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MSSNYeNews: October 25, 2019 – Surprises

October 23, 2019 admin

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 25, 2019
Vol. 22 Number 40

Colleagues:

It’s not the surprise that matters, it’s how you react to it.
Innocent Mwatsikesimbe, Author

This week’s epistle concerns two unrelated surprises. The first is a new law about the performance of pelvic examinations under anesthesia (see story below). For years, one way medical students learned to perform this necessary skill was in the operating room immediately prior to surgery. Concerns were raised (and rightly so) by women who later learned of this unwanted “surprise,” no matter how clinical it might have been. In 2011 (reaffirmed in 2017), ACOG released a Committee Opinion that explicitly states:

Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery.

Still, sporadic reports indicated that this practice was ongoing which then prompted legislative action. Hospital legal teams are now huddling to draft appropriate consent language. In the meantime, the best way to deal with this (as always) is simply to discuss the matter with your patient ahead of time, eliminating any surprise.

Surprise Bills

As for the second surprise, Surprise Bills are still the subject of furious debate in Congress. Because of your efforts and those of medical societies across the country, the prospect of handing over to insurers, the power to set the benchmark for all fees is no longer a done deal. In fact, the House Bill HR 3630, which would do just that, has but 3 cosponsors while HR 3502, which resembles New York’s law, has 100. Of course, this fight is far from over as the insurers are waging their fight on many fronts. One thing you can do is go here to send a letter to your members of Congress. I urge everyone to do so as this issue is critical to all physicians.

So are these two surprises really unrelated? Perhaps in a way, they are not. There are indeed wheels within wheels. Individually, we may not be able to exert sufficient pressure but together, with everyone’s hand on the needle, we may move it sufficiently to achieve the desired end.

Once again, I leave you with Benjamin Franklin:

We must indeed all hang together or, most assuredly, we shall all hang separately.

Comments? comments@mssny.org ; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still nearly 500 bills that passed both houses in 2019 that were awaiting delivery to the Governor. But with just a few months left in the year, the flurry of bill signings/vetoes has begun.

Physicians can quickly and easily send a letter to the Governor here on the following:

Support ending mid-year formulary changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year. Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law here.

Support partial prescription fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.

Oppose liability expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills here.

New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
As recently reported, Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. The law was designed to respond to reports of medical students being asked to perform such exams, without express patient consent, as part of their medical training in teaching hospitals.

Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has already given oral or written consent; or
the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

It would also make violation of such provision an element of physician misconduct. Several other states have passed similar laws expressly banning this practice without clinical justification. MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care. The American College of Obstetricians & Gynecologists have issued an ethical opinionthat “Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery”. The law takes effect on April 4, 2020.

Physicians Welcome to Provide Public Comments on DSRIP at 10/30 in Syracuse Public Forum
Next Wednesday, October 30, the New York State Department of Health (NYSDOH) will be holding a Public Comment forum for New York’s 1115 waiver at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202. A similar forum was held today in New York City.

The open comment period for both forums will be from 11am to 2pm. In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Specifically, the NYS Health Department is seeking from the federal government a continuation of DSRIP for the 1-year balance of the 1115 waiver ending on March 31, 2021 and to extend an additional 3 years from April 2021 to March 31, 2024. Click Here to view the Amendment Proposal.

Background on the DSRIP Program

The roughly $6 billion Delivery System Reform Incentive Payment (DSRIP) program provides incentives for Medicaid providers to create and sustain an integrated, high-performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving the quality of care, improving the health of populations and reducing costs.

The DSRIP program promotes community-level collaboration and aims to reduce avoidable hospital use by 25% over the 5-year demonstration period. A total of 25 Performing Provider System (PPS) were established in different regions of the State to implement innovative projects across three domains: system transformation, clinical improvement and population health improvement (New York’s Prevention Agenda).

While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as community physician practices, some have raised concerns that not enough funding has been made available to physicians who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.

NYDOH to Offer Free Coaching, Nicotine Replacement Therapy to Vapers
The New York State DOH has announced new services for e-cigarette users seeking help to stop vaping, including free quit-coaching and nicotine replacement therapy through the New York State Smokers’ Quitline. The quitline is available for New Yorkers of all ages, including adolescents.

The DOH added the service to the quitline to address the growing need to help users of e-cigarettes break their dependence on vaping. The New York “Department of Health announced Monday that it has expanded services available through the New York State Smokers’ Quitline in response to a nationwide outbreak of vaping illnesses that has killed 33 people and hospitalized nearly 1,500 more. Those interested can contact the quitline by calling 1-866-NY-QUITS (1-866-697-8487) any day of the week beginning at 9 a.m. A specially trained quit coach will assess users of e-cigarettes for type of product, frequency of inhalation, and dependence.

Based on the assessment, a user may be eligible to receive complimentary patches, gum, lozenges or a combination of these products. Quit coaches also will help users develop a personalized quit-plan and guide them to consult their health care professionals and health insurance plans for additional stop-smoking medication and support.

Similar to the eligibility guidelines for cigarette users, users of e-cigarettes who qualify for the quitline’s free NRT will receive a starter kit with a minimum two-week supply and can receive up to two kits per year – the second after 90 days from the first shipment. More information about eligibility is available online at www.nysmokefree.com.

It’s Tomorrow: New York Will Accept Vaping Devices on Drug Take Back Day
New Yorkers will be able dispose of their vaping devices and cartridges at more than 200 locations across the state as part of National Prescription Drug Take Back Day for the first time on Saturday, Gov. Andrew Cuomo announced this morning.

With nearly 150 vaping-related lung illnesses reported in the state, New York will partner with the Drug Enforcement Administration to collect e-cigarette devices and cartridges in addition to prescription drugs and other medications.

New Yorkers can dispose of medications and vaping devices at 223 locations across the state. More than 400 health care facilities will also dispose of their unused and expired medications as part of the national Take Back Day.

Study: How Physicians’ Belief in Treatment Effectiveness Can Impact Patients
The NPR (10/21, Vaughn) “Shots” reports that a study shows “that patients can pick up on subtle facial cues from doctors that reveal the doctor’s belief in how effective a treatment will be,” which “can have a real impact on the patient’s treatment outcome.” The article adds, “Researchers randomly assigned undergraduate students to play the role of a patient or a doctor.”

The study “found that during the administering of the pain stimulus, the doctor group showed measurably less pain expression in their faces when they believed that the patient actors had been given a cream that provided actual pain relief.” Within “trials where the doctor group believed the cream was effective, patients reported that they found the doctors more empathetic.” The results were published in Nature Human Behavior.

CMS Sanctions UnitedHealthcare Plan: 3 Things to Know
One of UnitedHealthcare’s Medicare Advantage plans will face enrollment restrictions for 2020 due to compliance issues.

Three things to know:
1. CMS sanctioned the UnitedHealthcare plan because for the third year in a row, the plan did not adhere to a rule requiring it to have a medical loss ratio of at least 85 percent. A medical loss ratio measures how much of an insurer’s revenue goes toward medical claims versus overhead costs.
2. UnitedHealthcare said despite added benefits, the plan fell out of compliance because of a federal legislation reducing the health insurer’s tax liability for 2018.
3. Enrollment for the affected plan will be suspended for the 2020 contract year. The health plan is sold in nine states to less than 1 percent of UnitedHealthcare’s Medicare Advantage members. Becker’s Hospital News Payer Issues (October 15)

Could Your Practice Use Some Professional Help?
MSSNY’s IMG Subcommittee, through its Clearinghouse Opportunities Program, is looking for physicians who can offer IMG candidates meaningful experiences that will help them become familiar with the US healthcare system and prepare for residency training. Many IMG candidates have previous experience in their own countries as faculty members, practicing physicians or researchers, and they need a way to stay involved in health care as they wait for residency training opportunities. Others have recently graduated from medical school abroad.

IMGs who are ECFMG certified may be asked to assist with computer work, data collection, shadowing you while you treat your patients, help with research and special projects, and assist in any non-clinical activities in physician’s offices. Physicians in any specialty who have a position to offer are encouraged to contact MSSNY. Please send a brief description of the work with which you could use help, your requirements and any compensation that may be available, to Ruzanna Arsenian (rarsenian@mssny.org).

Pro Publica: Doctor Payments from the Drug Industry
Sunshine laws may seem stringent, but doctors continue to benefit from the biopharma industry. A ProPublica investigation has found more than 700 doctors who have earned at least $1 million from drug makers or medical device companies over the past five years alone. Another 2,500 made at least $500,000.

The ProPublica analysis found that Xarelto, a blood thinner made by Janssen, generated the most payments to doctors — with $29.2 million dropped in 2016 alone.

Of the top 20 drugs with the most annual spending on doctors from 2014 to 2018, six made the list in each of the years: Invokana to treat type 2 diabetes, the blood thinners Xarelto and Eliquis, the antipsychotic Latuda, the immunosuppressive drug Humira and the multiple sclerosis drug Aubagio. Another three drugs were on the list for four years: Victoza to treat type 2 diabetes, psoriasis treatment Otezla and the cholesterol-lowering drug Repatha. (Research funding and royalties are not included.)

Xarelto topped the list in spending for four years, totaling more than $123 million in payments from 2014 to 2018. In March, its makers, Johnson & Johnson and Bayer AG, agreed to pay $775 million to settle about 25,000 lawsuits claiming that the companies had failed to warn patients that Xarelto could cause fatal bleeding.

CDC Report: Teen Suicide Rate Spikes
A new CDC report shows suicide rates among youths and young adults ages 10 to 24 spiked over a decade, outpacing the suicide rate of other age groups and ending years of relative stability. Yet, researchers say they are not sure what is driving the jump in suicide rates among youth and young adults.

TO: New York State Residents and Fellows
MSSNY Announces the 15^th Resident/Fellow/Medical Student Poster Symposium

When:    Friday, April 24, 2020
Where:   Westchester Marriott
Tarrytown, New York
Time:      1:30 pm – 4:00 pm

Click here for detailed guidelines. Deadline for abstract submission is 4:00 pm, Monday, February 3, 2020. We welcome your participation. Participants must be MSSNY members, and membership is free for first-time resident/fellow members. Join online.

Still Time for NY Ambulatory Clinics to participate in the AHRQ Safety Program!
Beginning in December 2019, this program combines evidence-based guidance with strategies to address the attitudes, beliefs, and culture that often pose challenges to improving antibiotic prescribing.

Participation in this AHRQ program will help clinics meet the Centers for Medicare and Medicaid Services Merit-based Incentive Payment System (MIPS) requirements and can demonstrate compliance with the new Joint Commission Ambulatory Antimicrobial Stewardship Standard as many of the concepts are similar.

Continuing education credits including Maintenance of Certification (MOC) for ABIM, ABP, and ABFM will be offered at no charge for participants.

