January 22, 2016 – Yes to Corporate Partnerships?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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January 22, 2016
Volume 16, Number 3

Dear Colleagues:

Yesterday’s Council meeting included a lengthy discussion concerning changes related to the corporate practice of medicine statutes being considered by the New York State Departments of Health and Financial Services. The architects of healthcare reform in the state of New York are seeking to improve how healthcare services are delivered to the residents of the state. There is a prevailing view that in order to improve health outcomes, adjustments need to be made that change how relevant services are delivered.

The current view is that services that are critical to improving outcomes for many costly chronic conditions is delivered in an incomplete and/or fragmented fashion.  In order to improve outcomes, we must improve the coordination of services as well as the modalities and organizations that provide the relevant services. This is where things get wickedly complex and where we, as the highest order licensed healthcare professionals, have the duty to weigh in to insure safe delivery of high quality, evidence-based medical care.

Separation of Physicians and Non-Physicians

We enter into the arena of “wicked problems,” because the healthcare initiatives being considered challenge many of our longstanding beliefs concerning the practice of medicine and the separation of licensed professionals so that non-physicians cannot create professional medical organizations to deliver professional services. These new models do not always seek to create entities that deliver professional physician services. Rather, they seek to allow for the creation of new— perhaps hybrid— entities wherein physicians can deliver professional services that only they can deliver while others—perhaps non-professionals— deliver other services that are critical to the improvement of the physicians’ medical services.

Do we allow room for exploring new delivery models that challenge our views of how we protect the scope of practice of our profession? Do we push the envelope a bit to allow room to explore new models, making sure that physicians have the professional medical and financial control of these new delivery models?  Do we simply draw a line in the ground and raise the standard in the name of protecting our patients while archaic and cumbersome models continue to fail us?  Do we take the risk that our hard stance on the corporate practice of medicine gets railroaded by the political and regulatory machinery to the detriment of our patients because we were unwilling to initiate changes in a manner whereby we could safeguard the health and wellbeing of our patients and our profession?

The challenges facing us are great.  Many of us do not like the changes being proposed. Nonetheless, our Oath, when we entered the profession, requires us to rise above long-held beliefs, and rethink these beliefs in light of changes.

We Must Lead the Way

We must consider these changes and create the mechanisms that improve the delivery of care while we stand firm in the defense that it is the MEDICAL PROFESSION that must lead and control these novel delivery systems in order to insure evidence-based quality and safety outcomes that provide the desired value for our money.

Short of these, the most advanced healthcare system in the world is doomed to collapse or fall into mediocrity.

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

Please send your comments to comments@mssny.org


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MSSNY Lobby Day Scheduled for March 8th – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on March 8th in the Lewis Swyer Theatre in the Egg located at the

Empire State Plaza in Albany, New York.  Please register here if you plan to attend.

A full slate of legislators have been invited to dialogue with Advocacy Day participants including:

  • Donna Frescatore, Executive Director, NYS Health Benefit Exchange;
  • Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief luncheon to which members of each House are invited to dine and speak with their constituents will follow the morning program.   County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Given the wide range of threats physicians face including legislation that would expand the statute of limitations with a broad date of discovery exception potentially increasing physician premiums by 14.5%; legislation to repeal the Trial Lawyers contingency fee limits, potentially increasing premiums by over 10%; significant reductions in eligibility of the Excess Program; legislation that will mandate physicians to take a 4-hour Pain Management CME course every two years; and a move to effectuate statutory and regulatory changes to implement a value-based payment structure under Medicaid and potentially to Medicare and commercial products as well.

PHYSICIANS ARE ENCOURAGED TO IMMEDIATELY REGISTER TO ATTEND THE MARCH 8TH LOBBY DAY IN ALBANY.                                            
(GOVERNMENTAL AFFAIRS STAFF)


Physicians Urged to Oppose Huge Cuts to Excess Medical Liability Insurance Program
Physicians are urged to contact their legislators to object to the huge cuts contained in the Executive Budget to the Excess Medical Malpractice Insurance program.  If permitted to go forwarded, it would unfairly result in more than half of the physicians currently enrolled being dropped.   MSSNY’s strong opposition to these cuts will be a major component of MSSNY’s testimony to the joint meeting of the Assembly Ways & Means and Senate Finance Committees this Monday examining the proposed Health Budget.

Specifically, the proposal would prioritize funding for those physicians who practice in higher risk specialties and in more litigious regions of the State.  However, by cutting the funding by $25 million, it would mean that 55% of physicians who currently receive this essential coverage would be dropped from the program.  In upstate communities north and west of Greene and Columbia counties, coverage would continue only for neurosurgeons, bariatric surgeons and OB-GYNs. That means that in the Capital District, in Northern New York, in Central New York, in western New York and in the Southern Tier every family physician, internist, pediatrician, ophthalmologist, emergency room physician, vascular surgeon, cardiologist, radiologist, pathologist, otolaryngologist, dermatologist and allergist would be automatically dropped.  Even in some downstate communities including in the Bronx, Kings, Queens, Westchester, Sullivan and Orange counties, many primary care physicians, ophthalmologists, otolaryngologists, pathologists, dermatologists and allergists would be dropped.

The Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level.  The program was created over 30 years ago as a result of the liability insurance crisis of the mid-1980’s to address concerns among physicians that their liability exposure far exceeded available coverage limitations.  They legitimately feared that everything they had worked for all of their professional lives could be lost as a result of one wildly aberrant jury verdict. This fear continues today since New York State has failed to enact meaningful tort reform to ameliorate this risk. The size of verdicts in New York State has continued to grow significantly and physician liability premiums remain far out of proportion compared to the rest of the country.  Absent meaningful liability reform, full funding for the Excess program is absolutely essential in today’s very challenging practice environment.

At a time when the state is seeking to attract and retain physicians, this proposal deters physicians from wanting to practice in New York State for fear of putting themselves and their families in financial jeopardy for judgements and settlements exceeding the limits of their primary coverage.

Please urge your legislators to reject these cuts and restore full funding for the program!
(AUSTER, DEARS)


Contact Your Legislators to Support a  Health Republic Guarantee Fund
With the failure of the Executive Budget to include a Guarantee or other fund to cover the likely   hundreds of millions in payments due to Health Republic contracted providers, all physicians are urged to continue to contact their legislators and demand that the State Legislature take action to create such Guarantee or other fund.  Urging the Legislature to enact a Guarantee fund as part of the State Budget process will be a major component of the testimony that MSSNY will give this Monday at a joint meeting of the Assembly Ways & Means and Senate Finance Committees. 

MSSNY has worked with hospital associations to press key State Legislative leaders that it is absolutely imperative for the stability of our health care system that this be addressed soon.  We have shared with public officials the results of MSSNY’s survey that concluded that physicians are owed at least tens of millions of dollars in outstanding claims, of which:

  • 11% are owed $100,000 or more;
  • 20% are owed $25,000 or more; and
  • 49% are owed $5,000 or more.

Moreover, we have shared data from 5 large medical practices in the Lower Hudson Valley that together are owed over $12 million.

Please be on the lookout early next week for a new survey that seeks updated information from you whether this amount has grown since our initial survey was sent in November.  Please take the time to complete this survey, as the data is critical to our advocacy efforts.

And please take the time to send a letter to your legislators at this link.

Remind them that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs, insurance companies dropping physicians from their networks and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for patient care and employment in your community.
(AUSTER, DEARS) 


Disastrous Liability Expansion Bill Back on Assembly Calendar; Physicians Must Contact Their Legislators to Oppose Now!
All physicians must continue to contact their Senators and Assembly members to urge that they oppose legislation (A.285, Weinstein) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

With the bill having passed the Assembly in 2015, but not the Senate, it resumed a place on the Assembly Calendar, where it could be voted on by the full Assembly at any time.   The bill was brought up for initial consideration on Monday 1/11, but was “laid aside” by the Assembly Republican Conference.

While the bill currently does not have a Senate sponsor, it is possible that similar legislation could be introduced shortly.   At the conclusion of the 2015 Legislative Session, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that they would be working with representatives on both sides of this issue.  Since that time, MSSNY working together with MLMIC and hospital associations have met with top Senate staff to discuss comprehensive medical liability proposals to work towards legislation that would reduce the outrageous cost of physician medical liability premiums.

As these discussions ensue, you need to let your legislators know that no liability increases can be tolerated!  MLMIC’s estimate is that A.285 could increase physician liability premiums by an untenable 15%!   New York physicians continue to pay liability premiums that are among the very highest in the country.  They also face rapidly increasing overhead costs to remain in practice such as the huge costs associated with implementing expensive and cumbersome electronic medical record systems.  At the same time, they face reduced payments from Medicare and commercial insurers, and many practices face losses of tens of thousands, hundreds of thousands and in some cases millions of dollars in losses due to the collapse of Health Republic.

And to make matters even worse, trial lawyers are aggressively pushing the Legislature to consider additional liability expansion bills such as legislation that would eliminate the statutory limitation on contingency fees in medical liability actions, legislation that MLMIC has estimated could have the effect of raising your premiums by over 10%.   Physicians need liability reform to bring down these costs, not legislation that increases them!
(AUSTER, DEARS)


CME Mandate Bill Taken Off NYS Assembly Health Committee Agenda; Senate Bill Moving in Health Committee
Assembly Bill 355 (Rosenthal) and Senate Bill 4348A (Hannon) which would create a continuing medical education mandate for practitioners with prescribing privileges was taken off the agenda of the Assembly Health Committee on Thursday but a slightly different Senate version of the legislation is on the Senate Health Committee agenda for next week.  Physician action is vitally important.  They are urged to contact their elected representatives to urge that they vote against this mandate!  Send an email through MSSNY’s Grassroots Action Center.

  1. 4348A, sponsored by Senator Kemp Hannon, authorizes the Commissioner of Health to establish standards and to review requirements for CME on pain management, palliative care and addiction, is on the Senate Health Committee agenda for Tuesday, January 26th. It would require health care professionals authorized to prescribe controlled substances to complete three hours of continuing medical education, prior to renewal of registration to practice, that involves pain management. The curricula must include but is not limited to, I-STOP and drug enforcement administration requirements for prescribing control substances; pain management; appropriate prescribing; managing acute pain; pain; palliative medicine; preventative, screening and signs of addiction; responses to abuse and addiction; and end of life care. The Commissioner may allow for exemptions if the health care professionals meet requirements to the Commissioner’s satisfaction. The Commissioner must report on the impact of this legislation and any recommendations no later than three years after its enactment.

MSSNY has strongly opposed this measure in previous legislative sessions. Continuing Medical Education is valuable to physicians in keeping up-to-date on new clinical information, and physicians throughout the state voluntarily take continuing medical education for continued professional development in those areas that pertain to their individualized practice.  However, this bill fails to recognize that the Medical Society of the State of New York, the specialty societies, the American Board of Medical Specialties, and the American Osteopathic Association have all been aggressively promoting voluntary CME on pain management and that there is other course work that addresses many of the above issues. (CLANCY, DEARS)


Concerns with One-Sided Workers Compensation Reform Proposals to be an Important Component of MSSNY’s Budget Testimony
MSSNY’s testimony to the Senate Finance and Assembly Ways & Means Committees to be presented this Monday will raise significant concerns with the sweeping Workers’ Compensation reform proposal contained in the Executive Budget.  Among the proposals of greatest concern to physicians and their injured worker patients:

  • Removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation, which is currently an important peer review function provided by county medical societies to assure physician applications are complete and physician applicants are appropriately qualified to deliver this needed care to injured workers;
  • Enables treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery with physicians; whether new funds will be allocated or whether existing fees will need to be cut to cover this expanded list of care providers; and whether a non-physician can perform an IME of an injured worker to review the care provided by a physician to an injured worker;
  • Removes the requirement for a referral by a physician as a pre-condition for an injured worker to receive psychological care;
  • Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose a $5,000 fine on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule; and
  • Prohibits an injured worker not subject to a collective bargaining agreement from seeking medical treatment from outside a Workers Compensation PPO before 120 days after his or her first visit to a preferred provider organization provider.

Exacerbating these concerns is that the proposal also does not meaningfully address the many excessive administrative hassles identified by physicians that have caused many physicians to choose to not participate in the Workers Compensation program.   While there have been some modestly positive actions taken by the WCB in recent years to encourage physician participation in the WC program through removal of arbitration fees and development of an electronic portal for facilitating authorizations from carrier, the Budget proposals if enacted could further chase physicians away from the program.

MSSNY has reached out to labor organizations to coordinate its advocacy in opposition to these adverse proposals.  MSSNY has also been working closely with county medical society leadership from across the State to encourage their outreach to their local Senators and Assemblymembers to request that these proposals be jettisoned from the Budget.
(AUSTER, DEARS)


Physicians Encouraged to Register for Opioid Prescribing Webinar on January 26
Physicians and other prescribers are encouraged to register for the first free webinar on opioid prescribing which will take place on Tuesday, January 26th at 12:30 p.m.  at the following link.

Click on the upcoming tab and select the programs. Physicians will need to register for each webinar.

The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are jointly providing this free,  four part webinar series on opioid prescribing.  Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

The first webinar will be conducted by Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN and the educational objectives are:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

The remaining webinar series will be held on:

Wednesday, February 10, 2016, 7:30 a.m. Faculty:  Charles E. Argoff, MD.  The educational objective:  Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.  Faculty:  Jeffrey Selzer, MD and the educational objective:    Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.

Thursday, March 10, 2016, 7:30 a.m. Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM and the educational objectives:  Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed; discuss strategies to reduce risk of treating pain in patients with substance use disorders.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing.

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.

