PRESIDENT’S MESSAGE
Charles Rothberg, MD |
June 30, 2017
Volume 17
Number 25 |
Dear Colleagues:
According to the Washington Post, Senate Majority Leader Mitch McConnell (R-KY) “intends to send a revised version of his health-care bill to the Congressional Budget Office today according to Capitol Hill aides and lobbyists.” This timeline points to McConnell’s attempt to hold a vote before the August recess.
We need to promote a message, by July 3, to Mitch McConnell and all the federal legislators, while they are home in their districts, that what is needed is to fix the health insurance system— not healthcare.
If we get them to rethink patient costs related to premiums, deductibles, co-insurance and/or co-payments, then affordable, usable quality healthcare can be provided to patients with medical needs. (A $6000 deductible is not usable to most people.) Both political parties will need to work together to get this done.
To help make America greater, we must put away party politics and get health insurance reform back on track. Outrageous deductible amounts are unaffordable to working families with health care needs. High deductibles mean high out-of-pocket cost to insureds, who (despite high premium costs) are left with paying for office visits as though they don’t have insurance. This is not right.
For example, an individual insurance premium of $10K+ annually, whereby that individual pays $140 in co-payments for TWO specialist visits and $80 for TWO PCP visits, while the health plan pays just $20 for all FOUR visits is not right either. Before Obamacare, this ‘feature’ of managed care was a deplorable hurdle and it still is. It was not right then, it is not right now. Current proposals don’t appear to address this issue at all.
The insurance industry is to blame and that is where more focus should be. There is far too much talk about perverse ‘incentives’ and ‘payment reform’ for providers of medical services such as physicians and hospitals. That, too, is wrong. Insurance reform is what is needed to fix the ills in the system.
Now – Senate, House, Republican and Democrat, how do you propose do fix the system?
Sincerely,
Charles Rothberg, MD
MSSNY President
Please send your comments to comments@mssny.org
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
US House Passes Medical Liability Reform Bill
By a largely party line 218-210 vote the US House of Representatives passed legislation to expand patient access to care by reducing the exorbitant cost of medical liability insurance. Among other provisions, the bill contains a provision that would limit to $250,000 the amount of non-economic damages that could be awarded in cases where the patient is enrolled in a Government-subsidized program like Medicare, Medicaid or an Exchange plan. It would also define federal standards for attorney contingency fees, statutes of limitations, certificates of merit and prohibiting apologies from being introduced into evidence.
After the bill was passed, MSSNY President Dr. Charles Rothberg issued the following statement praising the action of the US House:
“We have long maintained that medical liability reform is an essential component of health reform. We commend the House of Representatives for passing legislation (HR 1215) that if enacted could help to reduce some of the extraordinary costs faced by our physicians and hospitals and restore some balance to our medical liability system.
New York State was recently designated as the worst state in the country to practice medicine, in large part due to our excessive liability exposure as compared to all other states. Indeed, physicians in New York City, Long Island and the Lower Hudson Valley pay some of the highest liability premiums in the country. New York not only far exceeds all other states in terms of total medical liability payouts, we also spend more on a per capita than any other state in the country.
The actions of the US House of Representatives to address this huge problem stands in stark contrast to the New York State Legislature, which despite New York’s exorbitant costs, just passed legislation that would actually expand lawsuits against doctors and hospitals and impose huge new costs. MSSNY and many other health care provider associations are urging Governor Cuomo to veto this legislation.
As efforts continue to be undertaken to fix the flaws of the Affordable Care Act, we urge that comprehensive medical liability reform be included in these efforts.”
All 9 Republican members of New York’s Congressional delegation (Collins, Donovan, Faso, Katko, King, Reed, Stefanik, Tenney and Zeldin) voted in favor of the bill. All 18 Democrat members of New York’s Congressional delegation (Clarke, Crowley, Engel, Espaillat, Jeffries, Higgins, Lowey, C. Maloney, S.P. Maloney, Meeks, Meng, Nadler, Rice, Serrano, Slaughter, Suozzi, Tonko, and Velasquez) voted against the bill.