Benefits of participating include:

Reduce unnecessary antibiotic use and increase appropriate antibiotic use

 Enhance teamwork and communication around diagnosis and treatment of infections and antibiotic prescribing in your practice
 Improve patient safety and safety culture

Improve workflow, especially during the busy cold and flu season
Maintain and improve patient and family satisfaction

Eligible Clinics
Clinics that care for children and/or adults and are:

       Primary care clinics
       Urgent care clinics
       Student health clinics
       Community-based health clinics (e.g., Federally Qualified Health Centers or FQHCs)
       Outpatient specialty clinics that provide primary care (e.g., OB/GYN)

How Can I Learn More?
Attend an Informational Webinar (all times listed are Eastern Time):

October 30 1 p.m.
November 5 at 2 p.m.
November 14 at 2 p.m.
November 26 at noon
December 2 at 2 p.m.

Visit https://safetyprogram4antibioticstewardship.org/ or email antibioticsafety@norc.org.

This program is funded and guided by the Agency for Healthcare Research and Quality and led by Johns Hopkins Medicine and NORC at the University of Chicago.

CME

“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? on November 20 at 7:30am. This is a companion program to the October Medical Matters webinar: Influenza 2019-2020. William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here. Please click here to view the flyer for this program.

Educational objectives are:

Recognize the distinction between types of influenza and other similarly presenting illnesses
Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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.

Register Now for Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm

The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2 from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164^th St., A-540 Conference Room, Jamaica, NY, 11432. Please click here to register. To view the program flyer, please click here.

Program schedule:

7:30—8:20 am: Registration and Breakfast

8:20—8:30am: Welcome and Opening Remarks

8:30—9:30am: Health Matters for Women: Endometriosis *
Faculty: Lisa Eng, DO

9:30—10:30am: Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am: Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm: Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

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

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

**The Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.

The Academy of Medicine of Queens County designates EACH of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Classified

RENTAL/LEASING SPACE

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.

Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.

START SEEING PATIENTS IMMEDIATELY!!!
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Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom. Common waiting room, back office filing space and reception desks included. Affordable rent. Location East 60s between Park and Lexington. Easy distance to Lenox Hill Hospital and New York Cornell. Subway access within 1 block. Immediate occupancy available. Call James: 917-710-7643

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

PHYSICIAN OPPORTUNITIES

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net

Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change? Tired of working long shifts with an overwhelming patient load? Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.
Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton* Clinton Correctional Facility (sporting and recreational outlets)
Chemung                Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Dutchess                 Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                 Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene* Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston* Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence Riverview Correctional Facility (hiking, boating and museums)
Ulster                      Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

NYS Corrections Personnel Ad

Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

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

Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review. We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org Fax: (1-516) 833-4760 Equal Oppty Employer M/F

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

eNews

Connecticut, New Jersey and New York Medical Societies Commend Governors’ Efforts to Address “Cross-Border” Issues Relating to Cannabis, But Concerns Remain About Legalization of Marijuana Use

October 17, 2019 admin

MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

For Immediate Release

Connecticut, New Jersey and New York Medical Societies Commend Governors’ Efforts to Address “Cross-Border” Issues Relating to Cannabis, But Concerns Remain About Legalization of Marijuana Use

October 17, 2019, Westbury, NY—Following is a joint statement from the presidents of the Connecticut, New Jersey and New York Medical Societies:

“We commend the regional approach that the Governors of Connecticut, New Jersey, and New York are seeking to address ‘cross-border” issues relating to cannabis purchase and use.

However, our medical societies continue to have serious concerns with proposals to legalize the purchase of recreational or so-called “adult use” marijuana given the public health challenges that have arisen in other states that have legalized the purchase of marijuana for non-medical purposes.

These concerns have grown in recent weeks given the significant number of cases of pulmonary illness relating to the use of vaping devices, which have included many instances where cannabis was being vaped.

Important steps were taken this year in New York State to greatly reduce the threat of criminal sanction based upon possession of small amounts of marijuana, including expunging previous convictions for low-level possession offenses. We believe that similar “decriminalization” measures should be pursued in other states, and a review taken as to whether these laws are achieving their intended goals. Most importantly, we urge Congress and the President to work together to pass legislation to re-schedule marijuana under the Controlled Substances Act. Then, necessary research as to the health benefits and health risks of marijuana could begin.”

Art Fougner, MD
President, Medical Society of the State of New York

Marc Levine, MD
President, Medical Society of New Jersey

Bollepalli Subbarao, MD
President, Connecticut State Medical Society

# # #

About the Medical Society of the State of New York
Founded in 1807, the Medical Society of the State of New York is the state’s principal non-profit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

eNews

MSSNYeNews: October 18, 2019 – Foul Turns Fair

October 16, 2019 admin

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 18, 2019
Vol. 22 Number 39

Colleagues:

October marks the tenth anniversary of the establishment of FAIR Health. Among other things, FAIR Health holds the database of physicians’ charges. It wasn’t always that way. When the managed care networks were first set up, many physicians did not join the plans and were Out of Network. Were an insured to see one of these physicians, if their plan had an Out of Network provision, that physician would be paid according to the plan’s formula based on Usual and Customary Fee. The most widely consulted database for usual and customary was held and run by a company called Ingenix. Basically, all the insurers relied on Ingenix data for their payment determinations. However, it turned out there was a problem. Ingenix was a wholly owned subsidiary of United Healthcare – soon to be United Health Group.

Our Medical Society began an action that didn’t go far but attracted attention. Soon, then Attorney General Andrew Cuomo became interested and he began investigating how exactly insurers and Ingenix determined these out of network payments. Cuomo’s staff found the flies in that ointment.

A NY Times editorial from 2008 noted that the insurers’ ingenious Ingenix solution was an invitation for abuse since the insurers had a strong financial interest in keeping the payments to physicians low. Eventually, Attorney General Cuomo filed suit, thus joining Medical Societies in their actions against the insurers. When Ingenix was unable to demonstrate even that their figures were accurate, it was game over and United agreed to pay $50 Million that was used to set up a new database – FAIR Health.

Oh, but don’t shed a tear for Ingenix. It is still around – you know it as OPTUM.

And so it goes.

Comments? comments@mssny.org ; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

Please Continue the Fight for a Fair Federal Solution to Surprise Medical Bills
Please continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair federal legislative solution to the issue of surprise medical bills. By clicking here, you can send a letter, make a tweet and make a phone call to your elected officials. It only takes a few minutes and contains all of the details necessary to get our point across.

While MSSNY together with physician groups across the country are working diligently to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of legislation that emulates New York’s successful model, such as H.R.3502, sponsored by Representatives Ruiz and Roe. This week, the number of co-sponsors for this legislation reached 100, including 13 members of New York’s Congressional delegation (Clarke, Higgins, King, Lowey, Meng, S. Maloney, Morelle, Nadler, Rice, Rose, Stefanik Suozzi, and Velasquez).

At the same time, grave concerns have been raised about the alternative being pushed by insurance companies (H.R.3630, sponsored by Representative Pallone, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”. When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery. Please do not give them any more power. Please contact your Senators and Representatives today!

Patient Medical Debt Protection Act Introduced
Comprehensive legislation (A.8639/S.6757 – was recently introduced in New York that would place significant new restrictions on the billing of patients for outstanding medical bills. The legislation would also expand New York’s “surprise bill” law to address circumstances where a patient receives a bill from an out of network physician due to incorrect information regarding that physician’s participation status.

MSSNY, together with representatives for several specialty societies, have met with key legislative staff to have a further understanding of the legislation, including raising significant concerns with a component of the legislation that would require a consolidated bill for the services of hospitals and physicians for hospital-based care. We noted that the requirement to go through the hospital would substantially increase the circumstance where a physician is unpaid or underpaid for medical care delivered, since the physician bill will very often be a fraction of the hospital bill. The legislation is also unclear as to how such hospital based care would be billed to an insurance company when the patient has health insurance coverage. A major source of the problem facing patients, we noted, is the increasing number of health plans offering coverage with enormous deductibles, which necessitates legislative action to increase coverage options to reduce this huge financial burden for patients.

Please remain alert for further updates on this legislation.

Contact Your Members of Congress to Prevent a Medicare Conversion Factor Freeze
As Congress works towards a year end healthcare package, we are calling on Congress to stand with America’s physicians and patients by urging Congress to implement positive payment adjustments to the grossly inadequate Medicare fee schedule. Click here to send a letter to Senators Schumer and Gillibrand, as well as your congressional representative.

For years, physicians were faced with an uncertain environment as Medicare’s deeply flawed Sustainable Growth Rate (SGR) formula constantly threatened devastating cuts that would deeply impact the access to care for millions of patients. The Medicare Access and CHIP Reauthorization Act (MACRA) got rid of the SGR and provided modest increases for a few years, but physicians are now facing a pay freeze for the next six years.

According to the Consumer Price Index, economy-wide inflation increased 43 percent or 2.1 percent on average. However, adjusting for inflation in practice costs, Medicare physician pay has declined by 19 percent between 2001 and 2018. Based on these statistics it is clear that American physicians cannot continue to provide quality care to Medicare patients under the current payment system therefore;

We are urging Congress to:

Implement positive payment adjustments for physicians to replace the payment freeze over the next six years.
Extend the Advanced APM bonus payments for an additional six years.
Implement additional technical improvements to the MACRA MIPS program to reduce the hassles inherent in complying with the program.

These improvements will have an immediate impact and help protect physician practices from accruing additional penalties as they transition over to the MIPS and APM programs.

Albany Policy Forum Examines New York’s Enormous Medicaid Budget
This week the Empire Center for Public Policy held a policy forum: ‘Medicaid Migraine: Retaking control of New York’s Surging Health-Care Costs’ on Wednesday at the Albany Institute of History and Art. The forum, which was comprised of a panel of individuals from various organization which included Rose Duhan, President and CEO of Community Health Association of New York State, James Lytle, Partner, Manatt, Phelps & Phillips, Lara Kassel, Coordinator at Medicaid Matters and Harold Iselin, Managing Shareholder at Greenberg Traurig.

Rose Duhan, President and CEO, Community Health Care Associations of New York State: highlighted the disparity between the amount that is spent on Medicaid verses the overall amount spent on public health in New York State. She spoke about the need to focus on the social determents of health and investing in existing social services infrastructure to improve patients’ outcomes. She noted that the social aspects of health which includes access to food, housing and racism all drive healthcare costs and although cannot be solved in a single budget cycle require investment over the long term.

James Lytle, Partner, Manatt, Phelps & Phillips: noted that it shouldn’t be a surprise that Medicaid continues to have a cost-discipline issue. He noted that while New York is a compassionate state that avoids having to cut spending on programs, though nearly 1/5 of spending on health-care is wasted. With regard to the global cap, he noted the cap doesn’t cut costs; it simply counts them and is a barometer to show how much has been spent thus far. He also noted that long term care is the biggest driver of Medicaid spending due to an aging population with less family and community-based resources being available to them. Moreover, many stakeholders will be impacted if sudden big changes are made.