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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.
(CLANCY, DEARS)


Bill to Limit Opioid Prescriptions to Three-Ten Day Supply on Senate Health Agenda
Senate Bill 6091A, which would limit the initial prescription of Schedule II or III Controlled Substance to a three to ten day supply, is on the Senate Health Committee agenda for Tuesday, January 26th.   Sponsored by Senator Kemp Hannon, the bill is intended to encourage patients whose acute pain lasts longer than initially expected to follow up with a physician and it lessens the number of the pills left in medicine cabinets and available for diversion.  The bill does limit the number of co-pays for patients should they need additional prescriptions.

The Medical Society of the State of New York is opposed to this measure and believes that having the New York State Legislature place an arbitrary limit on any type of prescriptions interferes with the practice of medicine.   Its companion measure, A. 8601, sponsored by Assemblymember John T. MacDonald III, is in the Assembly Health Committee.

Physicians are urged to contact Senators on the Health Committee and urge defeat of this measure.  Senate Health Committee members are:   Senators Kemp Hannon, Hugh Farley, Simcha Felder, Martin Golden, Ruth Hassell-Thompson, Brad Hoylman, William Larkin, Betty Little, Jack Martins, Velmanette Montgomery, Terrence Murphy, Roxane Persaud, Gustavo Rivera, James Seward, Toby Stavisky, David Valesky, and Catharine Young.  
(CLANCY, DEARS)


Governor Nominates Vullo for DFS Superintendent
Governor Andrew Cuomo this week nominated Maria T. Vullo to serve as the Superintendent of the New York State Department of Financial Services. She is currently of counsel at Paul, Weiss, Rifkind, Wharton & Garrison LLP, where she was a partner for 20 years, and previously oversaw the Economic Justice Division in the Office of the New York State Attorney General.   DFS has had multiple Interim Superintendents since the previous Superintendent, Benjamin Lawsky, left the position last spring.  To read more about Ms. Vullo’s background, click here.
(AUSTER)


Centerlight Healthcare Settles for $47 Million in Medicaid Fraud Case
On Thursday, January 21st, Attorney General Eric Schneiderman announced a $47 million settlement with CenterLight Health Care and Centerlight Health System stemming from allegations of fraudulent Medicaid billing for unrendered services to 1,200 Medicaid recipients. As part of the settlement agreement CenterLight admitted that it enrolled ineligible Medicaid beneficiaries in its Managed Long Term Care Plan (“MLTCP”), which was contracted by NYS DOH to provide long-term community based health care; and that it used adult day care centers to provide community-based MLTCP personal care services that did not qualify as personal care services. In addition to its $47 million settlement, CenterLight agreed to additional monitoring for two-years by an independent compliance monitor and the A.G.’s Medicaid Fraud Control unit, and if necessary to revise its compliance policies.
(MCPARTLON) 


Inside Correctional Facilities—Increase in Staff Training on Inmate Mental Health
On January 21st, the New York State Senate passed a one-house bill sponsored by Senator Carlucci (D- Rockland/Westchester) which clarifies the eight-hour annual requirement for training of residential mental health treatment unit staff, as well as security, program services, mental health and medical staff with direct contact of inmates with mental illnesses. The bill was passed unanimously by the Senate, as it contains the language of a previously negotiated chapter amendment to a bill signed into law by Governor Cuomo last month. Current NYS Correction Law similarly requires that new corrections staff receive initial training in mental health treatment upon recruitment. The training topics include: types and symptoms of mental illnesses, the goals of mental health treatment, the prevention of suicide and training in how to effectively and safely manage inmates with mental illness. While a same-as bill has yet to be introduced in the Assembly, it will likely do so shortly.                                                                                            (MCPARTLON)


CMS Posts Information Regarding How Physicians Can Apply for Meaningful Use Hardship
The Center for Medicare and Medicaid Services (CMS) today posted information regarding changes to Medicare EHR Incentive Program hardship exception process.  Medicare is implementing these modifications as a result of the recently passed Patient Access and Medicare Protection Act, which established that the Secretary may consider hardship exceptions for “categories” of EPs, eligible hospitals, and CAHs that were identified on CMS’ website as of December 15, 2015.  Prior to this law, CMS was required to review all applications on a “case-by-case” basis.   The AMA had advised that it will review CMS’ materials and begin to educate physicians about how they can best apply for the exception.  Here is a link to the information CMS posted.

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

pschuh@mssny.org ldears@mssny.org            mauster@mssny.org  
pclancy@mssny.org bellman@mssny.org    


Council Meeting Notes: January 21, 2016

  • MLMIC’s Vice President, Don Fager, announced a 20% dividend for policyholders who are insured by May 1, 2016, and maintain continuous coverage through July 1, 2016.
  • Council approved the Board of Trustees report, which included approval of $100/day for delegates at the 2016 House of Delegates and approval for a MSSNY financial audit for 2015.
  • Council discussed MSSNY’s approach regarding the corporate practice of medicine as being proposed within the DSRIP program and agreed to enable leadership to carry on discussions with appropriate parties.
  • Dr. Maldonado stressed the importance of Legislative Day this year, which will be held on March 8 in Albany. He called on physicians to help ensure a large turnout to demonstrate the importance of our issues to legislators.
  • MSSNY will partner with the American Cancer Society and the American Cancer Society Action Network in a new anti-smoking campaign, 2016 New York is Kicking Butts Quit Smoking Campaign. The campaign is currently centered on NYC, but ACS hopes to expand it throughout the state. In New York City, smoking continues to be the number one cause of preventable death.
  • Council approved the following Resolutions:
  • 2015-268: MSSNY will encourage further research into genomic sequencing, including its ethical implications, its clinical implications and its financial implications and will also encourage efforts to increase the number of qualified genetic counselors in anticipation of the increasing clinical need.
  • 2015-253: MSSNY will seek federal legislation to ensure that as the government moves forward to value based payment and reform that the legislature and federal agencies seek direct physician input to ensure that bundled payments result in quality care and best patient outcomes, rather than just concentrating on the cost of care.
  • 2015-263: MSSNY will seek legislation or regulation to ensure that Medicare, Medicaid and insurance plans allow physicians to make dosing adjustments for approved medications to allow the patient to achieve therapeutic levels regardless of BMI and differing metabolic considerations. The dose administered should be within the purview of the treating practitioners based on clinical parameters, documented in the medical record.
  • First District Branch E-Prescribing Motion: MSSNY will press for legislation or regulation that would allow patients’ requests for paper prescription and pharmacy choice to be honored and that this legislation or regulation permit any patient to request opting out of electronic prescribing by requesting the same in writing to a physician who will then be permitted to issue a paper prescription in person or by fax.


MLMIC Policyholders Will Receive 20% Dividend
Our mission is to provide insurance at cost, without a profit motive. To offset premiums, we offer dividends to our policyholders whenever we can. This year, MLMIC policyholders will receive a 20% dividend. To take advantage of this dividend, you simply need to be insured by May 1, 2016, and maintain continuous coverage through July 1, 2016.

MLMIC is a mutual insurer, owned by our policyholders. Over the years, our financial strength has allowed us to pay more than $300 million in dividends to our policyholders, something no other insurer can match.

Learn More  or call (888) 793-0393. 


Medical Schools Seek Dollars for Diversity
The Associated Medical Schools of New York is lobbying the state legislature to boost its funding for fiscal 2017. The organization, which represents 16 public and private medical schools throughout the state, is requesting $2.4 million for scholarships and diversity initiatives, up from $1.6 million last year. The bulk of the money, $2 million, would fund four post-baccalaureate programs that help students from underrepresented backgrounds get into medical school. An additional $400,000 is for launching a new scholarship. African-Americans, Latinos and indigenous peoples make up 35% of New York’s population but only 9% of the physician workforce, according to a 2014 report from the SUNY Albany Center for Health Workforce Studies. Funding for AMSNY’s diversity initiatives was slashed by about 20% after the 2008 financial crisis. The requested funding would help restore the programming that was dropped, said Jo Wiederhorn, the group’s president and chief executive.


Mt. Sinai HCV Intensive Training Preceptorship Program
The Mount Sinai Institute for Advanced Medicine – CEI HIV/HCV Center for Excellence is proud to debut our HCV Intensive Training Preceptorship program! This 2-day clinical education program (March 24-25, 2016) provides an intensive experience for practicing clinicians (e.g. physicians, physician assistants, nurses and nurse practitioners) in New York State. Through a combination of didactic sessions and experiential training, clinicians are able to enhance their HCV prevention, treatment, and care knowledge and competence to better serve their patients.

All clinical experience shadowing will take place at a Mount Sinai affiliated clinic located in Manhattan, NY. Accepted applicants from upstate New York will be provided with an honorarium to assist with transportation and lodging expenses.

The deadline to apply is Friday, January 25 at 5pm. For more information, please visit: https://www.surveymonkey.com/r/HepCPreceptorship or contact sjobe@chpnet.org. 


EHR Incentive Hardship Exception Instructions Available NOW
Today, CMS has posted new, streamlined hardship applications, reducing the amount of information that eligible professionals (EPs), eligible hospitals, and CAHs must submit to apply for an exception. The new applications and instructions for a hardship exception from the Medicare Electronic Health Records Incentive Program 2017 payment adjustment are available here.

This new, streamlined application process is the result of PAMPA, which established that the Secretary may consider hardship exceptions for “categories” of EPs, eligible hospitals, and CAHs that were identified on CMS’ website as of December 15, 2015. Prior to this law, CMS was required to review all applications on a “case-by-case” basis.

Importantly, EPs, eligible hospitals, and CAHs that wish to use the streamlined application must submit their application according to the timeline established in PAMPA:

  • Eligible Professionals: March 15, 2016
  • Eligible Hospitals & CAHs: April 1, 2016

Please note: CAHs should use the form specific for the CAH hardship exceptions related to an EHR reporting period in 2015. CAHs that have already submitted a form for 2015 are not required to resubmit.

In addition, we have heard from stakeholders that they would like a more efficient approach for submitting applications from groups of providers. We have reviewed our administrative authorities and determined that groups of providers may apply for a hardship exception on a single application. Under the group application, multiple providers and provider types may apply together using a single submission. The hardship exception categories are the same as those applicable for the individual provider application.

Providers will have the option to submit an electronic file (in excel or csv formats) with all National Provider Identifiers (NPIs) or CMS Certification Numbers (CCNs) for providers within the group or use a multiple NPI or CCN form to submit their application. In addition, facilities which include both inpatient and outpatient settings may include both the individual NPIs for any eligible professionals and the CCN for the eligible hospitals and CAHs on the same single submission for their organization.


Physicians in Western New York Wary about Medical Marijuana Treatment
The Buffalo (NY) News (1/19, Davis) reports that “of the 226 doctors certified to recommend marijuana in New York State as of last week, 12 of them work” at the Dent Neurologic Institute in Amherst. Dr. Laszlo Mechtler, Dent’s medical director, is a “strong advocate for marijuana’s use where the scientific evidence shows it can help,” but “like many other physicians – remains wary about the drug.”

For physicians, the four-hour NYSDOH approved course is now available online. The online course is provided by TheAnswerPage, an established online medical education site, and includes the following topics: 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 course will cost $249 to take. Successful completion of the course will provide 4.5 hours of CME credits. The course may be accessed here.


Peconic Bay Joins Northwell Health Group
Newsday (1/19, Ochs) reports that Peconic Bay Medical Center and Northwell Health Group signed a formal agreement on Tuesday, making Peconic Bay the “21st hospital in the health system and anchoring Northwell’s presence on the East End.”  Peconic Bay chief executive Andrew Mitchell “said the agreement signals the beginning of a ‘new era for health care in central and eastern Suffolk’ that will make Peconic Bay, which serves about 200,000 patients and employs 1,300, a regional health care provider.” The agreement also signals the end of “Peconic Bay’s 10-year relationship with Stony Brook University Hospital and the demise of the East End Health Alliance formed in 2008.” 


CDC: Physicians Should Be Aware of Zika Virus in Pregnant Women
The CDC issued a travel warning to pregnant women and women of child-bearing age to avoid traveling to 14 countries in Central America and the Caribbean due to the risk of contracting the Zika virus, which is linked to severe birth defects. CDC is warning physicians to look out for symptoms of the Zika virus in pregnant women returning from trips to South and Central America http://wwwnc.cdc.gov/Travel. Published in

MMWR, the recommendations include:

  • All pregnant women should be asked if they have recently traveled to areas with active Zika virus transmission.
  • Those with recent travel to such areas and with symptoms of fever, rash, muscle aches, or conjunctivitis during or within 2 weeks of travel should be tested for Zika.
  • For pregnant women who test positive for Zika, clinicians should consider conducting ultrasounds every 3 to 4 weeks to monitor the fetus’s growth.

Zika is a mosquito-borne virus suspected of causing thousands of cases of microcephaly in infants born in Brazil over the past year. Last week, the CDC warned pregnant women to consider postponing travel to countries with ongoing Zika transmission.  Click here to read the full MMWR article.


Physicians Should Avoid Overuse of Antibiotics For Respiratory Problems
The CDC and the American College of Physicians have issued guidelines available at http://annals.org/article.aspx?articleid=2481815 intended to help physicians avoid overuse of antibiotics for respiratory problems. The guidelines were published in Annals of Internal Medicine. The guidelines “lay out how doctors begin deciding if antibiotics are warranted for” certain “respiratory complaints, explain that decision to patients and offer guidance on symptom relief.”


