November 20, 2015 – Doctors Owed Millions by HR

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 20, 2015
Volume 15, Number 44

Dear Colleagues:

MSSNY continues to communicate regularly with key staff at the New York Department of Financial Services (DFS), the New York State of Health, and the Governor’s office to obtain necessary information for physicians to be able to help their patients with the enrollment decisions they will have to make, as well as to assure that physicians are fully compensated for the care they have provided to patients insured by Health Republic.

This week, MSSNY’s advocacy on behalf of physicians treating Health Republic insured patients received much press attention across New York State this week after publicly releasing the results of its survey regarding the huge amounts of payments outstanding to these physicians. Of the over 850 respondents to MSSNY’s survey, 42% have outstanding claims to Health Republic, of which:

  • 9% are owed $100,000 or more
  • 19% are owed $25,000 or more
  • 47% are owed $5,000 or more

At the same time, MSSNY has heard from multiple physician practices that are owed between $1 and $5 million. Combining the survey results with financial data received from numerous physician practices across the state, it’s estimated that physicians across New York State are owed at least tens of millions of dollars from Health Republic.

Articles were printed in Crains Health Pulse, Newsday, the Syracuse Post-Standard; Buffalo Business First and the Riverhead Local.

At a time when the State is seeking to engage physicians and patients in new payment models and new networks, it is imperative that the State insure that physicians are treated fairly by insurance companies when they participate in such state-promoted products and innovation.  We are very concerned that physicians may be very reluctant to participate in what they view as risky health reform initiatives that promise upside benefits but ultimately could put their medical practices at risk.

Last week, DFS announced that Health Republic enrollees who do not select a new plan by November 30 will be auto-enrolled in Excellus, MVP or Fidelis for the remainder of 2015, provided consumers pay their premium by December 10.  In addition, Fidelis, Excellus, and MVP agreed to credit any deductible and out-of-pocket amounts that consumers have already paid through their Health Republic coverage during 2015 – helping ensure that individuals who make the transition will not be required to restart these payments in 2015.

Physicians who have not completed MSSNY’s survey yet may do so here.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Advice from Socio-Medical Economics re Closing of Health Republic (HR), Effective November 30, 2015
We are aware that there are misconceptions and confusion regarding the patient’s financial liability with this Co-Op failure. The fact that the Co-Op is closing on November 30th does not make medical care and treatment not covered when provided by an HR in-network practitioner to HR enrollees.

If an in-network HR physician is treating a HR enrollee, by contract, the physician is prohibited from billing the patient beyond any applicable deductible, coinsurance or copayment for covered services.  Billing beyond these amounts is considered “balance billing.” This balance billing prohibition is good for the term of the contract which ends on November 30, 2015.  HR and the NYS Department of Financial Services (DFS) have issued notices for patients to call a special hotline number (1-800-342-3736) with concerns about being billed beyond their cost sharing amounts. Staff from DFS indicated that they are trying to create a user-friendly system for physicians to research the patients’ 2015 deductible standing. If possible, if DFS can create a central repository for this research, it would be very helpful for physicians and their staffs.

For those physicians who have outstanding claims with Health Republic (HR) and want to be on record with regard to their debt resulting from this closure, please utilize one consumer complaint form from the following link to record the total dollar value expected from HR.  Submitting this information to DFS will not constitute any commitment from DFS or HR with respect to your recovery concerning your claims.

The HR patient is financially responsible for any unmet 2015 deductible and charges for non-covered services.  These would be the only exceptions that an HR in-network physician could bill an HR enrollee for through 11/30/15.

The New York State of Health has prepared the following Q&A to assist HR enrollees with the transition.   Some of this information should be helpful for our MSSNY members, as well:  http://info.nystateofhealth.ny.gov/sites/default/files/Health%20Republic%20FAQs%2011-16-15.pdf

Part of the Q&A for the patients reads as follows:

  1. What if I have already met or have paid towards my deductible in my current plan?
  2. If you are enrolled in a Health Republic plan that has an annual deductible, the NYS Department of Financial Services is working to ensure that your new health plan will not charge you for the amount of deductible you already met in 2015. Keep your records. You may need to provide your new plan with evidence that you have met all or part of the 2015 deductible.

We are in the process of asking HR, Excellus, Fidelis, and MVP if there will be a computer system for you to be able to verify a patient’s 2015 deductible status.  So far, we have been told that the specific mechanism has not yet been defined.  As soon as we are advised, we will be sure to alert you.

However, if you are scheduling a visit for a former HR enrollee for services rendered from 12/1 through 12/31/15, it is urged that you ask the patient to bring their latest HR EOB that shows their 2015 deductible standing.  If it has been met, the patient would only be liable for their co-payment or co-insurance.  If their 2015 deductible has not been met, you would be able to charge them that amount up to your contracted fee schedule with Excellus, Fidelis, or MVP.

If you have additional questions concerning this matter, please email Regina McNally, VP, Division of Socio-Medical Economics at rmcnally@mssny.org


Survey of the Week

How is your ICD-10 Implementation Working?
Please answer this one question survey.



Opportunity for Physician Peer Reviewers
The Empire State Medical, Scientific and Educational Foundation, Inc. (ESMSEF) would like to invite you to participate in physician peer review with our organization.  We have a need for physician reviewers who are board certified and in active practice.  We have an urgent need for physicians in all specialties.

ESMSEF is a subsidiary of the Medical Society of the State of New York (MSSNY) and has been performing independent medical peer review since 1984.  The Foundation currently has several contracts in New York State to perform medical peer review services.  The reviews to be performed are retrospective in nature and are time sensitive.  We generally allow approximately 10 days for completion of the physician review.  Reviews may be sent to your home or office or may be performed in our offices in either Westbury or Camillus (Syracuse).  Issues to be reviewed include medical necessity, diagnosis assignment and/or quality of care issues.

If you are interested in participating in peer review, please contact Jane Steinman, Physician Reviewer Coordinator at 1-800-437-2234 or via email at jsteinman@esmsef.com to request an application.  Or, you may download our application from the “Careers” section of the Foundation website at www.esmsef.com

CMS Finalizes Rule for Medicare “Virtual” Bundled Payments for Lower Joint Replacement
Despite concerns expressed by many physician and hospital groups, Medicare payments for hip and knee replacements in Buffalo and New York City metropolitan areas, as well as 65 other regions across the country, will be subject to a “virtual bundling” program, according to an announcement this week from CMS.   For more information, click here, here  and here.

Under the new program, the “Comprehensive Care for Joint Replacement (CCJR)” model, acute care hospitals in certain 67 geographic areas will receive retrospective reward payments or face financial liability relating to episodes of care for lower extremity joint replacement (LEJR).  While Medicare payments to hospitals, physicians and other providers would continue to be made on a fee for service basis, the acute care hospital that is the site of surgery would be held accountable for spending during the episode of care. There is a 5 year performance period, beginning April 1, 2016, and ending December 31, 2020.

Under the program, the episode of care begins with an admission to a participant hospital of a beneficiary who is ultimately discharged under MS-DRG 469 (Major joint replacement or reattachment of lower extremity with major complications or comorbidities) or 470 (Major joint replacement or reattachment of lower extremity without major complications or comorbidities) and ends 90 days post-discharge in order to cover the complete period of recovery for beneficiaries. The episode includes all related items and services paid under Medicare Part A and Part B for all Medicare fee-for-service beneficiaries, with the exception of certain exclusions.  Depending on the hospital’s quality and cost performance during the episode, the hospital would either earn a financial reward or be required to repay Medicare for a portion of the costs.

In the first year, 2016, there would payment rewards only for the hospital, no penalties.  Starting in 2017, the financial penalties are phased in.  In 2017, the potential penalty is capped at 5%.  In 2018, the penalty would be capped at 10%, and in 2019 and 2020, the penalty is capped at 20%.

CMS notes that “a participant hospital may wish to enter into certain financial arrangements with collaborating providers and suppliers who are engaged in care redesign with the hospital and who furnish services to the beneficiary during an episode. Under these arrangements, a participant hospital may share payments received from Medicare as a result of reduced episode spending and hospital internal cost savings with collaborating providers and suppliers, subject to parameters outlined in the rule. Participant hospitals may also share financial accountability for increased episode spending with collaborating providers and suppliers.”

The 67 areas across the country encompass numerous major population centers including 800 hospitals.  The locations where this “virtual bundling” program will occur include Erie and Niagara counties in Western New York, and Bronx, Dutchess, Kings, Nassau, New York, Orange, Putnam, Queens, Richmond, Rockland, Suffolk and Westchester counties in downstate New York.


Medicare Advantage Plan to Shut Down
Touchstone Health HMO, a Medicare Advantage plan, will wind down operations at the end of the year, ending coverage for more than 10,000 members.

The White Plains insurer posted a notice on its website that informed members in New York City and Westchester and Orange counties that they would “no longer be enrolled beginning January 1, 2016.”

In October 2010, the insurer had about 17,000 members, with optimistic projections of clearing the 20,000 threshold. But membership fell 36%, to 10,864, in October 2015, according to CMS data.

Founded in 1998, the company is majority-owned by Essex Woodlands, a health care venture-capital fund, and Garden City, L.I.’s HealthCare Partners IPA. Essex Woodlands has a 60% stake—its managing director, Steve Wiggins, a founder of Oxford Health Plans, is on Touchstone’s board—with the rest held by HCP.

By the end of 2014, Touchstone was $8.5 million below its minimum net worth requirements, with assets exceeding liabilities by $9.6 million. The insurer earned $402,000 in net income on $157.9 million in revenue, with a profit margin under 1%.

A spokesman for the state Department of Financial Services said the closure “was a voluntary decision by the company. We’re working with the company and other regulators to help ensure consumers are protected.” (Crains 11/12/15)


MSSNY Announces Physician’s Emergency Preparedness Toolkit; Earn up To 15 Free CMEs
The Medical Society of the State of New York announces the creation of the Physician’s Emergency Preparedness Toolkit.  This toolkit provides resources necessary to enhance public health security and preparedness for all hazards and contains an extensive list of electronic resources for physicians to use during, or in preparation of, public health emergencies.   Upon completion of the toolkit, physicians can receive up to 15 hours of free continuing medical education credits.

The toolkit is comprised of four modules and is available at the MSSNY CME website here.   Physicians new to the MSSNY CME site will need to create a username and password.   Once registered, and logged into the site, click “My training page” on the toolbar located at the top of the instruction page.   The modules discuss liability protections for physicians during a public health emergency, provides information on the federal and state framework for responding to a public health emergency, and the best practices for a public health emergency.

The toolkit also includes:

  • A physician “go” bag checklist
  • An emergency preparedness checklist
  • A Psychological Impact desk reference card
  • A Biological, Chemical and Radiological Terrorism desk reference card

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designated this enduring material for a maximum of 15 AMA PRA Category 1 Credits TM. Physicians should claim only the credits commensurate with the extent of their participation in the activity.

MSSNY has also created an Emergency Preparedness Podcast.  The podcast features discussions with several of New York’s preeminent experts on emergency preparedness and focuses on a remembrance of the events of September 11th, 2001 and on MSSNY’s efforts toward an aware and prepared physician and healthcare provider community in New York State.  The podcast can be accessed here.

The toolkit was created by members of the MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response Committee in cooperation with the New York State Department of Health.  A copy of the flyer for the toolkit and podcast is here.

For further assistance and/or questions please contact Pat Clancy at pclancy@mssny.org or Melissa Hoffman at mhoffman@mssny.org


“With 44 Rx Opioid Related Deaths A Day, What Can One Physician Do?”
The Medical Society of the State of New York announces that its website has resources, tools, best practices, and voluntary education programs to help physicians to better understand the opioid epidemic.  The Medical Society is one of eight state societies that is part of the AMA’s Task Force to Reduce Opioid Abuse.   Established in 2014, this task force has embraced five concepts for implementation throughout the nation. The Task Force believes that physicians have a professional obligation to reverse the nation’s opioid epidemic. The five goals of The Task Force are:

  • Increase physicians’ registration and use of effective PMPs
  • Enhance physicians’ education on effective, evidence-based prescribing
  • Reduce the stigma of pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing

MSSNY recognizes the severity of this public health epidemic and is committed to implementing solutions to combat it.  In New York, we have already reduced the incidence of doctor shopping by 86% because physicians are checking the Prescription Monitoring Program prior to prescribing a controlled substance. MSSNY also supported legislation to increase access to naloxone to reduce deaths from overdose.  MSSNY also supports efforts increase voluntary education and training for physicians on safe prescribing practices.   According to IMS data, New York has seen substantial decreases in the number of prescriptions written for oxycodone, hydrocodone and other controlled substances. New York’s utilization rate for these medications is below other states that currently require prescriber education of opioid medications. But there’s more to do.   The MSSNY website provides information on best practices that physicians may find helpful when considering a controlled substance and common recommendations found in opioid prescribing guidelines, including tools such as opioid calculators. Additionally, there are free continuing medical education programs through the PCSS-O and prevention and other information for your patients.  To learn more, click here.

MSSNY representatives to the AMA Task Force to Reduce Opioid Abuse are MSSNY Councilor, Frank Dowling, MD and Pat Clancy, MSSNY Vice President for Public Health and Education. Further information can be obtained by contacting Pat Clancy at pclancy@mssny.org.


Register Now For Final 2015 E-Prescribing CME Webinar on Dec. 9th
The Medical Society of the State of New York will host its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here. Select training session and the upcoming tabs.

The webinar will be held on Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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.

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013. The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.


MSSNY Announces 2016 Medical Matters Schedule for 2016
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled “Immunizations During A Disaster,” with Dr. William Valenti as faculty.  All programs will begin at 7:30am.

Registration is now open to physicians and other public health officials:

https://mssny.webex.com/mw3000/mywebex/default.do?siteurl=mssny

Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016. Further information on these programs can be found here

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


Informal Review Request Period for 2016 Value Modifier Open Now Through November 23, 2015
The period for requesting an informal review of the 2016 Value Modifier is open now and ends November 23, 2015. For groups with 10 or more eligible professionals (EPs) that are subject to the 2016 Value Modifier, CMS established an Informal Review Period to request a correction of a perceived error in their 2016 Value Modifier calculation. These groups may request an informal review of their 2016 Value Modifier determination, now through November 23, 2015 11:59pm EST.

The 2014 Annual Quality and Resource Use Reports (QRURs) are now available for every group practice and solo practitioner nationwide. Groups and solo practitioners are identified in the QRURs by their Taxpayer Identification Number (TIN). The QRURs are also available for groups and solo practitioners that participated in the Medicare Shared Savings Program, the Pioneer Accountable Care Organization (ACO) Model, or the Comprehensive Primary Care initiative in 2014, and to those TINs consisting only of non-physician EPs.

The 2014 Annual QRURs show how groups and solo practitioners performed in 2014 on the quality and cost measures used to calculate the 2016 Value Modifier. For groups with 10 or more EPs that are subject to the 2016 Value Modifier, the QRUR shows how the Value Modifier will apply to physician payments under the Medicare Physician Fee Schedule (PFS) for physicians who bill under the group’s TIN in 2016. For all other groups and solo practitioners, the QRUR is for informational purposes only and will not affect their payments under the Medicare PFS in 2016.

Authorized representatives of group and solo practitioners can access the 2014 Annual QRURs on the CMS Enterprise Portal using an Enterprise Identify Data Management (EIDM) account with the correct role. For more information on how to access the 2014 Annual QRURs, visit How to Obtain a QRUR.

Additional information about the 2014 QRURs and how to request an informal review is available on the 2014 QRUR website and through the QRUR Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).


NY Worker’s Compensation Board Proposes Regulation Changes
As of November 12, 2015, the following proposed regulation changes have been published to the Board’s website:

Amendment of 12 NYCRR 324.3 (Variances)

Amendment of 12 NYCRR 324.4 (Optional Prior Approval)

Amendment of 12 NYCRR 311.1 (Funeral Expenses)

Amendment of 12 NYCRR 325-1.4 (Authorization for Medical Services)

Amendment of 12 NYCRR 300.5 (Stipulations)

Repeal of 12 NYCRR 300.13, 300.15 and 300.16 and Addition of 12 NYCRR 300.13 (Administrative Review, Full Board Review and Reconsiderations)

Amendment of 12 NYCRR 300.27 (Meetings of the Board)

Amendment of 12 NYCRR 300.36 (Section 32 and Voluntary Binding Review)

The proposed regulation changes will be published in the November 10, 2015 edition of the State Register. Comments on the proposed regulations will be accepted for 45 days, from November 10, 2015 through December 28, 2015.

Please send questions or comments on the proposed regulations to: Heather M. MacMaster, Associate Attorney, Workers’ Compensation Board, 328 State Street, Schenectady, New York 12305-2318, telephone: (518) 486-9564, or email your comments to the Board atregulations@wcb.ny.gov.


From NY Workers Compensation Board: December District Dialogue Sessions
Thank you to all who attended our Fall District Dialogue Sessions. We are very fortunate for everyone’s participation and contribution, making our District Dialogues a continued success. Please join us for our Winter 2015 District Dialogue Sessions. This will be the Board’s sixth District Dialogue Session since we began holding these sessions in September 2014. We hope you will join us at one of our District Offices. The locations, dates and times are as follows:

WC Schedule_Updated

 

*Due to the relocation of the Albany District Office, the Albany District Dialogue date is still to be determined. An update will be sent when a location, date and time are decided.

It will be here before you know, so be sure to mark your calendars! We look forward to seeing and hearing from you.

If you have any questions, please contact Outreach@wcb.ny.gov


Classifieds

Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Modern 3000 sq. ft. medical office to rent near the United Nations.
Handicapped accessible; private reception area; secretarial area available; 6 exam rooms.  Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.


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


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

November 13, 2015 – Does Health Republic Owe You Money?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 13, 2015
Volume 15, Number 43

Dear Colleagues:

The news of the financial meltdown of Health Republic has grown increasingly grim.

Questions are being raised if or how much physicians, hospitals and others will be paid for the care they have provided to HR-insured patients.  As such, it is imperative that physicians complete a MSSNY survey sent to you multiple times this week to aggregate the amounts that you are due from Health Republic. Hospital associations have been quoted in numerous news reports as being owed over $150 million.

We need to get similar hard data from physicians to help MSSNY advocate on your behalf to be treated fairly.  If you have not already responded, please complete this survey NOW by clicking here.

As of this writing, more than 40% of the survey respondents have outstanding claims to Health Republic, of which:

  • 7% are owed $100,000 or more
  • 15% are owed $25,000 or more
  • 43% are owed $5,000 or more
  • 74% are owed $1,000 or more

Combining the survey results we have received so far with financial data received from numerous physician practices across New York State, it is estimated that physicians across New York State are owed at least tens of millions of dollars from Health Republic.

MSSNY has been in continuous contact with DFS and New York State of Health officials to obtain necessary information for physicians to be able to help their patients with the enrollment decisions they will have to make.  We have also been advocating to these officials to assure that physicians be fully paid for the care they have provided to patients insured by Health Republic.