Lara Kassel, Coordinator of Medicaid Matters New York: emphasized on the need for policy makers to look at Medicaid from the perspective of the consumer; those who are directly benefitting from the program. She added that their perspective comes from the advocacy and highlighted the importance of looking at their organization as an equal partner when it comes to budget-making.

Harold Iselin, Managing Shareholder at Greenberg Traurig: noted that the global cap has been a useful tool that has added predictability to budgeting. He spoke about the three main drivers of Medicaid costs; Enrollment, Health-Care Costs and Special Programs. Regarding enrollment, he noted that it is a good sign and having an increase in enrollment is a good thing. In relation to utilization costs, he noted that overall it has been a successful outcome, adding that it has not spiked even in terms of long-term care. When it comes to unit costs however, he highlighted three major drivers; minimum wage, pharmacy costs and hospital costs. In terms of minimum wage he noted that it was originally supposed to be outside of the global cap but was added into it later on. In relation to pharmacy costs, he noted that as new treatments were introduced namely the Hep-C treatment, costs went up. He added that though physician costs have stayed flat overall, there must be more investment into primary care. He concluded by mentioning that you cannot look at the global cap without looking at the general fund and state funding in general.

MSSNY, CT, and NJ Medical Societies Commend Governors’ Efforts to Address “Cross-Border” Issues Relating to Cannabis; Concerns Remain About Legalization of Marijuana Use

On October 17, MSSNY released the following joint statement to the press:

“We commend the regional approach that the Governors of Connecticut, New Jersey, and New York are seeking to take to address ‘cross-border” issues relating to cannabis purchase and use.

Art Fougner, MD
President, Medical Society of the State of New York
Marc Levine, MD
President, Medical Society of New Jersey
Bollepalli Subbarao, MD
President, Connecticut State Medical Society

Montefiore Plans to Close Mount Vernon Hospital
Montefiore Health System plans to close its Mount Vernon hospital and invest $41 million to build an emergency department and ambulatory care center, officials said Tuesday. Upon completion of the 40,000-square-foot health care complex, the 121-bed hospital will close. Montefiore expects construction to be completed by the end of next year. It still must receive state Department of Health approval for the project. The hospital will be replaced by the emergency department and medical offices for primary and specialty care.

Montefiore Health System, which has its flagship hospital in the Bronx, has expanded rapidly in the Hudson Valley. It has taken over management of hospitals in Cornwall, New Rochelle, Nyack, Newburgh, and White Plains. It is negotiating to add St. John’s Riverside Hospital in Yonkers. Services at the new center will include primary care, mental health care, specialty care, pediatrics, chronic disease management, wound care and imaging services. Its emergency department will include equipment for cardiac diagnosis and monitoring as well as an X-ray machine and CT scanner.

Weill Cornell Medicine Eliminates Medical Ed Debt for Qualifying Students
A transformative new scholarship program established by Weill Cornell Medicine will eliminate medical education debt for all students who qualify for financial aid, the institution announced today. A lead gift from The Starr Foundation, directed by Weill Cornell Medicine Overseer Maurice R. Greenberg, in partnership with gifts from Joan and Board of Overseers Chairman Emeritus Sanford I. Weill and the Weill Family Foundation have made this longstanding goal possible. Learn more.

HHS: Physicians Guide to be More Cautious When Tapering Patients Off Opioids
HHS “published a guide https://bit.ly/2VB5Eej” instructing physicians to be more cautious in tapering patients off opioids in response to reports of some physicians cutting patients off from opioids too fast or “in some cases even dismissing patients from their practice.”

The new guide states that doctors “should never abandon” pain patients, and warns of risks including “acute withdrawal, pain exacerbation, anxiety, depression, suicidal ideation, self-harm, ruptured trust, and patients seeking opioids from high-risk sources.” It says that opioid doses are typically reduced by between 5 and 20 percent a week, but that slower tapers are often better tolerated, partly because they are less likely to trigger withdrawal symptoms.

The guide also lays out reasons to consider tapering patients off opioids, stressing that the benefits of staying on the drugs need to outweigh the risks. Those risks are substantial, including addiction and overdose, but many chronic pain patients and their doctors say they have been able to stay on high doses of opioids and function competently. (NY Times, 10/17)

As of October 8, the CDC confirmed 28 deaths associated with the use of e-cigarettes, or vaping, and 1,299 lung injury cases.

WORKERS COMP

Workers Comp Webinars for Medical Providers
The Board is hosting webinars to provide training on the Drug Formulary and prescription prior authorization process. These are being offered at different times so you can choose one that best fits your schedule. Visit the Board’s website to register for one of the sessions listed below.

October 22, 8:30 a.m. – 9:30 a.m.
October 24, 4:30 p.m. – 5:30 p.m.
October 29, 8:30 a.m. – 9:30 a.m.

More Information

For more information, visit wcb.ny.gov/content/ebiz/drugformulary/
General Formulary questions: WCBFormularyQuestions@wcb.ny.gov
Technical support questions: WCBCustomerSupport@wcb.ny.gov
Subscribe for email notifications

Case Count for Vaping-Related Lung Injury Up
CDC yesterday said as of Oct. 15, the number of people sickened from a lung illness linked to vaping and e-cigarettes rose to 1,479 cases. So far, 33 people have died from the illness—which officials are now calling EVALI, short for “e-cigarette or vaping product use associated lung injury”—and additional deaths are being investigated.

Only Alaska among the 50 states and the District of Columbia has yet to see a case. Deaths confirmed as part of the outbreak total 26.Moreover, it is reported that the CDC will shortly step up its surveillance efforts on “vaping illness” in a novel way. The agency will request that doctors seeing patients with suspected respiratory infection ask about their use of vaping products.

An updated guidance will “advise physicians on how to diagnose and manage patients who may have both a lung infection and a vaping injury,” the news service reported.

Physicians suspecting a patient has vaping-related lung damage are asked to get a detailed history of substances used and obtain the actual products for testing, if possible, as well as to report the case to local or state health departments.

The CDC said it still had no clear idea of what is causing the vaping-related illnesses. The general profile for victims has not changed either: most are young men and the majority used THC e-liquid products.

Amazon Pays for Employees to Travel to California for Cancer Care
Amazon is aiming to control healthcare spending by paying to send employees to California to receive cancer care, according to The Wall Street Journal. Seattle-based Amazon will cover travel expenses for employees diagnosed with cancer who see physicians at Duarte, Calif.-based City of Hope.

More than 380,000 of Amazon’s workers and families are eligible for the benefit, which can be used for any cancer diagnosis, according to the report. Dene Sparrman, Amazon’s director of global benefits, told The Wall Street Journal the benefit is designed to lower healthcare spending and increase employees’ choices. “Instead of waiting for patients to get the wrong care first, then reaching out to the expert, this model is designed so that the patient has access to expertise as early as possible to help ensure the correct care is delivered first,” she told The Wall Street Journal. The new benefit also enables Amazon workers to meet with City of Hope physicians by videoconference, when allowed by state regulations, according to the report. (October 15, WSJ)

WEBINARS/CME/SYMPOSIUMS

“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? On November 20 at 7:30am. This is a companion program to the October Medical Matters webinar: Influenza 2019-2020. William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here. Please click here to view the flyer for this program.

Educational objectives are:

Recognize the distinction between types of influenza and other similarly presenting illnesses
Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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.

Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm
The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2nd from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432. Please click here to register. To view the flyer, please click here.

Program schedule:

7:30—8:20 am: Registration and Breakfast

8:20—8:30am: Welcome and Opening Remarks

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

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

**The Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.

The Academy of Medicine of Queens County designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Classified

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PHYSICIAN OPPORTUNITIES

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

eNews

MSSNY eNews: October 11, 2019 – R-E-S-P-E-C-T

October 10, 2019 admin

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 11, 2019
Vol. 22 Number 38

Colleagues:

The term “provider” has bothered me for a long time. And it should bother you as well. ACP President Dr. Robert McLean posted Defining our identity does not include the ‘P word’ for his September President’s message. The central theme is a reminder that the practice of Medicine is a profession. Physicians have a unique relationship with patients that is considerably more than the “Cable Guy” who comes to install your TV service. Dr. McClean writes:

… Such a fundamentally unique and sacrosanct relationship as that between patient and physician is not merely “providing” a health service. And that is why the term “health care provider” is so inappropriate. The patient-physician relationship does not consist of simple transactions where we provide and patients consume. That marketplace terminology implies that health care can be conceptualized as just another commodity.

… The primacy of this relationship has been eroded with the commoditization of aspects of the health care delivery system.

Dr. McClean is not the only physician upset by “provider creep.” Washington pediatrician, Dr. Niran Al-Agba goes one step further, writing in the Kitsap Sun: The sneaky cynicism of calling your doctor a ‘provider’. She traces the history of provider as a pejorative back to 1930’s Germany:

… According to Dr. Saenger, who wrote Jewish Pediatricians in Nazi Germany: Victims of Persecution, “the 1937 issue of the Reichs Medizinal Kalender, a directory of doctors, the remaining Jewish doctors in Germany were stigmatized by a colon placed before their names. Their medical licenses were revoked in 1938. They could no longer call themselves ‘Arzt’ or ‘doctor.’ They were degraded to the term ‘Behandler’ or freely translated, ‘provider.’

She continues:

Insulting any person on the basis of their race, ethnicity or gender is morally wrong. Using the word “provider” to describe a physician is and will always be insulting, personally and professionally; it is demeaning and devalues the education and degree conferred upon every physician. Why are physicians forced to suffer repeated use of this derogatory professional insult? And why have physicians as one professional body not risen up in anger at this injustice?

While I would not equate those who call physicians “the P word” with the Third Reich, people should realize that Provider is insulting and demeans our noble profession.

Dr. McClean concludes:

And by the way, this terminology issue was raised through the ACP Board of Governors way back in 2008. Hence, it has been ACP policy since 2009 to eliminate use of the term “provider” and “prescriber” in lieu of “physician” in all publications and communications. Pass it on.

I would add that this has been MSSNY policy since 2011:

Professionalism in Terminology 207.956

The leadership and staff of the Medical Society of the State of New York shall not in written or spoken word, use the term “provider” in referring to physicians

With that, I give you the inimitable Aretha Franklin.

Comments? comments@mssny.org ; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

eNews

DFS Proposes Regulation to Ensure Patients Have More Detailed Notice of New York’s Surprise Bill Law
New York Department of Financial Services (DFS) Superintendent Linda Lacewell announced this week a proposed regulation to assure patients that receive a claim for the services from a non-participating physician or a non-participating referred healthcare provider receive notice from their health plan and non-par treating physician about the protections of New York “surprise bill” law. This action follows a recent report of a Long Island patient on “CBS This Morning” who received surprise bills totaling hundreds of thousands of dollars that weren’t covered by his healthcare plan.