Longtime MSSNY Member Rufus Nichols, MD Passes Away
Rufus Nichols, MD passed away on January 20, 2016 after a battling a long illness.  Today would have marked Dr. Nichols’ 46 years as a member of the Society.  Many of you may remember seeing him at the House of Delegates. He served on many important MSSNY Committees: Committee to Eliminate Health Care Disparities; International Medical Graduates Committee; Long Term Care Committee; Organized Medical Staff Section (Officer); and Preventive Medicine and Family Health Committee.

Notes of condolence may be sent to Mrs. Jackie Nichols, 394 Joanne Court, Bartonsville, PA 18321.The funeral will be held at Bethlehem Church, 89-45 Lefferts Blvd., Richmond Hill, NY 11418.  Here is the website – Bethlehem Church NYC.

Services are as follows:


Classifieds

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


Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49th Street, this ground level office is 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



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

January 15, 2016 – Governor’s Speech Challenges Physicians

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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January 15, 2015
Volume 16, Number 2

Dear Colleagues:

While on the surface the course of healthcare delivery in New York appears to be moving along unfettered, much is happening at levels that have not fully gotten doctors’ full attention.  This week, I would like to highlight several for you.  It is impossible to provide a full review of all the issues in one short column so I ask that you do your homework with others in your group, hospital medical staff or county society.

Senate Roundtable on Health Republic

Last week, Dr. Scott Hayworth (Mt. Kisco Medical Group) and I participated in a Senate roundtable on the Health Republic fiasco.  Other parties included representatives from the DOH, DFS, hospital provider side and other insurers. By far, the largest cohort was that of the insurers. It was an opportunity for the Committee on Health to hear views from stakeholders as to the causes of the debacle and how we should move forward.

Dr. Hayworth and I were clear in our presentations on three points:

1) MSSNY alerted NYS health officials a year earlier to the closing that Health Republic had serious payment problems.

2) Physicians have been harmed significantly, leaving them with financial losses that will impact their abilities to provide necessary services to other patients.

3)  Failure to make physicians whole in the solutions brought forth by the state will likely dissuade doctors from participating in any future DSRIP and SHIP initiatives for fear of another failed healthcare reform project sinking them.  We made it very clear—a guaranteed State Fund is necessary to make physicians whole and ensure future success of physician engagement in DSRIP and SHIP.

Governor’s Budget

The Governor’s Budget this year presents several challenges to physicians.  First, there is the proposal once again to expand the terms under which retail clinics can operate in New York.  Second, there is once again an effort to eliminate the second layer of excess coverage for malpractice at a time when the legislature is consideration expanding the date of discovery and statute of limitations on filing a lawsuit for malpractice.  Third, there is a push to expand the scope of healthcare providers who can participate in the Workmen’s Compensation Board program. Finally, there is NO budgetary proposal for the establishment of a guarantee fund to address the losses in the Health Republic debacle.  

Insurer Mergers and Physician Opposition

This past week, the Physician Advocacy Institute sent a 14-page letter outlining its opposition to the merger of several large insurers in the country, highlighting the problems that such controlling entities would have in the marketplace and on the practices of physicians.  I encourage you to review this work done by an organization MSSNY helped found through the United Healthcare lawsuit settlement several years ago.

E-prescribing

Finally, it is imperative that physicians who have not as yet enrolled in the state’s e-prescribing program do so ASAP. The March 27, 2017 is looming.  A caveat–it will be impossible to complete the instructions before the deadline if you wait much longer.  We encourage you to consider the member discounted DrFirst option endorsed by MSSNY.

If you believe you qualify for a waiver, apply NOW.

Have a Happy Martin Luther King’s Day!

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Governor Andrew Cuomo Delivers Joint State of the State and Budget Message
Gov. Andrew Cuomo this week set forth his state of the state message proclaiming the accomplishments of his administration over the past five years of his term and unveiling143.6 billion budget for the coming 2016-17 fiscal year.

Many of Cuomo’s 2016 priorities have been released over the past week including plans for a massive, multi-year infrastructure investment for airports, roads and bridge construction as well as a strengthening of mass transit systems in the New York City area, and increasing the state’s minimum wage to $15 (in NYC by 2018  and by July 2021 for businesses in the rest of State) and proposing 12 weeks of paid family leave in the budget, which would be paid for with a $1 paycheck deduction for employees.

Earlier in the week, Governor Cuomo announced a $7M grant to four organizations working to control obesity, diabetes, heart disease and stroke. The funding will allow each organization to implement strategies to encourage lifestyle change and link community programs to include clinical services. Included among the four organizations awarded funding were: Albany County Department of Health ($879,880); HealtheConnections ($2M); Hudson River Healthcare ($2M) and P2 Collaborative of WNY ($2M).

Cuomo proposed divvying up more than $2 billion in settlement relief funds to a variety of areas. He wants to spend $700 million on a plan that would stabilize the Thruway Authority’s finances, $340 million for what is being term a toll “reduction” plan, $200 million on a transportation capital plan, $640 million to provide affordable housing and combat homelessness and $225 million for economic development.

Cuomo’s proposal included an increase of $1.4 B on education aid, an increase of more than 6 percent. Overall, education aid would increase by $2.1 billion over the next two years.

Components of the Governor’s tax cut for small businesses include: a reduction of the corporate tax rate for small businesses from 6.5% to 4%; increasing the exemption from 5-15% of income for tax purposes for sole proprietors and farmers; and granting a 15% exemption for partnerships and s-corps.

The Governor proposes adoption of broad new ethics measures, including limits on outside income for the Legislature. He also proposed to limit how much money lawmakers can earn in the private sector to 15 percent of their base salary. Cuomo also proposed that lawmakers end the practice of allowing single donors to give unlimited contributions through a network of limited liability companies. Cuomo also proposed public financing of political campaigns, which Senate Republicans have insisted they will not pass.

Describing the personal issues faced by his partner Sandra Lee last year, the Governor ended his presentation by proposing a $90M program in NYS for breast cancer screening and an initiative to require all health insurers to cover breast cancer screening.

In addition, the budget contains a number of initiatives—some of which we have seen previously- which will if ultimately enacted by the Legislature impact physicians and patients across NYS including the proposals listed below:

  • Limit Access to Excess Medical Malpractice Coverage. The Governor has again proposed (as he did three years ago) to significantly limit access to the second layer of medical malpractice coverage. Specifically, the proposal would require the Superintendent to, at least once every five years beginning on July 1, 2016, rank from highest to lowest each class and territory combination used for apportionment of premiums to pay for the excess coverage.  Ranking will be a function of physician primary coverage costs and “applicable” (and unspecified) excess tier factors. The proposal requires the Superintendent to grant priority for purchasing policies in descending order beginning with high risk class and territory combination until the appropriation is exhausted. This initiative will result in a $25 million reduction to the program from $127.4M to $102.4M. Three years ago, he proposed somewhat different language but his articulated goal was to limit Excess coverage to physicians with the highest risk…which would have left nearly 40% of physicians who currently have such coverage without it.
  • Authorizes Establishment of Retail Clinics. The Governor has proposed to enable the establishment of ‘limited service’ clinics which provide a limited list of services in retail stores- provided that they adhere to regulations which would among other things require them: to be accredited; accept walk ins; adhere to advertising and signage standards; disclose ownership interests; directly employ a medical director; and strengthen primary care through integration of services with the patient’s other health care providers. The justification given for this proposal is “to increase access to economical primary care services for Medicaid recipients and reduce unnecessary emergency room and inpatient visits”. This proposal is also somewhat modified from those advanced in previous years. It now would allow diagnostic and treatment centers (owned by hospitals), community health centers and federally qualified health centers to operate a limited services clinic.  The proposal would also require an establishment to ‘demonstrate a commitment’ to operate limited service clinics in medically underserved areas; and would allow the department in determining whether to approve additional limited service clinic locations, to consider whether the operator has fulfilled its commitment to operate limited services clinics in medically underserved areas of the state.
  • Makes Significant Changes to Workers Compensation program. The Governor’s proposal would expand the list of providers who are eligible to deliver (and receive payment directly form the W/C program) to include acupuncturists, nurse practitioners, physician assistants, and social workers. Currently, only chiropractors, physicians, podiatrists, psychologists and physical therapists were authorized to receive reimbursement from the workers’ compensation program. Ostensibly, NPs and PAs employed by physicians provided care but the physician’s practice was reimbursed. The proposal also eliminates need for county medical society review of physicians looking to be authorized to deliver care. The initiative would also enhance the flexibility of hearing times and enables virtual hearings for workers compensation cases. See related article.
  • Health Republic. The Governor’s proposed budget does not include language to require the creation of a Guarantee Fund or identify the use of any settlement monies or other pool of monies to address the financial plight of physicians and other providers due to the recent demise of Health Republic. MSSNY is working closely with several physician practices, the Greater New York Hospital Association and HANYS to urge enactment of legislation to reimburse providers who have incurred significant losses as a result of providing care to HR insureds.
  • Statutory Proposals to advance DSRIP/VBP. The Governor’s proposed budget did not include the statutory language changes that have been advanced by various subcommittees to the VBP Workgroup, the Governor’s State of the State message did stipulate that “in 2016, DSRIP will move to the next phase of transforming the health care delivery system in New York by implementing pilot programs to replace expensive fee-for-service payments with ‘value-base’ payments that reward providers for successful patient outcomes and help achieve one of the core DSRIP goals of reducing avoidable hospital admissions by 25 percent over five years.”
  • Additional funding ($200M) to combat AIDS. Specifically, these funds will be used to expand the availability of affordable housing and housing assistance for those living with HIV and identify undiagnosed persons, link them with treatment and facilitate access to necessary medications to keep them HIV negative to prevent spreading the disease.
  • Additional funding ($6M) to combat heroin epidemic. These funds will continue to support prevention, treatment and recovery programs targeted toward chemical dependency, residential service opportunities, and public awareness and education activities.
  • Permits certain state facilities to share patient medical records. Permits facilities, including facilities operated or licensed by the Department of Mental Hygiene, to share clinical records with managed care organizations, behavioral health organizations, health homes, and other entities authorized by the Department or Department of Health (DOH) to provide, arrange or coordinate health care services for Medicaid recipients for whom such entities are responsible.
  • Eliminates the prescriber prevails. Eliminates existing statutory prescriber prevails protections for medications for patients covered in the Medicaid program, except for atypical antipsychotic and anti-depressants. (DEARS, AUSTER, CLANCY, MCPARTLON) 

Executive Budget Seeks to Marginalize Physician Care to Injured Workers
The Governor’s proposed Budget released this week contains sweeping changes to long standing Workers’ Compensation laws to, according to the supporting memo: ensure the system provides more timely and appropriate medical and wage replacement benefits to workers; provide broader and more accessible options for medical care; make hearings more accessible through flexible scheduling and use of virtual hearings; and streamline Workers’ Compensation Board processes and administration to expedite decision making.

While these goals are obviously shared by the physician community, the proposal includes a number of seriously problematic proposals that could further discourage physician participation in the Workers’ Compensation program.  Among the proposals:

  • Removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation, which is currently an important community function provide by county medical societies;
  • Enables treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery with physicians; whether new funds will be allocated or whether existing fees will need to be cut to cover this expanded list of care providers; and whether a non-physician can perform an IME of an injured worker to review the care provided by a physician to an injured worker;
  • Removes the requirement for a referral by a physician for an injured worker as a pre-condition to receive psychological care;
  • Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose a $5,000 fine on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule; and
  • Prohibits an injured worker not subject to a collective bargaining agreement from seeking medical treatment from outside a Workers Compensation PPO before 120 days after his or her first visit to a preferred provider organization provider.

Of further concern, the proposal does not address any of the many excessive administrative hassles identified by physicians that have caused many physicians to choose to not participate in the Workers Compensation program.   While there have been some modestly positive actions taken by the WCB in recent years to encourage physician participation in the WC program through removal of arbitration fees and development of an electronic portal for facilitating authorizations from carrier, the Budget proposals if enacted could further chase physicians away from the program.   MSSNY has reached out to labor organizations to coordinate its advocacy in opposition to these adverse proposals. (AUSTER)


MSSNY Lobby Day Scheduled For March 8th– Physicians Urged To Attend And To Wear Your White Coats
SAVE THE DATE- MSSNY’s Physician’s Lobby Day will be held on March 8th in the Louis Swyer Theater in the Egg located on the Empire State Plaza in Albany New York.  A full slate of legislators and key staff to the Departments of Health and Financial Services has been invited to dialogue with Lobby Day participants including:

  • Donna Frescatore, Executive Director of the NYS Health Benefit Exchange
  • Troy Oechsner, Acting Executive Deputy Superintendent Of Insurance , Department of Financial Services
  • Jason HElgerson, Medicaid Director, Department of Health
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair Richard Gottfried; Senate Insurance Committee Chair and Assembly Insurance Chair Kevin Cahill.
  • Senate Majority Leader John Flanagan, Assembly Speaker Carl Heastie

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


Date of Discovery Liability Expansion Bill Back on Assembly Calendar; Physicians Must Contact Their Legislators to Oppose Now!
With the Legislature back in Session, all physicians must again contact their legislators to urge that they oppose legislation (A.285, Weinstein) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

With the bill having passed the Assembly in 2015, but not the Senate, it resumes a place on the Assembly Calendar, where it could be voted on by the full Assembly at any time.   The bill was brought up for initial consideration on Monday 1/11, but was “laid aside” by the Assembly Republican Conference  at MSSNY’s rquest.  While the bill currently does not have a Senate sponsor, it is likely to be introduced shortly.