Certainly, the financial meltdown of Health Republic is a strong reason why many have called for the New York State Legislature to enact a special fund to assure claims will be paid and prevent against similar problems in the future.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance

For Late-Breaking News: See item below

Health Republic Enrollees to Transition to Excellus, MVP or Fidelis Coverage
Health Republic enrollees who do not select a new plan by November 30 will be auto-enrolled in Excellus, MVP or Fidelis for the remainder of 2015, according to an announcement today by the NYS Department of Financial Services and NY State of Health.

In addition, Fidelis, Excellus, and MVP have agreed to credit any deductible and out-of-pocket amounts that consumers have already paid through their Health Republic coverage during 2015 – helping ensure that individuals who make the transition will not be required to restart these payments in 2015.

According to the press release, during the third week of November, individuals enrolled in Health Republic through NYSOH and who have not yet selected a new health plan for December 1, 2015, will receive an auto-enrollment notice from NYSOH telling them — based on their county of residence – whether they will be auto-enrolled in either Fidelis Care, Excellus, or MVP.  Individuals who reside in the Rochester area (including Livingston, Monroe, Ontario, Seneca, Wayne and Yates counties) will receive an offer to enroll from Excellus. Individuals who reside in Ulster County will receive an offer to enroll in MVP.  Individuals who reside in all other counties of the state will receive an offer to enroll from Fidelis Care. In order for coverage to become effective, individuals will need to make their premium payment for the month of December 2015. Consumers will be auto enrolled into the same metal tier or option that is most similar to the coverage the individual selected through Health Republic.

As noted in the DFS press release, under New York law, Health Republic members who are: a) in an ongoing course of treatment with a physicians for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when their new coverage becomes effective, may be able to continue to receive care from their physician for up to 60 days (or through pregnancy) under their new health insurance policy, even if the physician does not participate with the new health insurer (subject to agreement by that physician).


Affiliation between Albany Med and Saratoga Hospital Still Being Worked Out
The Albany (NY) Business Review (11/9, French, Subscription Publication) reported that “details of the planned affiliation between Albany Medical Center, the second-largest health system in the Albany area, and Saratoga Hospital are still being worked out” and may not be finalized for months. However, “another affiliation being pursued by Albany Med provides a roadmap for what the agreement might look like,” a deal with “Columbia Memorial in Hudson.” Under that agreement, “Albany Med’s board” would have “a say in approving new board members for Columbia.” However, “Columbia Memorial’s board of directors would still recruit and select those new directors.” 


PTSD and TBI in Returning Veterans: Identification and Treatment 

Date and time:   December 4, 12:30 – 1:30 PM via WebEx

Presenter:          Dr. Joshua Cohen

Program Summary: A look into the two most common disorders facing returning veterans today, from symptoms and diagnosis to treatment and recovery, and how to overcome the unique challenges posed by military culture.

For any questions, contact: Greg Elperin at gelperin@mssny.org

Please register here. 


REGISTER NOW FOR FINAL 2015 E-PRESCRIBING CME WEBINAR ON DEC. 9TH
The Medical Society of the State of New York will host     its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here. Select training session and then upcoming tabs.

The webinar will be held on Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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. 

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org 

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.   The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.   


Startup Cureatr Targeting Albany Market.
The New York Business Journal (11/11, French) reports healthcare startup Cureatr, which notifies “a patient’s primary care doctor in real-time if that patient goes to the emergency room,” will start by targeting the Albany area. The company is currently working at Albany Medical Center “and is now working on partnering with the other major hospital systems in the region, CEO Dr. Joe Mayer said.”


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations during a Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.

Registration is now open to physicians and other public health officials here. Go to training session and upcoming sessions tab.

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include:  Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Further information or assistance in registering for any of these programs, may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 


AMA Urges Department of Justice to Reject Further Health Insurer Consolidation; MSSNY Makes Similar Request to NY-DFS
The AMA has written to the Department of Justice, Antitrust Division, to urge that DOJ block the proposed mergers of health insurance giants Anthem (the parent of Empire BC/BS) and Cigna, as well as Aetna and Humana.  MSSNY had previously written to the New York Department of Financial Services (DFS) to urge that either the proposed Anthem-Cigna merger be rejected in New York State, or require that the merged entity agree to reform numerous market conduct issues that were identified in the recent DFS 2015 Guide to Health Insurers.  Concerns with the proposed mergers has also been the subject of numerous op-eds written by County Medical Society Presidents across New York State, including in the Binghamton, Buffalo and Jamestown papers.

According to a recent AMA report, the proposed health insurer consolidation would significantly enhance the market power and/or raise competitive concerns of these combined entities in multiple states across the country, including, within New York State, Long Island, New York City and the Hudson Valley.

Among the key points in the AMA letter to the DOJ were:

  • The proposed mergers are occurring in markets where there has already been a near total collapse of competition.
  • A growing body of peer-reviewed literature suggests that greater health insurer consolidation leads to price increases, as opposed to greater efficiency or lower health care costs.  The mergers would reduce pressures on plans to offer broader networks to compete for members and would create fewer networks that are simultaneously under no competitive pressure to respond to patients’ access needs.
  • Health insurer monopsony, or buyer power, acquired through the proposed mergers would, as the Department of Justice has found in earlier cases, likely degrade the quality and reduce the quantity of physician services.  In the long run health insurer exercise of monopsony power may motivate physicians to retire early or seek opportunities outside of medicine that are more rewarding. This would exacerbate an already significant shortage of primary care physicians in the United States;
  • There is no evidence supporting the insurer’s claim that the proposed mergers would lead to greater efficiencies and innovative payment and care management programs; and
  • Fostering competition, not consolidation, benefits American consumers through lower prices, better quality, and greater choice.


Office of National Coordinator Seeks Physician Input on Aspects of Meaningful Use
In an effort to improve the interoperability of EHRs the AMA is assisting the Office of the National Coordinator (ONC) with gathering information to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use.   The AMA has asked physicians to take a 5-10 minute survey that will help ONC create a new standard that will reduce the number of pages in the summary of care document, thus making it easier to find relevant information.     The survey link is here. The survey will close on November 30.


Doctors Without Borders Recruiting Doctors; Info Session on Nov. 19 in Manhattan
Doctors Without Borders is recruiting qualified MEDICAL AND NON-MEDICAL professionals in New York to respond to ongoing humanitarian crises and join their team of dedicated humanitarian aid workers. They are hosting a recruitment information session at their New York headquarters New York Recruitment Info Session Thursday, November 19, 2015 at 7:00 PM at Doctors Without Borders, 333 Seventh Ave, Second  Floor, NY, NY.  Click here to learn more. Click here to register for the New York session


Deadline for Review of Informal Review Extended until November 23

Question: When is the new deadline to appeal two penalties?

Answer: CMS has extended the deadlines for physicians and group practices facing two different Medicare penalties in 2016 to request an informal review if they believe the government made a mistake. The penalties, which whittle down reimbursement, are levied under Medicare’s Physician Quality Reporting System (“PQRS”) and the Value Based Payment Modifier (“VBM”) program. The original deadline for an informal review of both penalties had been November 9, 2015 but has now been extended until November 23, 2015.

In PQRS, Medicare penalizes physicians for unsatisfactory reporting of clinical quality data. The penalty in 2016, based on performance in 2014, will lower fee-for-service payments by 2%. Physicians, medical groups, and accountable care organizations can learn if they are due for a pay cut by obtaining a PQRS feedback report for 2014.

The CMS website explains how to obtain the report. Requests for an informal review can only be made online through the Quality Reporting Communication Support Page of CMS. CMS promises a decision, which is final, within 90 days.

To read more about this deadline extension and how to file for informal reviews, please visit:https://www.qualitynet.org/portal/server.pt/community/pqri_home/212.

If you have any questions, please contact Kern Augustine Conroy & Schoppmann, P.C. at 1-800-445-0954 or via email at info@DrLaw.com.


AMA Summary of the 2016 Medicare Physician Fee Schedule Final Rule
On October 30, 2015, CMS released the (1,358 page) 2016 Medicare Physician Fee Schedule (PFS) Final Rule with comment period. CMS has issued a general fact sheet and a PQRS payment adjustment fact sheet. Table 62 shows the impact of the rule on individual specialties. The AMA submitted detailed comments on the Proposed Rule on September 8, 2015. The Final Rule is scheduled for publication in the Federal Register on November 16, 2015. CMS will accept comments by 5 PM on December 29, 2015, regarding interim final relative value units (work, practice expense, and malpractice); interim final HCPCS codes (in the Preamble and Addendum C); and changes to the physician self-referral HCPCS/CPT codes (tables 50-51). 

Physician Payment Update & Misvalued Codes Target
The Medicare Access and Chip Reauthorization Act (MACRA) called for annual updates of 0.5 percent from July 2015 through 2019. The Protecting Access to Medicare Act of 2014 (PAMA) set an annual target for reductions in PFS spending, from adjustments to relative values of misvalued codes. Then the Achieving a Better Life Experience (ABLE) Act of 2014 accelerated those targets, increasing the target to 1 percent for 2016 and keeping it at 0.5 percent for 2017 and 2018.

The AMA opposed these targets as completely unnecessary. The RUC and CMS have been engaged in intensive efforts to identify and address misvalued services for many years, long before Congress got involved. CMS has recognized the RUC’s vital role in helping value Medicare services. Since the RUC Relativity Assessment Workgroup began in 2006, the RUC and CMS have identified over 1,900 services through 16 different screening criteria for further review, and the RUC has recommended reductions and deletions for 1,045 services, leading to redistribution of nearly $4 billion.

In the final rule, CMS brought its methodology more in line with AMA and RUC recommendations, and rolled back planned payment reductions for both radiation treatment services (completely) and lower GI endoscopy (partially). Together with redistributions recommended by the RUC, this yields a net savings of 0.23 percent, requiring a 0.77 percent reduction to meet 1 percent target. Taking into account the 0.5 percent positive update (and a -0.02 percent budget neutrality adjustment), the 2016 Medicare conversion factor is reduced by 0.29 percent to $35.83, just 10 cents below the 2015 conversion factor of $35.93. 

Advanced Care Planning
CMS finalized separate Medicare payment for two CPT codes for advance care planning services, which include conversations between patients and their physicians before an illness progresses and during treatment. The rule specifically referenced the AMA recommendations. This represents not only a win for CPT, the RUC, and the AMA, but also a turning point towards a new approach to pay for advance care planning. The Medicare statute currently provides coverage for advance care planning under the “Welcome to Medicare” visit available to all Medicare patients, but they may not need these services when they first enroll. Separate payment for advance care planning codes recognizes the additional time needed to conduct these conversations, and provides a greater opportunity and more flexibility to have these planning sessions at the most appropriate time for patients and their families. CMS is also finalizing payment for advance care planning when it is included in the “Annual Wellness Visit.” 

“Incident to” Services
In the 2014 PFS final rule, CMS set explicit requirements that “incident to” services must be furnished consistent with applicable state law, including state licensure and other requirements for the “auxiliary personnel” providing the services. In the 2016 PFS final rule, CMS is also requiring that “the physician or other practitioner who bills for incident to service must also be the physician or other practitioner who directly supervises the auxiliary personnel who provide the incident to services.” (Incident to services may also be billed by clinical psychologists, PAs, NPs, CNSs, and certified nurse-midwifes. General supervision is sufficient for chronic care and transitional care management services, except patient visits.) The AMA and other physicians expressed concerns that this requirement – and CMS’ proposal to remove current regulatory language widely interpreted as allowing the supervising physician (or practitioner) to be someone different from the person who initiated the patient’s treatment and is overseeing their general care – would adversely impact the physician community, particularly group practices and multispecialty clinics. Fortunately, CMS agreed to continue its policy that the supervising physician (or practitioner) for a particular incident to service does not have to be the same person who is “treating the patient more broadly” and is adding clarifying regulatory language to that effect. The rule also finalizes regulatory changes that prohibit auxiliary personnel from providing incident to services if they have been excluded from Medicare, Medicaid, or other federal health programs or have had their enrollment revoked. 

Other Payment Issues

  • Primary Care Bonuses End: While not highlighted in the final rule, it is important to keep in mind that the 10 percent incentives – that section 5501(a) of the Affordable Care Act established for Part B services by primary care practitioners – are scheduled to end on December 31, 2015.
  • Phase-In of Significant RVU Reductions: The PAMA specified that a decrease in value for a service of 20 percent or more, without a change in the underlying code for the service, must be phased-in over a two-year period. CMS is adopting its proposal to reducing the value for a service by 19 percent in the first year, and by the remainder in the second year.
  • Misvalued Code Changes/Lower GI Endoscopy Services: CMS is adopting codes for lower gastrointestinal endoscopy as revised by the CPT Editorial Panel and related values “more closely tied” to the RUC’s recommendations.
  • Misvalued Code Changes/Radiation Therapy: CMS did not finalize the new code set for radiation therapy treatment. Changes will be implemented, over 2 years, to the utilization rate for capital equipment used in radiation therapy, to 35 hours per week (70 percent utilization) instead of 25 (50 percent utilization). CMS also seeks comment on the price and usage of linear accelerators.
  • Part B Drugs/Biosimilars: Payment for a biosimilar biological product will be based on the average sale price of all biosimilar biological products within the same billing/payment code.
  • Technical Errors: There are two errors in the Final Rule that will be corrected in a technical correction notice:

o The 0.5 percent update was not applied to the Anesthesia conversion factor. With the appropriate application, we estimate that the correct 2016 Anesthesia conversion factor should be $22.4426.

o The work GPCI (geographical practice cost index) floor, extended under MACRA until January 1, 2018, was not applied. The GPCI tables incorrectly list work GPCIs below 1.0 for 51 localities.

Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging
PAMA requires that providers who order advanced diagnostic imaging services consult with AUC via a clinical decision support mechanism. PAMA also requires CMS to specify AUC from among those developed or endorsed by national medical professional specialty societies and other provider-led entities; to approve clinical decision support mechanisms; to collect additional information on the Medicare claim form; and to develop a prior authorization program based upon the claims information. CMS is establishing which organizations are eligible to develop or endorse AUC, the evidence-based requirements for AUC development, and the process CMS will follow for qualifying provider-led entities. Consistent with concerns expressed by the AMA, CMS says it will not have AUC in place and ready for consultation by ordering physicians by the January 1, 2017 deadline, so the requirement for consultation will be delayed. Also consistent with AMA advocacy, CMS is reconsidering application of the AUC to emergency departments, and will review this issue in next year’s PFS rule. 

Medicare Opt-Out
Prior to MACRA, physicians and practitioners that wished to renew their opt-out were required to file new valid affidavits with their Medicare Administrative Contractors (MACs) every 2 years. CMS clarifies in the final rule that under MACRA, physicians and practitioners that filed valid opt-out affidavits on or after June, 16, 2015 are not required to file renewal affidavits. Such physicians and practitioners may cancel the renewal by notifying all MACs with which they filed an affidavit in writing, at least 30 days prior to the start of the new two-year opt-out period. 

Physician Quality Reporting System (PQRS)
Despite objections from the AMA and other physician specialty societies, CMS is maintaining the same strict minimum measure reporting requirements—of nine measures covering three National Quality Strategy domains—for the 2016 reporting period which determines the 2018 PQRS payment adjustment. Individual eligible professionals (EPs) or group practices that fail to satisfactorily report or otherwise participate in PQRS for 2016 will receive a 2 percent negative payment adjustment on covered professional services in 2018. CMS is finalizing additions to the PQRS measure set to fill gaps, and deleting measures considered “topped out,” duplicative, or replaced. The 2016 PQRS measure set will have 281 measures and the GPRO Web Interface will have 18. CMS will allow group practices to report quality measure data using a Qualified Clinical Data Registry (QCDR), as required under MACRA. 

Physician Compare
All 2016 individual EP and group practice PQRS measures will be available for public reporting on Physician Compare. This includes ACO measures and “CAHPS for PQRS survey” measures for groups of two or more EPs that have the required sample size and collect data via a CMS-specified certified CAHPS vendor. CMS is withdrawing its plan to indicate (on profile pages) which EPs and which group practices receive a VM bonus, but is finalizing the inclusion on Physician Compare of:

  • Certifying board, including the American Osteopathic Association Board;
  • An indicator for individual EPs who satisfactorily report PQRS Cardiovascular Prevention measures in support of the Million Hearts initiative (on profile pages);
  • Individual and group-level QCDR measures;
  • In the downloadable database: Value Modifier tiers for cost and quality; whether the EP or group practice is high, low, or neutral on cost and quality; the resulting payment adjustment; which eligible EPs or group practices did not report quality measures to CMS; utilization data for individual EPs; and
  • An item (or measure)-level benchmark based on the Achievable Benchmark of Care (ABC™) methodology, displayed as a five-star rating.

Value-Based Payment Modifier (VM)
CMS will no longer apply an automatic VM penalty to TINs receiving a PQRS penalty, if on informal review at least 50 percent of EPs avoid the PQRS penalty. If CMS does not have sufficient data to calculate their VM quality score, they will be considered “average quality.” CMS is finalizing the following key provisions for the 2016 reporting period/2018 payment adjustments:

  • The VM will apply to nonphysician EPs who are Physician Assistants (PAs), Nurse Practitioners (NPs), Clinical Nurse Specialists (CNSs), and Certified Registered Nurse Anesthetists (CRNAs) practicing either in groups or as solo practitioners.
  • The quality-tiering methodology will apply to all groups and solo practitioners. However, PAs, NPs, CNSs, and CRNAs will not receive downward adjustments under quality-tiering in 2018.
  • The maximum upward adjustment under quality-tiering will continue at: o +4.0 times the adjustment factor for solo physicians and groups with 10 or more EPs.

o +2.0 times the adjustment factor, for solo physicians and groups with 2 to 9 EPs.

o +2.0 times the adjustment factor for solo and groups of PAs, NPs, CNSs, and CRNAs.

  • The amount of payment at risk is: o -4.0 percent for groups of physicians with 10 or more EPs.

o -2.0 percent for solo physicians and groups with 2 to 9 EPs.

o -2.0 percent for solo and groups of PAs, NPs, CNSs, and CRNAs.

Beginning with VM adjustments in 2017:

  • The VM is waived for EPs and groups if at least one EP who billed for PFS items and services under their TIN participated in the Pioneer ACO Model, Comprehensive Primary Care Initiative, or other similar Innovation Center model (such as Comprehensive ESRD Care Initiative, Oncology Care Model, and the Next Generation ACO Model).
  • The Medicare Spending per Beneficiary measure will only apply to EPs with at least 125 episodes.
  • For solo practitioners and groups with 2 to 9 EPs, the All-Cause Hospital Readmissions measure will not be used in the quality calculation.

Medicare Shared Savings Program (MSSP)

  • The final rule adds a “Statin Therapy for the Prevention and Treatment of Cardiovascular Disease” measure in the Preventive Health domain to align with PQRS reporting.
  • Measures can stay or revert to “pay for reporting” if a measure owner determines they no longer align with updated clinical practice or cause patient harm.
  • The rule clarifies how EPs in an ACO can meet their PQRS requirements.
  • “Primary care services” include claims submitted by Electing Teaching Amendment hospitals and exclude certain services furnished in Skilled Nursing Facilities.

