MSSNY eNews: August 21, 2020 – The Scope of the Problem


Dear Colleagues:

Healthcare is a team effort that is optimized when the team members, including the patients, work together—communicating, merging observations, expertise, and decision-making responsibilities—with the common goal of providing the safest, best possible care.  Effective teams, whether in healthcare, sports or other arenas, have leaders. In healthcare, those leaders are the physicians who have 7 years or more of postgraduate education and at least 10,000 hours of clinical experience.

There is no “I” in Team: Independent and Team are Mutually Exclusive

Over the last decade, there have been movements to disrupt the physician led team with calls for non-physician health care practitioners to practice independently.  However, independent and team are mutually exclusive.  There is no “I” in team— “independence” fragments our teams, puts our team members at odds, creates confusion for patients, drives up healthcare costs and most importantly, threatens quality and safety. Particularly disturbing and worrisome is that the pandemic is being used as an excuse to accelerate independent practice and bypass the usual checks and balances on changes in scope of practice.

During the peak of the pandemic, the Governor issued an Executive Order that eliminated physician supervision/collaboration requirements for non-physician practitioners as part of an “all hands-on deck” approach.  Thankfully, in New York we currently have among the lowest number of COVID-19 cases in the country and yet various Executive Orders, including last week’s Executive Order 202.55 that continues the waiver of otherwise required supervision and/or collaboration, have been issued.

MSSNY has urged the Governor’s office and the legislature to restore the statutory supervision and/or oversight requirements as soon as possible. The length of time that these supervision requirements have been waived has become a de facto scope of practice change that has bypassed the State Legislature—and some non-physician practitioners are applying to work outside of hospital settings in a far different scenario than the reason that the supervision requirements were waived in the first place.

A Disturbing Trend

Further demonstrating this disturbing trend, this week the U.S. Department of Health and Human Services (HHS) issued emergency authorization to allow state-licensed pharmacists to order and administer all vaccines to children and adolescents ages 3-18 years, a move that will create further chaos in getting children properly immunized. Taking children out of the medical home where they can get immunized, get screened for developmental milestones, and get the medical care that they need, will only lead to a further fragmentation of a child’s health care. This is contrary to a team approach, and the legality is questionable as this presumes to pre-empt state statutes.

Physician led teams are the best vehicle to achieve the quadruple aim of providing better patient experience, better population health, lower overall costs and improved professional satisfaction.  The pandemic should not be used as justification to make scope of practice changes that disrupt the team model and compromise care.

Bonnie Litvack
MSSNY President

Please Urge Governor Cuomo to Veto Mandatory OPMC Signage Legislation
All physicians are urged to contact Governor Cuomo to request that he veto legislation (S.6678-A/A.7991-A) requiring every physician’s office to post a sign regarding how a patient can file a misconduct complaint with the OPMC.

Let the Governor know that this proposal would create unnecessary distrust in the physician-patient relationship and unfairly singles out physicians. This legislation is also unnecessary because this information is already easily available through a simple internet search.  With nearly 10,000 complaints already made each year to OPMC (resulting in only a few hundred actual disciplinary actions), it is clear there is already strong public awareness of this oversight body. Send a letter and tweet to the Governor opposing this baffling legislation.

Crain’s NY Business: MSSNY Issues Statement Criticizing New Rule Allowing Pharmacists to Administer Vaccines to Children
Crain’s New York Business (8/21, Henderson) reports MSSNY issued a statement in opposition to “a new rule that allows state-licensed pharmacists to administer vaccines to children.” MSSNY “noted that it joins with the American Academy of Pediatrics in opposing the emergency authorization from the Department of Health and Human Services, saying the measure is not needed and could cause harm.”

MSSNY President Dr. Bonnie Litvack said, “This is a completely unnecessary move on the part of the Health and Human Services and will cause further chaos in getting children properly immunized. New York state’s pediatric offices have been opened throughout the pandemic and remain open. They are safe places to receive the vaccination, and most importantly, parents and children already have an established relationship with the pediatrician.”