MLMIC’s estimate based upon similar legislation is that this single bill could increase physician liability premiums by an untenable 15%!   New York physicians continue to pay liability premiums that are among the very highest in the country.  They also face rapidly increasing overhead costs to remain in practice such as the huge costs associated with implementing expensive and cumbersome electronic medical record systems.  At the same time, they face reduced payments from Medicare and commercial insurers, and many practices face losses of tens of thousands, hundreds of thousands and in some cases millions of dollars due to the collapse of Health Republic.  Therefore, YOU NEED TO LET YOUR LEGISLATORS KNOW THAT NO LIABILITY INCREASES CAN BE TOLERATED!

MSSNY is working with many other groups also impacted by this legislation, including hospitals, nursing homes, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.   (AUSTER, DEARS)


Contact Your Legislators to Support a Health Republic Guarantee Fund
With the failure of the Executive Budget to include a Guarantee or other fund to cover the likely   hundreds of millions in payments due to Health Republic contracted providers, all physicians are urged to continue to contact their legislators and demand that the State Legislature take action to create such Guarantee or other fund.

Last week, MSSNY President Dr. Joseph Maldonado strongly urged key State Senators to work to enact a fund to assure that Health Republic claims are completely paid, and that this legislation be enacted in the opening weeks of the 2016 Legislative Session.   Dr. Maldonado’s statements were made as part of a Senate Health & Insurance Committees Roundtable discussion examining the demise of Health Republic, discussing solutions to minimize its adverse consequences, and working to prevent similar events in the future.  The meeting was chaired by Senate Health Committee Chair Kemp Hannon and Insurance Committee Chair James Seward.

To read Dr. Maldonado’s full written statement to the State Senate click here.

Dr. Maldonado’s comments received extensive media coverage, including in Buffalo Business First, Crain’s Health Pulse, and in an Associated Press article that was printed in papers across the country. 

Please remind your legislators that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for your community.
(AUSTER, DEARS)


Legislation Before Assembly to Accord Due Process Rights When Physicians Are Non-Renewed By A Health Insurer
Legislation (A.1212, Lavine/S.4751, Hannon) is back before the full Assembly that would assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company can be non-renewed.  The legislation is in response to situations such as the disrespectful way by which Emblem treated 750 of its network physicians who were unceremoniously dropped from the network in October based upon specious allegation of failure to transition to value-based payments, severing patient treatments relationships for countless patients.  MSSNY has raised this issue with Department of Financial Services, Department of Health, and Attorney General, as well as the entire New York State Legislature. (See MSSNY letter to DFS here.

The legislation passed the Assembly overwhelmingly in 2015, but not the Senate.  Physicians can send a letter in support of this legislation here.  A customizable template is provided.
(AUSTER, DEARS)


Cuomo Calls for Ethics Reform
On Wednesday, Governor Cuomo introduced two freestanding Article VII Ethics reform bills in his budget proposal designed to address the public perception of Albany’s political culture quagmire.

The first bill, a smorgasbord of ethics reform, tackles: (1) closing the LLC Loophole by removing an LLC’s designation as an individual, requiring LLCs making political expenditures to register with the State of Board  of Elections, and to disclose direct and indirect LLC ownership thereby proportionally attributing such political expenditures toward individual campaign contribution limits; (2) capping outside earned income of legislators to no more than 15% of member base compensation, with exceptions for investments and capital gains accrued prior to taking office, and tying members’ ability to vote in the legislature on compliance with civil penalties up to $50,000; (3) reforming campaign finance with heightened disclosure requirements for intermediaries, and proposing a system for the public financing of campaigns; (4) reforming the Freedom of Information Law (FOIL) by statutorily making both houses of the legislature subject to FOIL requirements; (5) expanding the Joint Commission of Public Ethics (JCOPE) civil penalty jurisdiction and mandating JCOPE hold one meeting location for every meeting open to the public; and (6) requiring political consultants to register as lobbyists.

The second bill, a constitutional amendment subject to voter approval, would strip a public official of his or her pension or retirement benefits/privileges if they are convicted of a crime related to public office. The constitutional amendment would be retroactive in the sense that benefits/privileges are subject to forfeiture regardless of when such rights accrued or vested.

The ambitious and seemingly all-inclusive ethics reform bills are highly contentious in both houses, and are unlikely pass without significant changes.
(DEARS, MCPARTLON)

MSSNY and OASAS to Conduct CME Webinars on Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free,  four part webinar series on opioid prescribing.  Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing. 

Tuesday January 26, 2016,  12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation. 

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Selzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.  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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.
(CLANCY, DEARS)


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org.                                         (CLANCY)


E-Prescribing Waiver Applications Now Available from BNE
With March 27, 2016 as the date that all prescriptions must be electronically submitted, the New York Bureau of Narcotic Enforcement has announced the availability of the Electronic Prescribing Waivers (EPW) application on the Health Commerce System (HCS).

A prescriber must have a HCS account in order to file an electronic prescribing waiver.  Using the HCS account is the quickest way to file the EPW application.

This application allows an institution, medical group practice or an individual practitioner to submit a request for a waiver from the requirement to electronically prescribe. Below are links to instructions for completing the online application on the Health Commerce System, based on the type of requestor:

Institution

Medical Group Practice

Individual Practitioner

If physicians do not have an HCS account, a paper version is NOW available upon request. Please contact the BNE at 1-866-811-7957, option 1.  The paper form is available for applications for institutions, group practices and individual practices and will be sent to requestors.

If physicians experience difficulties with their HCS account,  please call:  1-866-529-1890.  If a prescriber experiences any issues with the on-line Electronic Prescribing Waiver, they should call 1-866-811-7957.                                                                 (CLANCY, DEARS) 


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:

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 programs are: 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.
(CLANCY, HOFFMAN) 


NYS DOH AIDS Institute Announces HCV Provider Directory
The AIDS Institute Viral Hepatitis Section is excited to announce the launch of the NYS HCV Provider Directory.  The purpose of the directory is to provide the public and other providers with a listing of HCV care and treatment providers within the State. The directory is an expansion of the existing HIV Provider Directory re-launched last year by the AIDS Institute.

Participation in this directory is voluntary. The information is compiled through provider self-identification, and includes physicians, nurse practitioners, physician assistants, and doctors of osteopathic medicine with the experience in HCV care and treatment and who meet the NYSDOH definition of an experienced HCV provider.

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

pschuh@mssny.org ldears@mssny.org            mauster@mssny.org  
pclancy@mssny.org bellman@mssny.org    


CVS Pharmacies in NY Can Sell Naloxone without Prescriptions
Yesterday, the New York State DOH announced an agreement with CVS/pharmacy to help prevent opioid overdose deaths in New York State. This agreement, which became effective January 2, authorizes 479 CVS/pharmacy locations across the State to provide naloxone to their customers without a prescription. Pharmacists are currently receiving training and ordering naloxone for their stores. Naloxone (also known as Narcan®) is a medication that reverses opioid overdose.
Although traditionally administered by emergency medical (EMS) or hospital personnel, naloxone can be administered by laypeople with minimal training. CVS pharmacists are now able to provide this training in addition to dispensing the naloxone to their customers. All individuals who are given naloxone should still go to the hospital with EMS personnel. Naloxone is effective in blocking the effects of an opioid for 30 to 90 minutes. When the naloxone has worn off, someone may slip back into a life-threatening overdose. For more information, click here.


REMINDER:  All Prescriptions Must Be Sent Electronically Beginning March 27th
With the e-prescribing mandate quickly approaching on March 27th, we at MSSNY yare concerned about the lack of preparedness expressed by New York doctors.  Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate.

We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are compliant with the law.

As a MSSNY member benefit, you qualify for a substantial discount on DrFirst’s industry-leading Rcopia® with EPCS GoldSM.  The cost is $500 for a one-year license (a $299 discount) and includes e-prescribing for both legend drugs and controlled substances, as well as the DEA-required identity proofing and two-factor authentication soft token.

If you buy now, you’ll be ready when the deadline arrives, and DrFirst will extend your software license from now until March 27, 2016 at no additional charge. To purchase online, visit www.drfirst.com/MSSNY and use coupon code MSSNY, or call the MSSNY E-prescribing Hotline at 866-980-0553.

To learn more, register for DrFirst’s educational e-prescribing webinar to help you learn more about I-STOP and the patient safety and workflow benefits of using e-prescribing.  Sign-up today using the registration links below:

1/19 @ 12:00 pm – http://www.drfirst.com/mssny/mssny-lp/#webinar


MSSNY Multi-Section Meeting February 27 for YPS, Residents and Students
MSSNY’s Young Physicians, Resident and Fellow, and Medical Students Sections will hold a joint meeting on Saturday, February 27, 2016. While the business portions will be held separately, all three sections will get together to partake in a leadership presentation* by Richard Popovic, a highly experienced consultant in the fields of physician leadership, strategy, management and patient safety.

Don’t miss this essential leadership presentation and opportunity to discuss relevant issues with your colleagues and help shape MSSNY policy. Section Governing Council elections will be held. Business meetings will take place at MSSNY offices, 865 Merrick Avenue, Westbury, and the leadership presentation at the Hilton Garden Inn (across the street). Web conferencing will be available. The Hilton is offering a corporate room rate of $164.00 for those who may wish to stay overnight (contact sbennett@mssny.org for corporate number).

YPS and RFS can register at sbennett@mssny.org. Students can register at mreyes@mssny.org.

  • YPS business 8:00 am
  • MSS business 9:00 am and after lunch as necessary
  • Presentation 10:30 am
  • Lunch noon
  • RFS business 1:00 pm

*This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of MSSNY and the Medical Educational & Scientific Foundation of New York, Inc. (MESF). MSSNY is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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


CDC To Provide $2M to Combat Chronic Diseases in Western NY
Buffalo Business First reports that the nonprofit organization, the P2 Collaborative of Western New York, “will receive $2 million over three years from CDC to fight chronic diseases such as obesity, diabetes, heart disease and stroke in the eight-county region. The article points out that “P2 is among four organizations across New York that will receive $7 million in all.” Recipients for the grants were “selected based on high rates of chronic disease and/or more than 40 percent minority population in the counties they serve.” The funds “will support strategies in community and care settings that promote health, support and reinforce healthful behaviors, encourage lifestyle change program participation and link community programs to clinical services.” 


Eight Marijuana Dispensaries Open throughout State
On January 7, Columbia Care opened the first medical marijuana dispensary in New York City on East 14th Street in Manhattan; other dispensaries that opened in the state were in White Plains, Syracuse, Williamsville, Albany, Kingston, Amherst, and Liverpool.


Average Age of First-Time Moms in US at All-Time High
On January 14, a report released by the Centers for Disease Control and Prevention revealed that the average age of first-time mothers is at an all-time high in the United States http://www.cdc.gov/nchs/data/databriefs/db232.htm The report put the average age at 26 years, 4 months for first-time moms in 2014. Lead author T.J. Mathews from the CDC attributed the change to the drop in teen moms. Overall, the average age of first-time moms “has been rising in every racial and ethnic group, and in every state,” but the highest average ages for first-time moms are still in the Northeast.

American Academy of Pain Medicine Meeting in February in Palm Springs
The American Academy of Pain Medicine (AAPM) 32nd Annual Meeting will be held February 18-21, 2016, in Palm Springs, CA. The theme of this year’s event is Ensuring Access to Pain Care: Engaging Pain Medicine and Primary Care Teams. Of particular connection to their work on the AMA task force, the Academy is offering a preconference session titled Opioid and Non-Opioid Medications Management: Filling in the Gaps, Prescribing for the Whole Patient. Learn more by visiting www.painmed.org/annualmeeting.


Classifieds

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


Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49th Street, this ground level office is 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



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

January 8, 2016 – Do You Need Opioid Education?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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January 8, 2015
Volume 16, Number 1

Dear Colleagues:

For several years, MSSNY has fought state legislation aimed at mandating CME for chronic pain management and opioid abuse.  The fight thus far has been successful but honestly, the odds of doing this again are slim.  How can we all help to win the battle once and for all?  The answer is: EVIDENCE that physicians are voluntarily educating themselves.  While you may have already done this through other programs, I am asking every MSSNY member to ante up their non-financial contribution by signing up for one of the webinar times listed below.  If we get sufficient numbers, we may be able to show robust evidence that we can do this voluntarily and a mandate is unnecessary.  Short of doing this voluntarily and providing the State evidence of it, mandatory CME WILL succeed because much of the public believes many of us are prescribing inappropriately and abetting many patients in becoming addicted to prescription pain medications.  Regardless of how you feel on what is the best solution, signing up will go a LONG way in our talks with legislators.

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. We have also supported legislation to increase access to naloxone to reduce deaths from overdose. We have also supported efforts to increase voluntary education and training for physicians on safe prescribing practices. Our efforts have proven successful.  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.

If we educate ourselves now voluntarily, we may be able to stave off an extensive mandatory course in the near future.

Beginning on Tuesday, January 26, at 12:30 pm
, MSSNY and the New York State Office for Alcoholism and Substance Abuse Services are presenting a free, four-part webinar series on opioid prescribing— Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain. This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing. Registration is now open here.

National experts Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN will compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health and explain the requirements of New York State laws/regulations with regard to prescribing of controlled substances.

On Wednesday, February 10, 2016 at 7:30 am
, Charles E. Argoff, MD will discuss evidence-based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

On Tuesday, February 23, 2016, 7:30 am
, Jeffrey Seltzer, MD will describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral. 

On Thursday, March 10, 2016 at  7:30 am,
Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM will recommend tools to assist in the management of patients for whom opioids are indicated and prescribed and discuss strategies to reduce risk of treating pain in patients with substance use disorders.

Registration is now open to physicians here.

Registration is now open to physicians and other prescribers in your practice here.