Physician Self-Referral Law
The physician self-referral law prohibits: (1) a physician from making referrals for certain “designated health services” (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship, unless the requirements of an applicable exception are satisfied; and (2) the entity from filing claims with Medicare (or billing another individual, entity, or third party payer) for those DHS furnished as a result of a prohibited referral. The final rule establishes two new exceptions and clarifies certain terms and requirements.

New Exceptions: Permit payment to physicians by hospitals, Federally Qualified Health Centers (FQHCs), and Rural Health Clinics (RHCs), to compensate non-physician practitioners under certain conditions; and permit timeshare arrangements for the use of office space, equipment, personnel, items, supplies, and other services. CMS believes these will enhance access to care, particularly in rural and underserved areas.

Physician-Owned Hospitals: The ACA established new restrictions on physician-owned hospitals, including setting a baseline physician ownership percentage they cannot exceed, and requiring statements of physician ownership on websites and in advertising. CMS is clarifying that a broad range of actions comply with these requirements, and finalized changes to the physician ownership calculation, effective January 2017, to include all physicians, not just those who refer to the hospital.

Clarifying Terminology and Policy Guidance: Relating to settlement of overpayments resulting from physician self-referral law violations is designed to “reduce perceived or actual noncompliance.”

  • Compensation paid to a physician organization cannot take into account the referrals of any physician in the physician organization (as opposed to the referrals of a physician who stands in the shoes of the physician organization).
  • Employees and independent contractors do not have to sign arrangements with the physician organization and a DHS entity.
  • Exceptions to the referral and billing prohibitions can be based on a collection of documents.
  • The terminology that describes these types of arrangements was made more consistent.
  • The term of leases and personal service arrangements lasting at least 1 year, and otherwise compliant, does not have to be in writing.
  • Expired lease and personal services arrangements can continue indefinitely if otherwise compliant.
  • A 90-day grace period is allowed to obtain missing signatures, inadvertent or not.
  • DHS entities can give physicians items used solely for a purpose identified in the statute.
  • A financial relationship does not exist when a physician provides services to hospital patients in the hospital, if both the hospital and the physician bill independently for their services.
  • The exception for ownership in publicly traded entities allows over-the-counter transactions.
  • The definition of a locum tenens physician was simplified.
  • Geographic service areas were clarified for FQHC and RHC physician recruitment exceptions.
  • Under the retention exception, retention payments based on physician certification may be no more than 25 percent of the physician’s current annual salary averaged over 24 months 


 


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org


Office Near UN for Rent
Modern 3000 sq. ft. medical office to rent near the United Nations. Handicapped accessible; private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.

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


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

November 6, 2015 – NY Is Not Part of the Herd

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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November 6, 2015
Volume 15, Number 42

Dear Colleagues:

Standing Up for Your Beliefs and Position

Our state medical society has a long history of leading change in many controversial areas, often being the lone voice of advocacy or opposition.  History has proven that those well-reasoned and critically analyzed positions have been spot on in their assessments and recommendations.  During the tenure of the previous two presidents, MSSNY took such positions, specifically on the SGR—when were the only state that did not sign onto the national letter.  Once again, our society has risen to lead by example.

This past week, I declined to sign onto a national letter asking for particular changes in the National Association of Insurance Commissioners’ Model Bill for network adequacy. Instead, we chose to draft our own letter highlighting the merits of the more robust network adequacy legislation accomplished in New York’s legislation wrought in part through the efforts of our Immediate Past President Dr. Andrew Kleinman.  Numerous attorney generals and legislators in other states have been looking at New York’s legislation as being more protective of patient needs in access to care via network adequacy.  In addition, our state’s legislation has protected both patients and physicians when these medical services have been sought out of network.  Other state medical societies have been looking at our efforts in this arena and are opting to follow our lead in this arena.

As New Yorkers, we have always understood the challenges that prompt us to go beyond conventional participation in advocacy efforts.  We are prepared to be contrarians when solutions proffered by others shortchange our patients and profession.  We are proud of the legislation on surprise bills and network adequacy that protects New York’s patients and physicians even when our lone voice of advocacy engenders bogus claims of “limited networks that are robust” or are alluded to as purveyors of conspiracy theories.

What gives us the fortitude to be the lone person advocating for the best interests of our patients and doctors?  It is our commitment to the oaths we made to protect our patients and profession when we first entered the profession.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Council Notes
At the meeting on November 5, Council approved the following:

  • Childhood Vaccination Resolution
    MSSNY will support the repeal to eliminate all non-medical exemptions for childhood vaccinations prior to attending school in New York State.
  • Resolution 113:
    Resolution 113 was amended and adopted as follows: That the Medical Society of the State of New York investigate logistics of including MSSNY and County Medical Society opt-out dues in the NYS Department of Education biennial registration billing and payment.
  • Resolution 60:
    Council adopted substitute resolution 60, which states that MSSNY will work with the NY chapters of the American Academy of Pediatrics to advocate for the following: that health insurers comply with the law that required them to provide coverage for autism and related services; insurers take the necessary steps to include sufficient physicians in networks; work with AMA and other societies to advocate for federal legislation to require self-insured plans to provide such coverage; work with similarly interested organizations to identify gaps in services and treatment.
  • Resolution 117:
    MSSNY will seek legislation and regulation that vertically integrated hospital systems must prove to the DOH a need to employ an individual physician in the market place and obtain a Certificate of Need for each of their employed physicians and that the certificate of need process include an evaluation of the employment agreement, insofar as it be limited to fair market values of physician services and not include ancillary services.
  • Presidential Appointments to the Council Workgroup
    The workgroup will develop guidelines for collaborating with non-MSSNY physician groups seeking MSSNY engagement.
  • Presidential Nomination to AMA Senior Physicians Section
    Dan Koretz, MD will serve as the Senior Physician Section liaison with the AMA.  Dr. Koretz will provide two-way communication between MSSNY and the SPS through participation in virtual Assembly calls and the annual and interim meetings.
  • Virtual Council Meeting in January
    The January Council meeting will be held remotely, with various locations around the state connecting via WebEx.


NY Practices Waiting To See Impact Of New ICD-10 Coding System
POLITICO New York (11/3, Velasquez) reports healthcare providers in New York State “say it’s still too early to know what sort of repercussions the new [coding] system will have on their operations,” one month into the transition. As of October 1, those providers who are “covered by the Health Insurance Portability Accountability Act (HIPPA) had to transition to a tenth version of the International Statistical Classification of Diseases, also known as ICD-10.” Regina McNally, the vice president of socio-medical economics at the Medical Society of the State of New York, says, “If there are going to be some problems of any significance, we have to wait a little further down the road before those issues.”


Medical Journal Article Concludes that Higher Spending Physicians Sued Less; Profound Implications for Value-Based Payments
As was widely reported in the Washington Post  and the New York Times this week, a British Medical Journal article concluded that physicians who spent the most health-care resources on hospitalized patients had the lowest likelihood of being sued.   MSSNY will be sharing these articles with key legislators and Cuomo Administration officials, noting that the results of this study have profound consequences for efforts to shift commercial and Medicaid payments to a value-based construct.  Physicians could find themselves in a “Catch 22” situation, where in acting to assure their patients are able to get all the care they need and to reduce the risk of being sued, they may find themselves being penalized by public payors and commercial insurance companies for exceeding spending targets used under such value-based payment paradigms.

In the study, researchers tracked more than 24,000 Florida physicians over a nine-year period and found that in six specialties, physicians who were found to have spent the most health-care resources on hospitalized patients had the lowest likelihood of being sued.


MSSNY Joins AMA and Other Medical Societies in Seeking Congressional Intervention to Delay Unworkable Meaningful Use Requirements
As new CMS regulations will make Stage 3 of the electronic health record (EHR) meaningful use program even less achievable and more disruptive, MSSNY joined 110 other medical associations in a joint letter initiated by the AMA to members of the Senate  and the House urging Congress to intervene.  The letters point out that “the Centers for Medicare & Medicaid Services (CMS) has continued to layer requirement on top of requirement, usually without any real understanding of the way health care is delivered at the exam room level.”

MSSNY Board of Trustees member and Saratoga Springs ENT Dr. Robert Hughes and MSSNY staff recently joined physician leaders from other states in Washington DC to advocate for numerous bills including legislation (HR 3309, Ellmers) to reduce the hassles associated with complying with onerous federal regulations governing the use of electronic medical records.  The bill contains a provision to postpone the implementation of Meaningful Use Stage 3 until 75% of physicians can meet Meaningful Use Stage 2.

Physicians are encouraged to email their members of Congress and tell them that the nation’s patients and physicians need significant changes to meaningful use Stage 3. They also can submit comments on the Stage 3 regulations during the 60-day comment period that ends Dec. 15. The AMA’s dedicated website BreakTheRedTape.org makes it simple to submit comments directly to Congress and CMS.


Final 2016 Medicare Physician Fee Schedule rule issued
Late last Friday, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Physician Fee Schedule rule for 2016, along with a fact sheet describing many of its most notable provisions.

The AMA notes that as a result of the interplay between numerous statutory provisions, the Medicare fee schedule conversion factor will be reduced by 0.29% in 2016, from $35.93 to $35.83.

Here’s why: The Medicare Access and Chip Reauthorization Act (MACRA), which repealed the SGR, increased the conversion factor by 0.5% on July 1 and called for additional annual updates of 0.5% from 2016 through 2019.  However, the Protecting Access to Medicare Act of 2014 enacted in April 2014, established an annual target for reductions in Medicare payment schedule expenditures that result from adjustments to misvalued codes.  The Achieving a Better Life Experience Act of 2014, enacted in December 2014, accelerated the application of the expenditure reduction target, setting targets of 1% for 2016 and 0.5% for 2017 and 2018.  Unfortunately, the Medicare payment rule only identified “misvalued code” changes that achieved 0.23% in net reductions, which required CMS to impose a 0.77% reduction to all Medicare professional services, more than offsetting the increases contained in MACRA.

Among its numerous provisions, the Medicare fee schedule rule for 2016 includes provisions to establish payments for advanced care planning.  It also sets forth terms for the bonus and penalties physicians will face in the Value-Based Modifier Program in 2018 based upon 2016 performance.  Groups of physicians with 10 or more face a bonus or penalty of +/- 4%; while solo practitioners and or physicians in groups of 9 or less face a bonus or penalty of +/- 2%.  The program will sunset after 2019 as part of the transition to the Merit Based Incentive Payment System (MIPS).


More Leeway in Two-Midnight Rule
CMS issued changes to the two-midnight rule last week that give physicians broader leeway to determine if someone should be treated on an inpatient basis. But the controversial policy is largely intact. Whether a hospital will be reimbursed for an inpatient stay that lasts fewer than two nights will depend on such factors as the severity of a patient’s symptoms and the likelihood of an adverse event. Inpatient stays that do not keep a patient in the hospital overnight will be prioritized for review. “We will continue to monitor hospital admission practices and look for any evidence of gaming,” CMS told Modern Healthcare. But instead of sending recovery audit contractors who are paid to dispute claims to conduct the initial review, quality improvement organizations will be the first to investigate. GNYHA was among the plaintiffs in a class-action suit filed earlier this year that challenged reimbursement cuts made in association with the two-midnight rule. The group voiced support for the changes in a memo released on October 30.


MSSNY’S Advocacy Matters CME Series on November 10: Foster Gesten, MD to Focus on State Health Innovation Plan (SHIP)
Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.   

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please click here.

The objectives of November 10th Advocacy Matters  program are as follows:

1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.

  1. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  2. Describe the five strategic pillars and three enablers of system transformation.
  3. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please go to mssny.webex.com and click on the “Upcoming” tab.  A “Register” link appears to the right of the program name.

To read the flyer, please click here.

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

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment.  Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

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

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

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified.

The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.


Avoid Medicare Penalties
Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, – 2.0% but it could be more. Understanding the rules can be confusing but is necessary. MSSNY has arranged special rates for members from Covisint – a service to help practices with PQRS reporting.  With Covisint PQRS you can confidently avoid the 2017 payment adjustment of -2.0%.

Covisint features include:

  • Paper and electronic data collection methods
  • Web-based application access and data entry
  • Easy and Quick …
    The measures group option only requires 20 patients

HIPAA-compliant database

Automated data submission

MSSNY Members save $100. Call (516) 488-6100, Extension 403 or email: eskelly@mssny.org for your MSSNY Member discount code. Use it at the time of submission and receive a discounted submission rate of $199.

Have questions about PQRS? Plan to attend one of our live Q&A sessions to get all of your questions answered and more. Thursday, November 19, 2015 at 11:00 am ET – Click here to add this meeting to your calendar.

Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more 


MSSNY To Conduct E-Prescribing Webinars Monday, Nov. 9 and Monday, Dec. 9
MSSNY will host two free continuing medical education webinars on E-prescribing for MSSNY members on Monday, November 9th and Wednesday, December 9, 2015 at 7:30 a.m.

Registration is now open to MSSNY physicians by clicking here.

Select “Training Center” and the “Upcoming” tab.  Then click “Register” link to the right of desired session.

A copy of the flyer can be found here.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,”  includes the following educational objectives are:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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. 

Further information can be obtained by contacting Miriam Hardin at mhardin@mssny.org or Terri Holmes at tholmes@mssny.org.  

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.   The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances from March 27, 2015 to March 27, 2016.  


Buyer Beware: Too Good to Be True?
There are now over 40 insurers competing for medical liability insurance in NYS. Sometimes premium quotes can seem too good to be true.  This might be because insurers are providing less coverage, shifting coverage from occurrence to claims made, or offering an attractive discount that may not persist.  If a quote seems too good to be true, give MLMIC a call at (716) 648-5923. We’ve seen a lot in our 40 years in NYS and can often spot differences that may make a difference. 


MEDCO Offering Free Crosswalk Guides
FREE Crosswalk Guides (18 Specialties) are available here:www.medcoconsultants.com.


Do You Want to Present Your Project at MSSNY’s 11th Annual Symposium on April 15?
MSSNY is pleased to announce our 11th Resident/Fellow/Medical Student Poster Symposium on Friday, April 15, 2016 at the Westchester Marriott in Tarrytown, New York from 2 pm – 4:30 pm. Click here for detailed guidelines.Deadline for abstract submission is 4 pm, Monday, January 25, 2016.We welcome the participation of your residents and fellows. Participants must be MSSNY members, and membership is free for first-time resident members.
Join online at www.mssny.org.


Be There! Fall Residents,YPS and Students Get Together in NYC Next Friday
Anuradha Khilnani, MD and the New York County Medical Society, in collaboration with the AMA, is hosting a networking social for physicians, residents and medical students.

When:   Friday, November 13

When:   7-9 pm

Where: The Royalton Hotel 44 W. 44th St


For Your Patients: Q&A for Health Republic Members

Q. I was previously notified that my Health Republic coverage would end on December 31, 2015. Is this a change?

A. Yes, this is a change. Your Health Republic coverage will end one month earlier on November 30, 2015.

Q. Why is my Health Republic coverage ending sooner?

A. Based on an in-depth review by the NYS Department of Financial Services and the federal Center for Medicare and Medicaid Services (CMS), it has been determined that it is in the best interest of consumers to wind-down coverage under Health Republic on November 30, 2015 rather than at the end of the year.

Q. How do I select a new plan?

A. You can:

Log in to your Marketplace account before November 16th and visit the “Plans” tab at the top of the screen.

  • Select “Find a New Plan” at the bottom of the screen to see your health plan options.
  • Once you have chosen your plan, be sure to select “confirm and checkout” to confirm your enrollment in your new plan for December 1, 2015 coverage.
  • Or, you can call our special customer service helpline at 1-855-329-8899 and our customer service representatives will help you select a new plan or give you contact information for an in-person assistor in your area who can help you.

Q. What should I consider when I select my new plan?

A. You should consider:

  • Whether your health care providers are in the new health plan’s network.
  • Whether the prescription drugs you take are covered by the new plan.
  • The premium cost of the new plan.

To find contact information for the health plans offered on NY State of Health and links to each health plan’s provider network directory visit http://info.nystateofhealth.ny.gov/PlanCustomerService 1

Q. Do I have to select the same metal tier (platinum, gold, silver, bronze) as I am enrolling in Health Republic?

A. No. You can select any health plan that is available in your area and any metal tier.

Q. What happens if I don’t select a plan by November 15?

A. In order to ensure you are covered during the month of December 2015 you must pick a new plan by November 15th.

Q. Do I still have coverage for the month of November?

A. Yes. Provided that you pay any required premium for the month of November 2105, you are covered by Health Republic through November 30, 2015.

Q. What if I have already met or have paid towards my deductible in my current plan?

A. If you are enrolled in a Health Republic plan that has an annual deductible, the NYS Department of Financial Services is working to ensure that your new health plan will not charge you for the amount of deductible you already met in 2015. Keep your records. You may need to provide your new plan with evidence that you have met all or part of the 2015 deductible.

Q. Will my providers be in my new plans’ network?

A. You should ask both your providers and the plan you are considering joining about whether your providers participate with the new plan. To find contact information for your health plan and a link to the plan’s provider network directory visit at: http://info.nystateofhealth.ny.gov/PlanCustomerService

Q. What if I am receiving treatment when my Health Republic coverage ends on November 30, 2015 and my provider is not in the new plan’s network?

A. If you are either: a) in an ongoing course of treatment with a provider for a life-threatening or a degenerative and disabling condition or disease, or b) in the second or third trimester of a pregnancy when your new coverage becomes effective on December 1, 2015, then you may be able to continue to receive care from your provider for up to 60 days (or through pregnancy) under your new health insurance policy, even if your provider does not participate in your new health insurer’s network. To receive transitional care, your provider must agree to accept as payment your new health plan’s reimbursement for such services and to certain other conditions of providing care under the new policy. If your provider agrees, you will receive the services as if they were being provided by a participating provider. You will only pay for any applicable in-network cost sharing. You, your representative or your provider should contact your new health insurer to determine if you are eligible for transitional care. To request transitional care, call your new health plan’s customer service and let them know that you are new the plan and ask how to request transitional care. If you experience any problems with the process, you can call the NYS Department of Financial Services toll free number 1-800-332-3736 for assistance in filing this request with your health plan.

Q. What should I do if I have scheduled procedures or medical care in December 2015?

A. If you have care scheduled during the month of December 2105, you should do the following:

  • Visit the NY State of Health website, call the NY State of Health Customer Service Center at 1-855-329-8899 or visit an in-person assistor to review your plan options.
  • Ask your provider which health plans they participate with.
  • Select your health plan.
  • Call your new plan’s customer service to tell them that you have scheduled procedures or care in December 2015 and ask if you need prior-authorization.

Q. If I select a plan for December 1, 2015 will I be automatically enrolled into that plan for January 1 or do I need to make a separate plan selection for January coverage?

A. Current Health Republic enrollees will need to return to the Marketplace beginning on November 16 to select a plan with an effective date of January 1, 2016.

Q. Can assistors offer support to current Health Republic members by phone instead of only providing in-person assistance?

A. Yes. Assistors can provide support telephonically to current Health Republic enrollees in order to assist in selecting plans for December 1, 2015 and January 1, 2016.