At this point, it is not clear what the Senate will do with this legislation. It has been reported that some US Senators are seeking to include medical liability reform provisions within the broader health care reform debate.
Tell Governor Cuomo to Reject Medical Liability Expansion Bill and Call for Comprehensive Liability Reform
All physicians are urged to call Governor Cuomo at 518-474-8390 and send a letter here urging that he veto a so-called “cancer only” medical liability statute of limitations expansion bill (S.6800/A.8516) that passed the Legislature over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC. Please urge that legislation be enacted instead that provides for comprehensive medical liability reform.
This ambiguously drafted bill, introduced in the final days and passed in the final hours of the 2017 Legislative Session, would expand the medical liability statute of limitations for cases involving “alleged negligent failure to diagnose a malignant tumor or cancer”. The bill would permit lawsuits 2.5 years from the “date of discovery” of such alleged negligence, up to an outside limit of 7 years.
While it is likely that a more narrowly focused bill will reduce somewhat the premium increase needed from the 15% projected increase for an earlier version of this bill, there is great ambiguity in the legislation as to which cases the 7-year limit would apply that will undoubtedly generate significant litigation. Moreover, the bill does not just apply to treatment that occurs after the proposed effective date of the bill but has a very significant retroactive impact, subject to numerous interpretations, for which insurance companies have not reserved premium dollars (another reason to veto the bill!). These errors and/or ambiguities are likely the result of the bill being “rushed into print” to meet the constitutional “3-day aging” requirement before a bill can be considered by the Legislature.
Besides the bill’s drafting errors, of greatest concern, the bill completely ignores the exorbitant medical liability costs that New York physicians already pay, which was reflected in MSSNY President Dr. Rothberg’s statement about the failings of this bill:
“New York’s physicians are extremely concerned about the ultimate impact to New Yorkers’ access to care if the statute of limitations expansion bill (S.6800/S.8516) considered by the Legislature today is ultimately signed into law. Many New York hospitals and physicians are already struggling to keep their doors open.
New York State has already earned the dubious distinction as the absolute worst state in the country in which to practice medicine, in large part due to its overwhelming liability costs. The bill will add significantly to these costs that have already driven physician after physician out of private practice, and in many cases driving them out of New York altogether. It will also discourage countless others from coming here to practice. We urge Governor Cuomo to veto this legislation and bring parties together to pass comprehensive, not one-sided, medical liability reform. New Yorkers’ access to health care is at stake.”
Again, please urge the Governor to veto this bill and encourage your colleagues to do the same! Please let the Governor know how this bill will harm patient care and exacerbate existing physician shortage issues in your community.
MSSNY President Issues Statement Expressing Deep Concerns US Senate Health Reform Legislation, Communicates to NY Congressional Delegation
As the US Senate was deciding this week whether to begin floor debate on its proposal to repeal and revise much of the Affordable Care Act, MSSNY President Dr. Charles Rothberg issued the following statement expressing deep concerns about the legislation’s impact to New York:
“While a wholesale review of the flaws of the ACA should be undertaken, we are deeply concerned about potentially significant adverse consequences to New York’s residents and its health care system arising from proposals before the House and Senate.
The House and Senate bills will replace the low cost coverage hundreds of thousands of New Yorkers currently have with tax credits that for many will be insufficient to purchase coverage. Patients may face huge new out of pocket costs or worse, they may not purchase any coverage at all. In addition, we also have strong concerns about the bill’s long-term impact on funding for New York’s health care system.
We look forward to working with the members of New York’s Congressional delegation and urge that they work towards enactment of legislation that enhances rather than reduces affordable and comprehensive coverage options for our patients. We also urge that they work proactively with physicians and physician advocacy associations to ensure that proposed remedies will truly address patient care and coverage needs.”