We are strongly urging physicians to voluntarily take these webinars; please assist us in this endeavor. If there are any questions regarding this; please call Pat Clancy at 518-465-8085 ext 311.

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


MSSNY Fights for Guarantee Fund to Pay for Unpaid Health Republic Claims
MSSNY President Joseph Maldonado, MD, MSc, MBA strongly urged key State Senators this week to work to enact a Guarantee or other special fund to assure that Health Republic claims are completely paid, and that this legislation be enacted in the opening weeks of the 2016 Legislative Session.   Dr. Maldonado’s statements were made as part of a Senate Health & Insurance Committees Roundtable discussion examining the demise of Health Republic, discussing solutions to minimize its adverse consequences, and working to prevent similar events in the future.  The meeting was chaired by Senate Health Committee Chair Kemp Hannon and Insurance Committee Chair James Seward.

To read Dr. Maldonado’s full written statement, click here and to view the Senate Roundtable in its entirety click here.

In addition to Dr. Maldonado, other participants in the roundtable discussion included MSSNY member Dr. Scott Hayworth, President of the Mt. Kisco Medical Group, as well as representatives of the Greater New York Hospital Association, the Healthcare Association of New York, the New York Health Plan Association, the Conference of Blue Cross/Blue Shield Plans, the National Association of Health Underwriters, United and Health Now.   Also participating were DFS Executive Deputy Superintendent Troy Oechsner and New York State of Health Executive Director Donna Frescatore.

The roundtable discussion focused on the events leading to the collapse of Health Republic and legislative solutions to prevent against such insurer collapses in the future.  This included extensive discussions whether revisions were necessary to New York’s law requiring DFS to approve premium rates as well as whether the State should enact a special Guarantee fund to address unpaid medical claims from physicians and hospitals for care to Health Republic-insured patients.   In arguing for the necessity of a Guarantee fund, Dr. Maldonado highlighted the commitment of physicians to continue to deliver the care needed by their patients despite the knowledge that it was highly unlikely that Health Republic would able to cover these claims.  In particular, he highlighted the tens of millions of dollars in outstanding claims that are owed to medical practices across New York State.  For example, 5 medical practices in the Lower Hudson Valley alone are owed over $12 million.  Moreover, MSSNY’s survey with close to 1,000 respondents showed 42% with outstanding claims to Health Republic, of which:

  • 11% are owed $100,000 or more;
  • 20% are owed $25,000 or more; and
  • 49% are owed $5,000 or more.

Dr. Maldonado’s statement also noted that, in addition to these tangible financial consequences, there is another consequence to physicians – fear of “being burned” again in what may be viewed as risky health care initiatives.  He noted that he had heard from many physicians who are now expressing great reluctance to participate in other new health coverage initiatives, as well as reluctant to participate in other reform initiatives that hold out the promise of upside financial benefits but also could potentially put their medical practices at risk.   MSSNY’s statement included a statement from William Moorely, President & CEO of the Westchester County Association who expressed “deep concern wit the financial consequences to physician practices and patients across New York State as a result of The Collapse of Health Republic” and urged the enactment of legislatures to make physicians and hospitals whole.                      
(AUSTER, DEARS)

Senate Health Committee Moving CPH Immunity Bill and Protection for Statements Made During Peer Review
The Senate Health Committee next week will advance two bills strongly supported by MSSNY. The first bill (S. 3461A, Hannon) would clarify that the statutory liability protections offered for physician participants in the Committee for Physicians’ Health (CPH) program extend to the organization who sponsors the program as well as to the employees of the sponsoring program acting without malice and within the scope of its functions for the committee. Assemblyman Gottfried has introduced the companion bill (A.7267) in the Assembly.  Last year, the Senate passed the bill but it was never reported out of the Assembly Codes Committee.

The second bill (S.4698, Hannon) would extend the confidentiality provisions relating to discovery of testimony to apply to statements made by any person in attendance at peer-review committee that is a party to an action the subject matter of which was reviewed at such meeting. Assemblyman Gottfried has sponsored the companion bill (A.3353) in the Assembly.                           
(DEARS, AUSTER)


MSSNY and OASAS to Conduct CME Webinars on Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free,  four part webinar series on opioid prescribing.  Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing. 

Tuesday January 26, 2016,  12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Selzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits. 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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.
(CLANCY, DEARS) 


E-Prescribing Waiver Applications Now Available from BNE
With March 27, 2016 as the date that all prescriptions must be electronically submitted, the New York Bureau of Narcotic Enforcement has announced the availability of the Electronic Prescribing Waivers (EPW) application on the Health Commerce System (HCS).

A prescriber must have a HCS account in order to file an electronic prescribing waiver.  Using the HCS account is the quickest way to file the EPW application.

This application allows an institution, medical group practice or an individual practitioner to submit a request for a waiver from the requirement to electronically prescribe. Following are links to instructions for completing the online application on the Health Commerce System, based on the type of requestor:

Institution

Medical Group Practice

Individual Practitioner

If physicians do not have an HCS account, a paper version is NOW available upon request. Please contact the BNE at 1-866-811-7957, option 1.  The paper form is available for applications for institutions, group practices and individual practices and will be sent to requestors.

If physicians experience difficulties with their HCS account,  please call:  1-866-529-1890.

If a prescriber experiences any issues with the on-line Electronic Prescribing Waiver, they should call 1-866-811-7957.
(CLANCY, DEARS)


NYS Medical Marijuana Program Launched on January 7th
The New York State Department of Health initiated the state’s Medical Marijuana Program on January 7, 2016; this program will make approved forms of medical marijuana, available with a physician’s certification at designated dispensaries across New York State. The program provides access to medical marijuana to certified patients suffering from cancer, HIV/AIDS, ALS (Lou Gehrig’s disease), Parkinson’s disease, multiple sclerosis, intractable spasticity caused by damage to the nervous tissue of the spinal cord, epilepsy, inflammatory bowel disease, neuropathies and Huntington’s disease.

Physicians seeking to certify patients for the use of medical marijuana are required to take a four and ½  hour online educational program.   The physicians CME certificate must then be forwarded to DOH.   This course is available at TheAnswerPage, an established online medical education provider here.

The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course.

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.

The course includes 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.  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.  The NYS Department of Health has indicated that 150 physicians have taken the course and also said that a list of physicians names, who have given their consent to the DOH for their names to be made public,  should be released shortly.

The department’s press release provided the following information:  “In order to obtain medical marijuana, a patient must receive a DOH Medical Marijuana Program certification from a registered physician.   The patient must then access DOH’s online Patient Registration System to apply for a registry identification card. Additional information regarding registration can be found here.

To apply for a registry card, certified patients will need: a valid DOH Medical Marijuana Program certification form issued and signed by a registered practitioner, photographic identification, documentation of his or her temporary or permanent New York State residency, and designated caregiver information, if applicable.  A patient who is under the age of eighteen or who is otherwise incapable of consenting must apply through a proxy.

Patients with valid registry identification cards are then eligible to purchase medical marijuana from one of the dispensing locations across the State.  DOH selected five registered organizations on July 31, 2015 to grow marijuana and manufacture it into approved forms.  Each registered organization operates a manufacturing facility and four dispensing facilities. Information on the registered organizations can be found at here.
(CLANCY)


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org.
(CLANCY)


MSSNY is Member of The AMA’s Task Force on Opioid Abuse
The Medical Society of the State of New York is participating on the American Medical Association’s (AMA) national Task Force to Reduce Opioid Abuse.  The task force, established in 2014, consists of over 20 medical national specialty organizations and MSSNY is one of the eight state medical societies on the task force.  The goals of the task force are to:

  • Increase physicians’ use of effective PMPs
  • Enhance physicians’ education on appropriate 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.

The task force ultimate goals are to create a behavioral shift in physicians to create a sense of urgency that they are a part of the solution to the opioid epidemic and to tap into their fundamental desire to effectively help their patients and improve their patients’ health.  The task force will also urge physicians to use PMPs to have a better—realistic—perspective about patients’ use of opioids.  Dr. Frank Dowling, MSSNY Councilor and Pat Clancy, Vice President of Public Health and Education are MSSNY appointees to the task force.

MSSNY has also developed a page entitled, “Opioids: What One Doctor Can Do“  This page is located on the MSSNY website and is located in a blue box at the top of the home page:  www.mssny.org   The page provides information on the AMA Task Force, provides resources and best practices for physicians and also provides tools for physicians along with patient information.
(CLANCY)


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.

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 programs are: 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.
(CLANCY, HOFFMAN) 


Legislative Advocacy Leadership Workshop for HCV Clinicians to Be Held January 15
A legislative leadership workshop will be held January 15, 2016 for HCV clinicians at Lenox Hill Hospital, 130 East 77th Street, NY, NY; Aron Board Room.  The workshop is sponsored by the Empire Liver Foundation, HepCx, and NYC Health Department.   Clinicians can learn about strategies to change policies and support legislation. The workshop will also be broadcast over WebEx.    Further information and/or to register for the conference,  please  Eric Rude at erude@health.nyc.gov
(CLANCY)

REMINDER:  All Prescriptions Must Be Sent Electronically Beginning March 27th
With the e-prescribing mandate quickly approaching on March 27th, we at MSSNY are concerned about the lack of preparedness expressed by New York doctors.  Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate.

  • We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are compliant with the law.
  • As a MSSNY member, you qualify for a substantial discount on DrFirst’s industry-leading Rcopia® with EPCS GoldSM.  The cost is $500 for a one-year license (a $299 discount) and includes e-prescribing for both legend drugs and controlled substances, as well as the DEA-required identity proofing and two-factor authentication soft token.
  • If you buy now, you’ll be ready when the deadline arrives, and DrFirst will extend your software license from now until March 27, 2016 at no additional charge. To purchase online, visit www.drfirst.com/MSSNY and use coupon code MSSNY, or call the MSSNY E-prescribing Hotline at 866-980-0553.
  • To learn more, register for DrFirst’s educational e-prescribing webinar to help you learn more about I-STOP and the patient safety and workflow benefits of using e-prescribing.  Sign-up today using the registration link below
  • 1/19 @ 12:00 pm – http://www.drfirst.com/mssny/mssny-lp/#webinar


Longtime MSSNY Counsel Don Moy Retiring from Kern Augustine Conroy & Schoppmann
Don Moy Esq.
Kern Augustine Conroy & Schoppmann, P.C. would like to announce that as of December 31, 2015, one of its partners, the esteemed Donald (“Don”) R. Moy, Esq. has retired.  Over the past five years, the partners, attorneys, staff and clients of Kern Augustine Conroy & Schoppmann have had the honor and privilege of working with Mr. Moy, one of the most honorable, knowledgeable and respected attorneys in the world of healthcare law, and he will truly be missed.

Don Moy’s career has been dedicated to the counseling of physicians, other healthcare professionals, and medical societies and other professional associations in matters pertaining to the regulation of the profession, including state and federal regulatory issues.  Prior to working with KACS, Mr. Moy served as the Senior Vice President and General Counsel to the Medical Society of the State of New York (“MSSNY”) for 25 years.

As the firm transitions as MSSNY’s General Counsel, David Vozza and David Adelson will take over Mr. Moy’s role with MSSNY, however, Mr. Moy will also be available to the firm on a consulting Of Counsel basis to ease and bolster the transition.  Mr. Vozza and/or Mr. Adelson can be reached at 1-800-445-0954 or via email at dvozza@drlaw.com and dadelson@drlaw.com, respectively.


AG Announces Settlements to Stop Prohibited ‘Direct Access Testing’
DirectLabs and LabCorp Are Prohibited from Enabling New Yorkers to Receive Clinical Laboratory Testing Without Required Medical Provider Oversight 

Attorney General Schneiderman recently announced agreements with Direct Laboratories LLC and Laboratory Corporation of America that prevent these companies from enabling New Yorkers to undergo clinical laboratory testing without a licensed medical provider’s involvement, as required by New York State law.

DirectLabs, a Louisiana-based company, advertises “direct access” to laboratory testing, and sells requisitions directly to consumers, with no physician involvement, for over 250 different tests and testing packages, including tests for parasites, heavy metals, thyroid levels, vitamin levels, various cancer markers, and specific diseases such as celiac disease and rheumatoid arthritis.  Without a health provider overseeing the test results in the context of a person’s clinical overall presentation, these test results can give consumers a mistaken impression to the detriment of their health – particularly where tests may have a propensity for either false positives or false negatives.

“My office is committed to helping all New Yorkers take control of their health and make educated health care decisions,” Attorney General Schneiderman said. “However, enabling consumers to purchase laboratory tests for serious medical conditions without consulting a physician does not help New Yorkers control their health, but rather risks placing their health in jeopardy.  Licensed medical providers are essential to ensuring consumers undergo testing that will yield clinically useful results and that the results are properly interpreted in light of the patient’s medical condition as a whole.”

DirectLabs has been able to offer its direct testing service because of its relationship with LabCorp.  LabCorp provided DirectLabs with the technology needed to generate requisitions and receive test results, and LabCorp processed specimens based on DirectLabs’ requisitions.  As a result of DirectLabs’ and LabCorp’s actions, New Yorkers were able to undergo clinical laboratory testing without ever consulting a health care practitioner, even when New York State law requires that such testing be performed only at a licensed practitioner’s request.

The settlement with DirectLabs and LabCorp comes after an investigation by the Attorney General’s Health Care Bureau showed that DirectLabs sold requisitions for a wide range of tests, and that these requisitions were automatically generated with a licensed chiropractor’s name – who had never seen or spoken with the patients – in exchange for a $24 “access fee” payment.  Consumers could then take those requisitions to a LabCorp patient service center to have the testing performed at reduced prices negotiated between LabCorp and DirectLabs.  The chiropractor whose name appeared on the requisitions not only never met or spoke with any of the approximately 1,100 consumers whose laboratory tests he authorized, he did not follow up with any of the consumers about the test results.