CMS Extends Deadline for PQRS Informal Review Process

CMS is extending the 2014 Informal Review period. Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, PQRS group practices, and Accountable Care Organizations (ACOs) that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment now have until 11:59 p.m. Eastern Time on November 23, 2015 to submit an informal review requesting CMS investigate incentive eligibility and/or payment adjustment determination. This is an extension from the previous deadline of November 9, 2015.

All informal review requestors will be contacted 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.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 23, 2015 at 11:59 p.m.EST.

Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment – Informal Review Made Simple (available on the PQRS Analysis and Payment webpage) for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information, such as Social Security Number or Taxpayer Identification Number (TIN), in e-mail inquiries to the QualityNet Help Desk.

 

 

 

 


Classifieds


Office for Rent Near UN
Modern 3000 sq. ft. medical office to rent near the United Nations. Handicapped accessible; private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581.


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-Specialty Group Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.
Job requirements:
• Current Board Certification / Recertification
• Current & Unrestricted NYS license, DEA & NPI
• Must be on panels of managed Medicaid and HMO plans
• Working knowledge of EMR
• Take detailed patient history
• Do physical examinations
• Order medically necessary tests, equipment, etc
• Be able to make complex decisions
• Write Prescriptions
• Provide treatments
• Venipuncture
• Give injections
• Follow-up – evaluation of test results and with patients
• Provide referrals to specialists
NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to: medicmiche@aol.com or hrld_weissman@yahoo.com


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’ Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com.


PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room; large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

October 30, 2015 – Chicken Little Was Wrong!

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
October 30, 2015
Volume 15, Number 41

Dear Colleagues:

The sky is falling! The sky is falling! Y2K is here again!

All of our fear and angst with regard to the complete overhaul of our diagnostic coding system did not kill us (yet). From all accounts, health plans may have experienced minor glitches, but they claim that they expeditiously fixed any problems so that we did not feel any significant pain.

To my knowledge, no physicians had to use any of the more exotic new codes like V91.07-“burn due to water skis on fire” or V97.33- “sucked into a jet engine.”

CMS, according to yesterday’s press release, states that there is an expectation that “this change will enable providers to capture more details about the health status of their patients to improve patient care and public health surveillance.”  Really! It is an insult to physicians in the trenches to be told how to quantify their life’s work by the switching of the numbers game in midstream. However, since CMS and other health plans are the fiduciary, we were forced (kicking and screaming) to make some concessions.

If any of you have experienced significant maladies from the transition, please call Regina McNally in our Socio-Medical Economic Division at 516-488-6100 ext 332, who will alert any carrier that is causing you cash flow harm.

CMS reports that they are “carefully monitoring the transition and is pleased to report that claims are processing normally.” Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Following this time table, more meaningful information will be available on the ICD-10 transition in November.

According to their press release, CMS “is continuing its vigilant monitoring process of the ICD-10 transition and shared the following metrics detailing Medicare Fee-for-Service claims from 10/1-10/27.” Their stats are as follows: total claims submitted-4.6 million per day; total claims rejected due to incomplete or invalid diagnosis codes— 2.0% of total claims submitted; total claims rejected due to invalid ICD-9 codes— 0.11% total claims. 

From what we have NOT heard, the sky did not fall.
Now that we have survived the first “tsunami,” we can move onto the next fiasco—e-prescribing.

We have five months to batten down the hatches.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


NYDFS, NYSOH, CMS Announce Additional Actions Regarding Health Republic
The New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace (NYSOH), and the CMS today announced additional actions regarding Health Republic Insurance of New York and a transition plan for Health Republic customers.

On September 25, 2015, NYDFS directed Health Republic to cease writing new health insurance policies and announced that the co-op will commence an orderly wind down after the expiration of its existing policies. However, a subsequent NYDFS and CMS-led review of Health Republic’s finances has found that the company’s financial condition is substantially worse than the company previously reported in its filings to NYDFS. In light of these developments, NYDFS and the NYSOH Marketplace have determined that it is in the best interest of consumers to end all Health Republic policies – both individual and small group – on November 30, 2015 so that customers can transition to new coverage after that date.


From Regina McNally, VP Socio Med; Here Are Contact Numbers for Insurers
Recently, I have been hearing from our members that many have been having difficulty reaching various health plans and/or health insurance related entities.  So, I contacted many of these organizations to create a one-stop shop for contact information.

Please share this with your colleagues and office staff.

If you or your staff has better contacts to get your issues resolved, please be sure to continue to utilize those contacts. The attached is meant to be helpful for those persons who do not have that first point of contact or need another point of contact with an organization.

Of course, I continue to be available to you and yours for situations whereby an impasse has been reached and I might be of some assistance. I am here to help. Click here to view the contact list.


House and Senate Both Pass Budget Package to Raise Debt Ceiling and Prevent Medicare Premium Increases
This week, both the US House of Representatives and the US Senate passed a sweeping Budget package to raise the debt ceiling limit until 2017 and to prevent a 52% increase to millions of seniors’ Medicare premiums that otherwise would have gone into effect in 2016. The House passed the Budget package by a 266-167 vote and the Senate passed it by a 64-35 vote. The only New York member of Congress who voted against it was Rep. Lee Zeldin (R-Suffolk County).

Of particular concern, the package would extend for an additional year, through 2025, the 2% Medicare payment sequester provisions that had originally been enacted by the Budget Control Act of 2011.

The Budget package also contains a number of controversial provisions, including: a measure to limit Medicare payments to hospitals for services provided at newly acquired physician practices to the same fee that would be paid for health care services provided in a private physician office; a measure to require generic drug manufacturers to pay additional rebates to the Medicaid program if the price of the drug has increased faster than inflation; and a measure to repeal a section of the ACA that requires employers with more than 200 employees to automatically enroll new full-time equivalents into a qualifying health plan if offered by that employer.

The Budget agreement will also provide two years of relief from existing sequestration spending caps that could have resulted in cuts to a number of public health programs, including the National Institute of Health, Agency for Healthcare Research and Quality and Primary Care Training Programs.

To read a comprehensive summary of the provisions, click here.


AMA Scorecard on EHR Usability Shows Many Vendors Not Meeting User-Centered Goals
The AMA announced this week that a comparative EHR Usability Framework it had partnered with MedStar Health to develop shows many EHR vendors are not meeting basic standards for user-centered design and formal usability testing processes. 

Using information supplied by the vendors to the Office of National Coordinator (ONC) and available publicly, the MedStar Human Factors Center and AMA collaborators reviewed 20 prevalent EHR products.  The review used a 15-point methodology and assigned a numeric value based on the vendor’s compliance with best practices for UCDA score less than 15 means basic usability process standards were not met. Vendors are only required to report the process they followed for eight EHR features that are considered important areas for patient safety. Thus a perfect score using the AMA/MedStar framework only reflects the processes used to design these eight capabilities and does not reflect the design and evaluation of the hundreds of other capabilities in the EHR or the actual usability experienced by physicians and other end-users.

The AMA announcement noted that its’ goal is to promote EHR vendor adherence to UCD best practices as represented in the 15-point usability framework in the design and redesign of their products. To improve the usability of EHRs there is a need to better promote rigorous usability development processes based on recognized methods and standards. This framework can be used by ONC to improve their certification program, and as a method to track improvements EHR vendors make as they recertify their products over time.

Physician experiences documented by the AMA demonstrate that most EHR systems fail to support effective and efficient clinical work, and continued issues with usability are a key factor driving low satisfaction with many EHR products,” said AMA President Steven J. Stack, M.D. “Our goal is to shine light on the low-bar of the certification process and how EHRs are designed and user-tested in order to drive improvements that respond to the urgent physician need for better designed EHR systems.”

To read more, click here.


MSSNY’S ADVOCACY MATTERS CME SERIES on Monday, November 10
Foster Gesten, MD: Focus on State Health Innovation PLAN (SHIP)

Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health, will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.  

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please go to the following this link.

The objectives of November 10th Advocacy Matters program are as follows:

  1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.
  2. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  3. Describe the five strategic pillars and three enablers of system transformation.
  4. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please click here to register.

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

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment. Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified. The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials. 


Op-Ed in Support of Collective Negotiation in Binghamton Press & Sun Bulletin
Broome County Medical Society President Dr. Michael Herceg authored an op-ed in the Binghamton Press & Sun Bulletin this week calling on the NYS Legislature to pass a bill (A.336, Gottfried/S.1157, Hannon) strongly supported by MSSNY to permit independently practicing physicians the ability to collectively negotiate patient care terms with market dominant health insurers.  To read the op-ed, click here: The op-ed highlights many of the challenges that New York physicians face in seeking to be able to continue to deliver the timely quality care expected and deserved by patients, including overly burdensome insurer-imposed administrative hassles, rapidly increasing deductibles and exorbitant medical malpractice insurance costs.


Avoid Medicare Penalties
Reporting PQRS has never been more important. The penalty for not reporting is, at a minimum, – 2.0% but it could be more. Understanding the rules can be confusing but is necessary. Attention MSSNY Members! Save $100. Call (516) 488-6100, Extension 403 or email: eskelly@mssny.org for your MSSNY Member discount code. Use it at the time of submission and receive a discounted submission rate of $199.

Have questions about PQRS? Plan to attend one of our live Q&A sessions to get all of your questions answered and more. Thursday, November 19, 2015 at 11:00 am ET – Click here to add this meeting to your calendar.

Visit Covisint at: www.pqrs.covisint.com or contact them at 866.823.3958 for more information.


Study Says Popular Over-The-Counter Cold Medicine Doesn’t Work
A study published in the Journal of Allergy and Clinical Immunology: In Practice suggests that the over-the-counter oral decongestant phenylephrine “simply doesn’t work at the FDA-approved amount found in popular non-prescription brands, and it may not even work at much higher doses.” Researchers at the University of Florida “failed to find a dose of phenylephrine within the 10 mg to 40 mg range that was more effective than a placebo in relieving nasal congestion.”  The study is available at: http://bit.ly/1WkmcEN


USPSTF Recommends Blood Glucose Screening For All Overweight Adults between Ages of 40 And 70
In the recommendations appearing Oct. 27 in the Annals of Internal Medicine, the US Preventive Services Task Force (USPSTF) advises blood glucose testing for all adults who are overweight and who are between the ages of 40 and 70, even if they display no symptoms of diabetes.
The specifics of the screening recommendations, classified as Grade B, note additional risk factors for patients with a high percentage of abdominal fat, high cholesterol, high blood pressure, physical inactivity, and smoking.” For those patients whose glucose levels are normal, re-screening every three years was recommended. 


Doctors Without Borders Recruiting Doctors; Info Session on Nov. 19 in Manhattan
Doctors Without Borders is recruiting qualified MEDICAL AND NON-MEDICAL professionals in New York to respond to ongoing humanitarian crises and join their team of dedicated humanitarian aid workers. They are hosting a recruitment information session at their New York headquarters New York Recruitment Info Session Thursday, November 19, 2015 at 7:00 PM at Doctors Without Borders, 333 Seventh Ave, Second  Floor, NY, NY.  Click here to learn more. Click here to register for the New York session


CMS Now Accepting Comments on Section 101 of MACRA through November 17
On October 15, the Centers for Medicare & Medicaid Services (CMS) announced an extension to the comment period for the Request for Information (RFI) for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The comment period, which was originally 30 days and scheduled to close on November 2, 2015, will now close on November 17, 2015.

The RFI seeks public comment on Section 101 of MACRA, which is subject to notice and comment rulemaking. Section 101 repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule (PFS) and implements scheduled PFS updates, including a higher update rate for “qualifying participants in Alternative Payment Models (APMs)” beginning in 2026.

Section 101 also adds the new Merit-based Incentive Payment System (MIPS) for eligible professionals (EPs); sunsets payment adjustments under the current Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program; and consolidates aspects of those programs into the new MIPS.

In addition, Section 101 of the MACRA promotes the development of APMs by providing incentive payments for certain EPs who participate in APMs and by encouraging the creation of additional Physician-Focused Payment Models (PFPMs).

Submit a Formal Comment by November 17
CMS encourages the public to submit comments by November 17. Comments can be submitted in several ways, including:

  1. Electronically
  2. By regular mail
  3. By express or overnight mail
  4. By hand or courier

For more information, view the complete Medicare Access and CHIP Reauthorization Act of 2015 and visit the CMS website.


Classifieds


Exceptionally Distinctive Large Medical Offices for Sale. 115 East 61 Street, NYC
Great location between Park and Lexington Avenues— conveniently located between midtown and Upper East Side. Easy access to hospitals and transportation. Full–time attended lobby. No steps. Beautiful well–lit space adaptable to all specialties. Prestigious all–medical/dental building. Liberal sublet policy. Contact Sharon F. Aspis at (212) 692–6139.


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-Specialty Group Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.
Job requirements:
• Current Board Certification / Recertification
• Current & Unrestricted NYS license, DEA & NPI
• Must be on panels of managed Medicaid and HMO plans
• Working knowledge of EMR
• Take detailed patient history
• Do physical examinations
• Order medically necessary tests, equipment, etc
• Be able to make complex decisions
• Write Prescriptions
• Provide treatments
• Venipuncture
• Give injections
• Follow-up – evaluation of test results and with patients
• Provide referrals to specialists
NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to: medicmiche@aol.com or hrld_weissman@yahoo.com


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’ Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com.


PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room; large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

October 23, 2015 – Social Media Is Pow! Pow! Powerful

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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October 23, 2015
Volume 15, Number 40

Dear Colleagues:

This week, we followed the story of the near closing down of the family practice residency program at Columbia University/New York Presbyterian Hospital.  The reports indicate that the closures were not due to financial constraints but rather to “strategic priorities.”  The event serves as an excellent case study for health policy, communications and business school students.

I will be delving more into some of the valuable insights offered by this real-time case in my November News of New York column.  Today, I would like to focus on the power of social media.  Most of us are familiar to some extent of its value and power.  For the least engaged of us, we may participate for social purposes; most of have family members who are fully immersed in social media.  Yet, in the case of the residents and faculty in the family practice residency program, social media was used not as a social tool but rather as a powerful tool for action.

Social media as a power tool for action is a concept well known to younger physicians and medical students.  They use it not only for social purposes but also for change management.  It is not merely a “keeping you up-to-date” tool.  Rather, it is an informational tool used expressly to effect action and change.  Therein, lies the key difference in how social media is used by younger physicians versus older physicians.  If older physicians engage in social media professionally, it is to disseminate knowledge.  When younger physicians engage social media, they disseminate knowledge AND seek to effect change.  It is not merely a cerebral tool—rather, it is a tool to effect change.

The speed with which Columbia University/Presbyterian Hospital reversed its decision regarding the family practice program and the power of the individuals and entities that weighed in on the decision to reverse change attests to the value of social media to effect change.  It is a tool for organizing stakeholders and entities that can effect change when individuals, by themselves, are incapable of effecting change.

While many organized medicine organizations have captured the power of social media as a tool for disseminating knowledge, I believe most have not fully captured or harnessed the capabilities to the extent that the residents in the Family Practice Program at Columbia did when they managed a reversal of the program’s closure.  It is time we as a state society and amalgam of county and specialty societies begin to explore how we, too, can convert our use of social media from merely knowledge dissemination to a  powerful action tool for effective change.

Decision can be reversed!

While I laud the residents and faculty that used these tools to effect change, I think there is a larger brilliant teaching moment to be gained from this event.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC


DOH Bureau of Narcotic Enforcement Information on Medical Marijuana Program
The New York State Department of Health’s Bureau of Narcotic Enforcement announces the availability of the required four-hour medical use of marijuana course. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course. The Compassionate Care Act, signed into law on July 5, 2014, authorized the Department of Health to implement a Medical Marijuana Program in New York State. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must:

  • be qualified, by training or experience, to treat patients with one or more of the serious conditions eligible for medical marijuana;
  • be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law, in New York State;
  • possess a Health Commerce System (HCS) Medical Professions Account user ID and password;
  • possess an active Drug Enforcement Administration (DEA) registration number; and
  • complete the four hour Department-approved medical use of marijuana course.

Departmental officials anticipate that the four hour department approved online course is available to practitioners through the TheAnswerPage, an established online medical education provider here.

The course will include the following topics, which are required in the regulations: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence.  The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course. Additional information regarding the practitioner registration process is available on the Department’s Medical Marijuana Program webpage, which can easily be accessed via the this link.

Please monitor this webpage frequently for updates and the department may be contacted with any questions: New York State Department of Health, Bureau of Narcotic Enforcement,

Medical Marijuana Program, Riverview Center,50 Broadway, Albany, NY 12204; Call 866-811-7957 or email mmp@health.ny.gov for more information. 


MSSNY Joins Physician Leaders in our Nation’s Capital to Advocate for Administrative Simplification
This week, Saratoga Springs ENT and MSSNY Board of Trustees member Dr. Robert Hughes joined MSSNY staff and physician leaders from other states in Washington DC to advocate for legislation to reduce some of the overwhelming bureaucratic hassles physicians are facing in various aspects of the Medicare program.  Joint advocacy meetings with representatives of the California, Florida and Texas medical associations were held with numerous Senators and Representatives who serve on key health care policy committees in support of legislation to:

  • Reduce the hassles associated with complying with onerous federal regulations governing the use of electronic medical records (HR 3309, Ellmers);
  • Restore some fairness in the conducting of audits by Medicare Recovery Audit Contractors (HR 2568, Holding);
  • Repeal the excise tax on comprehensive health insurance plans (“Cadillac Tax”) that was contained within the ACA scheduled to go into effect in 2018 (several bills including: S.2075, Brown; S.2045, Heller; and HR 2050, Courtney).

There was wide support for many of the provisions contained within each of these proposals, and substantial efforts are being made to incorporate elements of these proposals into various end of year “must do” bills under development by Congress.  Meetings were held with the offices of Senator Charles Schumer, Rep. Tom Reed (Ways & Means Committee) and Rep. Chris Collins (Energy & Commerce Health Subcommittee) from New York; Senator John Cornyn, Rep. Dr. Michael Burgess and Rep. Kevin Brady (Chair, W&M Health Subcommittee) from Texas; Senator Bill Cassidy (Senate HELP Committee) from Louisiana; Rep. Dianne Black (W&M Health Subcommittee) and Rep. Marsha Blackburn (E&C Health Subcommittee) from Tennessee; and Rep. Dr. Tom Price (W&M Health Subcommittee) of Georgia.


MSSNY’S ADVOCACY MATTERS CME SERIES on Monday, November 10

Foster Gesten, MD to Focus on State Health Innovation PLAN (SHIP)

Foster Gesten, MD, Medical Director for the Office of Health Insurance Programs for the Department of Health, will present on the State’s Health Innovation Plan on MSSNY’s November 10th  Advocacy Matters program. The program will run from 12:30- 1:30PM.  

The Centers for Medicare and Medicaid Services’ State Innovation Models Initiative is providing support to states for the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states. New York State has received a grant to pursue the implementation of its Health Innovation Plan, centered on statewide implementation of an Advanced Primary Care (APC) model, which will facilitate integrated care delivery and which will rely on emerging health information technologies and primary care workforce to promote the objectives of population health. For more information on the State’s Health Innovation Plan, please go to the following this link.

