prescribe ANY controlled substance. This assures that patients are not “doctor shopping” for controlled substances from multiple prescribers. This I-STOP component of the law has been in effect since August 27, 2013 and remains unchanged by proposed legislation.

On March 27, 2016, an additional component of the I-STOP law took effect.  This portion of the I-STOP law mandates that all prescriptions for both controlled and non-controlled drugs be electronically filed to all pharmacies located in New York. There were allowances for a few exceptions to this mandate, such as: a power failure; or, the script would be filled by a pharmacy out of NYS; or, it would be impractical for a patient to obtain an electronically prescribed drug in a timely manner, and the delay could adversely impact the patient’s medical condition.

However, the law requires that any time a paper or oral prescription is used, the prescriber is obligated to send an email to the NYS Department of Health containing a burdensome amount of information.

MSSNY supported legislation that will ease the administrative burden resulting from the patient’s need for expeditious relief, the patient’s need to fill a script out of state, and/or transmission failures.  Electronic transmission of prescriptions have a 3% to 6% failure rate.  Since 255 million prescriptions are filled each year in NYS, between 7.6 and 15 million are subjected to technological failure.  It is unrealistic to expect prescribers to send an email each time an electronic failure causes a prescription to be handwritten or phoned into the pharmacy.

I would not want to be the patient waiting for a necessary prescription and caught in the limbo of today’s technology.  In addition, if patients are traveling out of state, they may need a paper prescription to take with them to be filled when they reach their destination.

Again, the original purpose of I-STOP— the duty to consult the State’s registry before prescribing any controlled substance— has NOT been modified by the new legislation.

Twelve additional exceptions were announced by the Department of Health that do not require reporting  to the DOH— which include compounded drugs, prescriptions that contain long or complicated directions, prescriptions for patients in nursing homes and residential health care facilities as defined in Article 28 of the Public Health Law.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York
Briarcliff Manor, NY
Thomas Madejski, MD
Vice-President, Medical Society of the State of New York
Medina, NY

 

Please send your comments to comments@mssny.org


enews large

DOH: New Report re Use of Marijuana under Compassionate Care Act
The recommendations in a new report, “Medical Use of Marijuana Under the Compassionate Care Act,” published by the DOH this week, stated that New York’s medical marijuana program should double in size and include a broader range of authorized health providers.

Since the program began operations in January, more than 5,000 patients have been certified with the program while more than 600 physicians were registered across the state. The DOH said that’s more than other states whose programs have been in existence for significantly longer than New York’s program.

The DOH made three recommendations tied to increasing access:

·        Doubling the number of suppliers by registering five more organizations over the next two years; allowing nurse practitioners to certify patients

·        Evaluating the possibility of home-delivery services to allow for expanded distribution

·        Recommended exploring ways to make it easier for health-care facilities and schools to possess and administer medical marijuana for patients.

Among the 10 qualifying medical conditions, neuropathies and cancer make up the two largest categories of patients, with 1,704 or 34.1 percent and 1,238 or 24.8 percent, respectively. Pain is cited by 53.5 percent or 3,737 patients as the qualifying complication, while severe or persistent muscle spasms accounts for another 21.1 percent, or 1,477 patients.

AG: HealthNow Revising Mental Health/Nutritional Counseling Coverage
New York Attorney General Eric Schneiderman announced a settlement with HealthNow this week to address the company’s “wrongful denial of thousands of claims for outpatient psychotherapy and more than one hundreds of claims for nutritional counseling for eating disorders”. The wrongful denials totaled more than $1.6 million in patient claims.  The agreement requires HealthNow to pay members for the wrongfully denied claims, revise its policies, and eliminate a company policy that subjected all psychotherapy claims to review after a member’s 20th visit.

To read the AG’s press release, click here. 

According to the press release, the AG’s Health Care Bureau initiated an investigation last year after receiving patient complaints that HealthNow was improperly requiring all outpatient behavioral health visits be preauthorized after the first 20 visits per year, and by excluding coverage for nutritional counseling for eating disorders.  The investigation revealed that since 2012, HealthNow conducted thousands of wrongful reviews in outpatient behavioral health cases under its 20-visit threshold.  As a result, they denied coverage for outpatient behavioral health services for approximately 3,100 members, even though HealthNow generally did not impose the same type of utilization review process for outpatient medical services.

The AG settlement requires HealthNow to eliminate utilization review for outpatient behavioral health treatment based on set thresholds that trigger review, including but not limited to the 20-visit threshold it has applied since 2010. HealthNow will also cover nutritional counseling for eating disorders, including anorexia nervosa and bulimia nervosa. HealthNow will also reimburse members who paid out of pocket for treatment after their claims were denied under the 20-visit threshold or nutritional counseling exclusion, and retrain its staff regarding these reforms.

Consumers with a complaint regarding health insurance coverage for behavioral health treatment, or any other health care-related complaint, may always contact the Attorney General’s Office Health Care Helpline at 800-428-9071.


Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!



If You Are Thinking of Retiring, Notify All Participating Plans
For doctors who are considering retirement, please be aware that you should notify any plans that you have done business with of your retirement date.

For Medicare, only:

Please be aware of the following:

SE1617 –  Timely Reporting of Provider Enrollment Information Changes

Reviewing your Medicare provider enrollment in the Provider Enrollment Chain Organization System (PECOS) system, takes about 10 minutes.  https://pecos.cms.hhs.gov

Your password for this system is the one you would have obtained when you created your National Provider Identifier (NPI) number.  If you don’t know your password, please call the National Plan & Provider Enumeration System.  The NPI Enumerator may be contacted at the following:  NPI customer service: 800.465.3203 |800.692.2326 (TTY); or, you can email them here.

For Medicaid:

…..end/terminate my enrollment with the Medicaid Program Send a letter to Computer Sciences Corporation, PO Box 4610, Rensselaer, NY 12144-4610, which includes your NPI (if appropriate) and a contact name and telephone number for questions. When your file has been closed, you will receive a notification letter. Questions? Contact CSC at 800-343-9000.

For any other insurance plans, you should notify them of your retirement date.

Plans should be able to update your provider record with the retirement date; but, still pay you for any dates of care provided before that date.
Regina McNally, VP MSSNY Div. Socio-Medical Economics

Sept. 15 Deadline to Apply for Advanced Primary Care Medical Home Model
Comprehensive Primary Care Plus (CPC+), a multi-payer program that will include 5,000 primary care practices nationwide, begins in January 2017. CPC+ is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support delivery of comprehensive primary care. CPC+ builds upon the CPCI demonstration and offers 2 primary care practice “tracks” with incrementally advanced care delivery requirements and payment options to meet the diverse needs of practices.

CPC+ is specifically identified in the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) as an advanced Alternative Payment Model (APM). Most practices that qualify for CPC+ will receive significant additional payment and, by qualifying as an advanced APM, will be excluded from the upcoming Merit-Based Incentive Payment System (MIPS).

Comprehensive Primary Care Plus (CPC+), the CMS Innovation Center’s new national advanced primary care medical home model, is now accepting applications. New York State is one of only 14 regions selected for this initiative. The deadline to apply is Sept. 15.

Who can apply: CPC+ targets primary care practices with varying capabilities to deliver comprehensive primary care. In order to participate, all CPC+ practices must demonstrate multi-payer support, use Certified EHR Technology (CEHRT), and demonstrate other capabilities. CPC+ will provide financial support and educational resources to assist practices with elements such as data collection and team based care that can have an impact far beyond CPC+. Participants from CPCI are eligible and encouraged to apply. Not all practices who apply will be selected, so this webinar is crucial to obtaining the information you to need to apply.

Why CPC+ is important: Besides the additional payments tied to CPC+, practices that participate in CPC+ and meet certain requirements will be excluded from MIPS and will receive the 5% Advanced APM bonus payment on their fee-for-service payments starting in 2019, as per the MACRA law.

CMS is conducting Open Door Forums throughout August and September, featuring Question and Answer sessions, overviews of key model elements, and step-by-step instructions for completing the CPC+ Practice Application. For more information, go here.

This webinar is being conducted specifically for the designated NYS Region to discuss CPC+ with state officials, those who participated in CPCI, and the payers who will be participating in this initiative.

New Report on Protecting New Yorkers from Zika Virus
NYC’s public advocate, Letitia James, released a report, “Protecting New Yorkers from Zika Virus” on protecting New Yorkers from the Zika virus. Recommendations included allowing Medicaid coverage of mosquito repellent when prescribed by a doctor. As of July 29, there were 387 reported cases of Zika virus, including 45 cases involving women who were pregnant.

The Wall Street Journal (8/25) reports that a survey of state and local laboratories suggests that the US has the capacity to perform between 3,500 and 5,000 Zika tests weekly, considerably less than what is required under the Center for Disease Control and Prevention’s worst-case scenario of a Zika outbreak. According to the WSJ, the survey’s findings are likely to spark a rush to expand lab capacity as Zika continues to spread in the US.

Nursing Homes: Sept. 20 Webinar re Challenges/Successes of Quality Initiatives
During a webinar on September 20, from 11 a.m. to 12:30 p.m., three ETTA leadership teams will discuss their journeys, successes, and challenges implementing very different quality improvement initiatives:  communicating effectively with hospital emergency departments, reducing psychoactive medications, and respiratory rounding in the nursing home.

Each presentation will include lessons learned about the vital role effective communication plays in achieving and sustaining success in nursing home quality improvement.

All nursing homes are welcome to register online for this free webinar.

Medical Direction and Medical Care in Nursing Homes Education, Training, and Technical Assistance (ETTA) is a quality improvement initiative funded by the Department of Health to educate nursing home leadership teams about and facilitate the implementation of Medical Director and Attending Physician Guidelines.