“We are taking this action to strengthen the law so that New Yorkers have all the information they need to avoid surprise medical bills,” said Superintendent Lacewell. “After hearing about − and resolving – a recent issue, we know that if it could happen to one consumer; it could happen to others.”

The proposed regulation would require health plans that receive a claim for the services of a non-participating physician or a non-participating referred healthcare provider that could result in a surprise bill to provide additional notice to the insured consumer.

The notice would advise that the insured consumer may receive a surprise bill based on the claim and would include a description of surprise bills and the New York Out-of-Network Law’s Independent Dispute Resolution (IDR) process for surprise bills, as well as instructions on how to submit a dispute, a copy of an assignment of benefits form, and the healthcare plan’s designated addresses for submitting the form. The notice would be included on or with the explanation of benefits.

Additionally, the proposed regulation requires health plans that determine that services billed by a healthcare provider as emergency services are not emergency services to notify the consumer that the consumers may receive a surprise bill for such services and that consumers may be protected from any such surprise bill. The notice would include the healthcare plan’s contact information as well. If a health plan receives an assignment of benefits form and determines that a disputed bill is not a surprise bill, they would be required to notify the consumer in writing of the procedures for filing a grievance or appeal and provide information on how to file a complaint with DFS.

It is also important to note that the proposed regulation would require non-participating physicians who bill consumers for emergency services or a surprise bill to inform the consumer of the IDR process, along with providing the claim form and assignment of benefits form which non-participating physicians already must send with surprise bills.

Click here to view a full copy of the proposed amendment, which will be published in the October 23, 2019 State Register and subject to a 30-day notice and public comment period.

MSSNY President, Dr. Fougner, Comments in Crain’s re Surprise-Billing Amendment Proposes More Requirements for Insurers and Physician
Dr. Arthur Fougner, president of the Medical Society of the State of New York, said that the society is “supportive of efforts to assure patients are notified by insurers of the limitations of their coverage, and the protections available to them under our surprise bill law,” in a statement provided to Crain’s. “We are continuing to review the new proposal and will seek to provide feedback to DFS regarding the contents of the proposed disclosure form.”

Urge the Governor to Support Formulary Protection Legislation!
MSSNY joined AARP and over thirty various health and consumer organizations in sending a letter to urge Governor Andrew Cuomo to approve S.2849/A.2969 that would protect health plan members from increases in out-of-pocket prescription drug costs in the middle of a contract year.

In a press release by AARP, Dr. Arthur Fougner, President of MSSNY said: “MSSNY strongly urges that this formulary protection bill be signed into law as it would provide significant protection from the adverse consequences many patients face as a result of non-medical switching of prescription drugs. If a treatment is working, it should not be changed due to financial constraints. In medicine as in sports, you don’t change a winning game; it’s unreasonable to force patients to change a successful course of treatment for any reason other than medical need.”

MSSNY encourages physicians, as well as their families, friends and other sympathetic individuals to send these letters to their lawmakers.

Protect your patient’s prescriptions! Urge the governor to sign formulary protection bill into law by clicking here.

Click Here to view the full letter!

Medical Society Raises Concerns About Trump’s Order on Medicare
Although the Medical Society of the State of New York supports the goal of President Donald Trump’s executive order on Medicare, it is concerned with several policy directions the order advances, according to a statement issued Tuesday by Dr. Art Fougner, president of the society.

“In particular, we are concerned with the apparent goal to expand the Medicare managed-care program, which likely could include efforts to disincentivize continued or new enrollment in the Medicare fee-for-service program,” Fougner said. “This is especially problematic in light of multiple instances in recent years where Medicare managed-care plans dropped huge numbers of physicians from their Medicare Advantage networks. This, in turn, significantly reduces care options for our patients.”

The society also takes issue with proposals to expand “already cumbersome Medicare value-based payment programs,” Fougner said. Specifically, many smaller physician practices have reported challenges with the Medicare Merit-based Incentive Payment System, such as burnout from spending more time on health-tech systems than on treating patients “to meet well-intended but often overreaching value programs.”

Additionally, Fougner said that some proposals in the order seem to focus on expanding the scope of other types of health practitioners. The combined care of a team headed by a physician is what is best for patients, he said.

Trump’s executive order states that it is focused on empowering patients to “select and access the right care, at the right time, in the right place, from the right provider.” Another focus is to help the fiscal sustainability of the Medicare program through alternative payment methodologies linked to value, increased choice and lower regulatory burdens for providers.

Dr. Fougner said, “We look forward to working with medical associations across the country to work with the administration toward preserving and strengthening the Medicare program so that our seniors continue to have timely access to the quality care they need and deserve.” (Crain’s Health Pulse Oct 8)

Physicians – Beware of Fake Letters Claiming to be from NYS Board for Medicine
Please should be aware that the New York State Board for Medicine has advised of a scam where physicians have received a bogus letter claiming to be from the “NY State Education Department, Office of the Professions” indicating that their license has been suspended for “Illegal Drug Trafficking Under Section 33(c) of The Aviation Drug Trafficking Control Act of 1984”.

The Board for Medicine has advised MSSNY that, should any physician receive such a letter, that they be aware that they would not receive such a letter from the NYS Board for Medicine or NYSED.

New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has already given oral or written consent; or
the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

Several other states have passed similar laws expressly banning this practice without clinical justification. MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.

Bronx Teen Is First to Die in New York from Vaping
A teenager from The Bronx became the first New Yorker to die from vaping last week, state officials said Tuesday. The 17-year-old boy treated at Montefiore Hospital is among nearly two dozen people across the nation whose deaths have been linked to the use of electronic cigarettes, officials said.

“Parents have to know, young people have to know: You are playing with your life when you play with this stuff,” Gov. Andrew Cuomo said at an unrelated news conference at his Manhattan office.

The boy was first treated for a “vaping-associated respiratory illness” early last month and was hospitalized again in late September before his Oct. 4 death, according to the Democratic governor’s office. The teen’s death was reported Tuesday to the state Department of Health, which is investigating the case, officials said.

The boy may be the 20th person in the United States to die from a vaping-related illness amid an outbreak of lung ailments linked to the habit.

The U.S. Centers for Disease Control and Prevention had confirmed 18 vaping deaths in 15 states as of Oct. 1, and another was reported in Massachusetts on Monday.

Some 110 people across the Empire State — including 21 in New York City — have come down with serious lung illnesses after using at least one vape product, according to the state health department. Officials have attributed most of those cases to black-market cannabis vape devices rather than nicotine-based e-cigarettes sold in stores.

The spate of sicknesses nonetheless spurred state authorities to ban flavored e-cigarettes, but a pending lawsuit blocked the measure from taking effect last week.

Poll: New Yorkers Back Ban on E-Cigs
A majority of New Yorkers support Gov. Andrew Cuomo’s emergency ban on flavored e-cigarettes and think vaping is a serious public health problem, according to a poll published Monday.

The Siena College Research Institute found that 78% of the more than 800 New Yorkers surveyed believe e-cigarette use and vaping represent either a very serious or somewhat serious public health problem. Nearly two-thirds (61%) of New Yorkers support banning flavored e-cigarettes, and 52% support banning the sale of all e-cigarette and vaping devices.

The poll found that 12% of New Yorkers vape on a regular basis.

The poll—which has a margin of error of 4.3 percentage points—was conducted between Sept. 22 and Oct. 1. That means the final results came in two days before a state court temporarily blocked Cuomo’s prohibition on flavored e-cigarettes in response to a lawsuit from the industry.

Health Commissioner Howard Zucker vowed after the court’s decision that the state will use “every tool at our disposal to address this crisis.” More than 1,000 people have been diagnosed with vaping-related illnesses in the U.S., with 18 reported deaths, according to data from the U.S. Centers for Disease Control and Prevention.

Physicians Welcome to Provide Public Comments on DSRIP at 10/25 NYC and 10/30 Syracuse Public Forums
The New York State Department of Health (NYSDOH) will be holding Public Comment Days for New York’s 1115 waiver program on:

October 25^th 2019 at Baruch College, 55 Lexington Ave. (Corner of 24th St. & Lexington Ave.), Room 14–220 (14^thFloor), New York, NY 10010.
October 30^th 2019 at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.

Background on the DSRIP Program

Hassle Factor Form Now in Easy-to-Use PDF Format
MSSNY’s Hassle Factor Form has been updated. The updated PDF version of the form can be found at the following this link.

Anyone can access the form by clicking on the drop-down box of RESOURCES from the MSSNY home page – www.mssny.org. Then, scroll down to Payer Relations (SME). Now, scroll to Hassle Factor Form and click. This is a more user friendly form.

The County Medical Societies can send it to their members and add it to their websites. The PDF version can be used by the county medical societies to gather data/information from the membership for interacting with DFS.

Doctor Sues Kaiser Permanente over Opioid-Related Patient Satisfaction Scores
An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

Eryn Alpert, MD, worked at Kaiser Permanente from 2012 to December 2017, when she was fired. The lawsuit alleges her dismissal stemmed from her failure to accept patient satisfaction scoring tools. It alleges these tools were structured to incentivize physicians to prescribe opioids, even when medically unnecessary. The lawsuit said this pressure was greater in the emergency department, where patients often went seeking prescriptions and would leave poor reviews if they didn’t receive them, according to the report.

In the lawsuit, Dr. Alpert alleges her resistance to prescribing unnecessary opioids created a high standard deviation in her patient scores, which in turn prevented her from gaining shareholder status three years in a row, according to the report.

CME

“Influenza 2019-2020” CME Webinar on October 16; Registration Now Open
Are you prepared for flu season?
The first of MSSNY’s 2020 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2019-2020” on Wednesday, October 16, 2019 at 7:30 a.m.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are:
Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
Describe clinical and laboratory diagnostic features and treatment specific to each flu season
Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated

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

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.

“When Is the Flu Not the Flu?” CME Webinar on November 20 at 7:30am; Registration Now Open
. This is a companion program to the October Medical Matters webinar: Influenza 2019-2020. William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are:

Recognize the distinction between types of influenza and other similarly presenting illnesses
Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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.

Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm
The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2nd from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432. Please click here to register.

Program schedule:

7:30—8:20 am: Registration and Breakfast

8:20—8:30am: Welcome and Opening Remarks

* 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 Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.

CMS

HHS Issues Opioid Tapering Guidance for Clinicians
The Department of Health and Human Services today released a guide to help clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain. Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the guide reviews issues to consider when changing a patient’s chronic pain therapy. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction,” said Adm. Brett Giroir, M.D., HHS assistant secretary for health.