This week, MSSNY also joined on to a letter to New York’s Congressional delegation along with over 30 other New York health care advocacy organization that noted that “By eliminating the cost-sharing reduction payments in 2020, and pegging tax credits for consumers to the very low actuarial value Bronze Plan, the Senate bill will significantly reduce funding for our state’s Essential Plan, jeopardizing coverage for 700,000 low-income New Yorkers. These changes will also lead to higher prices in our state’s individual insurance market, especially for older New Yorkers. And the bill hits providers hard by imposing cuts at the same time as the number of uninsured people seeking care will rise.” Specifically, the letter called on New York’s Congressional delegation to:
- Ensure uninterrupted health insurance coverage for the 24 million Americans, including the 850,000 New Yorkers, who gained coverage under the Affordable Care Act (ACA);
- Do not harm New York State’s budget and do not shortchange New York’s Medicaid program by repealing the expansion under the ACA and profoundly restructuring it into a per capita cap program;
- Protect the more than 700,000 New Yorkers who gained coverage under the ACA’s Essential Plan;
- Do not harm health care consumers and providers;
- Maintain and improve our insurance markets for individuals, families, and small employers
MSSNY/County Society Physician Leaders Participate in Regional ACA Town Hall Forums
This week MSSNY and county society physician leaders participated in forums organized by the Cuomo Administration designed to highlight concerns to the public with the legislation before the Congress that would repeal and revise much of the Affordable Care Act (ACA). MSSNY Treasurer and Cobleskill internist/pediatrician Dr. Joseph Sellers participated at the forum in Hudson, and Erie County Medical Society President and Roswell Park urologist Dr. Willie Underwood participated at the forum in Buffalo (along with former MSSNY House of Delegates Speaker and AMA President Dr. Nancy Nielsen).
Both Dr. Sellers and Dr. Underwood noted that it was appropriate for Congress to examine and seek to fix the flaws of the ACA, given the increasing use of health plans with narrow networks and high deductibles. However, both Dr. Sellers and Dr. Underwood noted MSSNY’s concerns “with proposals before Congress that would replace provisions that may cause New Yorkers who currently have low cost, “first dollar” coverage through the Essential Plan or expanded Medicaid to lose this coverage. Instead they will have to purchase coverage with tax credits where they may only be able afford policies with high deductibles and other high cost sharing responsibilities.
Or worse yet, they may not purchase any coverage at all.” Moreover, both articulated to the Governor’s top health care staff at these forums the importance of including medical liability reform within ACA reform discussions, given New York’s recent designation as the worst state in the country to be a physician, in large part due to its excessive liability costs.
AG: Would Sue Federal if Provision Affecting NY Medicaid Spending Became Law
Crain’s New York Business (6/27) reports New York Attorney General Eric Schneiderman said on Tuesday that he would “sue the federal government if Senate Republicans pass their bill to repeal the Affordable Care Act.” Schneiderman said the measure unconstitutionally interfered in the governance of New York by shifting Medicaid costs from counties to the state government.
MSSNY President Charles Rothberg, MD with Jerome Adams, MD
MSSNY Supports Dr. Jerome M. Adams’ Nomination as US Surgeon General
Indiana State Health Commissioner Jerome Adams, MD, MPH, has been nominated as Surgeon General of the US by President Donald Trump.
Trained as an anesthesiologist, Adams has been outspoken about the risks of prescription opioid painkillers and the need to address the opioid epidemic. Dr. Adams took the helm at the Indiana Health Department in October 2014. Just a month later, the first cases of what would later be recognized as a full-blown HIV outbreak were detected in the community of Austin in southeastern Indiana.
The virus was being spread primarily by intravenous drug users sharing needles to inject the prescription opioid oxymorphone. In 2015, Dr. Adams worked to persuade then Governor Michael Pence to authorize an emergency needle exchange for 30 days, although Governor Pence was morally against needle sharing.
MSSNY President Charles N. Rothberg, MD, stated, “Dr. Adams has a proven track record to make public health a priority despite political hurdles. He is reminiscent of Dr. C. Everett Koop (US Surgeon General, 1982-1989), who was a champion of public health. Dr. Adams is in touch with the public needs.”
Dr. Adams wrote in May 2015, “We are building a model for prevention and response should this type of outbreak happen in other communities in the US. I would like nothing better than to tell you this unprecedented HIV epidemic will never happen anywhere else. But I can’t do that.”