Under the settlement with DirectLabs, DirectLabs will no longer operate in New York State and must refund all customers with requisitions that have not yet been presented to a laboratory for testing to be performed.  Under the settlement agreement with LabCorp, LabCorp’s patient service centers in New York will no longer accept specimens for examination pursuant to requisitions generated by DirectLabs or any similar company.  Further, LabCorp will ensure that requests for laboratory testing submitted by health care providers are within the provider’s scope of practice as set forth by the New York State Education Department and that the providers’ licenses are current.  DirectLabs is obliged to pay a $24,500 penalty, while LabCorp will pay a $225,000 penalty. 


Reward Yourself Everywhere! MSSNY Credit Card!

  • Earn Cash back for the things you buy most. MSSNY credit card!
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  • Earn more cash back for the things you buy most, and get a $100 cash rewards bonus after qualifying purchases by using the MSSNY BankAmericard Cash Rewards™ credit card.
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  • Reap the benefits of the BankAmericard Cash Rewards™ Visa Signature® credit card for MSSNY, and get a $100 cash rewards bonus after qualifying purchases.
  • We’ve partnered with Bank of America – check out our new Rewards Product. It’s pretty awesome.
  • We’ve partnered with Bank of America to give you the opportunity to earn cash back with The BankAmericard Cash Rewards™ credit card for MSSNY
  • Using this card benefits MSSNY – at no additional expense to you.
  • The MSSNY annual House of Delegates is set for April 2016. Register now using your MSSNY BankAmericard Cash Rewards™ card and earn cash back.
  • Museum on Us. Looking for weekend plans? Simply present your MSSNY credit or debit card at a participating museum on the first weekend of each month for free admittance! Your card gains you free access to some of the best museums in the country. Which museum are you going to visit? Museums on Us®

Resident/Fellow/Medical Student Poster Symposium Reminder
Deadline for abstract submission is 4 pm, Monday, January 25, 2016 for the Annual Poster Symposium on Friday, April 15, 2016 at the Westchester Marriott in Tarrytown, New York from 2 pm to 4:30 pm.
Click here for detailed guidelines


Holding of 2016 Date-of-Service Claims for Services Paid Under the 2016 Medicare Physician Fee Schedule
In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2016 services paid under the MPFS for up to 14 calendar days, (i.e., Friday, January 1, 2016 through Thursday, January 14, 2016). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
MPFS claims for services rendered on or before Thursday, December 31, 2015 are unaffected by the 2016 claims hold and will be processed and paid under normal procedures and time frames.


CMS Announces the 2015 PQRS Data Submission Timeframes

  • EHR Direct or Data Submission Vendor (QRDA I or III) – 1/1/16 – 2/29/16
  • Qualified clinical data registries (QCDRs) (QRDA III) – 1/1/16 – 2/29/16
  • Group practice reporting option (GPRO) Web Interface – 1/18/16 – 3/15/16
  • Qualified registries (Registry XML)  – 1/1/16 – 3/31/16
  • QCDRs (QCDR XML) – 1/1/16 – 3/31/16

Submission ends at 8:00 P.M. Eastern Time on the end date listed. An Enterprise Identity Management (EIDM) account with the “Submitter Role” is required for these PQRS data submission methods. Please see the EIDM System Toolkit for additional information.

Eligible Professionals who do not satisfactorily report quality measure data to meet the 2015 PQRS requirements will be subject to a negative PQRS payment adjustment on all Medicare Part B Physician Fee Schedule (PFS) services rendered in 2017.

For questions, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. – 7:00 p.m. Central Time. Complete information about PQRS is available at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html.


USPSTF Releases Draft Recommendation on Who Should Use Statins
On December 21, the US Preventive Services Task Force (USPSTF) issued a draft recommendation on “who qualifies for cholesterol-lowering statins.” In the new “draft guidelines” released for public comment, the USPSTF says “the…medications will be of most benefit to some people ages 40 to 75 whose risk of cardiovascular disease over the next decade is at least 10 percent. The USPSTF concluded that people with a 10% or greater risk of heart problems in the next 10 years, based on the 2013 AHA-ACC calculator, and who have diabetes, high cholesterol, high blood pressure or who smoke, can lower their risk of having a heart attack or stroke by a ‘moderate amount’ by taking a statin.”

The draft recommendation states that USPSTF maintains that “there’s not enough evidence to recommend screening all children and teens for high cholesterol.” It remains unclear “if such screening up to age 20 reduces the risk of cardiovascular disease in adulthood.


FDA Lifts Lifetime Ban on Blood Donations from Gay Men
On December 21, 2015, the Food and Drug Administration lifted a decades-old lifetime prohibition on blood donation by gay and bisexual men. The FDA will continue to ban “men who have had sex with men in the past year, however, saying that the measure was needed to keep the blood supply safe.” Dr. Peter Marks, deputy director of the FDA’s Center for Biologics Evaluation and Research, spoke at a press conference and said that the 12-month deferral period was “supported by the best available research,” and that the newest blood tests are “highly accurate but not perfect,” which is “why the elimination of all deferrals is not feasible at this time.” However, gay rights groups consider the lifting of the life time ban, “a major stride toward ending a discriminatory national policy, but had wanted blanket bans for gay men to be removed entirely.”

Dr. Marks said the policy change is “backed by sound scientific evidence” and will “continue to protect our blood supply.” The FDA had “considered eliminating all restrictions on blood donations from gay and bisexual men, but concluded that would increase the transmission of HIV through the blood supply by 400 percent.” Dr. Marks said Monday that “an increase of that magnitude is not acceptable.” Dr. Marks wrote in a statement that the FDA “will continue to actively conduct research in this area and further revise our policies as new data emerge.”


Classifieds

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


Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49th Street, this ground level office is 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



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

December 18, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 18, 2015
Volume 15, Number 47

Dear Colleagues:

If you have claims outstanding with Health Republic, please take a moment to click on this link which will bring you to MSSNY’s grassroots action center and a letter which you can send to your elected State Senator and Assemblyman to call for action to assure that physicians and other healthcare stakeholders are paid for services rendered to patients of the now defunct Health Republic.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  MSSNY also continues to share with key legislators and the media our collective concerns regarding the severe consequences to physicians’ practices as a result of the collapse of Health Republic, and advocating for a special fund to assure physician claims for care provided to HR-insured patients are fully paid.

This includes sharing the results of our survey of nearly 1,000 respondents, which has generated extensive media coverage from across New York State, including the Wall Street Journal and New York Times.  Please add your voice to these efforts to better assure that physicians are not left holding the proverbial bag!

Submit All Your Claims Now!

In the meantime, you must submit all HR claims for services rendered up to and including November 30, 2015. Although we cannot project the outcome of this debacle, it is safe to report that if your claims are not filed, they will never be considered.

Send Us Your Bounced Checks!

MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds. If you have received notice from your bank that an HR check bounced, send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction.

On a related matter, if you are holding reimbursement checks from HR, they will bounce if you try to deposit it.  We urge you to send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor. Again, please email rmcnally@mssny.org.

Thank you for your patience while we continue to assist you in the process.

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance



Alert from MSSNY General Counsel Don Moy:  NYS Court of Appeals Decision Exposes Physicians and Other Health Care Professionals to Liability to Non-Patient Members of the General Community
The majority’s decision in Davis v. South Nassau Communities Hospital must be viewed as alarming to physicians and other health care professionals.  Physicians who administer or prescribe medication to patients must be prepared to document that they advised the patient of the foreseeable side effects of the medication, and, in particular, if the medication could foreseeably impair the patient’s ability to safely operate an automobile. Physicians must be prepared to document that they advised the patient not to drive while taking the medication.

These are the facts in Davis v. South Nassau Communities Hospital (issued on December16, 2015): Patient W was treated by Dr. H at the ER of a hospital. As part of the treatment, the doctor intravenously administered to W an opioid narcotic painkiller and a benzodiazepine drug, and, allegedly, failed to warn W that such medication could impair her ability to safely operate an automobile. Shortly thereafter, W drove herself from the hospital and, while allegedly impaired by the medication administered to her, she crossed a double yellow line and struck a bus driven by plaintiff Davis.

The NYS Court of Appeals reversed an appellate court and held that under these facts, the doctor had a duty to warn the patient about the patient’s ability to drive safely, and the failure of the doctor to fulfill this duty to the patient could subject the doctor to liability to any member of the general community who is harmed as a result of the patient’s driving. The Court of Appeals opined that the “cost” of the duty  imposed upon physicians and hospitals is a “small one” because the “duty” requires the doctor to do no more than simply warn the patient of the dangers of driving. The Court emphasized that the doctor had no obligation to prevent the patient from driving.

The Court further held that its ruling does not create a new obligation on doctors because a doctor who administers prescribed medication already has a duty to advise the patient of the foreseeable side effects of the medication.  Rather, stated the Court, the ruling “merely extends” the scope of persons who may sue the doctor for failing to fulfill that responsibility to the patient.

The Court sought to limit the reach of its decision by stating that this decision should not be construed as an erosion of judicial precedent that courts need to proceed cautiously and carefully in recognizing a new “duty of care”.  Judge Leslie Stein issued a scathing dissenting opinion  and rebuked the majority decision  as  “precipitous” and contrary to the firmly established judicial precedent of the state that, in general, a physician’s duty is to the patient, and the corresponding liability may be extended to a non-patient only in rare and narrow circumstances, such as to an immediate family  member  where the physician knew or should have known  that treatment provided to the patient  could create risk of harm to immediate family members. To her knowledge, stated Judge Stein, there has been no precedent in the state that has held that a physician’s medical treatment of a patient could expose the physician to liability to an unidentified class of members of the general community.

Judge Stein stated that despite the majority’s attempt to limit the reach of its decision, she feared a “slippery slope” and that the decision could be precedent to expand liability to doctors in other areas of treatment. 


Congress Passes Year End Spending, Tax Relief Bills that Includes “Cadillac Tax” Delay, Extension of 9/11 Responder Health Coverage, and MU Hardship Provisions
The US House and Senate passed two massive legislative packages, an omnibus appropriations bill and tax revision bill, before Congress adjourned for the holidays.  Importantly, among the provisions is a 2-year delay of the so-called “Cadillac Tax” on benefit-rich health insurance plans enacted as part of the ACA that was to become effective in 2018.  Since this tax would strongly discourage employers from offering comprehensive health insurance coverage to their employees, the MSSNY House of Delegates adopted policy calling for this tax to be repealed.

The $1.1 trillion FY2016 omnibus appropriations package will fund federal agencies and programs through September 30, 2016. Many of the earlier debated policy riders, such as the proposal to “defund” Planned Parenthood, were omitted from the bill. In addition to the delay of the “Cadillac tax”, some of the other health-related provisions include the following:

  • Funds for the 9/11 emergency responder health care benefits were reauthorized and expanded;
  • A one-year delay of the health insurance tax (for 2017)
  • IPAB operational funding was cut by $15B (although the panel has never actually been established)
  • Requiring the HHS Secretary to implement an education campaign to inform breast cancer patients about the availability and coverage of breast reconstruction and other available alternatives post-mastectomy.
  • Breast cancer screening recommendations issued by the USPTF were blocked for 2 years
  • AHRQ funding was cut by $30M (earlier House version had zeroed out agency funding)
  • Funding for NIH was increased by $2B
  • Additional funds were provided for opioid prescription drug overdose prevention
  • $20M was provided for the National Diabetes Prevention Program
  • The annual ban on using CDC funding for gun violence epidemiological research was extended

A second $650B package extends a broad range of tax-related polices, including a two-year moratorium on the Medical Device Tax, also enacted as part of the ACA.

Moreover, there was a “last second” bill passed by Congress that grants CMS the authority to expedite applications for exemptions from Meaningful Use Stage 2 requirements for the 2015 calendar year through a more streamlined process, alleviating burdensome administrative issues for both providers and the agency.  In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use Stage 2 for a period of 90 consecutive days during calendar year 2015.  However, CMS did not publish the Modifications Rule for Stage 2 of meaningful use until Oct. 16. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.  The legislation is designed to address this flaw.

Click here for a more detailed summary from the AMA on Congress’ action.


State Supreme Court Justice Ruled Child Flu Vaccination Not Mandatory in NYC
State Supreme Court Justice Manuel Mendez ruled Thursday that the New York City Department of Health and Mental Hygiene (DOHMH) may not require that children receive a flu vaccination to attend “city-licensed preschools and day care centers, striking down one of the more ambitious public health initiatives of the Bloomberg administration.” Justice Mendez ruled that “the city had exceeded its authority” and if the city wants to require flu vaccines, the Legislature would have to vote to add it to the list. 

Physicians Dropped from Emblem Should Contact Their State and Federal Legislators To Supplement MSSNY’s Advocacy


Physicians who have been unfairly dropped from Emblem’s participating physician network are urged to contact their state and federal legislators from MSSNY’s Grassroots Action Site here and ask for them to take action to push Emblem to reverse its decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services, as well as the NYS Department of Health and Attorney General’s office.

Moreover, MSSNY has written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.   MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Importantly, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani last week to ask for “further clarity on this issue.”   Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.     


MSSNY and OASAS To Conduct CME Webinars On Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free, four part webinar series on opioid prescribing.  Entitled,Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open at here.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing.

Tuesday January 26, 2016, 12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Seltzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.

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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.