The objectives of November 10th Advocacy Matters program are as follows:

  1. Describe the fundamental components of the State Health Innovation Initiative and its core objectives.
  2. Describe the Advanced Primary Care (APC) model and how physician practices can achieve this status.
  3. Describe the five strategic pillars and three enablers of system transformation.
  4. Describe how the Plan will promote meaningful, value-based payment arrangements across the State’s payers and insurers and how physician practices will be affected.

Physicians interested in participating in the coming November 10th program may register for Advocacy Matters. Please go to https://mssny.webex.com and click on the “Upcoming” tab.  A “Register” link appears to the right of the program name.    

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

Advocacy Matters is a CME series held on the second Tuesday of every month. It is sponsored by MSSNY’s Legislative and Physician Advocacy Committee. It is intended to enhance communication with physicians concerning issues of the moment. Elected officials, agency officials, and key legislative/agency staff will be invited to discuss regulatory and legislative matters.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. Any discussion of investigational or unlabeled uses of a product will be identified.

The planners and faculty participants do not have any financial arrangements or affiliations with any commercial entities whose products, research or services may be discussed in these materials.


NY Judge Rules Against Lawsuit that Makes Assisted Suicide a Crime
On October 19, a state civil judge ruled against a lawsuit that makes assisted suicide a felony. Judge Joan Kenney ruled that while she was sympathetic to the patients’ plight, the US Supreme Court has already found that New York state laws prohibiting assisted suicide do not violate civil rights.

Attorney General Eric Schneiderman argued against assisted suicide because of New York’s “longstanding commitment to the preservation of life,” he said. In her decision, released on October 19, Judge Kenney quoted a 1997 ruling by former US Supreme Court Chief Justice William Rehnquist that states laws barring lethal medication do not “infringe on fundamental rights.”

The patient plaintiffs, a 55-year-old former FedEx worker with AIDS, an 81-year-old retired attorney with bladder cancer and a 60-year-old philanthropist with Lou Gehrig’s disease — are appealing the decision.

Currently, assisted suicide is legal in Montana, Washington, New Mexico, Oregon and Vermont.


AMA Expresses Concerns with NAIC Proposal to Enhance Network Adequacy
The AMA has written to the National Association of Insurance Commissioners (NAIC) to express concerns with several aspects of its proposal to revise its Managed Care Plan Network Adequacy Model Act, which has not been updated since 1996.  The purpose is to develop template legislation for consideration by State Legislatures.  While states are certainly not required to enact these model acts, they are often given strong consideration.  To view a copy of the letter, click here.

The letter does reference several positive aspects of the NAIC proposal, including: stronger regulation and transparency of provider directories; a shift away from using accreditation as a “deeming” tool; a focus on access to appropriate specialty care, including pediatric specialty care; and transparency in carriers’ selection standards have been included in the draft model act.

However, the letter also sets forth several concerns with the template proposal that have been highlighted to AMA by specialty societies and state medical societies from across the country, including MSSNY.  These include:

  • The draft legislation fails to require prior approval by regulators of health plan networks;
  • The draft legislation fails to require that tiered networks be sufficiently comprehensive to meet insured’s needs;
  • While the draft legislation outlines several types of quantitative measurements that may be used to measure network adequacy, it fails to require the use of these quantitative standards;
  • The draft legislation could be construed to permit health insurers to use telemedicine technologies to meet network adequacy requirements; and
  • The draft legislation would greatly undermine the incentive for health insurers to establish comprehensive physician networks by permitting insurers to only have to pay their woefully inadequate in-network rates or Medicare rates, for care by out of network physicians in a hospital.  This element of the Model Act revisions would give enormous new powers to health insurance companies, far different than the very carefully crafted compromise law enacted in New York State in 2014 that balanced the need for patients to avoid facing sometimes very large “surprise” medical bills with the need to assure that physicians are paid fairly for providing this needed care in often life-threatening situations.

MSSNY is also developing its own letter to the NAIC that will raise similar concerns. 


From NGS: Claims Submitted for Hepatitis/Pneumococcal Vaccines Denied in Error
Description of the Problem

National Government Services has identified a claims processing issue in which claims for the following immunization and administration procedures codes incorrectly denied due to an incorrect diagnosis code. Codes: G0010, G0009, 90630, 90669, 90670, 90732, 90739, 90740, 90743, 90744, 90746, 90747

What This Means to You

A system error impacted providers who submitted claims for these services in which they reported ICD-10-CM diagnosis code Z23.The system issue has caused these claims to deny

in error as having an invalid diagnosis code.

                                              Current Status of Problem

A mass adjustment will be made to claims that denied in error; adjustments will be completed soon. It is unnecessary to resubmit the claim or to request an appeal. No provider action is needed.
Please watch the Production Alerts section of our website and Email Updates for additional information regarding this issue. We apologize for any inconvenience this may have caused. 


Register Now For E-Prescribing CME Webinars
MSSNY is hosting two free continuing medical education webinars on E-prescribing on November 9 and December 9 at 7:30 a.m. for MSSNY members.

Registration is now open to MSSNY physicians by clicking here.

Select training center and the upcoming tabs.   A copy of the flyer can be found here. The webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 a.m.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives are:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.

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.

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013. The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.  


Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days.  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide.

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately.

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay.  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact rraia@mssny.org for your cards. 


  MSSNY’s Amazing Doctors

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Dr. Amar Atwal, Dr. Ephraim Atwal and Dr. Ken Anthone 

Three surgeons, Drs. Kenneth D. Anthone, Amar Atwal and Ephraim Atwal offered free cataract surgeries on October 16 at their clinic, Atwal Eye Care in Cheektowaga (Erie) for non-insured and low income area residents as well as military veterans, and recent immigrants. Dr. Anthone has donated 150 cataract surgeries locally with the Eyes On America Foundation. Dr. Amar Atwal is the Founder and Medical Director of Atwal Eye Care/ Buffalo Care Associates and Buffalo Ambulatory Surgery Center. Dr. Ephraim Atwal specializes in Laser Vision Correction including LASIK and PRK. This was the group’s seventh year providing free surgery to people in need.


Five MSSNY Members Will Be Honored at Westchester Doctors of Distinction
The Third Annual Westchester Doctors of Distinction Award will be held on October 29 at the Bristal in Armonk. The honorees are:

  • Craig Zalvan, MD for the Humanitarian Award
  • Scott D. Hayworth, MD for the Lifetime Achievement Award
  • Andrew Kleinman, MD for Leadership in Medical Advocacy Award
  • Robert Gary Josephberg, MD for Excellence in Medical Research
  • Mark Russakoff, MD for Leadership in Medical Advocacy

For more information, call 914-949-2990

 


Classifieds

PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room;  large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

October 16, 2015 – Are You Burnt Out? Help on the Way!

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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October 16, 2015
Volume 15, Number 39

Dear Colleagues:

Over the past five years, there has been an acute growth in interest in the subject of physician stress and burnout.  This is in part the result of financial and economic crises as well as practice stresses including liabilities, regulatory and healthcare reform uncertainties.  Whereas in the past, physicians were by and large able to manage stress individually and use a day off and vacation to assist in this endeavor, the stresses facing physicians today have eroded those mechanisms and have rendered past approaches difficult or irrelevant.

The standardized questionnaire measuring these three scales of physician burnout is called the Maslach Burnout Inventory (MBI). The designers of the MBI described physician burnout as “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.” That vivid description really puts a deeper and more serious description to what some of us are feeling or observing on a daily basis.

While our profession in New York has very successfully created a mechanism for helping physicians who are failing to manage their stress in a manner which has threatened patient care (Committee for Physician Health), little attention has been paid to identifying and understanding the stressors which currently wear down physicians.  Many would agree that the uncertainty created by decreased reimbursement, narrowed networks, increased severity of malpractice awards and health care transformation cannot be addressed by taking an afternoon off or increasing vacation time.  Furthermore, these stressors creep into our lives such that the experience is similar to the parable of the frog in a slow boiling pot.  Thus, efforts need to be undertaken to better understand and identify the stressors and develop mechanisms for healthy coping with these so that we don’t drive physicians to burnout, impairment and perhaps even suicide. Signs of these issues in fellow physicians are sometimes subtle and usually masked, but even simple gestures in reaching out to a stressed colleague may make a world of difference.

This year, the House of Delegates passed Resolution 200 which called for the development of programs to help physicians 1) identify physician stress and burnout and 2) manage and treat these. Council has agreed to address the resolution passed earlier this year through a mechanism that is separate from CPH but which uses the knowledge of many of our physicians within that committee as well as our wider MSSNY community. In addition,the Medical Educational Scientific Foundation (MESF) will be developing programs to help address this issue.  If you have an interest in working on this project, please contact MESF Executive Director Tom Donoghue at tdonoghue@mssny.org or call 516-488-6100ext 350.

Yes, in so many ways we are our brother’s keeper.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC


VA Program Presents an Opportunity for Community-Based Physicians
After asking for physicians’ help to enhance care for veterans last November, the U.S. Department of Veterans Affairs (VA) has released information for physicians interested in delivering care through the Veterans Choice Program.

A recently released VA fact sheet (log in) offers detailed guidance on how community-based physicians can partner with the VA to deliver care to our nation’s disabled veterans. Dubbed the Veterans Choice Program, this new benefit was authorized by Congress as a short-term solution to the VA’s workforce shortage and care delivery problems that were exposed last year.

AMA advocacy successfully influenced the legislative language to ensure that physicians in the private sector could provide care to veterans. Members of Health Net’s or TriWest’s PC3 provider networks are automatically eligible to deliver care through the Veterans Choice Program. More information about the Veterans Choice Program, including the eligibility criteria for veterans and how physicians can apply to deliver care, can be found on the AMA’s Supporting Veteran Health Web page.

In 2014, hundreds of MSSNY physicians signed onto a list affirming that they would be honored to treat veterans. Now, they can. 


From Workers Comp Board: Creating Web-Based Medical Authorization Portal
The New York State Workers’ Compensation Board is creating a web based Medical Authorization Portal. We would like for physicians associated with MSSNY to participate in a “User Acceptance Testing” of this system before it becomes available to all stakeholders in the Workers’ Compensation Claims process at the end of this year. Any physicians within your organization that would like to participate are welcome. The only criteria is that they have an authorization number to treat workers’ compensation claims patients.

To help facilitate this testing, we would also like for you to provide the top three carriers or third party administrators you send the highest volume to (ranked from highest to lowest) of the following Workers’ Compensation Board forms: MG-1, MG-2 and the C-4 Auth.

We thank you in advance of your anticipated agreement to participate in this new web based application that the Workers’ Compensation Board, as well as all of the other stakeholders in the claims system, have created to improve the way workers’ compensation claims are handled within the state.

Please contact me to indicate your willingness to participate in this user testing or if you have any additional questions regarding this subject. I may be reached by email at Anthony.Contento@wcb.ny.gov or by telephone at (518) 402-6186. 


Health Republic NY Won’t Honor Policy Renewals
Health Republic Insurance of New York sent brokers a notice on October 16 that it is not honoring small-group policy renewals for Nov. 1 and Dec. 1. That sudden action—even given the fact that the insurer is winding down its operations—will leave clients scrambling to find alternative insurers in about three weeks’ time for the earlier date, and just over seven weeks for the latter.

On Oct. 9, William Friedman, the insurer’s senior vice president of commercial sales, emailed brokers with the news that the Department of Financial Services told Health Republic “we cannot renew small-group policies with Nov. 1 and Dec. 1 renewal dates. This means that those groups’ current health insurance policy with Health Republic will not renew and will end at midnight the day before those groups’ scheduled renewal date (i.e. midnight on 10/31 for 11/1 renewal).”

The language for the termination letters is online here.

“We certainly understand that this provides relatively shorter notice for this particular segment of consumers, but we believe that given the company’s financial condition, allowing the company to write new business isn’t in the interest of consumers overall,” a DFS spokesman said. “That’s the broader public policy reason for this particular approach.”

According to state law, insurers must give small-group policy holders 30 days’ written notice for non-renewals. But the state’s insurance regulator may be invoking powers outside that notification law.

GNYHA said that DFS is conducting an “audit to determine whether the insurer has sufficient funds to operate and continue paying provider claims through the end of each employer’s contract period. DFS could require Health Republic to terminate all small-group enrollment on a certain date.” 


Many Faces of Flu CME Webinar on October 21st; Registration Now Open
The Medical Society of the State of New York will begin its 2016 Medical Matters continuing medical education (CME) webinar series with “Many Faces of Flu 2015” on Wednesday, October 21, 2015 at 7:30 a.m.  Registration is now open for this free webinar here.

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. Educational objectives are: 1) Recognize the distinction between seasonal, Avian and Pandemic flu; 2) Describe clinical and laboratory diagnostic features and treatment; 3) Identify recommended immunizations and antiviral medications for treatment.

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.

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.

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 2016 and topics include: public health preparedness; immunizations and recommendations during a disaster; and radiological emergencies.  Program dates for Medical Matters will be announced shortly.


Exchange Announces 2016 Offerings; New Options for Low Income New Yorkers
New York Health Insurance Exchange officials this week announced the insurers offering health and dental plans to individuals and small business owners in 2016, as well as the insurers that will be offering the new Essential Plan to eligible, lower income New Yorkers.   The open enrollment period begins on November 1, and runs through January 31, 2016.

There are 16 insurers that will offer Qualified Health Plans on the Individual Exchange Marketplace in 2016, and 8 insurers that will be offering coverage on the Small Business Exchange Marketplace, or SHOP, in 2016, for businesses with 100 or fewer employees.    To view a county by county map of the plans being offered in each county, click here.

There are also 13 insurers that will be offering coverage for the New Essential plan which is available to single New Yorkers who make $23,540 or less; couples who make $31,860 or less; or a family of 4 that makes $48,500 or less; and who are not eligible for Medicaid.  The Essential Plan has no annual deductible and offers the same essential benefits as other health insurance plans. Consumers pay just $20 a month per adult or nothing at all depending on their income. Additional information on the Essential Plan can be found here. To view a county by county map of these plans being offered in each county, click here.

The New York State Department of Financial Services had previously announced the approved health insurance plan rates for insurers seeking to offer coverage in New York’s marketplace on July 31, 2015.

The New York State of Health website does not as of this moment contain a listing of the network participants for each plan for 2016.  However, this information will be added to the website shortly, as it was for 2015 plans.

As has been widely reported, the press release also noted that Health Republic will not be offered for 2016, and that persons enrolled in Health Republic will receive a renewal notice providing information about how to select another plan for 2016. NY State of Health and Department of Financial Services staff will be available to assist Health Republic consumers with this transition to new coverage.


Agreements with Urgent Care Centers to Improve Plan Participation Disclosure
New York Attorney General Eric Schneiderman announced agreements with four urgent care centers in New York City and Long Island to provide more detailed information to consumers about the centers’ participation with health plans, as required by New York’s recently enacted “surprise medical bill law.”  

In July, AG Schneiderman issued letters to 20 urgent care centers across New York State requesting information about the centers’ representations on websites that they participate in a certain health plan networks.  The AG raised concerns that these centers’ website disclosures might have inaccurately disclosed their health plan network participation status, confusing consumers into believing these centers were “in-network”.

The press release announcing the settlements noted that, after review of the disclosures and underlying contracts, the AG concluded that the information provided was at times unclear, incomplete, or not specific enough. The urgent centers that signed agreements were: 181st Street Urgent Care in Manhattan; Brookdale Urgent Care, affiliated with Brookdale Hospital; New York Doctor’s Urgent Care with two locations in Manhattan; and Cure Urgent Care, with three locations in Manhattan and Long Island.  Disclose to patients the availability of fee information, and, upon request, disclose to the patient the total cost for services that the center will bill the patient.


MSSNY Conducting E-Prescribing Webinars November and December
The Medical Society of the State of New York will host two free continuing medical education webinars on E-prescribing on November 9 and December 9 at 7:30 a.m Registration is now open to MSSNY physicians by clicking here. Select training session and the upcoming tab.   A copy of the flyer can be found here. 

Additional webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives are:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances 

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.

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.


Why EHRs Get in the Way – and What You Can Do About It

Date: Wednesday, October 21, 2015 from 12:00 p.m. – 1:00 p.m. (EST)

50% of practices want to dump their EHR. 72% of physicians say that their EHR distracts them from face time with patients. And 59% of doctors wouldn’t recommend the field of medicine to their own children. Has our health information technology let us down? Join athenahealth for this free webinar, where they’ll discuss the biggest barriers to better, more focused patient care, and what you can do about them. See more details here.

Athenahealth is a vetted MSSNY member benefit. 


E-Prescribing Of All Substances Required by March 27, 2016
For physicians who prescribe controlled substances, there are steps to complete in order to electronically prescribe controlled substances.  These include the following:

Note that federal security requirements include a third party audit or DEA certification of the software.

  • Second, you must complete the identity proofing process as defined in the federal requirements. Third, you must obtain a two-factor authentication as defined in the federal requirements. Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found here.

EPCS systems must be registered through the ROPES system. ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

Under “My Content,” click on “All Applications” and then click on “R.” Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so before January 1. The waiver process will be electronic.   Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance. DOH has indicated that more information on the waiver process will be available shortly.

Information regarding e-prescribing may be accessed at the following links:

http://www.health.ny.gov/professionals/narcotic/electronic_prescribing

http://www.op.nysed.gov/prof/pharm/pharmelectrans.htm


DOH Commissioner Grand Rounds Now Online: “Ending the HIV Epidemic”
The New York State Department of Health has placed the Commissioner Grand Rounds now online with the first program called Ending the HIV Epidemic.  This program will focus on the unique populations most at risk for HIV, increase clinician awareness of the new indications for HIV treatment and the new modalities for HIV prevention. To view this program click here. Further information on the program may be obtained here.


Attention Paper Claim Submitters: Changes due to the implementation of ICD-10
With the implementation of ICD 10 on October 1, 2015, it is important to use the appropriate ICD Indicators on claim submissions. 

The “ICD Indicator” identifies the ICD code set being reported. It is imperative that you enter the applicable ICD indicator according to the following:

Indicator Code Set
9 ICD-9-CM Diagnosis
0 ICD-10-CM Diagnosis

Dates of service October 1, 2015 and after, the ICD-10-CM indicator should be “0”

Dates of service September 30, 2015 and prior, the ICD-9-CM indicator should be “9” 

Line item 21 on the CMS 1500 claim form or the electronic equivalent shall be submitted with the appropriate indicator of “0” for ICD-10-CM or “9” for ICD-9-CM.

Item 21

Oct26a

Note: It is mandatory that you enter the indicator as a single digit between the vertical, dotted lines.

For additional information on ICD-10, visit our ICD-10-CM section of our website at www.ngsmedicare.com.



Helpful ICD-10 Reminders

Now that ICD-10 is a reality, below are a few reminders:

Always code each health care encounter to the level of certainty known for that encounter. All providers are expected to code correctly and have sufficient documentation to support the codes selected.

ICD-10-CM External Cause Codes
Medicare did not require external cause reporting in ICD-9-CM and does not require external cause reporting in ICD-10-CM. Similar to ICD-9-CM, there is no national requirement for mandatory ICD-10-CM external cause code reporting. Unless you are subject to a state-based external cause code reporting mandate or these codes are required by a particular payer, you are not required to report ICD-10-CM codes found in Chapter 20 of the ICD-10-CM, External Causes of Morbidity.