In July of 2016, Indiana joined the list of states with standing orders for naloxone, the antidote to revive people who overdose on opioids. Subsequently, Indiana, residents can go to registered pharmacies, nonprofit organizations, and health centers and get naloxone without needing a prescription.
In 2016, Dr. Adams gave a presentation on fighting the spread of hepatitis C and HIV at the National Rx Drug Abuse & Heroin Summit in Atlanta. He said in his presentation, “Speak to your audience in their language. To change behavior, public health program workers need to confront ignorance and denial, conduct small pilot programs, and use successes to gain support.”
Dr. Adams earned bachelor’s degrees in biochemistry and biopsychology from the University of Maryland in 1997. He then earned a master’s degree in public health from the University of California at Berkley, and a medical degree from the Indiana University Medical School. He has been a researcher at medical schools in both the Netherlands and Zimbabwe and has worked under Nobel Prize winner Dr. Tom Cech.
Dr. Adams is married and has three children.
Click here to read press coverage of MSSNY’s support of Dr. Adams’ nomination.
NYS Provider & Health Plan Look-Up
The New York State Department of Health, together with the NY State of Health, this week announced the launch of the NYS Provider & Health Plan Look-Up, an online tool that consumers can use to research those health insurance plans with which a physician (and other health care practitioners) participates. It also lists practice locations for each physician. Previously, a consumer would have to go to the website of each health insurance company to determine if a physician participated with a particular plan.
Physicians should take the opportunity to go to the website to see with which health plans they are listed to participate to determine if there are inaccuracies in their listings. The most efficient way to report an error is for the physician or someone on his or her behalf to select the Contact Us button on the website. Then select the health plan and the reason for the contact. The issue will be routed electronically to the DOH and to the selected health plan(s) for review and follow-up.
CDC Working on New Approach for Early-Stage Lyme Disease Detection
STAT (6/28) reports that the number of Lyme disease cases is rising, and given that the current FDA-approved laboratory test does not consistently detect the disease in its early stages, the CDC is focusing on creating a new Lyme test using “metabolomics,” which measures “metabolite biosignatures” rather than the body’s immune response. The article extensively quotes CDC microbiologist Claudia Molins, who says, “We want a test that can be used within the first two weeks of infection and that does not rely on antibody production.” STAT adds that by using metabolomics, “the CDC aims to create a Lyme ‘signature’ of small molecules in the blood – an approach that, in early testing, catches a dramatically higher share of early infections.”
2018 EHR Hardship Exemption
July 1 is the deadline for avoiding the 2018 penalty imposed by the federal government’s Electronic Health Record (EHR) Incentive Program in its final year if you were not successful in reporting Meaningful Use in 2016 (the performance year for the 2018 penalty). If you think you might not have reported sufficient data please review the following links:
Instructions
Hardship Application
The deadline for the hardship application is 11:59 PM on Saturday, July 1, 2017
Social Security Number Removal Initiative (SSNRI)
As we reported previously, beginning in April 2018, CMS will start mailing new Medicare cards with Medicare Beneficiary Identifier (MBIs) to people with Medicare. CMS is figuring out the best way to mail the cards. CMS will keep clinicians and beneficiaries posted about critical information so everyone can be ready to ask Medicare patients at the time of service if they have a new card with an MBI.
Beginning in October 2018, through the transition period, when physicians submit a claim using the patient’s valid and active Health Insurance Claim Number (HICN), NGS Medicare will return both the HICN and the MBI on every remittance advice. The MBI will be in the same place you currently get the “changed HICN.” The new MBI format is explained at the following website: https://www.cms.gov › Regulations and Guidance › EHR Incentive Programs
Important Modification on E&M Exam for Expanded Problem and Detailed Levels
The originally planned differentiation in examination requirements for Expanded Problem Focused (2-5) and Detailed (6-7) levels of service will no longer be considered mandatory for providers as of 7/1/2017. NGS developed these suggestions in response to multiple provider queries on the original levels (both EPF and Detailed at 2-7), and has received strong provider support for delineating the two levels as a means of more accurately coding a service.