MSSNY Is Member of AMA’s Task Force On Opioid Abuse
The Medical Society of the State of New York is participating on the American Medical Association’s (AMA) national Task Force to Reduce Opioid Abuse.  The task force, established in 2014, consists of over 20 medical national specialty organizations and MSSNY is one of the eight state medical societies on the task force.  The goals of the task force are to:

  • Increase physicians’ use of effective PMPs
  • Enhance physicians’ education on appropriate 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.

The task force ultimate goals are to create a behavioral shift in physicians to create a sense of urgency that they are a part of the solution to the opioid epidemic and to tap into their fundamental desire to effectively help their patients and improve their patients’ health.  The task force will also urge physicians to use PMPs to have a better—realistic—perspective about patients’ use of opioids.  Dr. Frank Dowling, MSSNY Councilor and Pat Clancy, Vice President of Public Health and Education are MSSNY appointees to the task force.

MSSNY has also developed a page entitled, “Opioids: What One Doctor Can Do.“  This page is located on the MSSNY website and is located in a blue box at the top of the home page:  www.mssny.org   The page provides information on the AMA Task Force, provides resources and best practices for physicians and also provides tools for physicians along with patient information.


NYS Connects with Other Prescription Monitoring Programs; Allows Prescribers to Assist In Reducing Doctor Shopping Across State Lines
New York State has announced that it has joined the National Association of Boards of Pharmacy PMP InterConnect hub which will allow participating states to share information from prescription monitoring programs to prevent consumers from “doctor shopping” for prescription drugs over state lines.  The New York’s Prescription Monitoring Program, (PMP) is an electronic system allows prescribers and pharmacists statewide to ensure patients do not obtain multiple prescriptions for dangerous controlled substances.  New York prescribers are required to check patient information on the PMP prior to issuing controlled substances, and this requirement was implemented under the ISTOP law.  New Jersey and Connecticut are both on the NABP PMP Interconnet hub, though other neighboring states, including Massachusetts, Pennsylvania and Vermont, are not.  MSSNY strongly supports this move and believes it will give important information to physicians about their patients.


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org 


Tomorrow Is Last Day to Submit PQRS Status Questions
If you have any questions regarding the status of your 2014 PQRS reporting or are concerned about potentially receiving the PQRS negative payment adjustment in 2016, please do not hesitate to submit an informal review request. CMS will be in contact with every individual eligible professional (EP) or PQRS group practice that submits a request for an informal review of their 2014 PQRS data. Additionally, revised 2014 Annual Quality and Resource Use Reports (QRURs) are now available via the CMS Enterprise Portal.  All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which is available now through December 16, 2015 at 11:59 p.m. Eastern Time. 

Follow these steps to submit an informal review request:

  1. Go to the Quality Reporting Communication Support Page (CSP)
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”
  7. Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

For additional questions regarding the informal review process, contact the Quality Net 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.


MSSNY Teams with CA, FL and TX Medical Societies to Urge Meaningful Use Reforms
With uncertainty surrounding whether Congress would be able agree to changes to the overly burdensome meaningful use requirements, MSSNY teamed with the medical associations of California, Florida and Texas on a letter this week to CMS Acting Administrator Andy Slavitt urging needed reforms.  In particular, the letter notes that “Physicians across this country are uniformly frustrated, angry, and demoralized by these difficult regulations.  Most physicians are working hard to meet the requirements and cannot because of the lack of specialty measures, the all-or-nothing approach, vendor problems, the lack of interoperability or other issues beyond their control.  Many physicians have been early adopters of technology and are enthusiastic about using EHR as means to improve workflow, patient care and quality outcomes.  However, the EHR incentive program must have feasible and attainable requirements to help physicians achieve these goals rather than act as a burden and hindrance to EHR use by physicians”.

Reforms to the MU program urged in the letter include: delaying implementation of MU Stage 3; giving physicians proportional credit for the measures that are successfully completed, instead of the existing “all or nothing” approach; and expanding the hardship exemptions to recognize physicians who are victims of hacking or other disruptive technology problems related to their vendors, as well as physicians who are close to retirement.


PTSD and TBI in Returning Veterans: Identification and Treatment
Live CME Seminar at Southampton Hospital
Date and time:
January 7, 8-9 AM Live at Southampton Hospital

Presenter:        Dr. Frank Dowling

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

For more information, please read our flyer.

Please register here. 


New York Ties for Top Score in Preventing and Responding to Disease Outbreaks
A December study from Trust for America’s Health (TFAH) states that New York is “tied for top billing in terms of preventing, diagnosing and responding to disease outbreaks.” The TFAH used data from the Centers for Disease Control and Prevention to create a “scoring system with metrics such as flu vaccination rates, food safety and HIV/AIDS surveillance – and then evaluated each of the 50 states to see how they stacked up.” New York is among the five states that “maxed out at 8/10 points.” Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states—Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah—tied for the lowest score at three out of 10.

The report, from TFAH and the Robert Wood Johnson Foundation (RWJF), concluded that the United States must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea. 


Fight for Healthcare in Rural Communities

By Congressman Tom Reed (NY-23)

I care deeply about protecting access to health care and ensuring residents in rural areas have the resources and services they need. It is only fair that rural residents have equal access to quality primary and pediatric care as those living in urban areas. That is why we fought to secure funding for new health care access points across upstate New York.

Earlier this year, we introduced the Rural Hospital Access Act, which protects access to care by providing enhanced levels of Medicare funding to rural hospitals. This legislation makes permanent both the Medicare-dependent hospital program and the enhanced low-volume Medicare adjustment, which enable rural hospitals to offer the same medical services as are provided by hospitals in large cities. This is critically important because it allows seniors, veterans, and individuals with disabilities to receive quality health care right in their own communities.

The enhanced reimbursements provided by these Medicare programs have a direct impact on rural hospitals across upstate New York. An example is St. James Mercy Hospital, a central access point for residents in Steuben County. This hospital is currently undergoing a major restructuring, as part of a new vision for health care in their community. The enhanced reimbursements are critically important because they provide not only a crucial source of revenue, but also a sense of certainty and stability. This will allow rural hospitals like St. James to effectively serve local residents now and for generations to come.

Many of us depend on rural hospitals and medical facilities for health care, from pediatrics to inpatient and maternity services. It is only right we protect these services by supporting rural hospitals. We will continue fighting to ensure seniors, veterans, and individuals with disabilities have access to the care and services they need, regardless of where they live.

Congressman Tom Reed (NY-23)

2437 Rayburn House Office Building

Washington, D.C. 20515

(202)225-3161


Rep. Sarbanes:  Bill to Allow Retired Doctors to Retrain for Community Health
Rep. John Sarbanes (D-Md.) has reintroduced a bill that would allow physicians who have ceased practicing medicine to receive grants to become retrained if they pledge to work at a community health center, school health clinic or Veterans Affairs medical center for two years. This legislation would establish a grant program for medical schools, hospitals and non-profit organizations to create or expand their physician reentry programs which give physicians a streamlined process for credentialing and continuing medical education to return to medical practice after an absence. Funding could also be used to assist with credentialing fees, loan repayments and salaries. In return for this assistance, these physicians would serve at community health centers, VA medical centers or school-based health centers to help fill the shortage of primary care doctors. Participating physicians would be able to practice on a full- or part-time basis and would be covered under the Federal Tort Claims Act, which provides physicians with medical liability protection. 


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 programs are: 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.


MSSNY Adult Immunization Podcast Now Available
William Valenti, MD, chair of MSSNY’s Infectious Disease Committee and Monica Sweeney, MD, MPH, vice chair of MSSNY Committee to Eliminate Health Care Disparities, discuss adult immunization in an effort to educate and inform patients and physicians in New York State about the importance of adult immunization.   The audio podcast can be accessed here. 


CDC Issuing Guidelines Urging Primary Care Physicians to Monitor Opioids
In a research letter in JAMA Internal Medicine, investigators “examined Medicare claims from 2013 to see which doctors prescribed opioids and how many prescriptions they filled.” The analysis revealed that “the drugs are prescribed by a broad cross-section of medical professionals – including doctors, nurse practitioners, physicians’ assistants and dentists – rather than concentrated among a small group of practitioners.”

Moreover, the analysis also revealed that on a “doctor-by-doctor level, pain management specialists and anesthesiologists handed out the most prescriptions for opioids,” but because there are more family physicians than specialists, as a group, “their number of painkiller prescriptions was higher than for any other category of health care worker.

In light of the findings, the Centers for Disease Control and Prevention issued new guidelines on December 14, urging primary-care physicians to closely monitor their patients’ use of opioids and take a more “conservative approach” to prescriptions in order to mitigate “a crippling epidemic of addiction to the powerful narcotics.”

Written comments must be received on or before January 13, 2016. You may submit comments, identified by Docket No. CDC-2015-0112 by any of the following methods:

  • Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
  • Mail:National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE., Mailstop F-63, Atlanta, GA 30341, Attn: Docket CDC-2015-0112.

Instructions: All submissions received must include the agency name and Docket Number. All relevant comments received will be posted without change to http://regulations.gov, including any personal information provided. For access to the docket to read background documents or comments received, go to http://www.regulations.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


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

December 11, 2015 – MSSNY Aids Physicians in Taking Control of Their Practices

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
December 11, 2015
Volume 15, Number 46

Dear Colleagues:

First of all, Happy Chanukah to all who are celebrating the miracle of the holiday.

This year, the MSSNY HOD called for the creation of a Task Force that would explore and recommend options to assist MSSNY’s physicians in independent practice to remain viable in that environment. After a call for interested MSSNY members to participate, I put together a team of physicians from various specialties and geographic locations that had an interest and/or expertise in the subject.  Some physicians have business degrees while others have engaged in entrepreneurial projects transforming how they deliver health and wellness care to the residents of New York.  I selected Drs. Tom Lee and Paul Lograno to lead the effort.  To date, the group has had two meetings and has begun developing various options to help a broad spectrum of physicians in different practice environments. In the next few months, you will be hearing more about options available to you that many of your colleagues have embarked on that have helped them be happier physicians thriving in the turbulent environment of healthcare reform.

In addition to this effort, I have asked a group of MSSNY Councilors to develop guidelines that will guide how we collaborate with other groups of physicians who are seeking to remain out of network or who wish to engage in advocacy that relates specifically to their specialty practice. A Task Force to address physician burnout and stress will begin its deliberations in January under the leadership of Dr. Michael Privetera from the University of Rochester.

Tipping Point

The recent events concerning disenrollment of physicians from Emblem Health and United Healthcare as well as the Health Republic fiasco have become the tipping point.  WE WILL NOT SIT BACK AND TAKE THIS ANY LONGER.  If we cannot get collective negotiation or be assured that the private practice model will be supported by government legislative and regulatory reforms, then we must take matters into our own hands and develop mechanisms for group survival/individual survival.  For some, it will mean creating new physician-owned-and-run groups or IPAs.  For others, it will mean dropping out of many insurance products and establishing direct care practices. For others, there may be other models that some of you have developed.  MSSNY is working on highlighting successful options to opt out of the madness being foisted upon us.

Do you have an interest in getting involved?  Do you have a successful alternative model of delivering healthcare that is working for you?  Have you changed how you practice and become a happier and less stressed out physician while remaining in private practice?  Are you a young physician engaged in an innovative practice model?  We want you to get involved in our grassroots led effort.  Let us know.  We are bringing together talented and successful colleagues who have been quietly engaging successful strategies.

Contact Eunice skelly @ eskelly@mssny.org

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Senate Health Committee Chair Urges Emblem to Reconsider Dropped Physicians
Noting that he has “heard from a number of physicians as well as the Medical Society of the State of New York” regarding Emblem’s decision to not renew contracts with approximately 750 physicians, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani this week to ask for “further clarity on this issue.”   MSSNY had written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services in addition to contacting the State Legislature.

Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Physicians can send a letter to their legislators urging their efforts to reverse Emblem’s action from here.

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.

If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount. We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


Western New York Congressman Presses CMS to Assure That HR Claims Are Paid
Noting the several physicians he has heard from, Representative Chris Collins (R-Western New York) pressed CMS Acting Administrator Andy Slavitt this week to identify what steps the federal government could take to assure physicians and other health care providers are fully paid for the care that they have provided to their patients insured by collapsed co-op health insurer Health Republic.  The questioning occurred as part of a US House of Representatives Energy & Commerce Committee hearing into the functioning of state Exchanges.  MSSNY had written to the entire New York Congressional delegation late last week to share with them the numerous articles from papers in nearly every region across New York State highlighting the consequences of the collapse of Health Republic, and asking for their assistance to assure, once the full accounting and distribution of the assets of the Health Republic is completed, that health care providers are made whole.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  Physicians can send a letter to their state legislators and Governor Cuomo to urge that steps are taken, including the creation of a special state fund, to assure that these claims are fully paid.

Moreover, this week, the New York State Association of Health Underwriters announced its support for a special fund to assure Health Republic claims are paid.

MSSNY also continues to hear from dozens of physicians that reimbursement checks issued by Health Republic have been returned by the bank for insufficient funds.   If you have received notice from your bank that an HR check bounced, please let us know by sending an email to rmcnally@mssny.org


Cadillac Tax, Meaningful Use Relief Under Consideration in Year End Congressional Budget Talks
As Congress scrambles to pass a year end Budget bill, a number of health care issues of great importance to physicians continue to be under strong consideration for incorporation into the package.  This includes additional provisions that could provide some needed hardship exceptions to overly burdensome meaningful use requirements, as well as a delay in the implementation of the so-called “Cadillac Tax” on comprehensive health insurance coverage scheduled to go into effect in 2018.  The Cadillac Tax, a component of the ACA, imposes 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 form 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.  Please remain alert for further updates on these items. 