Signs and Symptoms
In both ICD-9-CM and ICD-10-CM, sign/symptom and unspecified codes have acceptable, even necessary, uses. While you should report specific diagnosis codes when they are supported by the available medical record documentation and clinical knowledge of the patient’s health condition, in some instances signs/symptoms or unspecified codes are the best choice to accurately reflect the health care encounter.

If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information is not known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate unspecified code (for example, a diagnosis of pneumonia has been determined but the specific type has not been determined). In fact, you should report unspecified codes when such codes most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It is inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing to determine a more specific code.
Related Content


Classifieds


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-SpecialtyGroup Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.

Job requirements:

  • Current Board Certification  / Recertification
  • Current & Unrestricted NYS license, DEA & NPI
  • Must be on panels of managed Medicaid and HMO plans
  • Working knowledge of EMR
  • Take detailed patient history
  • Do physical examinations
  • Order medically necessary tests, equipment, etc
  • Be able to make complex decisions
  • Write Prescriptions
  • Provide treatments
  • Venipuncture
  • Give injections
  • Follow-up – evaluation of test results and with patients
  • Provide referrals to specialists

NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to:
medicmiche@aol.com or hrld_weissman@yahoo.com 


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’ Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com.


PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room;  large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

October 9, 2015 – What the Health Republic Shut Down Means for Physicians

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
October 9, 2015
Volume 15, Number 38

Dear Colleagues:

Last week, the DFS announced that it would not allow Health Republic, the only health co-op in New York State, to write new policies after Dec 31, 2015. Effectively, no new individual insurance policies will be written. However, those existing small business products that expire in 2016 may be allowed to continue into 2016, depending on the company’s financial status.

What does this mean to you as a physician?

  1. Physicians should be aware that some consumers may not continue to pay their premiums for a product they may consider defunct. If the patient has not paid their premium, Health Republic will not pay their claims. So, you need to verify that your patient still has an active policy and you should get a hard copy of this verification to substantiate any decisions or actions that you make based on this policy.
  2. Physicians should consider whether they can maintain their Health Republic network enrollment for the small business products that may continue until sometime in 2016. It is unclear at this time if the company will have adequate funds to reimburse physicians for professional services they have rendered. In addition, physicians should consider the implications to their practice and to their patients if they continue to provide services for a plan that will not pay them for services rendered in good faith. Physicians should consult with their practice attorney to understand their contractual obligations and any new payment agreements they might be able to consider with regard to their Health Republic patient population.
  3. Physicians should also review their contracts to determine whether or not they can disenroll as a provider, thus mitigating any financial losses incurred if the insurer cannot reimburse them for services rendered. Physicians should also think about the implications of these actions to their patients and be ready to provide guidance to their patients as they begin to look at other insurance products in the market. Open enrollment for the health care exchange market starts on November 1.
  4. Physicians should consider the ethical and legal implications of continuing to provide services to patients with serious illnesses or require ongoing treatment or surgery for a chronic condition.
  5. Although it is the company’s responsibility to notify its subscribers, members, patients and all providers of health care of its imminent closure, you should review your contract regarding your personal time frames for ceasing your contractual obligations.

Read your contract and make the best decision for you and your practice.

JOSEPH R. MALDONADO Jr

Please send your comments to comments@mssny.org


MLMIC


CMS Releases Final Rule to Permit Greater Flexibility in Meeting Meaningful Use
The Center for Medicare and Medicaid Services (CMS) this week announced a final rule attempting to reduce the hassles physicians have experienced in attempting to demonstrate Meaningful Use of electronic medical records.  According to the CMS fact sheet, the changes include:

  • Reducing the number of objectives from 20 to less than 10 and providing flexibility so that providers may choose measures that are most relevant to their practices;
  • Aligning certain aspects of the reporting of clinical quality measures with other CMS Medicare quality reporting programs;
  • Permitting a 90 day (rather than one year) reporting period for all providers in 2015, as well as extending the 90 day reporting period to providers new to EHR incentive programs in 2016 and 2017; and
  • Delaying mandatory compliance with Meaningful Use Stage 3 until 2018.

AMA President Dr. Steven Stack issued the following statement in response to the issuance of the rule:

“While the AMA is still in the process of reviewing the Meaningful Use regulations published today, we are pleased that CMS and ONC listened to the AMA and the concerns of physicians in several key areas in the modifications rule. In particular, the agency addressed the delay in issuing the modifications rule by allowing a hardship exemption for physicians who are unable to attest this year, providing needed relief for those uncertain about the 2015 program requirements. We also acknowledge that the agency is working to improve patient engagement by ensuring that patients can access portals while still providing flexibility in the measure requirements.

“The AMA continues to believe that Stage 3 requires significant changes to ensure successful participation, and improve the usability and interoperability of electronic health record systems. We urge CMS to use the additional public comment period provided for Stage 3 to further improve the program and consider changes related to the Medicare Access and CHIP Reauthorization Act, which was signed into law earlier this year. We also want to make sure that EHR vendors have the time they need to further test products for interoperability, usability, safety and security. We hope that health IT certification is nimble enough to accommodate future technology innovations and that the program is not seen as final at this time.”


Why EHRs Get in the Way – and What You Can Do About It

Date: Wednesday, October 21, 2015 from 12:00 p.m. – 1:00 p.m. (EST)

50% of practices want to dump their EHR. 72% of physicians say that their EHR distracts them from face time with patients. And 59% of doctors wouldn’t recommend the field of medicine to their own children. Has our health information technology let us down? Join athenahealth for this free webinar, where they’ll discuss the biggest barriers to better, more focused patient care, and what you can do about them. See more details here.

Direct weblink here.

Athenahealth is a vetted MSSNY member benefit.


NYU School of Medicine Receives $20M for Department of Plastic Surgery
On October 7, NYU School of Medicine announced a $20 million gift from international businessman and philanthropist Hansjӧrg Wyss to establish a named Department of Plastic Surgery at the medical school—one of the only fully-accredited, academic plastic surgery departments in the country.

The Wyss Department of Plastic Surgery has one of the largest residency and fellowship programs in the world, as well as a research program that has made contributions in transplantation, wound healing, craniofacial biology, surgical simulation, and distraction osteogenesis. It also has the largest academic group of board-certified plastic surgeons in the country, with expertise in reconstructive facial surgery, microsurgery, breast reconstructive surgery, aesthetic surgery, wound care and hand surgery.

A native of Switzerland, Mr. Wyss served as CEO of Synthes, Inc., a medical research and device manufacturing company. 


Federal Officials Permit NY AG to Investigate ERISA Health Plan Violations
New York Attorney General Eric Schneiderman and US Department of Labor officials announced this week that they would share information and work cooperatively to address violations of the federal Employee Retirement Income Security Act (ERISA) and New York State laws covering health insurance plans. The agreement makes it possible for the two law enforcement agencies to refer cases to one another, conduct joint investigations into potential violations of law and assist each other with enforcement cases.  To read the joint press release, click here.

Currently, New York State is prohibited from enforcing New York laws against self-insured health plans, which provide health insurance coverage for about half of New York workers.  As such, the many physician and patient protections MSSNY together with other groups have successfully fought to achieve in New York do not apply to these self-insured plans  According to the press release, the agreement will allow the NY AG and DOL to collaborate on enforcement efforts involving New York insurance companies violating state and federal law.  These carriers often use the same procedures to administer self-insured health plans on behalf of employers.

Attorney General Schneidermansaid “New Yorkers work hard for the wages they are paid and the employee benefits they are promised – and my office will do its part to ensure that workers are not cheated out of the benefits they have earned.  By teaming up with the U.S. Department of Labor’s Employee Benefits Security Administration, we will make sure that all types of health plans comply with our vital federal and state consumer protection laws, such as the federal Affordable Care Act’s preventive services provisions and laws requiring equal coverage for mental health and addiction treatment.”

The press release also notes that consumers with questions or concerns about health care matters should call the Attorney General’s Health Care Bureau Helpline at 1-800-428-9071.


CMS Virtual Office Hours Series Regarding 2015 PQRS
The series will include three separate sessions that will cover topics related to PQRS measures, such as explaining what a quality measures is, measures-related resources and next steps for participation in 2015 PQRS.

The first session, titled “2015 PQRS Reporting: Introduction to Quality Measure Reporting”, has been scheduled for Wednesday, October 14, 2015 from 2:00 – 3:00 p.m. ET. Dates and times for other sessions in the series will be announced soon.

This PQRS Virtual Office Hours session will allow stakeholders an opportunity to ask a CMS representative questions about how to get started with quality measures for 2015 PQRS reporting. To participate in this session, please register beginning on Wednesday, October 7th 2015 at 12:00 p.m. ET here.

A few notes about this webinar:

  • You will only be able to register on or after 12:00 p.m. EST on October 7th, 2015. 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 quality measures questions for 2015 PQRS reporting will be addressed on this call. All other questions, including questions regarding program requirements and/or policy, should be directed to the QualityNet help desk. 

Want more information about PQRS?

Complete information about PQRS is available on the CMS PQRS web site. 


EpiPens Save Lives But Can Cause Injury, Too
A new case series published online on October 6 in Annals of Emergency Medicine identifies design features of EpiPens, the most commonly used autoinjector, that appear to be contributing to injuries in children (“Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in Children”).

“We were surprised by the severity of some of these injuries, including thigh lacerations and embedded needles,” said lead study author Julie Brown, MDCM, MPH, of Seattle Children’s Hospital and University of Washington in Seattle, Wash.  “We can’t think of anywhere else in pediatric medicine where we would hold a needle in an awake child’s leg for 10 seconds.  That’s a set-up for injury, particularly in the uncontrolled, stressful setting of anaphylaxis.  In addition, the instructions for use do not mention patient restraint, so parents are not appropriately prepared.”

Researchers identified 25 cases of epinephrine autoinjector-related injuries from intentional use to treat a child’s allergic reaction.  (One additional case involved a 5-year-old child who accidentally injected himself in the ankle with his older cousin’s EpiPen. The needle was bent underneath the boy’s skin and had to be removed at the emergency department.) Twenty children experienced lacerations, as did one nurse.  In four cases, the needle stuck in the child’s limb.  The EpiPens were administered principally by the patient’s parent (15 cases, including two nurses), though some injuries were also caused by nurses (six cases) and educators (three cases).  Lacerations were up to 3 inches long.

Dr. Brown and her team made five recommendations for reducing the risk of injury when using an EpiPen:

  1. The child’s leg should be immobilized.
  2. The action of administering epinephrine and site of delivery should be as well controlled as possible.
  3. The needle should remain inserted in the thigh for as short a time as possible.
  4. The needle should be strong enough that it does not bend during use.
  5. The needle should never be reinserted.

A recently marketed device, the Auvi-Q (Allerject in Canada) has a self-retracting needle that is gone in under two seconds.  “On the face of it, this would appear to be a safer design for use in children,” commented Dr. Brown.  “While EpiPen likely holds a larger share of the epinephrine auto-injector market, it is notable that we did not see any injuries associated with the use of Auvi-Q or Allerject devices, even in recent years.”
An estimated 5.9 million children in the United States have a food allergy. .


Attention Paper Claim Submitters: Changes Due to the Implementation of ICD-10
With the implementation of ICD 10 on 10/1/2015, it is important to use the appropriate ICD Indicators on claim submissions.

The “ICD Indicator” identifies the ICD code set being reported. It is imperative that you enter the applicable ICD indicator according to the following:

Indicator Code Set
9 ICD-9-CM Diagnosis
0 ICD-10-CM Diagnosis

Dates of service 10/1/2015 and after, the ICD-10-CM indicator should be “0.”

Dates of service 9/30/2015 and prior, the ICD-9-CM indicator should be “9.”

Line item 21 on the CMS 1500 claim form or the electronic equivalent shall be submitted with the appropriate indicator of “0” for ICD-10-CM or “9” for ICD-9-CM.

                 Item 21item21

Note: It is mandatory that you enter the indicator as a single digit between the vertical, dotted lines. Failure to enter the appropriate indicator will result in your claim being rejected/denied.

For additional information, visit the ICD-10-CM section of our website.


SCOTUS Will Not Hear Challenge to New York’s School Vaccination Rules
The US Supreme Court has decided not to hear a challenge to New York’s requirement that all children be vaccinated before they can attend public school, upholding the Second Circuit’s court ruling that said the policy does not violate students’ constitutional right of religious freedom. In the New York case, two students who sought religious exemptions to avoid vaccination requirements were temporarily barred from going to school after a fellow student was diagnosed with chicken pox. A judge denied the request for a vaccine exemption after finding that the mother’s concerns were primarily health-related and not based in religion.


Chronically Ill in ACA Plans Pay More Drug Costs than the Employer Covered
Chronically ill people enrolled in individual plans sold on the ACA exchanges “pay on average twice as much out-of-pocket for prescription drugs each year than people covered through their workplace,” according to a study published in the Health Affairs journal on October 5.  Researchers at Emory University in Atlanta found that patients with at least one chronic condition paid on average $621 out of pocket for prescription costs on silver plans, compared to $304 for those with employer-based coverage. Overall, the study said, patients in the most-popular silver plans pay 46 percent of their total drug spending on average, compared to 20 percent for patients in typical employer-sponsored plans.


Classifieds


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-SpecialtyGroup Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.

Job requirements:

  • Current Board Certification  / Recertification
  • Current & Unrestricted NYS license, DEA & NPI
  • Must be on panels of managed Medicaid and HMO plans
  • Working knowledge of EMR
  • Take detailed patient history
  • Do physical examinations
  • Order medically necessary tests, equipment, etc
  • Be able to make complex decisions
  • Write Prescriptions
  • Provide treatments
  • Venipuncture
  • Give injections
  • Follow-up – evaluation of test results and with patients
  • Provide referrals to specialists

NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to:
medicmiche@aol.com or hrld_weissman@yahoo.com 


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’ Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com.


PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room;  large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

October 2, 2015 – Day Two ICD-10 – NGS Reports High Volume

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
October 2, 2015
Volume 15, Number 37

Dear Colleagues:

Now, we are at Day Two of the transition to ICD-10. This morning, we had a status call with staff at NGS Medicare, the plan with the highest claim volume for New York physicians.

They are happy to report that their systems are functioning well and are accepting claims from yesterday with the new ICD-10 codes. They have asked MSSNY to remind you of two important issues:

  • If there is a national coverage determination (NCD) or a local coverage determination (LCD) for a particular service, you must be sure to use the ICD-10 code listed in the policy in order to be paid. These LCDs and NCDs can be found by doing a search for the medical policy located on ngsmedicare.com
  • When using an ICD-10 code that contains the description of right side or left side, you still must use the RT or LT modifier after the procedure code since all claim processing edits for Medicare are still in effect. Failure to use the RT or LT may result in delayed processing or a denial.

Most importantly, when selecting an ICD-10 code, you must be sure that your medical documentation supports the diagnosis code selected. For example, if the diagnosis code indicates that the service reported pertained to the right eye, the left leg, etc., your medical record must state the same body part and” laterality.” If you need more information, please call or email Regina McNally at 516-488-6100 ext. 332 or email her at rmcnally@mssny.org.

Since MSSNY’s email is not HIPAA-secure, please do not include any patient identification (no PHI).

As we have been telling physicians, the best crosswalk is at http://www.aapc.com/icd-10/codes/

Also, as reported to us by NGS staff this morning, the volume of traffic caused the site to slow down yesterday, so patience may be required.

We are not the government and we are here to help.

Really.

JOSEPH R. MALDONADO Jr

Please send your comments to comments@mssny.org


MLMIC


DFS Orders Health Republic to Cease Offering New Health Insurance Policies; More Details About Claims Payment will be Forthcoming
As has been widely reported, the New York State Department of Financial Services has ordered Health Republic to cease writing new health insurance policies and the co-op will commence an orderly wind down after the expiration of its existing policies.  As was noted in the DFS’ 2015 Guide to Health Insurance, Health Republic was the subject of an overwhelming number of consumer and physician complaints and grievances for failure to timely pay claims and other coverage disputes.

MSSNY physician leadership and staff have been in close contact with top officials at the DFS to obtain necessary information that enables physicians to make informed decisions with regard to their practices, as well as to assist patients who may have questions about their coverage.  Please remain alert for further details as DFS together with federal officials complete a thorough examination of the financial wherewithal of Health Republic to pay out its claims.  After the DFS announced the wind-down of Health Republic, MSSNY President Dr. Joseph Maldonado stated the following: “MSSNY will work with the Department of Financial Services, the NYS Department of Health and Exchange officials to be sure patients insured by Health Republic are able to get the care they need and appropriately transitioned to new insurance coverage, as well as to assure that physicians and other providers are fairly and timely paid for the care they provide”.

While Health Republic individual market enrollee contracts will continue until the end of the year, they will not be permitted to offer coverage for 2016, meaning these patients will need to find coverage through other health insurance companies on the State’s Exchange.  Existing Health Republic small group plans – which, unlike individual plans, do not all have calendar-year policy terms – will remain in effect after the beginning of the year, though DFS will be analyzing the ability of Health Republic to continue these contracts. The DFS noted in its press release that “it will evaluate the best course of action with regard to small group plans based on Health Republic’s ongoing financial results. Any future determinations made on small group plans will be announced with appropriate notice to help provide a transition period to new coverage and protect policyholders.”

Anthony J. Albanese, Acting Superintendent of Financial Services, said: “Given Health Republic’s financial situation, commencing an orderly wind down process before the upcoming open enrollment period is the best course of action to protect consumers. Moving forward, we will work closely with New York State of Health and federal regulators to help ensure continuity of coverage for Health Republic’s customers.”


Extensive Insurer Complaint Data Contained in DFS’ 2015 Health Insurance Guide
The New York Department of Financial Services has released its 2015 Consumer Guide to Health Insurance Companies which contains comprehensive information regarding upheld consumer complaints, upheld prompt payment complaints, external appeal data and quality information for various types of health insurance plans offered in New York in 2014. 

Consumer/Provider Complaints

The report showed that Independent Health had the best (lowest) overall consumer complaint ratio among HMOs, PPOs and EPOs operating in New York State.  Independent Health also had the best (lowest) Prompt Payment complaint ratio for its HMO, PPO and EPO products.

Empire had the worst overall consumer complaint ratio and prompt payment complaint ratio among HMO products.   Health Republic had the worst overall consumer complaint ratio among EPO and PPO products, while HIP had the worst prompt payment complaint ratio among EPO/PPO products.

External Appeals

The report showed that there were 1,786 external appeals of health plan coverage denials in 2014, of which 714, or 40%, where reversed either entirely or in part.  The highest number of external appeals, 705, were taken against Empire, of which about 35% (242), were reversed entirely or in part.

Grievances

Health Republic was the health insurer which overwhelmingly had the highest number of grievances (6,801) filed against it in 2014.  Of the 4,554 closed grievances, 2,405 were found for the patient or provider.   A grievance is a complaint by a member or provider to a health insurance company about a denial based on limitations or exclusions in the contract.  According to the report, common grievances include problems getting referrals to specialists and disagreements over benefit coverage.