NGS Notice : Errors Causing Incorrect Part A and Part B Claim Denials
Date Reported: 10/9/2019
Status: Open
Provider Type(s) Impacted: Part A, Part B, HH+H
Description of Issue

National Government Services (NGS), along with all Medicare Administrative Contractors (MACs), is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. NGS is informing providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. This is causing claims to incorrectly deny based on invalid beneficiary entitlement.
National Government Services Action

NGS is actively pursuing a solution to this issue which will be shared with providers as soon as possible.
Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.
Proposed Resolution/Fix Date TBD

Calling All Physicians of Italian Heritage: Join Morgagni Medical Society
The Morgagni Medical society of New York is comprised of physicians of Italian heritage, who meet for social, educational and professional meetings in NYC quarterly. It is a nonprofit 501c3 organization, and sponsors a medical school scholarship in conjunction with the Columbus Citizen’s Foundation. Interesting people and speakers, exceptional dinners, opera night, exclusive club and venue events.

Members can march with their families in the NYC Columbus day parade. New members, both of Italian descent as well as Italophiles, have a great opportunity to share culture and profession. Check out www.Morgagnimedicalsociety.com, email Morgagni.society@gmail.com for information and join today!

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PHYSICIAN OPPORTUNITIES

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

eNews

MSSNY STATEMENT IN RESPONSE TO PRESIDENT’S EXECUTIVE ORDER ON MEDICARE

October 8, 2019 admin

MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

For Immediate Release
October 8, 2019

MSSNY STATEMENT IN RESPONSE TO PRESIDENT’S EXECUTIVE ORDER ON MEDICARE

Statement attributable to:
Art Fougner, MD
President, Medical Society of the State of New York

“We appreciate the goal of the President’s Executive Order (EO) to protect and strengthen the Medicare program for the tens of millions of seniors enrolled in the program who depend upon its coverage to meet their health care needs. We certainly support aspects of this initiative to reduce the administrative burdens associated with facilitating needed care for our patients. However, we are very concerned with a number of the policy directions this Executive Order appears to advance.

In particular, we are concerned with the apparent goal to expand the Medicare Managed Care program, which likely could include efforts to disincentivize continued or new enrollment in the Medicare fee for service program. This is especially problematic in light of multiple instances in recent years where Medicare managed care plans dropped huge numbers of physicians from their MA networks. This in turn significantly reduces care options for our patients.

We are quite troubled by proposals that seek to expand already cumbersome Medicare value based payment programs. Many smaller physician practices have reported significant challenges associated with participating and succeeding in the current Medicare Merit-Based Incentive Payment System (MIPS). The significant reporting requirements associated with the current MIPS program and other value programs are increasing “burnout” among physicians who must spend more time checking boxes on their HIT systems rather than treating patients to meet well intended but often overreaching value programs. A recent Annals of Family Medicine study reported that, during a typical 11 hour workday, primary care physicians spent more than half their time (nearly 6 hours) on data entry and other HIT system tasks, instead of with patients. There must be a comprehensive review of the fairness of the existing MIPS program before advancing measures that would expand it.

We are also very concerned with proposals that appear to seek to expand the scope of certain health care practitioners. There are many different types of health care professionals, each of which provide essential care for patients. However, patients benefit most from the combined care of a team headed by a physician whose education and training enables them to oversee the actions of the rest of the team, in order to provide the patient with optimal medical treatment. While the EO appears to recognize the applicability of state laws that govern the limitation of the scope of practice of certain health care practitioners, we are very concerned with the perpetuation of a false narrative that promotes equivalency of non-physicians despite the lack of similar education and training. Such scope expansions could lead to an increase in the “siloing” of care delivery rather than care received through an integrated team-based approach.

We look forward to working with medical associations across the country to work with the Administration towards preserving and strengthening the Medicare program so that our seniors continue to have timely access to the quality care they need and deserve.”

# # #

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

eNews

October 4, 2019: MSSNYeNews – The New Reefer Madness

October 1, 2019 admin

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 4, 2019
Vol. 22 Number 37

Colleagues:

Money, it’s a gas
Grab that cash with both hands and make a stash.”
-Roger Waters

Albany’s legislative season is almost upon us and that means the full court press for legal “adult-use” cannabis will be on. Governor Cuomo said as much, stating that he would be traveling to Connecticut and New Jersey to work on creating regional symmetry when it comes to legalizing recreational marijuana.

Today, I received an email which urged legalization to produce revenues sufficient to care for the homeless – clearly a laudable goal. Hold that thought – more in a moment.

Despite the opposition from law enforcement, county health officials and PTA’s, what’s the allure? Right – Money.

Legal cannabis has meant a veritable bonanza for state governments, with an estimated over $2 billion in cannabis sales for California. This, of course, has come at a different sort of price for citizens with legalization. There are indeed health risks, especially for two groups – children and pregnant women. When marijuana is in the home, especially in edible form, kids end up in emergency departments all too often. And we are not talking about Woodstock era pot either. Today’s product is often so potent, Tommy Chong might have issues. And then there’s pregnancy. There is sufficient evidence to warrant concern on the effects of THC on the developing brain. Yet in Colorado, almost two-thirds of dispensaries called were found to recommend cannabis for nausea and vomiting during pregnancy. This is clearly more than troubling.

Oh yes, and the homeless? it turns out that Colorado locals reported a serious increase of homeless in their neighborhoods. It appears that as in Oregon, Washington and California, transients tend to migrate to places that let them smoke legally. So that money will surely come in handy.

Oh, and the black market appears to do very nicely despite ample legal supply. Also, depending on the limits for personal use, the thought of the return of the Revenuers from the days of prohibition is not idle musing. Finally, given the vape lung situation, if vaporizer product is restricted or proscribed, the black market may be quite robust indeed. And again, those gummy bear edibles are hard for children to resist either.

This promises to be an interesting session indeed.

The last word, I leave to Barrett Strong.

Comments? comments@mssny.org ; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

eNews

Physicians Welcome to Provide Public Comments on DSRIP at 10/30 Syracuse Public Forum
The New York State Department of Health (NYSDOH) will be holding a Public Comment Day for New York’s 1115 waiver program on October 30^th 2019 at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202. The open comment period will be from 11am to 2pm. In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Background on the DSRIP Program

MSSNY encourages physicians, as well as their families, friends and other sympathetic individuals to send these letters to their lawmakers.

Protect your patients’ prescriptions! Urge the governor to sign formulary protection bill into law by clicking here.

Click Here to view the full letter!

Continue Fight for Fair Solution to Surprise Medical Bills; NY Law a Great Success
Please continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair federal legislative solution to the issue of surprise medical bills. By clicking here, you can send a letter, make a tweet and make a phone call to your elected officials. It only takes a few minutes and contains all of the details necessary to get our point across.

Recently, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation. Moreover, it noted that there were a total of 2,595 IDR decisions reached, an extremely low number considering that there are over 7 million Emergency Department visits in New York every year.

Furthermore, NY DFS Superintendent Linda Lacewell touted the success of New York’s law in a Daily News op-ed this week. And MSSNY joined several other northeastern state medical societies in a statement urging Congress to enact the right solution to address surprise medical bills.

Physicians: When to Seek Specialist Support for Transgender Patients
Endocrine News (10/1) reports that even though “endocrinologists are fairly well versed in caring for transgender patients, primary care physicians need to better understand their roles and know when to seek the counsel and support of specialists.” In 2017, “the Endocrine Society published a Clinical Practice Guideline on the treatment of gender dysphoric/gender incongruent persons,” but “primary care physicians need to know when to seek the support of specialists.” Just this “past July, Joshua D. Safer, MD, and Vin Tangpricha, MD, PhD, of the Mount Sinai Health System and Icahn School of Medicine at Mount Sinai in New York, N.Y. and the Emory University School of Medicine and Atlanta VA Medical Center in Atlanta, Ga., respectively, published a review in Annals of Internal Medicine” that “details the specific medical issues this population faces.”

DFS Superintendent: Do Not Buy Junk Health Insurance
New York State Department of Financial Services Superintendent Linda Lacewell reminded New Yorkers to file a complaint with the state if they believe they purchased junk insurance. “We know that so-called Trumpcare — or however else these short-term plans are marketed — is nothing more than a ploy to convince Americans to buy junk insurance,” she said. “These plans often fail to cover basic services and end up making health insurance more costly for consumers, and the fact that such junk insurance is allowed for sale anywhere in the US is an unfortunate product of the current federal administration’s continual dismantling of basic protections for Americans seeking quality and affordable health care.”

Judge OKs First Site in Philadelphia Where People Can Use Illegal Opioids
A judge has ruled that a Philadelphia nonprofit group’s plan to open the first site in the U.S. where people can use illegal opioids under medical supervision does not violate federal drug laws, delivering a major blow to Justice Department lawyers who have been working to block the facility.

U.S. District Judge Gerald McHugh ruled Wednesday that Safehouse’s plan to allow people to bring in their own drugs and use them in a medical facility to help combat fatal overdoses does not violate the Controlled Substances Act.

Prosecutors had contended that the plan violated a provision of the Controlled Substances Act that makes it illegal to own a property where drugs are being used — known as “the crack house statute.” But backers of Safehouse argued the law was outdated and not written to prevent the opening of a medical facility aimed at saving lives in the midst of the opioid crisis.

The decision means that America’s first supervised injection site, or what advocates call an “overdose prevention site,” can go forward. Justice Department prosecutors had sued to block the site, calling the proposal “in-your-face illegal activity.”

The ruling may pave the way for New York to open five supervised injection facilities, New York City Council Member Mark Levine said. The Cuomo administration has been slow to approve a pilot program that would establish four sites in New York City and a space in Ithaca that gives people a safe space to use drugs amid threats of prosecution from the Department of Justice. New York State Health Commissioner Howard Zucker cited those threats from the federal government in February as the reason for the holdup. The new court decision should remove that hurdle, argued Levine,
the Council’s Health Committee chairman. (WSJ, Oct.3)

NY First State to Offer Anonymous Whistleblowers Report Govt. Misconduct
New York, on Wednesday, became the first state to offer whistleblowers an anonymous electronic platform to submit tips about government misconduct. Through a new online portal, the state attorney general’s office will oversee shielded communications with whistleblowers who submit allegations of illegal or fraudulent behavior. The system is run through the downloadable TOR browser, which protects a person’s identity and location.

A spokesperson for the attorney general said the browser prevents officials from knowing a person’s name or location unless they submit a document or other evidence that may somehow identify them. They contend the complaints filed through the portal also would not be subject to disclosure under the state’s Freedom of Information Law due to law enforcement and privacy exemptions.

However, any law enforcement exception blocking the public disclosure of a complaint could be voided in cases where an investigation is closed or leads to an arrest. The privacy exception also may not apply to complaints that target agencies or corporations, rather than individuals.

In New York, whistleblowers can also submit complaints to the attorney general’s office through an online form or traditional mail or e-mail. (Times Union, 10/2)

Heads Up: Beware of Scam Calls from the “NY DEA” Demanding Information
Shirley Cosgriff, Executive Director of Broome, Delaware Otsego & Tompkins Counties alerted MSSNY that she received at least 3 phone calls asking directly for one of our physicians or one of our CRNA. When I questioned what the call was about I was told it was the NY Licensure division of the Department of Education…They informed me that if I could provide them with the doctor’s Social Security #, License number, DEA number and date of birth, they would be able to verify if they had the correct provider that’s license was in question.