Take this AMA Survey re Meaningful Use
In the AMA’s ongoing efforts to improve EHRs and 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 following is a link to 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, thus making it easier to find relevant information.  Please share the link with your members and encourage them to take the survey. The Office of the National Coordinator (ONC) has extended the survey deadline to December 23. Survey link http://goo.gl/forms/0fjoUxZwsS 


BNE Sends Letter Reminding You of E-Prescribing Requirement that Becomes Effective on March 27, 2016
The New York State Department of Health’s Bureau of Narcotic Enforcement has emailedl a letter to about 110,000 prescribers, through the Health Commerce System, reminding practitioners about the e-prescribing mandate that will take effect on March 27, 2016.  The letter encourages practitioners to begin E-prescribing if they have already implemented an E-prescribing software application or to begin the process to acquire an E-prescribing software application if they have not started the process.   A copy of that letter can be found here. BNE has also developed a patient brochure on e-prescribing and it can be found on BNE’s website.

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 35,000 prescribers have registered their systems with DOH.   This represents only about 1/3 of the prescribers in New York State.

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

  • First, 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. http://www.deadiversion.usdoj.gov/ecomm/e_rx/

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:

  • 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 are additional venders that now have software available to e-prescribe both non-controlled and controlled substances and information on these can be found at this link.

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 shortly. 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. 


Bureau of Narcotic Enforcement’s Physician Info 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 following link.

It is also expected that DOH will announce the process that physicians may be able to “certify” patients for receiving marijuana under the medical marijuana program.   It is anticipated that this process will be through the Health Commerce System.

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


Letter Re E-Prescribing from Director of Bureau of Narcotic Enforcement

Dear Prescriber:

Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.  This mandate does not apply to veterinarians.  Electronic prescribing of both controlled and non-controlled substances is currently permissible in New York. 

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements.  Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health (DOH), Bureau of Narcotic Enforcement (BNE). 

Please be aware that implementation timelines for EPCS software vary and may be lengthy.  If you have not already begun this process, BNE strongly recommends that you begin immediately.   

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper, to allow for time to resolve technical or workflow issues prior to the mandate’s effective date. 

Useful information related to electronic prescribing, including frequently asked questions, information regarding the EPCS registration process, and a downloadable patient-centered brochure to help your patients better understand electronic prescribing can be found on our website at www.health.ny.gov/professionals/narcotic. 

If you have any questions about the electronic prescribing mandate, please call 1-866-811-7957, option 1.

Joshua Vinciguerra
Director
Bureau of Narcotic Enforcement


The NY Society of Addiction Medicine to Host 12th Annual Conference Feb. 5 & 6
The NY Society of Addiction Medicine (NYSAM) will host its annual conference February 5 and 6 at the Crowne Plaza Times Square Hotel, 1605 Broadway, NYC. The conference entitled, “Critical Role of Addiction Medicine in Healthcare Reform: Best Practices,” is designed for physicians, medical students/residents, and addiction professionals.  Registration is required and the cost is as follows: Full conference price—Before January 15, 2016  NYSAM Member Rate: $350 Non-Member Rate: $425 Non Physician Rate: $225.  Residents/Fellows/Medical Students are free. Registration may be made by visiting the NYSAM website here or by contacting Elisabeth Kranson at (518) 689-0142 or via email: ekranson@asapnys.org 


Adelphi University MBA Program for Suffolk/Nassau County Medical Societies
The Nassau and Suffolk Medical Societies cordially invite all physicians to attend one of the MBA Information Sessions to learn more about how an MBA degree can give you the tools necessary to be an effective leader, critical thinker, negotiator and problem solver. Mark your calendar now and plan to attend.

Where: Suffolk County Medical Society, 1767-14 Veterans Highway, Islandia

  • Tuesday, December 8, 2015
  • Tuesday, December 15, 2015
  • Friday, December 18, 2015

Come in between 4:00 pm to 6:00 pm

Where: Adelphi University, 55 Kennedy Drive, Hauppauge- 11788

  • Monday, December 7, 2015
  • Wednesday, December 9, 2015
  • Monday, December 14, 2015

Come in between 8:00 am to 3:00 pm

Don’t miss out on this opportunity to learn more about how you can successfully position yourself in today’s healthcare system.

RSVP Maureen Leslie at 516 237-8607 or leslie@adelphi.edu or SCMS at 631 851-1400.


Consumers Warned About Raw Milk Listeria Risk in Allegany County
Food Safety News (12/11) reports “consumers in New York’s Allegany County and surrounding area were told not to consume ‘unpasteurized’ raw milk from the Gerald E. Snyder Farm due to possible Listeria contamination.” The notice “came from the New York Department of Agriculture and Markets.”

The public health warning came from the New York Department of Agriculture and Markets.The Gerald E. Snyder Farm is located at RD#1, 1444 Randolph Rd., Alfred Station, NY. The department has not yet associated any illnesses with the product that is subject of the public health warning.


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


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

December 4, 2015 – Are Your Health Republic Checks Bouncing?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
December 4, 2015
Volume 15, Number 45

Dear Colleagues:

As was reported in several media outlets this week, including Crains’ Health Pulse, Politico New York and WNYC, MSSNY has heard from many physicians outraged regarding the decision of EmblemHealth to drop hundreds of physicians from its network reportedly as part of its efforts to increase the use of value-based payments. However, at first glance, it appears that many of the recipients of these non-renewal letters were physicians in smaller practices who did not receive any advance notice by Emblem of its desire to migrate their payment structure to a value-based methodology.

Last week, the New York County Medical Society issued a press release warning of disruptions to long-standing patient-physician relationships, followed up by multiple MSSNY letters to the NYS Department of Financial Services (DFS) urging an investigation into how these actions by Emblem will affect its network adequacy and whether these physicians and their patients were truly given adequate notice.

We have been advised by DFS staff that they have initiated a review of Emblem’s action, and hope to have some answers to our questions next week.  Among the questions we have posed to DFS:

  • Were these 750 physicians dropped by Emblem given any advance notice of Emblem’s intention to drop them for any reasons including because they chose to deliver care to patients in a smaller practice setting?
  • Were any of these 750 physicians dropped by Emblem given the opportunity to enter into the value-based contracts espoused by Emblem to stay within Emblem’s physician network?
  • How many patients are impacted by Emblem dropping these 750 physicians from its network?  What is the total number of patient encounters with Emblem insureds that these 750 physicians provided over the last year?
  • What is the specialty of the physicians being dropped?  What are their hospital affiliations? Has DFS or DOH reviewed whether the dropping of these physicians will create shortages in any specialty or in any particular community served by Emblem?
  • How does the timing of the notice to these dropped physicians intersect with employer open enrollment periods?  For example, it was reported that the open enrollment date for New York City employees ends on October 31, just three days after patients received notice of these physicians being dropped. Were patients of these physicians given fair notice so that they could shop around for coverage for a health plan that includes their treating physicians?

Please let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.

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

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


MSSNY’S Advocacy Matters CME Series Webinar On December 8th
Jason Helgerson, NYS Medicaid Director to Discuss Delivery System Reform Incentive Payment Program (DSRIP) and the Move to Value Based Payment

Jason Helgerson, New York’s Medicaid Director, will present on the State’s Delivery System Reform Incentive Program (DSRIP) and on the move to value based payment on MSSNY’s December 8th Advocacy Matters program. The program will run from 12:30- 1:30PM.

DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.

To read our flyer, please click here.

Calling All Doctors Who Have Been Terminated by Emblem
MSSNY is trying to collect data on the physicians who have been terminated by Emblem health. We cannot help you if we do not who you are. We are in constant contact with The Department of Financial Services in an effort to assist New York State physicians who have received these notices from Emblem.

Please email our VP of Socio-Medical Economics Division Regina McNally at rmcnally@mssny.org with your name and contact information. 


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


File by Dec. 16 to Avoid Medicare Pay Cut of 2-4 %
Practices that may have thought they were safe from Medicare payment penalties next year could be in for an unpleasant surprise if they don’t take action now.

Problems with how the Centers for Medicare & Medicaid Services (CMS) has been collecting and analyzing data related to the Physician Quality Reporting System (PQRS) and the value-based payment modifier are leading to inappropriate penalties of 2-4 percent of Medicare payments for thousands of physicians.

How to avoid the penalty: File an informal review request with CMS before midnight EST on Dec. 16. CMS has said it will verify incentive eligibility and payment adjustment determinations for practices that file such a request.

Additional information about the process and contact information for questions is available in CMS’ informal review fact sheet.

Note: CMS has said the informal review system will be down Dec. 3-7 and unable to accept requests during that time.


Register Now For Final 2015 E-Prescribing CME Webinar on Dec. 9
MSSNY 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.

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.  


US Senate Passes Controversial Bill to Revise ACA and Defund Planned Parenthood
By a 52-47 vote, the United States Senate passed legislation (HR 3762) on Thursday that would repeal significant components of the Affordable Care Act.  Specifically, the bill would repeal the taxes on medical devices and the so-called “Cadillac” tax on comprehensive health insurance policies (slated to go into effect in 2018).  It would also reduce funding for the Public Health and Prevention fund created under the ACA and repeal the expansion of Medicaid contained in the ACA.  Furthermore, it would set at $0 the fines for individuals who fail to purchase health insurance coverage and large employers who fail to provide coverage to their employees, essentially repealing these mandates.  Of greatest controversy, the legislation would also defund Planned Parenthood for one year.

While the bill is expected to be passed by the House of Representatives, it is almost certainly going to be vetoed by President Obama, and there are insufficient votes for an override.    The significance, however, is that it is likely to be the first time a bill repealing large sections of the ACA has been approved by the entire Congress.  New York’s Senators Charles Schumer and Kirsten Gillibrand voted against the bill.


Revitalizing MSSNY’s Organized Medical Staff Section – Get Involved!
MSSNY members are invited to get involved in the reestablishment of our OMSS. OMSS is a viable entity to advance the interests of your medical staff, your group practice or your institution, and to air and have MSSNY help address your issues.

OMSS also offers a prime opportunity for leadership development.

We would like to invite you to participate in an online meeting at which candidates for office will introduce themselves, and elections will be held. A slate of previously nominated candidates will be presented, and nominations will be accepted from the floor. Even if you are not running for office, please join to have your vote counted. The webinar (telephone only option also available) will take place on Saturday, December 12, 2015 at 8:00 am and should last no more than two hours.

Kindly email eskelly@mssny.org at your earliest convenience to let us know if you will be participating.


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


MSSNY Announces 2016 Medical Matters Schedule for 2016
MSSNY 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.


Senate Finance Report on Solvadi Pricing: Profits over People
Gilead Sciences prioritized maximizing its revenue over recouping research and development costs and ensuring patient access when pricing its breakthrough hepatitis C treatment, Sovaldi, according to a Senate Finance Committee report released yesterday.

“Gilead pursued a calculated scheme for pricing and marketing its Hepatitis C drug based on one primary goal, maximizing revenue, regardless of the human consequences. There was no concrete evidence in emails, meeting minutes or presentations that basic financial matters such as R&D costs or the multi-billion dollar acquisition of Pharmasset, the drug’s first developer, factored into how Gilead set the price. Gilead knew these prices would put treatment out of the reach of millions and cause extraordinary problems for Medicare and Medicaid, but still the company went ahead,” stated the report. The drug costs $1,000 per pill or $84,000 per patient for a 12-week course of treatment. According to the report, fewer than 3% of eligible Medicaid beneficiaries received the treatment last year because of the drug’s high price. Gilead says it disagrees with the report’s findings, noting that it provides financial assistance for the treatment to uninsured individuals. (Wall Street Journal 12/1)


Mandatory Electronic Prescribing in New York State
Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements. Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health, Bureau of Narcotic Enforcement (BNE).

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper. This will allow for time to resolve technical or workflow issues prior to the mandate’s effective date.

Please be aware that implementation timelines for EPCS software vary and may be lengthy. If you have not already begun this process, it is recommended that you begin immediately.

The laws regarding issuing and dispensing prescriptions for controlled substances, from paper to the electronic method, have not changed. Only the format has changed.

Useful information related to electronic prescribing, including frequently asked questions and information regarding the EPCS registration process, can be found on BNE’s website here.


ACEP: Under New Reg, Plans Not Required To Pay Fairly for Emergency Care
A new regulation issued by the Department of the Treasury, the Department of Labor and the Department of Health and Human Services last week stated that health insurance companies can pay doctors in emergency departments essentially whatever they like, opening the door to the possibility of reimbursements that do not even cover the costs of care.  The American College of Emergency Physicians (ACEP) expressed astonishment at the ruling, given the feedback emergency physicians have given to CMS over several years, as well as the timing.  Dr. Jay Kaplan, president of ACEP, said that the organization was considering legal action.

“This new ruling will significantly benefit health insurance companies at the expense of physicians, because they know hospital emergency departments have a federal mandate to care for everyone, regardless of ability to pay,” said Dr. Jay Kaplan.  “They will continue to shift costs onto patients and medical providers, as well as shrink the number of doctors available in plans.  Instead of requiring health plans to pay fairly, this ruling guarantees that insurance companies can pay whatever they want for emergency care.  If history tells us anything it’s that insurance companies prefer to pay as close to nothing as possible, while building their war chest for profits and litigation.”

“This is a scary environment for patients,” said Dr. Kaplan.  “Insurance companies are alleging that doctors are charging too much, rather than admitting they are paying too little.  This ruling by CMS unfortunately suggests that the federal government is on the side of Big Insurance rather than patients and their physicians.”


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.

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 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

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