Quality Rankings

CDPHP was the HMO that had the highest overall patient rating, and highest patient rating for ease in obtaining appointments with specialists and other needed care.  Oxford was the lowest among HMO products for patient rating, with HIP having the lowest patient rating for ease in obtaining appointments with specialists and other needed care.

United had the highest overall patient ranking among EPO and PPO products, with CDPHP, Empire and HIP close behind.  MVP had the lowest overall patient rating for EPO/PPO products.  CDPHP had the highest patient rating among EPOs/PPOs for ease in obtaining appointments with needed specialists and other needed care, with Excellus and Independent Health close behind.   Aetna was the lowest ranking EPO/PPO for ease in obtaining appointments with specialists and other needed care.

Dr. Joseph Maldonado, president of the Medical Society of the State of New York, said the most common complaints he hears from members are related to claim denials, preauthorization and failure to pay promptly. He said the poor ratings for the largest insurers are consistent with members’ gripes. “It will only get worse with these mergers, because the power insurers exert on physicians is essentially take it or leave it, particularly in the New York area,” he said. [Crain’s Health Pulse, 10/1]


From Socio-Med Division: Info re HITECH EHR Meaningful Use Audits
Not to be the bearer of more bad news, but you need to be aware that MSSNY has been contacted by medical practices who are currently going through a Medicare Meaningful Use audit by Figliozzi and Company.

First, any measure that was attested to with a “yes or no” answer must be corroborated with a screen print as supporting documentation confirming that your system did or did not complete the measure.  However, the screen print MUST have the EHR company logo printed somewhere on the document or it will not be accepted.  Secondly, the Security/Risk Analysis, the practice must provide an actual security risk analysis that was conducted including who conducted the test (i.e., IT Vendor) date of the test, time of the test and the result of the test in report format.  A check list is not enough and will not suffice or be accepted.  From what we understand this risk analysis report must have been done on each computer within the practice.

For more information about these audits, please refer to the following links:

http://www.figliozzi.com/index.htm and https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/downloads/ehr_supportingdocumentation_audits.pdf

NYCDOMH: Legionnaires Disease Cluster in Morris Park, Bronx (updated 9/30)
Cases: Reported individuals with Legionnaires: 13; Death associated with the Morris Park cluster: 1; Individuals hospitalized: 11; Discharged from hospital: 1; All patients have underlying health conditions
Highlights: On Sept. 21, when the first case was reported, the Health Department’s disease detectives began investigating immediately.

Since Saturday, environmental scientists visited all cooling towers and took samples. 

Download the Morris Park LD Fact Sheet (PDF)Other languages: [Español]
View the Legionellosis Cluster in Morris Park by Diagnosis Date (PDF)
View the Legionellosis Cluster in Morris Park by Onset Date (PDF) 


NGS Provider Outreach & Education Presents Live Events Part B Providers
The JK Provider Outreach and Education Department is offering live educational events specifically designed for and dedicated to educating our Part B providers. Join us and learn about many topics that will help you prepare compliant and accurate Medicare claims as well as prevent unnecessary claim rejections, returns and denials.

Identical training sessions will be held at various locations. Here is what will be covered:

  • Medicare Part B Updates
  • Common Modifiers
  • Medicare Secondary Payer
  • Global Surgery
  • How to Submit Medicare Claims Correctly and Avoid Costly Denials and Unprocessable Claims
  • Advance Beneficiary Notice of Noncoverage (ABN)
  • Fraud and Abuse/Compliance
  • Reopenings/Appeals

Cost: $100 per participant paid prior to the event; includes breakfast, lunch, and access to printable training materials and provider job aids.

Cancellation Policy: The cost of this session is $100 per attendee. This registration fee can be transferred to another attendee/location if a request is submitted prior to the date of the event. Please submit request for cancellation/refund at least 48 hours prior to the event start time.

Note: No new registrants will be accepted on the day of the session.

Intended Audience: New and established Medicare Part B providers and office staff members who submit claims to National Government Services.

Time: 8:00 a.m.–4:00 p.m. eastern time. Check-in will begin at 8:00 a.m. Schedule includes break for lunch (refreshments/meals provided).

Materials: Will not be provided at the session. A link will be sent with your confirmed registration to the materials that will be used. When printing the materials, we suggest using multiple slides per page to reduce paper.

Credits: Five Medicare University Credits and five Continuing Education Units

Questions about this event can be addressed to maria.petruzziello@anthem.com

Register at www.ngsmedicare.com under the education calendar.

  • East Syracuse- The Hilton Garden Inn, 6004 Fair Lakes Road, on Thursday, Oct. 29
  • East Elmhurst, December 3 @ LaGuardia Airport Marriott, 102-05 Ditmars Blvd., $10 parking


Dr. Michael Simon Appointed to AMA Joint Commission Board
MSSNY congratulates Michael B. Simon, MD, an anesthesiologist from of Wappingers Falls (Dutchess), who has been appointed to the AMA’s Joint Commission Board of Commissioners. Dr. Simon’s term begins on January 1, 2016; he will be eligible for two additional three-year terms. Dr. Simon is past president of the New York State Society of Anesthesiologists (NYSSA) and currently MSSNY’s serves as Chair of Member Benefits Committee.


“MANY FACES OF FLU” CME Webinar on October 21; Registration Now Open
The Medical Society of the State of New York will begin its 2016 Medical Matters continuing medical education (CME) webinar series with “Many Faces of Flu 2015” on Wednesday, October 21, 2015 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 access 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 seasonal, Avian and Pandemic flu; 2) Describe clinical and laboratory diagnostic features and treatment; 3) Identify recommended immunizations and antiviral medications for treatment.   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 2016 and topics include: public health preparedness; immunizations and recommendations during a disaster; and radiological emergencies.  Program dates for Medical Matters will be announced shortly.


MSSNY to Conduct Three E-Prescribing Webinars This Fall
The Medical Society of the State of New York will host three free continuing medical education webinars on E-prescribing. The first webinar will be held as part of MSSNY’s Advocacy Matters on Tuesday, October 13 at 12:30 pm. Registration is now.

Select training session and the upcoming tab.

A copy of the flyer can be found here.

Additional webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 am. The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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.

Further information can be obtained by contacting Miriam Hardin at mhardin@mssny.org or Terri Holmes at tholmes@mssny.org.


E-Prescribing Of All Substances Required By March 27, 2016
Physicians and other prescribers are reminded that New York State’s e-prescribing requirements for non-controlled and controlled substances will go into effect on March 27, 2016. The NYS Department of Health’s Bureau of Narcotic Enforcement has provided information to physicians and other prescribers to assist them in their transition to electronic prescribing. Practitioners should continue their efforts to become compliant with the law, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances (EPCS), and registering their certified software applications with the Bureau of Narcotic Enforcement.  According to state officials, over 22,000 prescribers have registered their systems with DOH.

For physicians who prescribe controlled substances, there are additional steps to complete in order to electronically prescribe controlled substances. These include the following:

  1. The software you currently use must meet all the federal security requirements for EPCS, which can be found on the Drug Enforcement Agency’s (DEA) web page.

Note that federal security requirements include a third party audit or DEA certification of the software.

  1. You must complete the identity proofing process as defined in the federal requirements. Third, you must obtain a two-factor authentication as defined in the federal requirements. Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found HERE.

EPCS systems must be registered through the ROPES system. ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

  • Login to the Health Commerce System (HCS) at https://commerce.health.state.ny.us
  • Under “My Content” click on “All Applications”
  • Click on “R”
  • Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

EPCS became permissible in New York State and over 90% of the pharmacies can now accept e-prescribing for controlled substances, according to officials from BNE.

DrFirst and MSSNY have partnered to bring MSSNY members the industry’s leading e-prescribing solution at a special discounted price and information on this program can be found here.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so before January 1. The waiver process will be electronic.   Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance.  DOH has indicated that more information on the waiver process will be available shortly.

E-prescribing of non-controlled substances is also required under the law; however, registering of this system with the state is not necessary.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.   The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.

Information regarding e-prescribing may be accessed at the following links:

http://www.health.ny.gov/professionals/narcotic/electronic_prescribing/

http://www.op.nysed.gov/prof/pharm/pharmelectrans.htm


Classifieds


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-SpecialtyGroup Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.

Job requirements:

  • Current Board Certification  / Recertification
  • Current & Unrestricted NYS license, DEA & NPI
  • Must be on panels of managed Medicaid and HMO plans
  • Working knowledge of EMR
  • Take detailed patient history
  • Do physical examinations
  • Order medically necessary tests, equipment, etc
  • Be able to make complex decisions
  • Write Prescriptions
  • Provide treatments
  • Venipuncture
  • Give injections
  • Follow-up – evaluation of test results and with patients
  • Provide referrals to specialists

NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to:
medicmiche@aol.com or hrld_weissman@yahoo.com 


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’ Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com.


PURCHASE NY – LUXURIOUS CLASS A MEDICAL SPACE
3 exam rooms; one consulting room;  large secretarial/admin area. Shared waiting room. All specialties welcome. Three bathrooms in office suite. Large free parking lot. Call Dr. Howard Yudin 914-251-1261.



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

September 25, 2015 – ICD-10 Coming To You Next Thursday!

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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September 25, 2015
Volume 15, Number 36

Dear Colleagues:

October 1st and the ICD-10 compliance date is only 6 days away!

For better or worse, we have to deal with it. The biggest complaint is that ICD-10 contains lots more codes: 68,069 in the 10th edition compared with the 14,035 currently in use. It is here. And now— what we need to do is to identify problems early on so they can be addressed and resolved so that physicians will not experience cash flow problems.

As the transition date approaches, the regional office and CMS want to provide us with the best possible service. We may intensely dislike this change, but CMS has bombarded us in every possible media over the past two years to prepare us. MSSNY has done its due diligence in informing you of educational resources to ensure a smooth and successful transition.

CMS notified us yesterday that they will have real people available to answer your ICD-10 related questions or concerns. Anthony Jamrozy and Rebecca Birnbach will be our CMS New York Regional Office points of contact for ICD-10 related inquiries.  Anthony and Rebecca can be reached at anthony.jamrozy@cms.hhs.gov and rebecca.birnbach@cms.hhs.gov and will research and respond to any ICD-10 transition issues or concerns.

Also, as announced on the National Provider Call on August 27, the CMS ICD-10 Ombudsman is available to address ICD-10 related issues for individual physicians and stakeholders at icd10_ombudsman@cms.hhs.gov. Many resources are available to assist you with the transition, including the CMS ICD-10 website including Frequently Asked Questions the CMS ICD-10 Quick Start Guide and the Road to 10: CMS Online Tool for Small Practices.

Please check the website often, as content will be updated regularly. You can also keep up on breaking ICD-10 news by signing up for email update messages.

Just yesterday, a member sent this question to Regina McNally, VP of Socio-Medical Economics:

Question: What about resubmitting a previous claim which was ICD-9. Must it be resubmitted after Oct 1 with ICD -10 codes? 

Answer: This is Date of Service specific. For dates of service on or before September 30, 2015, you need to use ICD-9 diagnosis codes.  For dates of service on or after October 1, 2015, you must use ICD-10-CM diagnosis codes.

Regina is available to answer your questions. You can email her at rmcnally@mssny.org. This service is an excellent Members Only benefit!

JOSEPH R. MALDONADO Jr

Please send your comments to comments@mssny.org


MLMIC


Update: EmblemHealth Will Follow CMS’ Lead on Relaxed ICD-10-CM Rules
We asked EmblemHealth whetherthey will follow CMS’ leniency regarding ICD-10 coding specificity and whether they anticipated an impact to COB claims where Medicare is primary and CMS paid their portion of the claim based on a less specific code within the same family.  EmblemHealth’s ICD-10 experts reviewed the CMS FAQs we sent them and determined that their policies are aligned with CMS’. Providers must bill with valid ICD-10 codes with all of the expected digits accounted for. Specificity will not come into play as part of their claim systems’ adjudication processes as long as the code is valid. This holds true whether EmblemHealth is the primary or secondary payer. For more information on EmblemHealth’s ICD-10 approach, we recommend visiting their web site page “Getting Ready for ICD-10 Together” where you can find a robust set of useful resources:

                                                                        –Regina McNally, VP MSSNY Socio-Med


NYS Bureau of Narcotic Enforcement Fall Update On Electronic Prescribing
The NYS Department of Health’s Bureau of Narcotic Enforcement has released its Fall 2015 newsletter and it contains information on Electronic Prescribing of Controlled Substances (EPCS). Along with a general overview of EPCS, there is information on the registration process of EPCS with the NYS DOH, the electronic prescribing exceptions, out of state electronic prescription and electronic recordkeeping of controlled substances. A copy of the newsletter can be found HERE on the MSSNY website.  Further information on EPCS can also be found here.

Electronic prescribing of controlled and non-controlled substance will be required for all prescribers effective March 27, 2016.


MSSNY Hosts Three E-Prescribing Webinars During Fall; Sign Up Now!
The Medical Society of the State of New York will host three free continuing medical education webinars on E-prescribing. The first webinar will be held as part of MSSNY’s Advocacy Matters on Tuesday, October 13th at 12:30 p.m. Registration is now open to MSSNY physicians by clicking here.

Select training session and the upcoming tab.

A copy of the flyer can be found here.

Additional webinars will be held on Monday, November 9, 2015 and Wednesday, December 9, 2015 at 7:30 a.m.  The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  • Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances.

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. 

Further information can be obtained by contacting Miriam Hardin at mhardin@mssny.org or Terri Holmes at tholmes@mssny.org

E-prescribing of all substances will be required in New York State by March 27, 2016. ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013.The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.   


New FCC Ruling Affects Medical Debt Collecting
Question: How does the new FCC ruling on medical debt collections affect my practice? Can I be held responsible and fined for my vendor’s violation of the new rule?

Answer: The Federal Communications Commission (“FCC”) issued an interpretive ruling this summer clarifying an area of much confusion under the Telephone Consumer Protection Act. Prior to the FCC’s ruling, there was little guidance regarding autodialing, consent to call and reaching wrong numbers, particularly for cellphones. The new FCC ruling, though, will present a challenge to medical-debt collectors seeking to contact patients on their cellphones.

Pursuant to the ruling, the onus is on debt collectors to confirm express consent before autodialing a cellphone. Debt collectors complain that the ruling provides no relief or viable alternative when a collection agency does not know they have the wrong number for someone.

The FCC’s ruling does provide some exceptions for appointment reminders and test results; however, the FCC was explicit that the exemptions did not extend to bill collection efforts. Industry wide, medical debt collectors are now working to implement this ruling and be in compliance with the new requirements. Under the rule, debt collection companies’ penalties start at $500 and can swell to $1,500 for willful violations.

Healthcare providers also need to be aware of the interpretive ruling since they too can be held liable even when it is their vendors who fail to comply with regulations. Healthcare providers must obtain express written consent to call patients on their cellphones about billing issues.

This issue must be addressed immediately by all practices, as a number of health systems are reporting an increase in bad debt due to the increase of patients coming in with high-deductible plans. Patients’ failure to pay their deductibles adds up to millions of calls from healthcare debt collectors each year.

If you have any questions, please contact Kern Augustine Conroy & Schoppmann, P.C. at

1-800-445-0954 or via email at info@DrLaw.com. 


“Cadillac Tax” Repeal Legislation Introduced in the US Senate
Senator Charles Schumer (D-NY) was among the several members of the US Senate this week to co-sponsor legislation introduced this week that would repeal the so-called “Cadillac Tax” on higher cost health insurance policies offered by employers.  Included as part of the ACA, the “Cadillac Tax” is a provision that would, beginning in 2018, impose a 40% excise tax on group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage. It would undoubtedly have a greater impact in higher cost states such as New York, and would further discourage employers from offering comprehensive health insurance policies to their employees. MSSNY adopted policy at its 2013 House of Delegates meeting calling for legislation to repeal this tax.

The legislation was introduced by Senator Sherrod Brown (D-OH), and in addition to Senator Schumer, is co-sponsored by Senators: Patrick Leahy of Vermont; Mazie Hirono of Hawaii; Jeanne Shaheen of New Hampshire; Chris Murphy and Richard Blumenthal of Connecticut; Michael Bennet of Colorado and Bob Casey of Pennsylvania.  Senator Dean Heller (R-NV), and Martin Heinrich, D-NM, have also co-sponsored repeal legislation and Reps. Joe Courtney, D-CT, and Frank Guinta, R-NH, have both introduced separate repeal proposals.

To read more about this proposal, click here and here. 


Modules From The AMA Focus on Dealing With Physician Burnout
The problem of burnout and caregiver fatigue among physicians is real and immediate. In fact, research shows that the rates of overall burnout extend to about 40 percent of U.S. physicians, more than 10 percentage points higher than the general population. In response, the AMA has created an ambitious program aimed at successfully preventing burnout and promoting well-being by offering new online modules that help physicians learn their risk factors for burnout and adopt real-life strategies to reignite professional fulfillment and resilience.

“Physicians are professionals who at their core are called to self-sacrifice and inclined to always do what’s necessary to take care of patients,” said AMA President Steven J. Stack, M.D. “But modern medicine can take a toll over time, and the AMA wants physicians to know about the risks associated with burnout and the strategies to help combat it.”

Two new modules in the AMA STEPS Forward series offer key strategies for taking on burnout.

  • The first module,Improving Physician Resiliency, offers an internal approach to help physicians manage personal and professional stress. Physicians who are resilient are better equipped to manage the stress of relentless change in medical practice and less likely to experience burnout. The module provides simple, evidence-based solutions to help physicians foster resilience against stress and protect against burnout.
  • The second module,Preventing Physician Burnout, offers an external approach to help physicians make practice-level changes to improve workflow and reduce barriers to patient care. Increasing physician involvement in efforts to improve their practice environment results in better patient satisfaction, quality outcomes, and overall practice morale and productivity. The module provides assessment tools and targeted intervention strategies that reduce sources of stress and support professional well-being.


2016 PQRS Negative Payment Adjustment & The Informal Review Process
In 2016, CMS will apply a negative payment adjustment to individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option (GPRO) (including Accountable Care Organizations [ACOs]) that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment.

EPs, CPC practice sites, PQRS group practices, and ACOs that believe they have been incorrectly assessed the 2016 PQRS negative payment adjustment may submit an informal review between September 9, 2015 and November 9, 2015 requesting CMS investigate incentive eligibility and/or payment adjustment determination. All informal review requestors will be contacted 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.

All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which will be available September 9, 2015 through November 9, 2015 at 11:59 p.m. EST

Please see 2014 Physician Quality Reporting System (PQRS): Incentive Eligibility & 2016 Negative Payment Adjustment – Informal Review Made Simple (available on the Analysis and Payment section of the PQRS website) for more information.

For additional questions regarding the informal review process, contact the QualityNet Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. 