Click here to read MSSNY’s August 20 Press Release: MSSNY Opposes HHS Authorization to Allow Pharmacists to Administer Vaccines to Children

MSSNY’s Weekly Podcast

AMA Develops Comprehensive Summary of Medicare Proposed Rule for 2021
Please click here for a comprehensive summary prepared by the American Medical Association of the proposed 2021 Medicare physician payment rule.  A few key points from the summary:

  • Of significant concern, the proposed CY 2021 Medicare Physician Fee Schedule (PFS) conversion factor is $32.26, which represents an almost 11% reduction from the CY 2020 conversion factor of $36.09.  This is the result of positive adjustments in other parts of the rule.  As a result, AMA and MSSNY and many other societies are pushing for Congress to waive these problematic budget neutrality requirements.
  • Similarly, the proposed CY 2021 anesthesia conversion factor is $19.96, down 10% from the CY 2020 anesthesia conversion factor of $22.20.
  • The AMA/Specialty Society RVS Update Committee (RUC)’s recommendations account for only half of the reduction.  The remaining spending increases and resulting conversion factor reduction is attributed to various CMS proposals to increase valuation for specific services.
  • CMS proposed to accept approximately 75% of the RUC recommendations for Physician Work RVU Updates. Updates to the direct practice expense inputs are proposed for individual codes based on RUC recommendations. The proposed rule does not include the 1.0 work geographic practice cost index (GPCI) floor.
  • CMS proposes to implement finalized CPT descriptors, guidelines and payment rates effective on January 1, 2021, which will be a significant modification to the coding, documentation, and payment of evaluation and management (E/M) services for office and outpatient visits: retain 5 levels of coding for established patients, reduce to 4 levels for new patients, and revise code definitions. CMS revalues services analogous to office outpatient E/M visits.
  • CMS proposes to allow the three G-codes used to report opioid use disorder (OUD) to also be used for monthly treatment reporting for patients with substance use disorder (SUD) as well. So that they could be used to report monthly treatment of patients with any SUD, not just OUD.
  • CMS has proposed to permanently keep several codes that were temporarily added to the Medicare telehealth list, including the prolonged office or outpatient E/M visit code and certain home visit services. CMS also proposes to keep additional services, including certain emergency department visits, on the Medicare telehealth list until the end of the calendar year in which the PHE ends to allow more time to study the benefit of providing these services using telecommunications technology outside the context of a pandemic.

MLMIC Banner

Struggling with Life Stressors? MSSNY’s Peer to Peer (P2P) Program is Here to Help
If you or someone you know is struggling with everyday life stressors, reach out to the P2P program to be connected with a peer supporter to help!

Email: and request that you be connected with a peer supporter
Phone: 1-844-P2P-PEER (1-844-727-7337) and request that you be connected with a peer supporter

The Medical Society of the State of New York now offers to physicians, residents and medical students an opportunity to talk with a peer about some of life stressors. MSSNY’s Physician Wellness and Resiliency Committee launched a Peer 2 Peer (P2P) program to assist their colleagues who are need of help in dealing with work and family stressors. With the advent of the COVID-19 pandemic, some of the emotional issues related to this event, may also be troubling for our colleagues.

MSSNY is seeking volunteer peer supporters!
A peer supporter is an individual who has shared experiences, listens without judgement, can validate feelings and provide SUPPORT, EMPATHY AND PERSPECTIVE. This is someone who also provides supports to systems and practices and encourages the use of positive coping skills. They also help connect the individual with needed treatment.

Physicians, residents or medical students who are members of MSSNY can become volunteer peer supporters.

How are peers trained? MSSNY will provide free training to the volunteer peer through a training program. This training program will be offered virtually and consists of peer support and what makes a good peer (How to be a Peer), psychological first aid, and how the program will operate. There will also be other on-line course work that a peer can avail themselves of through MSSNY’s CME website. The virtual training programs will be offered more than once.

How to become a volunteer peer: Volunteer peers can be nominated by county medical society presidents, county medical society executives, or another physician, resident or medical students. To nominate an individual please send an email to Cayla Lauder at or call (518) 465-8085.

Scripps TV Features Segment on MSSNY’s Peer to Peer (P2P) Program
Doctors Rothberg and Dowling are featured in a segment on Scripps TV about MSSNY’s Peer to Peer program that connects physicians with their peers for emotional support.  The segment aired on WPIX-TV in NYC and on WKBW-TV in Buffalo, along with other stations around the country.