I asked if I could return their call and they gave me a phone of 804-293-0309. I called this number back, and was told it was “NYS DEA” and I had to provide the providers information in order to talk with a representative. I questioned why they were the NY DEA, when DEA is a federal organization.

They hung up.”

From MSSNY VP of Socio-Medical Economics Division Regina McNally: “I Googled the phone number and see that it has been used in SC and Florida. I have notified the NYSED, MSSNY leadership, the counties and our communications division. This needs to be shared with physicians and their staff so these wicked people don’t succeed.”

Clinicians Still Waiting for 2017 Advanced APM Bonuses
About 90,000 clinicians who participated in advanced alternative payment models in 2017 are concerned that they haven’t received bonuses from the CMS. Advanced alternative payment models, also known as advanced APMs, were created under MACRA in 2015 and offer an opportunity for clinicians to receive a 5% bonus to their Medicare payments if they participate. It requires clinicians to take on significant downside risk. The CMS said it would provide the positive payment adjustment in 2019 to eligible clinicians who participated in 2017. But providers are worried the bonuses still haven’t been distributed. In a letter Tuesday to CMS Administrator Seema Verma, nine provider groups, which include the American Medical Association and the National Association of ACOs, claim the bonus payments are delayed and it’s unclear why.
(Modern Healthcare, September 17, 2019)

CMS Penalizes 2,583 Hospitals for High Readmissions: 5 Things to Know
In fiscal year 2020, CMS will penalize 2,583 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released Sept. 30 cited in a Kaiser Health News report.

This is the eighth year of the Hospital Readmissions Reduction Program. To determine penalties for fiscal 2020, CMS examined hospitals’ 30-day readmission rates for patients who had originally been treated for the following conditions: heart failure, heart attack, pneumonia, chronic lung disease, hip and knee replacement or coronary artery bypass graft surgery. Scheduled readmissions were not counted.

CMS used patient data from July 2015 through June 2018 to determine the penalties. The agency compared each hospital’s reported readmission rate to national averages for each of the conditions to determine the penalties. (Beckers Hospital Review, Oct 1)

Here are five takeaways from the Kaiser Health News analysis:

Eighty-three percent of the 3,129 hospitals evaluated received a penalty.
CMS will cut payments to the penalized hospitals by as much as 3 percent for each Medicare case during fiscal 2020, which runs Oct. 1 through September 2020.
Fifty-six hospitals were hit with the maximum penalty. The average penalty will be a 0.71 percent payment cut for each Medicare patient.
Though 64 hospitals received the same penalty as the year prior, 1,177 hospitals received a higher penalty and 1,148 hospitals received a lower penalty.
In fiscal 2020, CMS will withhold an estimated $563 million in Medicare payments to hospitals under the Hospital Readmissions Reduction Program.

Access the full Kaiser Health News article here.

Criticism re CMS’ Proposal to Require Hospitals to Disclose Negotiated Prices
Modern Healthcare (9/30) reports hospitals and health insurers are criticizing CMS’ “proposal to make hospitals publicly post payer-negotiated rates for medical services would be bad for business and patients.” The article says that “hospitals also asked the CMS to rethink reimbursement cuts to 340B hospitals and for outpatient clinic visits.”

CME

RSVP Now for Veterans Matters: PTSD & TBI at the New York County Medical Society
The Medical Society of the State of New York and the New York County Medical Society are proud to announce Veterans Matters: PTSD & TB in Veterans scheduled for October 10^th 2019 at 5:30pm at the Manhattan Eye, Ear & Throat Hospital (MEETH). It is suggested that people arrive early for the opportunity to sign-in and grab refreshments. Early arrivers will also have the opportunity to sit in on the brief meeting of the New York County Medical Society’s Public Health Committee.

Veterans Matters: PTSD & TBI in Veterans

Where: MEETH
210 East 64^th St.
Manhattan, NY

When: Thursday October 10, 2019 5:30-8:15pm
Faculty: Adolph Meyer, MD

Educational Objectives:

Identifying signs and symptoms of PTSD & TBI
Examining evidence-based treatment modalities
Exploring military culture and methods to overcome barriers to treatment.

RSVP to Lisa Joseph at (212) 684-46-98 or email ljoseph@nycms.org

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.

“Influenza 2019-2020” CME Webinar on October 16; Registration Now Open
The first of MSSNY’s 2020 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2019-2020” on Wednesday, October 16, 2019 at 7:30 a.m. William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here. To view the flyer for this program, please click here.

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

Educational objectives are:

Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
Describe clinical and laboratory diagnostic features and treatment specific to each flu season
Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated

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.

October 17 DOH Grand Rounds Series: Strengthening Community and Health Care Provider Resiliency to Adverse Childhood Experiences
The 2019-2020 Commissioner’s Medical Grand Rounds series, Strengthening Community and Health Care Provider Resiliency to Adverse Childhood Experiences. The session will take place Thursday, October 17^th from 12 noon-2 pm. Please see the attached flyer.

Participants can join online via webcast or in-person at UHS Binghamton General Hospital in Binghamton, New York. As with all DOH Grand Rounds, the session is free of charge.

If you have any questions, contact Susannah Feinstein or Sam Meyer, Student Assistants: Office of the Commissioner at 212-417-4975 or 212-417-4341.

CDC EXTRA
CDC: Vaping Illness Cases Tops 1,000
https://www.cdc.gov/media/releases/2019/s1003-lung-disease.html

Classified

RENTAL/LEASING SPACE

PHYSICIAN OPPORTUNITIES

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

eNews

NORTHEASTERN MEDICAL SOCIETIES URGE CONGRESS TO ENACT FAIR SURPRISE BILLING REFORM LEGISLATION

October 1, 2019 admin

MEDICAL SOCIETY OF THE STATE OF NEW YORK
865 Merrick Avenue, Westbury, New York 11590-9007
www.mssny.org
Communications Division
Telephone: (516) 488-6100

For Immediate Release
October 1, 2019

NORTHEASTERN MEDICAL SOCIETIES URGE CONGRESS TO ENACT FAIR SURPRISE BILLING REFORM LEGISLATION

October 1, 2019, Westbury, NY— Our respective associations representing tens of thousands of physicians across the northeastern United States applaud the many members of the US Congress who are seeking to take action to protect patients from “surprise” medical bills. However, what is needed is a balanced, comprehensive solution to this problem, not a one-sided gift to America’s health insurance companies, some of the richest corporations in the United States. That approach will create shortages in our emergency departments and an acceleration of health care consolidation.

Proposals that have begun to advance in the US House and Senate appropriately prevent patients from facing surprise bills from out of network practitioners. However, they give unilateral control to the insurance industry to determine what should be the cost of care in these instances. No negotiation. No compromise. No recognition of special circumstances surrounding the care delivery. If Congress gives insurers this extraordinary new power, why would an insurer ever fairly negotiate with a physician to be in their patient care networks? In fact, in California, when insurers were given this discretion, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

The comprehensive laws in New York and Connecticut addressing this issue have been widely acclaimed because of the delicate balance it struck among health insurers, physicians, and hospitals to protect patients from surprise medical bills, while also ensuring the ability of hospital emergency departments to have available needed on-call specialty physician care to provide patient care when time is of the essence. In New York, when an insurer and physician cannot agree, the solution is decided through a low cost, simplified dispute resolution system. The arbitrator chooses the side that is more reasonable based upon a number of factors.

The New York and Connecticut laws rely upon benchmarks developed by an independent, non-profit entity that is free from insurer or physician control. This is particularly important given the insurance industry’s own notorious history in establishing benchmarks for out of network payment. In 2009, then New York AG Andrew Cuomo launched an investigation into United Healthcare’s ownership of the Ingenix database. The insurance industry agreed to stop using this conflicted database and agreed to contribute towards the creation of an independent data collection entity, Fair Health, which has become the reference database used by New York.

From the statistics, it is clear that New York’s law is working as it was intended. A just released report from the New York Department of Financial Services showed consumers have saved over $400 million since the law’s enactment. It also reduced out of network billing by nearly 35%. Furthermore, the relatively low number of claims decided since the law was implemented suggests that New York’s system is having the effect of pushing health insurers and physicians to resolve their differences without state intervention.

As stated by NY DFS Superintendent Linda Lacewell, “New York’s law has been a true success in bringing stakeholders together to solve the problem of excessive charges for emergency services and surprise bills.”

Given the success of New York’s law, we are concerned with proposals that will clearly deviate from this carefully crafted approach to the problem. Instead, we urge Congress to look to legislation, such as that sponsored by Congress members Ruiz and Roe (HR 3502), that would emulate New York’s successful approach.

CONNECTICUT STATE MEDICAL SOCIETY
MEDICAL SOCIETY OF DELAWARE
MAINE MEDICAL ASSOCIATION
MEDICAL SOCIETY OF NEW JERSEY
MEDICAL SOCIETY OF THE STATE OF NEW YORK
PENNSYLVANIA MEDICAL SOCIETY

# # #

MSSNY Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York
516-488-6100 ext 302
rraia@mssny.org

eNews

MSSNY-eNews: September 27, 2019 – Lean on Me

September 27, 2019 admin

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 27, 2019
Vol. 22 Number 36

Colleagues:

Please swallow your pride
If I have things you need to borrow
For no one can fill those of your needs
That you won’t let show

–Bill Withers

Physician stress, burnout, abuse, moral injury – there are many names but one thing is true. It’s a thing. Many common pathways sometimes drive physicians over the edge – figuratively but all too often, literally. Suicide is not painless. That a professional with all that’s invested in a career of caring could get to that point of utter desperation is a tragedy of more than Shakespearean proportions.

Physician suicide is not a new development. That physicians run a higher risk of suicide than any other profession has been known since the 1800s. But as Mark Twain said about the weather, everybody talks about it but no one seems to do anything about it. Of course, there are many “holes” in the Swiss cheese effect at play. Many moving parts clearly need to be addressed. Recent attention has been paid to wellness programs.

When an untoward event happens in one large Pediatric Oncology Department, the entire team gets together to discuss, commiserate, empathize with the caregivers. Other groups have social events, trying to restore the camaraderie of the old doctors’ lounge that seems to have disappeared. These efforts are clearly laudable, but they often can only take the edge off.

Physicians know that reaching out for help can come with a price – they can lose their hospital privileges and sometimes their career. While the safety of patients is at stake, the safety of the physician is also in jeopardy. Physician, heal thyself is unworkable. We need action.

I am happy to report that some help is on the way. But it will take effort. AMA (yes, I know) has a program that, in three states, has actually borne fruit. The Medical Society of the State of New York is about to come onboard with this program. You will be hearing more about these efforts in the coming weeks. But of course, then the real work begins – getting various groups to buy in.