DOH/CMS Will Host Training for Fully Integrated Dual Eligibles
CMS and the New York State Department of Health (DOH) will host a training for providers on the Fully Integrated Duals Advantage (FIDA) program. The event will include:

  • Remarks by Jason Helgerson, State Medicaid Director.
  • Presentations by Menahem Dimant, Medical Director of AlphaCare Signature FIDA Plan, and Dr. Lisa George, Medical Director of VNSNY Choice FIDA Complete, on the benefits of FIDA and their best practices and experiences.
  • An overview of FIDA by Melissa Seeley, Technical Director from the CMS Medicare-Medicaid Coordination Office, and Joseph Shunk, Interim FIDA Project Director from DOH.

The event will be held on Wednesday, September 30, 2015 from 10:00 AM to 1:00 PM at:

CMS New York Regional Office

26 Federal Plaza on Broadway (between Duane and Worth Streets)

New York, NY 10278

Continuing Medical Education (CME) and Continuing Education Units (CEUs) are available for this training. Please see details, below.

RSVP by September 25, 2015 for the Wednesday, September 30 training here.


“Many Faces of Flu” CME Webinar On October 21; Registration Now Open
The Medical Society of the State of New York will begin its 2016 Medical Matters continuing medical education (CME) webinar series with “Many Faces of Flu 2015” on Wednesday, October 21, 2015 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.

Educational objectives are: 1) Recognize the distinction between seasonal, Avian and Pandemic flu; 2) Describe clinical and laboratory diagnostic features and treatment; 3) Identify recommended immunizations and antiviral medications for treatment. 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. 

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.

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 2016 and topics include: public health preparedness; immunizations and recommendations during a disaster; and radiological emergencies.  Program dates for Medical Matters will be announced shortly. 


Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days!  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide!

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans, and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately!

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay!  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact rraia@mssny.org for your cards!


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

 


PHYSICIAN POSITIONS – REGO PARK MEDICAL ASSOCIATES
Rego Park Medical Associates 59-10 Junction Blvd, Elmhurst, NY 11373.
Established, Newly Renovated Multi-SpecialtyGroup Practice.
Full time position; Experience Preferred; Bilingual English and Chinese; OR English and Bengali; OR English and Russian; Good Salary and Benefits; Malpractice Insurance provided.

Job requirements:

  • Current Board Certification  / Recertification
  • Current & Unrestricted NYS license, DEA & NPI
  • Must be on panels of managed Medicaid and HMO plans
  • Working knowledge of EMR
  • Take detailed patient history
  • Do physical examinations
  • Order medically necessary tests, equipment, etc
  • Be able to make complex decisions
  • Write Prescriptions
  • Provide treatments
  • Venipuncture
  • Give injections
  • Follow-up – evaluation of test results and with patients
  • Provide referrals to specialists

NO RECRUITERS. Fax Resume to: (718) 592-3844 or (516) 626-0669
e-Mail Resume to:
medicmiche@aol.com or hrld_weissman@yahoo.com 

 


CLASSIFIED

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

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


BUILD YOUR DREAM OFFICE
Midtown Manhattan two blocks away from Grand Central
Station. 3100 RSF w/ 9 windows; building full of MDs and DDS.’

Asking $13,691/ month; Available April, 2016. Email at wnyllc@aol.com



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

September 18, 2015 – Addressing Stress BEFORE Doctor Burnout

NYRX
drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
September 18, 2015
Volume 15, Number 35

Dear Colleagues:

At our last House of Delegates, Resolution 200 was adopted. It calls for MSSNY to develop programs to “assist Physicians in early identification and management of stress.” The programs should concentrate on the “emotional and psychological aspects of handling stress in our professional and personal lives,” and most importantly, when to seek professional help. Resolution 200 was also adopted at the November AMA meeting.  What are we talking about—stress, anxiety, exhaustion—PHYSICIAN BURNOUT.

Physicians are generally hesitant to share their concerns regarding overloads of stress, depression or anxiety for many obvious reasons—stigma, fear of being perceived as weak or a professional failure.  While help through the Committee on Physician Health (CPH) exists for physicians whose coping skills have failed them deal with these stress, support for the rest of physicians coping sub-optimally is limited or often nonexistent.  Our concern is assisting physicians long before CPH monitoring or intensive treatment is required. We are talking about early intervention in physician burnout and what can be done to avoid it.

Sadly, we have all observed varying degrees of burnout in colleagues.  Its prevalence prompted much interest in the physician community. MSSNY’s Physician Burnout Working Group found 750 journal articles published in the last five years, with 87 published (so far) in 2015! They studied several effective programs, including one from the Canadian Medical Association and a private program in North Carolina that includes self-diagnostic tools and multi-media information and a confidential listserv.

MSSNY is looking at a collaborative approach with specialty societies, insurance carriers and large healthcare associations to address prevention strategies that can offer a helping hand long before burnout occurs. A comprehensive program could also be a valuable member benefit to medical staffs and independent physicians.

We will be seeking outside funding as we specify the scope of this important project. MSSNY’s MESF will also be working this critical area.

If you have a personal story to share about burnout and how you dealt with it, MSSNY would like to hear it. You may be able to assist us in this important project.

As Dr. Frank Dowling, a psychiatrist and Councilor from Suffolk County, and a member of the Working Group, said at the Council meeting yesterday, “If a doctor is not happy, his patients are usually not happy.”

I agree with his expert opinion.

JOSEPH R. MALDONADO Jr

Please send your comments to comments@mssny.org


MLMIC



Council Meeting Notes: September 17, 2015
Council discussed amended resolution 200, which was adopted at the HOD in May and resolved that MSSNY develop a series of programs to assist physicians in early identification and management of stress and that MSSNY introduce a similar resolution at the 2015 The AMA HOD. The AMA adopted a resolution to support these programs.  After discussion at the 9/17 Council meeting, the following recommendations by the working group were approved: MSSNY Council charges the Task Force, at the discretion of the president, with the responsibility of developing the physician burnout program for Council approval. The second approved recommendation expands the Task Force by inviting representation from all MSSNY district medical societies.

  • Dr. Frank Dowling presented information on the AMA Task Force to Reduce Opioid Abuse, which MSSNY has been involved with since the task force’s inception in November 2014. The task force consists of over 20 national medical specialty organizations and eight state medical societies. The goal is to change the dialogue so that physicians are working together to find solutions to the opioid epidemic. Council approved the goals of the task force and the concept of a media campaign, which MSSNY will implement in conjunction with the AMA.
  • Speaker of the House Dr. Geraci-Ciardullo announced the following dates for 2016:
    March 8-Advocacy Day in Albany (Council meeting will be held March 7)
    March 11-deadline for submission of resolutions (early submission of resolutions is encouraged by February 19)
    April 15-17-HOD in Tarrytown
  • MSSNY has sent a letter to Commissioner Zucker to encourage him to send a “Dear Colleague” letter reminding physicians of the March 27, 2016 e-prescribing mandate date. The letter also urged the publication of the “waiver process” as soon as possible to mitigate the potential influx of a significant number of waiver requests to the department in late March. Additionally, the letter urged Dr. Zucker to grant waivers to physicians who, due to their specialty or the voluntary or part time nature of their work, prescribe less than 25 prescriptions a year.


Members Only: Your Patients Can Save Up to 75% on Prescriptions
With the rising cost of generic and name brand medications, your patients could all use some help these days!  The New York RX Card, MSSNY’s newest Member Benefit, is a 100% Free and 100% confidential point of sale prescription discount card that can save your patients up to 75% on prescription medications!  It is free to everyone with no minimum nor maximum uses, no age or income requirements, no enrollment or approval process and it is accepted at over 68,000 pharmacies, nationwide!

This card will provide you with Rx medication savings of up to 75% at more than 68,000 pharmacies across the country including CVS/pharmacy, Duane Reade, A&P, Hannaford, Kinney, Kmart, Pathmark, Stop and Shop, Target, Tops, Waldbaums, Walgreens, Walmart, Wegmans, and many more. We encourage you to give cards to friends and family members. This card is pre-activated and can be used immediately!

The NYRX Card works on lowest price logic, to guarantee the best prices on medications.  It won’t lower co-pays or replace existing insurance, but in some cases the New York Rx price is even lower than your patients’ co-pay!  It can be used during the deductible periods in Health Savings Accounts and High Deductible Plans, lowering out-of pocket-expense on prescriptions. Medicare Part D recipients can use the card to discount their prescriptions not covered on their plan as well as receive discounts on medications not discounted when in the “donut hole.”

The NYRX Card is pre-activated and ready to go with no personal information taken or given. NYRX will mail as many cards you desire, directly to your office, with display stands. The cards typically are placed at the patient check out area. Some doctors also place them at the check in area. Contact rraia@mssny.org for your cards! 


Concerned about Transition to ICD-10? Website May Be Helpful
The following website should be helpful to any physician or his/her office practice staff that is concerned about the transition from ICD-9 to ICD-10 diagnosis coding:  http://www.aapc.com/icd-10/codes/.If you haven’t done so already before October 1, 2015 either you or your staff should crosswalk 10, 20 or 100 of your most common diagnosis codes that you use in your practice, today. Please be sure that if the ICD-10-CM diagnosis code contains the word left or right in its description, you should still include the LT and/or the RT modifier(s) when submitting your claim(s).  In addition, please be sure that your medical documentation contains the data to support the ICD-10-CM diagnosis/specificity selected. 


Dr. M. Monica Sweeney Named Vice Dean for Global Engagement and Clinical Professor and Chair of Health Policy and Management at SUNY Downstate

  1. Monica Sweeney, MD, MPH, FACP has been appointed vice dean for global engagement and clinical professor and chair of the Department of Health Policy and Management in the School of Public Health at SUNY Downstate Medical Center.

In these positions, Dr. Sweeney will provide leadership for the School of Public Health’s many globally-engaged teaching, service, and research activities both locally and internationally. As chair of the Department of Health Policy and Management, she will lead a department whose student enrollment is among the largest in the School’s five Master of Public Health degree tracks.

Dr. Sweeney’s most recent position was as the assistant commissioner for the Bureau of HIV/AIDS Prevention and Control in the New York City Department of Health and Mental Hygiene. Prior to that time, she served as medical director and vice president for medical affairs at the Bedford Stuyvesant Family Health Center in Brooklyn. Dr. Sweeney is the immediate past chair of the SUNY Downstate Council, and served on the Presidential Advisory Council on HIV/AIDS (PACHA), and as president of the Medical Society of the County of Kings. She has been a member of the board of directors of several prominent organizations, and has served as Co-Chair of the Physician Advisory Council of the New York State Department of Health AIDS Institute, and as President of the Clinical Directors Network.

In the fight against HIV/AIDS, Dr. Sweeney led the New York City Department of Health and Mental Hygiene’s prevention and control efforts for several years. Her service on the Presidential Advisory Council on HIV/AIDS resulted in new initiatives to control the disease globally.


New Dates for NYS Workers’ Comp Board’s District Dialogue Meeting
The New York State Workers’ Compensation Board’s District Dialogue meetings previously scheduled in Brooklyn on 9/22 and Manhattan on 9/23 have been rescheduled in recognition of Yom Kippur.

The new dates and times of the District Dialogues are as follows:

Brooklyn District Office
10/8/15
12:00pm – 1:00pm 
111 Livingston Street
Brooklyn, NY 11201
22nd Floor – Room 1917
 

Manhattan District Office
10/9/15
12:00pm – 1:00pm
215 West 125th Street
New York, NY 10027
Room 511

We apologize for any inconvenience this may have caused and thank you for your patience and understanding. We hope you are able to attend to hear the latest updates on BPR initiatives and discuss topics of interest to you during the Participant Dialogue Session.

If you have any questions, please contact Outreach@wcb.ny.gov.


Cucumbers Causing Salmonella Poona; Four Cases in NY to Date
CDC, multiple states, and the U.S. Food and Drug Administration(FDA) are investigating a multistate outbreak of Salmonella Poona infections. This investigation is ongoing. CDC will provide updates when more information is available. 418 people infected with the outbreak strains of Salmonella Poona have been reported from 31 states, an increase of 77 cases since the last update on September 9. New York has had 4 reported cases. Epidemiologic, laboratory, and traceback investigations have identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.

Several recalls of cucumbers that may be contaminated with Salmonella have been announced as a result of this investigation. The type of cucumber that has been recalled is often referred to as a “slicer” or “American” cucumber and is dark green in color. Typical length is 7 to 10 inches. In retail locations the cucumbers are typically sold in a bulk display without any individual packaging or plastic wrapping.

Consumers should not eat, restaurants should not serve, and retailers should not sell any of the recalled cucumbers. If you aren’t sure if your cucumbers were recalled, ask the place of purchase or your supplier. When in doubt, don’t eat, sell, or serve them and throw them out.

As of September 15, 2015, a total of 418 people infected with the outbreak strains of Salmonella Poona have been reported from 31 states. Among 290 people with available information, 91 (31%) report being hospitalized. Two deaths have been reported from California (1) and Texas (1). Please see the Timeline for Reporting Cases of Salmonella Infection for more details. 


CMS Releases 2014 QRURs and PQRS Feedback Reports
On September 9, 2015 CMS released the 2014 Quality and Resource Use Reports (QRURs) and 2014 Physician Quality Reporting System (PQRS) Feedback Reports. The 2016 PQRS and Value Modifier (VM) payment adjustments are based on 2014 reporting. For groups with 10 or more PQRS-eligible professionals (EPs) that are subject to the 2016 Value Modifier, the QRUR shows how the VM will affect Medicare’s 2016 payments to physicians. VM cost and quality scores will also be provided in the QRURs for other practices even though they are not yet subject to the VM. If physicians or group practices feel an incentive payment or penalty was performed in error they must file an Informal Review by November 9, 2015.

2014 EHR and QCDR Data Issues

As reported in the September 3, 2015 Advocacy Update Issue, CMS discovered various errors with the  2014 Physician Quality Reporting System (PQRS) data submitted by vendors on behalf of EPs and group practices that reported via electronic health records (EHR) and qualified clinical data registries (QCDR). CMS has stated there will be no need for physicians or group practices to submit a PQRS Informal Review request.

Because of the errors, the EHR and some of the QCDR data is inconsistent. Due to these errors, CMS will not post PQRS performance data for the affected practices on Physician Compare.  However, determination of PQRS and Meaningful Use payment will not be affected because they are based solely on whether the practice successfully reported rather than on their actual performance—simply receiving the data will allow CMS to deem a physician or group practice as successful for purposes of avoiding a payment adjustment in 2016 or for receiving a 2014 incentive.

For the value modifier, which involves calculating actual quality scores in addition to determining whether quality measures were reported, CMS has acknowledged the vendor data errors may create problems. Specifically, CMS will not be able to accurately calculate the PQRS portion of the Quality Composite Score. Instead, the quality score will be based solely on the claims-based outcomes measures and the Consumer Assessment of Healthcare Providers and Systems Survey, if applicable.

2014 PQRS Data Submission Problems

The AMA is aware of instances in 2014 where physicians and practices mistakenly registered for the PQRS group practice reporting option (GPRO) submission mechanism and/or at the last minute their EHR vendor would not support their preferred submission mechanism.  These groups or individuals, will have to file an Informal Review by November 9, 2015. We have been told this only affects a very small percentage of EPs and practices.

How to Access the Reports and File an Informal Review

In order to access the portal to review reports and/or file an Informal Review, an EIDM account is required. CMS transitioned the portal from the Individual Access to CMS Computer Services (IACS) to the Enterprise Identity Management System (EIDM) on July 13, 2015. The IACS system is now retired, but current PQRS and VM IACS users, their data, and roles have moved to EIDM, which is accessible from the portion of the CMS Enterprise Portal at http://portal.cms.gov. The EIDM system provides a way for business partners to apply for, obtain approval for, and receive a single user ID for accessing multiple CMS applications.

For more information on 2014 feedback reports and how to request them, see: How to Obtain a QRUR. 


MSSNY President Jos. Maldonado MD Receives Hispanic Health Leadership Award
Dr. Maldonado will receive the Hispanic Health Leadership Award from the National Hispanic Health Foundation (NHHF) and the Foundation of the National Hispanic Medical Association (NHMA) on December 3. The award is presented to “outstanding individuals who have served in significant leadership roles and have improved the health of Hispanics and other underserved populations.”

The award will be presented at the 12th Annual Hispanic Health Professional Student Scholarship Gala at the New York Academy of Medicine in New York City in recognition of Dr. Maldonado’s leadership and vision.

The goals of both the NHHF and NHMA are to improve the health of Hispanics and the underserved, to eliminate health disparities, to support Hispanic health services research and to advance culturally competent quality health care and diversity in the workforce. The vision of the NHHF was to develop this scholarship as the nation’s premier fund to encourage Hispanic health professional students complete their career goals.

Since 2005, the NHHF has awarded $585,000 to 175 outstanding Hispanic health professional students throughout the United States for exceptional academic performance, leadership and commitment to the Hispanic community. 


Touro College of Osteopathic Medicine Awarded NAACP Community Service Award
The National Association for the Advancement of Colored People (NAACP) Mid-Manhattan Branch has honored the Touro College of Osteopathic Medicine (TouroCOM) with its distinguished Community Service Award. The award was presented for TouroCOM’s commitment to training osteopathic physicians with an emphasis on practicing medicine in underserved communities and to increasing the number of underrepresented minorities and African Americans in medicine.

TuroPhoto Credit: Hubert Williams: TouroCOM’s Executive Dean Robert Goldberg, DO, surrounded by students, faculty and TouroCOM Community Board Members and partners, accepting the NAACP Mid-Manhattan Branch’s Community Service Award.

“TouroCOM has excelled in its commitment to expanding educational opportunities and careers in medicine, science, research and technology to underrepresented minorities and African Americans while also establishing linkages and programs for elementary and high school youth,” said Geoffrey E. Eaton, president of the NAACP Mid-Manhattan Branch.  “We salute your place in history and trumpet your achievements.”

“This is an award that was earned through the unified efforts of our students, faculty, staff and administration,” said TouroCOM Executive Dean Robert Goldberg, DO.  “It would not have been possible without the wisdom, guidance and support provided by our wonderful community advisory committee, led by Dr. John Palmer.  This recognition proves that with will, determination and fellowship, amazing things can happen!”

Among TouroCOM’s accomplishments noted at the luncheon were its success with MedAchieve, an after-school mentoring program for underserved Harlem high school students interested in medicine; Mentoring in Medicine, another program that brings high school students to TouroCOM’s anatomy labs and inspires them to pursue careers in medicine; and the Fund for Underrepresented Minority Students, which has held successful fundraising events in Harlem to fund scholarships for underrepresented minorities to attend the medical school.


Tourette Association Sponsoring Free Conference for Physicians in Ithaca

The Tourette Association of America / New York Centers of Excellence Consortium in partnership with Weill Cornell Medical College is offering a no-cost medical education conference for physicians and allied health professionals on Saturday, November 14, 8am-1pm Hilton Garden Inn Ithaca—Ithaca, NY. To learn more, visit the Tourette Association website. For questions, email NYprogram@tourette.org. Register here.

The conference will be offered through the Association’s partnership with the CDC, and has been approved for AMA PRA Category 1 Credit(s)TM*. Leaders of the New York Centers of Excellence Consortium have planned a practical update for providers on the recognition, diagnosis, treatment and management of Tourette Syndrome, other tic disorders, and commonly associated conditions (including ADHD and OCD).


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

 

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



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

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