America’s Health: Stories from Physicians on The Frontline
In response to the COVID-19 pandemic, The Physicians Foundation launched America’s Health: Stories from Physicians on The Frontline, to increase understanding of physicians’ challenges in our current health care system and to create an anthology of physicians’ experiences. The initiative features physicians from across the U.S. sharing their experiences from the COVID-19 pandemic and will cover a variety of topics, such as financial livelihood, physician safety and physician wellbeing.

Visit the Physicians Foundation website for more information.

Garfunkel Wild Ad

Veterans Matters: The Special Mental Health Needs of Women Veterans Webinar
The Medical Society of the State of New York is hosting a CME live webinar entitled Veterans Matters: The Special Mental Health Needs of Women Veterans on Tuesday, September 15, 2020 at 7:30 am.

Click HERE to view the flyer and register for the program!

When:      September 15, 2020 at 7:30 am
Faculty:    Malene Ingram, MD and Colonel, U.S. Army Reserves

Educational Objectives:

  • Review how the increased role of women in the military has impacted their mental health
  • Describe mental health concerns unique to women veterans and how to identify them
  • Identify the barriers that women veterans face in getting the specific care they need

For more information, contact Jangmu Sherpa at or call (518) 465-8085.

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.

P2P Stress Banner


Elegant, Custom Built Home with Unparalleled Craftsmanship – Rhinebeck, NY
Set on 10.6 acres in one of the most sought-after neighborhoods in Rhinebeck, this stunning home borders Drayton Grant Park at Burger Hill (a conservation land and the highest point in Rhinebeck). Features beautifully landscaped gardens with sweeping hilltop views and a well established vegetable garden and barn. This handsome home is generously proportioned throughout, with an inviting foyer entry with tastefully designed staircase, millwork, high ceilings, cherry wood floors and custom windows.

Rhinebeck Estate for SaleA world class kitchen with a marble counter-topped island, enjoys both a cozy fireside seating area perfect for winter evenings, and glass doors in the hexagonal eat-in-kitchen opening onto the expansive stone terrace for three season enjoyment and entertaining.

A luxurious Master suite, with high vaulted ceiling design, his and hers walk-in closets and a gorgeous master bath with cast iron clawfoot tub. The second floor also includes two spacious bedrooms with generous closets and 2 full bathrooms, An additional large sitting room/office could easily make a lovely fourth bedroom. Lower level features a media room, exercise room, bar, wine cellar and full bathroom. Additionally there is a two story barn equipped with water and electricity.

The house is located 7 minutes to the charming center of Rhinebeck village with its many superb restaurants, boutiques & shops. The highly rated Northern Dutchess Hospital, the excellent Rhinebeck schools and the County Fairgrounds, a most desirable venue destination throughout the year, are all nearby. Rhinecliff train station is a mile beyond with Amtrak service south to NYC(1hour 40 minutes) and north to Hudson, Albany, Niagara Falls and Montreal. View full listing Contact Nader Kayal, MD, 845-518-7780 / or Joshua M. Briggs at Heather Croner RE-Sotheby’s 917 213-9042 /

Upper East Side Office to Share
Includes waiting room, 2 exam rooms and room for medical assistants. Flexible schedule. Call Bianca at 212-327-1851.

For Sale: 715 Park Avenue
Medical office, 1,800 sq. ft. Rectangular, 11 1/2 ft ceilings, street level access. Private entrance on 70th Street, side of the building. Windows on Park Avenue and 70th Street. Excellent office space for plastic surgeon, dermatologist or dental practice. Central air conditioning, high voltage electric service, two bathrooms. *Sale could include active Cardiac / Medical Practice. Please contact Janet @ 212-288-5468.

Office Space and Quad-A Certified O.R. for Rent
Plastic surgery office and/or quad A – certified operating room available for rent. We welcome you to tour our facility, where safety and luxury are combined in the most prime location on the upper east side. We assure you will be delighted by what you discover. We take pride in our facility, where your patients’ safety and satisfaction are our number one priority.
    • Fully equipped operating room perfect for a board-certified plastic surgeon
  • Pre-op and recovery areas
  • A bright and modern waiting area
  • 3 consultation rooms, administrative room, kitchenette, and 2 bathrooms
  • Full day office rental per week / O.R. rental per case

For inquiries please call 212.737.8700, email

Office Space and Quad-A Certified O.R. for Rent