During the ETTA Successes from the Field: Part 2—More Quality Improvement Stories webinar on September 20, ETTA leadership teams from Smithtown Center for Rehabilitation & Nursing Care, Crown Nursing & Rehabilitation Center, and Maria Regina Residence will share stories of each of their quality improvement projects.

ETTA provides tools and resources that helped these teams strengthen communication among facility staff, and between the facility and outside partners, including nursing home medical directors and hospital physicians.

All ETTA project materials are easily used by any organization. ETTA tools, resources, archived webinars, and regional workshop learning materials are all available online.

This webinar is free and open to all nursing facilities across the state. Please register online.

Questions Contact our ETTA Program Director, Debbie LeBarron at dlebarro@hanys.org with any questions or concerns. 

Unique Payment Opportunity for Physicians in the Hudson/Capital Region
MSSNY, along with the NYS Department of Health and participating payers, CDPHP, MVP and Empire Blue Cross Blue Shield, invites you join us on a one-hour webinar to learn more about a unique payment opportunity being offered by CMS.

Two options available:
Webinar 1: Tuesday, August 30th
Time: Noon- 1 pm

Register 

Webinar 2: Tuesday August 30th
Time 6:00 – 7:00 pm

Register


CMS Proposes Expansion of Bundled Payments Program Including Cardiac Care Episodes
The CMS Innovation Center) will host a webinar next Wednesday August 31, 2016 from 12:00 to 1:00 PM to discuss its proposal to create a new Medicare bundled payment model for heart attacks and bypass surgery using 90-day episodes of care.   To register for the important webinar, click here.  MSSNY staff will be participating in this program.

CMS has proposed that the program be applicable in nearly 100 regions across the country, including in the New York City metropolitan statistical area (MSA), as well as in the Elmira, Rochester, Syracuse and Utica MSAs.  The model would be tested for 5-year performance period, beginning July 1, 2017, and ending December 31, 2021.

At the same time, CMS is proposing to expand the existing Medicare Joint Replacement Bundled Payment program adopted by CMS last year (and implemented this past April) to cover surgical hip/femur fracture treatment.  The Joint Replacement bundled payment program is currently applicable to 67 MSAs including the Buffalo and New York City MSAs.

To read the proposed regulation describing this proposal, click here.

To read the CMS fact sheet describing these new programs click here.

According to the CMS fact sheet, once the models are fully in effect, participating hospitals would be paid a fixed target price for each care episode, with hospitals that deliver higher-quality care receiving a higher target price.

While payment would still be made to hospitals and physicians on a fee for service basis, at the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) would be compared to the target price that reflects episode quality for the responsible hospital. Hospitals that work with physicians and other providers to deliver the needed care for less than the quality-adjusted target price, while meeting or exceeding quality standards, would be paid the savings achieved. Hospitals with costs exceeding the quality-adjusted target price would be required to repay Medicare.

As with the current Medicare hip surgery bundle program, upside and downside risk would be limited initially but increase significantly by years 4 and 5 of the program.

According to the CMS Fact sheet, Downside risk to hospitals would as follows:

  • July 2017 – March 2018 (performance year 1 and quarter 1 of performance year 2):  No repayment;
  • April 2018 – December 2018 (quarters 2 through 4 of performance year 2): Capped at 5%;
  • 2019 (performance year 3): Capped at 10%; and
  • 2020 – 2021 (performance years 4 and 5): Capped at 20%

Bonuses (payments from Medicare to hospitals) would be as follows

  • July 2017 – December 2018 (performance years 1 and 2): Capped at 5%;
  • 2019 (performance year 3): Capped at 10%; and
  • 2020 – 2021 (performance years 4 and 5): Capped at 20%.

Importantly, the CMS proposal would permit these bundled payments in certain circumstance to qualify as an Alternative Payment Model (APM) as set forth in the MACRA law passed by Congress last year.  Participation in an APM “pathway” could enable a physician to not have to participate in the Medicare Merit Based Incentive Payment System (MIPS) program as enacted through MACRA and further spelled out in a regulation proposed by CMS earlier this year.

Analysis of this proposal is ongoing and further updates regarding its impact upon patient care delivery will be provided.


CLASSIFIEDS


Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty).  Space is located in concierge building on 3rd Avenue (3 blocks to Grand Central Station).

2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft).  The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable.  Serious inquiries only, may contact us at 201-615-6963 or email us: cahnmd@gmail.com
Midtown1Midtown2



Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week.  Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.


Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!


Physician Opportunities

Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Primary Responsibilities:
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice

Required Qualifications:
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman
Practice Administrator
718-208-1215
e: michael@crownmd.com


Nurse Practitioner/ Family Practice Physician
Full time/part time Urgent Care; Primary care/urgent care experience necessary. Rome NY. 315-335-7777


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

 

 

 

 

 

 

 

 

 

 

 

 

 

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