Administrators must support the effort with more than a nodding of heads which in the past has only led to the “weeping and gnashing of teeth.” Legislators and regulators must see their way clear to smoothing the road to get this done. Various specialty boards must examine the added stresses they themselves have placed on their members. Physicians must also buy in. Otherwise, we’ll continue to see a mounting butcher’s bill.

It’s time.

Once again, I give you Bill Withers.

Comments? comments@mssny.org ; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

eNews

MSSNY Supports Call to Ban Menthol-Flavored E-Cigarettes
The following statement from MSSNY president Art Fougner, MD was released to the press on September 26:

“The physician community in New York applauds Governor Andrew Cuomo for taking steps to add menthol-flavored vape products to the emergency ban in New York, which took effect last week. We are hopeful that the regulations will be formally expanded when Health Commissioner Howard Zucker, MD, JD convenes another emergency meeting of the Public Health and Health Planning Council, possibly as early as next week.

While flavored vaping products like “Cotton Candy” and “Captain Crunch” are obviously targeted to entice teens to vape, menthol-flavored vape products are equally alluring and should not be available to our youth.

As we attempt to stop this growing public health crisis in New York, we fully support the ban on all flavored e-cigarettes. The health of our children is at stake.”

Cost of Employer-Based Family Health Coverage Hits Record High: $20,576
The cost of health insurance offered to workers through their employers is increasingly unaffordable, according to an annual report from the Kaiser Family Foundation.

The report, which included more than 2,000 interviews with nonfederal public and private firms, found annual premiums for employer-based family health insurance grew to $20,576 this year, surpassing $20,000 for the first time. Year over year, the cost of employer-sponsored family coverage is up 5 percent. On average, workers are paying $6,015 toward the cost of their coverage.

The average premium for family coverage has grown 22 percent over the past five years, according to KFF. Over the past decade, premiums have grown 54 percent. This growth has significantly outpaced growth in workers’ wages or inflation.
To view the full report, click here.

FDA Commissioner Says Agency Should Have Taken Action On Vaping Sooner
The Wall Street Journal (9/25) reports FDA acting commissioner Ned Sharpless said the agency acted too slowly to address vaping. Sharpless’ comments follow reports of hundreds of cases of vaping-related lung injuries, including several deaths.

The Hill (9/25) reports Sharpless told members of the House, “In retrospect, the FDA should have acted sooner, we should have begun regulating these devices sooner. But we’re going to catch up.” Sharpless added that “the agency is working to finalize guidance that will force e-cigarette manufacturers to submit their flavored products for review,” and following that, “all current flavored e-cigarettes — except tobacco— will be removed from the market.”

This Week: Nearly 300 New Cases of Vaping-Related Lung Disease
The CDC now reports 805 cases of confirmed or probable lung injury related to vaping, including e-cigarette use. This is an increase of 275 in the past week. Forty-six states have reported cases.

Some 38% of cases are in people aged 21 or younger. A total of 12 people in 10 states have died. CDC surveillance page for vaping-related lung illness

Appeals Court Orders Judge: Take New Look at Liver Donation Policy
Bloomberg Law (9/25) reports that the US Court of Appeals for the Eleventh Circuit “ordered a district court judge to take a fresh look at whether to temporarily block the Administration’s new policy for distributing donated livers to patients waiting for transplants.” The appellate court “said Sept. 25 the district court must go back and look at whether the Health and Human Services secretary legally had to refer the new policy to the Advisory Committee on Organ Transplantation and post it for public comment in the Federal Register before implementing it.” The new policy is currently on hold.

Research Looks Into Long-Term Effects of Hurricanes on Seniors with Diabetes
A study suggests that “long after the winds have died down and the flooding has subsided, huge hurricanes like Katrina may be shortening people’s lives, especially when it comes to seniors with chronic diseases like diabetes.”

Investigators “studying the short- and long-term effects of hurricanes Katrina and Rita found that older individuals with diabetes who lived in areas impacted by the storms had a 40% higher risk of mortality in the month following the storms compared to elderly diabetics who lived in unaffected counties.” The findings were published in Diabetes Care.

Majority of Data Breaches Involve Information That Could Enable Identity Theft
Reuters (9/23) reports researchers found that “more than 70% of healthcare data breaches in the U.S. have involved sensitive demographic or financial information that could fuel identity theft.” The findings were published in the Annals of Internal Medicine.

NY Society of Addiction Medicine Poster Contest
NYSAM (NY Society of Addiction Medicine) is once again proud to sponsor a competition for medical residents interested in addiction to submit a presentation addressing how addiction affects patients in their specialties. This is now our third year with this successful program. We have had excellent presentations the past two years, and would like to again encourage residents to submit a presentation. Submissions do not require original research, but should demonstrate thoughtful reflection, keen observation, and creativity about addiction and how you can address it through your specialty.

Please click here for competition details/rules. The deadline for submission is December 2, 2019.

The prize is a chance to present at the 2020 NYSAM Annual Conference at the Crowne Plaza Hotel Times Square on February 7-8, 2020. Two winning entries from across New York State will receive free transportation to the conference, a hotel room at the Crowne Plaza for one night, a $250 honorarium, and a plaque.

CME

RSVP Now for Veterans Matters: PTSD & TBI At NY County Medical Society
MSSNY and the New York County Medical Society are proud to announce Veterans Matters: PTSD & TB in Veterans scheduled for October 10^th 2019 at 5:30pm at the Manhattan Eye, Ear & Throat Hospital (MEETH). It is suggested that people arrive early for the opportunity to sign-in and grab refreshments. Early arrivers will also have the opportunity to sit in on the brief meeting of the New York County Medical Society’s Public Health Committee.

Veterans Matters: PTSD & TBI in Veterans
Where: MEETH 210 East 64^th St., Manhattan, NY
When: Thursday October 10, 2019 5:30-8:15pm

Faculty: Adolph Meyer, MD

Educational Objectives:

Identifying signs and symptoms of PTSD & TBI
Examining evidence-based treatment modalities
Exploring military culture and methods to overcome barriers to treatment.

RSVP to Lisa Joseph at (212) 684-46-98 or email ljoseph@nycms.org

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.

New Podcasts on Health Matters for Women
MSSNY proudly announces the addition of three new podcasts on Health Matters for Women to our podcast site here. The podcasts offer a variety of timely and relevant topics from health topics that concern women to emergency preparedness to veteran’s matters and adult immunizations. MSSNY’s latest podcast productions on Health Matters for Women are listed below.

Listen to Dr. Lisa Eng discuss Health Matters for Women: Endometriosis here.
Listen to Dr. Florence Shum discuss Health Matters for Women: Fibromyalgia here.
Listen to Dr. Florence Shum discuss Health matters for Women: Chronic Fatigue Syndrome (Myalgic Encephalomyelitis) here.

33^rd Annual Conference of Medical Society Executives

Attendees gather at the 2019 Annual New York State County and Specialty Society Executives Conference in Hunter, New York. It is a tradition that enables executives from around the state to learn from and support each other in helping doctors to win the battles they face each day. MSSNY president Arthur Fougner, MD spoke to the group about MSSNY’s strategic initiatives, while MSSNY’s Chief Legislative Counsel Moe Auster recapped the 2019-2020 MSSNY priorities, including single payer. James Beckner, executive director of the Richmond Academy of Medicine in Virginia, spoke about the county’s award-winning experience in engaging early career physicians in society activities

Attendees gather at the 2019 Annual New York State County and Specialty Society Executives Conference in Hunter, New York this week. It is a tradition that enables executives from around the state to learn from and support each other in helping doctors to win the battles they face each day. MSSNY president Arthur Fougner, MD spoke to the group about MSSNY’s strategic initiatives, while MSSNY’s Chief Legislative Counsel Moe Auster recapped the 2019-2020 MSSNY priorities, including single payer. James Beckner, executive director of the Richmond Academy of Medicine in Virginia, spoke about the county’s award-winning experience in engaging early career physicians in society activities.

Classified

RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17^th Street and 5^th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etc. Central HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room

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

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

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

PHYSICIAN OPPORTUNITIES

Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

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

eNews

MSSNY Supports Call to Ban Menthol-Flavored E-Cigarettes

September 26, 2019 admin

For Immediate Release

September 26, 2019

MSSNY Supports Call to Ban Menthol-Flavored E-Cigarettes

Statement attributable to:
Art Fougner, MD
President, Medical Society of the State of New York

As we attempt to stop this growing public health crisis in New York, we fully support the ban on all flavored e-cigarettes. The health of our children is at stake.”

# # #

Founded in 1807, the Medical Society of the State of New York is the state’s principal nonprofit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality healthcare services for all.

Media Contact:
Roseann Raia
Communications / Marketing
Medical Society of the State of New York
865 Merrick Ave.
Westbury, New York 11590
516-488-6100 ext. 302

eNews

MSSNY eNews: Watching the Detectives – September 20, 2019

September 18, 2019 admin

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 20, 2019
Vol. 22 Number 35

Colleagues:

On Monday, MSSNY applauded Gov. Cuomo’s emergency executive action to ban the sale of flavored e-cigarettes in the state. Flavored vaping products like “cotton candy” and “Captain Crunch” are obviously targeted to entice teens to vape. The health of our children is at stake. It’s time to address this head on before it affects an entire generation.

Vape Lung, VALI (Vaping-Associated Lung injury), Allergic Pneumonitis, Lipoid Pneumonia – these are all names for an acute and sometimes fatal lung injury which leaped into our lexicon as summer was coming to an end. Seven deaths and over 400 cases have been reported thus far in 36 states and the US Virgin Islands. Presentation is often fulminant, yet cases with slower onset have been reported. While clinical presentation resembles lipoid pneumonia, imaging is not typical for that disorder. Reports have been associated with street level THC products.

NY’s Department of Health issued an update on September 5th:

… As of September 5, 2019, the Department has received 34 reports from New York State physicians of severe pulmonary illness among patients ranging from 15 to 46 years of age who were using at least one cannabis-containing vape product before they became ill. However, all patients reported recent use of various vape products.

Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing.

At our meeting with NY State’s Commissioner of Health Dr. Howard Zucker on Tuesday, we were assured the Wadsworth Laboratory had not isolated any vitamin E acetate in any of NY’s Dispensary Medical Cannabis product.

Other investigators are not so sure Vitamin E is the only etiologic factor in vape lung, suggesting some patients have not fit the street pot Vitamin E pattern.

Curiously, the cases appear to be limited to the US and its territories. For example, Canada, despite its proximity, has reported no cases. There have been no cases thus far in the UK as well. The UK had banned certain flavored nicotine vaporizer oils because they contained diacetyl which had been linked to lung disease. Michigan and now New York have banned flavored e-cigs. We can only hope this makes a dent in the incidence of these cases.

Eerily reminiscent of the 1980’s Tylenol murders, the FDA has launched a criminal investigation. (See story below.)

For now, the take home message from WarGames applies – “The only winning move is not to play.”

We’ll all be watching the detectives.