We will not, however, mandate the changes as previously announced; all medical records reviewed will be subject to the original standard of 2-7 or the newly suggested levels of 2-5 and 6-7, in whatever manner is more beneficial to our providers. These suggestions apply to services coded as per the CMS 1995 Documentation Guidelines for Evaluation and Management Services; suggestions do not apply to services coded as per the CMS 1997 Documentation Guidelines for Evaluation and Management Services.
The posted NGS Evaluation & Management Documentation Training Tool reflects the 2-7 exam component standard for both coding levels, and will remain unchanged.
CLASSIFIEDS
Medical Space Available for Leasing
Currently (last 7 years) occupied by Lab Corp.
2,500 sq. ft. ADA compliant.
25-15 Steinway Street, Astoria, NY 11103
Please contact Landlord: 1-800-283-0602;
e mail:
wwwevans@yahoo.com
Office Space Available within Beautiful Medical Spa in Woodbury NY
Seeking an MD that is looking to rent space in Woodbury, NY within a beautiful, state-of-the-art Medical Spa. Located in the Woodbury Common with high profile brands such as Soul Cycle, Athleta, Chop’t and more, this area is exclusive, elite and high-traffic. Rental space can include from 1 – 4 rooms with office space, shared reception and retail area. Size of area and price are negotiable. Great opportunity to share like-minded patients.
ssoni@becomemedspa.com.
Manhasset Suite
Medical Suite to share- located at 1201 Northern Blvd, Manhasset. The medical space includes 4 exam rooms and consultation rooms. Direct access to office- NO STEPS. Conveniently located between St.Francis Hospital and NS/LIJ Hospitals. For more information, please call 516-365-4616 or email
RSwe777@aol.com
Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at
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Physician Opportunities
Position Available for Critical Care Physician to Join Established Practice in Nassau County, Long Island, NY.
The Physician will join our existing team of Board-Eligible/Board-Certified Intensivists. This is a PT/FT position including both nocturnal and daytime responsibilities. The Physician will work with a dedicated group of highly trained mid-level practitioners, respiratory therapists and nurses to provide Critical Care at St. Francis Hospital in Roslyn, NY. St. Francis was ranked one of the top 10 hospitals in the nation for Cardiac Care and is top rated nationally in seven other adult specialties.
We are expanding our Intensivist Program and are expecting to add an Intensivist to our group.
Nassau Chest Physicians, P.C. was established in 1978 to provide state-of-the-art care to patients with pulmonary diseases on Long Island. We have expanded our practice to include 8 Intensivist/Pulmonologists and 5 pure Intensivists. Since 2006, we have assumed management of Critical Care services at St. Francis Hospital-The Heart Center in Roslyn, NY.
St. Francis Hospital is New York State’s only specialty designated cardiac center and is a nationally recognized leader in cardiology and heart surgery, ear-nose-throat, gastroenterology and GI surgery, geriatrics, neurology and neurosurgery. More cardiac procedures are performed at St. Francis than at any other hospital in New York State. The hospital is located on the North Shore of Long Island; approximately 30 minutes from Manhattan. The hospital combines unrivaled expertise in cardiovascular medicine with top-ranged nursing (AACN Magnet Award) to provide the very best in patient care.
In addition, St. Francis offers excellent Thoracic, Vascular, Oncologic, Neurosurgical, and Orthopedic Surgical Programs. We have a very active Emergency Department. The hospital offers the latest in technologies such as Therapeutic Temperature Modification, Impella, ECMO and LVAD. Our excellent and experienced medical staff supports strong medical and surgical subspecialty programs.
Aside from Certified Critical Care Nurses, many who have more than 20 years of experience and are expert at caring for this complex patient population, we have a growing pool of Intensivist mid-level practitioners who work hand in hand with our Intensivist physicians to coordinate the care of the critically ill patient, minister to them and perform procedures.
Of course, a New York License is required. J1 or H1 VISAS accepted.
Additional Salary Information: Salary and benefits are competitive and commensurate with experience. Interested applicants, send resume to: dr.sorett@nassauchest.com
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355