Late-breaking news: Governor Andrew M. Cuomo and State Department of Health Commissioner Dr. Howard Zucker today re-issued a warning to New Yorkers to continue to refrain from using e-cigarette or vaping products as the number of vaping-associated illnesses sharply increases both nationally and in New York State. https://www.governor.ny.gov/news/governor-cuomo-and-health-commissioner-zucker-issue-renewed-warning-vaping-associated-illnesses

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

eNews

FDA Launches Criminal Probe as Vaping-Related Illnesses Top 500
In an update on the vaping crisis, federal health officials said today that, as of September 17, the number of confirmed and probable cases of lung injury associated with e-cigarettes and vaping products has climbed to 530 in 38 states and one territory, prompting the FDA to launch a criminal investigation into the possible causes.

“Sadly,” seven patients from six states have died as a result of their illness and “we do expect others,” Anne Schuchat, MD, principal deputy director, US Centers for Disease Control and Prevention (CDC), told reporters in a telebriefing.

She said the CDC will update case counts every Thursday going forward.

Earlier this week, the CDC activated its emergency operations center to help coordinate the investigation into the growing number of cases of severe lung illnesses linked to e-cigarette use.

The exact cause of vaping-related lung illness remains elusive. This investigation is “dynamic and complex and I wish we had more answers,” Schuchat said. “States are classifying cases and reporting them to CDC on a regular basis.”

She emphasized that “no consistent e-cigarette or vaping product, substance, additive, or brand has been identified in all cases; nor has any one product or substance been conclusively linked to lung injury.” Many patients reported using multiple types of products, some containing tetrahydrocannabinol (THC), THC plus nicotine, or nicotine only.

Based on available data, Schuchat said three quarters of the cases are males, two thirds are in people 18-34 years of age, 16% are younger than 18 years of age, and 17% are age 35 years or older. In all, more than half of the cases are under 25 years of age. Patients typically have reported cough, shortness of breath, and/or chest pain, gastrointestinal symptoms (nausea, vomiting, or diarrhea) as well as fatigue and fever.

The CDC continues to recommend that people consider not using e-cigarette products while investigations are ongoing.

Council Notes—September 19, 2019
Council approved the following:

MSSNY will recommend that the AMA seek legislation to ban anti-assignment provisions in health insurance plans and to support legislation requiring health insurers to issue payment directly to the physician when the patient or patient representative signs an agreement that permits payment directly to the physician.
MSSNY will advocate for increased payment for office based afterhours CPT Codes.
MSSNY will advocate for legislation and regulation requiring ALL credentialed physicians (employed and voluntary) be equally included on their hospital websites and Find-a-Doctor sites of the hospitals and other health care facilities and will recommend the AMA do the same.
MSSNY commends the Governor and the DOH Commissioner for their action to protect patients by banning sale of flavored e-cigarettes; recommends a moratorium on dispensing of vaporized products to new certificate holders for medical marijuana until data on long term safety is available; recommends rescheduling marijuana to Schedule II; and recommends funding in the State Budget for study of efficacy and harms of the current medical marijuana program.
MSSNY will create a Scope of Practice Ad Hoc Committee with the following members: Rose Berkun, MD, Co-Chair; Lisa Eng, DO, Co-Chair; Inderpal Chhabra, MD; Atul Kumar Gupta, MD; Richard Wissler, MD.
MSSNY will adopt the Accreditation Council for Continuing Medical Education (ACCME) Menu of New Criteria for Accreditation with Commendation. This year marks the end of a transition period in which CME providers had a choice between demonstrating the old commendation criteria and the new. Additionally, MSSNY will adopt the revised CME Annual-Reporting Requirements for MSSNY-accredited CME providers.

Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still 617 bills that passed both houses in 2019 that were awaiting delivery to the governor. In the past week alone, 59 bills were chaptered into law – the flurry of bill signings has begun. Of those 617, there are a few that stand out as priorities for MSSNY. When these bills arrive at the governor’s desk, he has to decide whether to sign them into law or to veto them and as such there is still a strong opportunity to influence the decision-making process.

Physicians can quickly and easily send a letter to the Governor here on these issues by using the MSSNY Grassroots Advocacy Center at http://tiny.cc/MSSNYGAC (direct links to these priority items are listed below). Please take a moment to voice your support/concerns on these very important issues!

Mid-year formulary changes – would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year. Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please reach out to the governor and let him know how helpful this bill would be by clicking here.
Partial prescription fills – would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
Malpractice expansion – two bills passed the legislature that will further tip the scales in lawsuits against physicians and others, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please let the governor know how destructive these bills would be by clicking here.

Please Continue the Fight for a Fair Solution to Surprise Medical Bills; NY Law a Great Success
Please continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair federal legislative solution to the issue of surprise medical bills. By clicking here, you can send a letter, make a tweet and make a phone call to your elected officials. It only takes a few minutes and contains all of the details necessary to get our point across.

This week, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation. Moreover, it noted that there were a total of 2,595 IDR decisions reached. With regard to IDR for out of network hospital “surprise” bills, 815 IDR decisions were rendered. Health plans prevailed in 13% of the cases, while physicians prevailed in 48% of the cases. There were split decisions in 39% of the cases. With regard to IDR for out of network emergency care services, 43% of decisions were in favor of the health plan, 24% were in favor of the provider, and 33% were split between the health plan and provider.

While MSSNY together with physician groups across the country are working diligently to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of legislation that emulates New York’s successful model, such as H.R.3502, sponsored by Representatives Ruiz and Roe. At the same time, grave concerns have been raised about the alternative being pushed by insurance companies (H.R.3630, sponsored by Representative Pallone, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.

When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

New York’s Opioid Tax Creating Concerns
Fortune (9/16) reports that New York “became the first state to place an excise tax on opioids sold to or within the state,” with supporters expecting “the tax to generate $100 million in revenue for the state, which Gov. Andrew Cuomo and his administration have said will be plowed into helping victims of the opioid crisis.”

The idea behind the tax “was to punish pharmaceutical companies for their role in the opioid epidemic,” but “the tax, which went into effect July 1, has already set off a ripple effect across the entire supply chain, as manufacturers and distributors have either stopped shipping to the state altogether or passed the tax onto each other.” Additionally, regarding the fear of social costs, health officials are concerned “the tax could drive patients to seek out opioids on the black market.”

If you have patients who are having difficulty obtaining their opioid prescriptions, MSSNY wants to hear from you so that we can ascertain how widespread this problem is. Please email mauster@mssny.org with any information you have regarding this situation.

Weill Cornell: Free for Students Who Qualify
On Monday, Weill Cornell Medicine in New York City, announced that all students who qualify for financial aid will get a full ride: All costs will be covered by scholarships, including tuition, room and board, books and other educational expenses. “Student debt has been in the national discussion for a long time, and we have been planning, strategizing and raising money,” said Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine and provost for medical affairs at Cornell University. “It’s the right time to offer debt-free medical education.”

In 2017, Columbia University announced a new endowment that it said would eliminate the need for medical students to take out loans for tuition; the neediest would also have living expenses covered. The David Geffen School of Medicine at the University of California, Los Angeles, offers full rides to about 20 percent of its entering classes, though the awards are based on merit, not need. In August 2018, the New York University School of Medicine said it would cover tuition for all its current and future students.

Of Weill Cornell’s 373 students, 52 percent qualify for need-based aid. A single year at the school — which sits in one of America’s most expensive ZIP codes, on the Upper East Side of Manhattan — costs more than $90,000, according to Weill Cornell. With need-based grants for the last academic year averaging about $38,000, students often relied on federal loans to bridge the difference. The average debt for a graduate of the program this year was $156,851. (NYT Sept.16)

Zocdoc Gets Federal OK to Book Medicare and Medicaid Visits
Zocdoc would not violate the federal anti-kickback statue by charging physicians for each Medicare or Medicaid beneficiary who books an appointment through its website, according to an advisory opinion issued by the U.S. Department of Health and Human Services’ Office of the Inspector General.

The opinion does not mention Zocdoc by name but Dr. Oliver Kharraz, Zocdoc’s CEO, wrote a blog post sharing the opinion. Kharraz said Zocdoc will restore access to its appointment-booking service for all Medicare beneficiaries and Medicaid beneficiaries in certain states including New York on Sept. 18. Zocdoc began charging doctors per new patient booking earlier this year, frustrating New York doctors who had grown accustomed to paying a flat monthly fee for access to the services. At that time, it restricted Medicare and Medicaid beneficiaries from using the service to book appointments to avoid running afoul of federal law.

It has now received guidance from the state Attorney General, state Department of Health and HHS that its pricing policy wouldn’t violate the law with certain caveats. (Crain’s Sept.17)

Most Not Screening Patients for All Five Social Needs Recommended by Feds
Researchers found that “most U.S. physician practices and hospitals are screening patients for at least one social need, but only a small percentage are screening for all five social needs recommended by the federal government.” The five social needs are: Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence.

The findings were published in JAMA.

CME

Sign Up for the Morning Briefing on October 17 in Binghamton
Strengthening Community and Health Care Provider

Resiliency to Adverse Childhood Experiences

Thursday, October 17, 2019 • 12 – 2 pm
UHS Binghamton General Hospital
Russell Community Room
10-42 Mitchell Avenue
Binghamton, NY 13903

The session will also be archived on the Department of Health website. The event is free of charge and available to all interested providers throughout New York State. Participants are eligible for 2.0 CME credits. Flyer.

MLMIC Presentation: Hot Topics in Healthcare: LIVE CME EVENT
Presenters: MLMIC and MAGNACARE
When: Tuesday, September 24, 2019
Time: 9:00 AM to 12:30 PM

Where: Long Island Marriott, 101 James Doolittle Blvd. Uniondale, NY 11553

CMS

The Deadline to Submit a MIPS Targeted Review Request is 2 Weeks Away
If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website. The MIPS payment adjustment you will receive in 2020 is based on your final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2020.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request for CMS to review their performance feedback and final score calculation through a process called targeted review. The deadline to submit your request is September 30, 2019 at 8:00 PM (EDT) – which is just 2 weeks away.

When to Request a Targeted Review

If you believe an error has been made in your 2020 MIPS payment adjustment factor(s) calculation, you can request a targeted review until September 30, 2019 at 8:00 PM (EDT). The following are examples of circumstances in which you may wish to request a targeted review:

Errors or data quality issues for the measures and activities you submitted

Eligibility and special status issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)

Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard

Note: This is not a comprehensive list of circumstances. CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by going to the Quality Payment Program website

Classified

RENTAL/LEASING SPACE

Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom. Common waiting room, back office filing space and reception desks included. Affordable rent. Location East 60s between Park and Lexington. Easy distance to Lenox Hill Hospital and New York Cornell. Subway access within 1 block. Immediate occupancy available. Call James: 917-710-7643

Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers.

PHYSICIAN OPPORTUNITIES

We have openings in the following counties offering a choice of urban, suburban or rural living:

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

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

eNews

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