MSSNYeNews: Iceberg Right Ahead – January 3, 2020

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

January 3, 2020

Vol. 23  Number 1



We all remember the scene from Jim Cameron’s Titanic when the lookouts first notice the looming iceberg. Well, that is how I felt when I opened my email before getting ready to celebrate the coming of the New Year. Then, I saw this on my twitter feed:

Doctor's Tweet

That is right— once again, the government’s first solution to a healthcare budget deficit is to cut doctors’ payments. We clearly are regarded as low-hanging fruit here. Imagine the response of say the TWU if the solution to MTA fiscal problems were to first cut the workers’ pay? Right. Well, it’s 2020 and our issue clearly comes into 20-20 focus.

It is as obvious today as it has ever been. Medicine is the only US enterprise that regularly gets to enjoy a Cost of Living DECREASE. While we await further budget details to be hashed out, this is time for real New Year’s resolutions.

Let me be clear – we all need to come together. A House of Medicine divided cannot stand. And so, I call for a gathering – a Summit— if you will. We will put out an invite for our many groups – our ethnic societies, our specialty societies, employed physicians, independent physicians – everyone should be present.

As the Doors put it: “The time to hesitate is through. No time to wallow in the mire.”

Let’s Do It!

Comments?; @sonodoc99

Arthur Fougner, MD
MSSNY President

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MSSNY’s Weekly Legislative Podcasts

Governor Vetoes Liability Expansion Bills Opposed by MSSNY
Governor Cuomo has vetoed two bills passed by the State Legislature that had been opposed by MSSNY and MLMIC that, if enacted, could have produced further increases to New York’s already exorbitant medical liability insurance costs.  The bills had also been opposed by many other groups who could have been adversely impacted.

The first bill (S.6081/A.2373) would have forced physician defendants into making a “blind gamble” regarding the selection of how a particular court award should be reduced in cases involving multiple defendants where one of the defendants settles prior to trial.

MSSNY raised concerns that this legislation could create the possibility of a plaintiff being unjustly enriched by collecting more than the jury ultimately determined the award to be.  The second bill (S.6552/A.2373) would have allowed plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question but had been sued by the original defendant.  MSSNY raised concerns that it could encourage those parties who are unable to satisfy their apportioned share of liability to dodge their responsibility, while allowing a plaintiff to target deep-pocketed third parties.

MSSNY thanks Governor Cuomo for vetoing these problematic bills, given the enormous liability exposure physicians already face.

Governor Vetoes Patient Protection Bills
At the end of 2019, Governor Cuomo vetoed two pieces of legislation strongly supported by MSSNY, and other patient advocacy groups, that would have protected patients from harmful business practices by Pharmacy Benefit Manager (PBMS), and health insurers, in New York.

  • Cracking Down on PBMs

The first bill, S.6531, would have increased the oversight, transparency and accountability of Pharmacy Benefit Managers (PBMS).

Although, similar protections in the 2019 budget were agreed to for Medicaid beneficiaries, and Governor Cuomo had proposed additional requirements for PBMs used by commercial plans, he vetoed the bill because of concerns that provisions could be pre-empted by ERISA, and invite scrutiny from the FTC and DOJ and “sweep in plans that are not true PBMs, but rather health benefit funds only.”

  • Ending Plans’ Ability to Make Mid-Year Changes to Drug Formularies

A second bill, S.2849, would have created a list of safeguards designed to protect patients with private, commercial health insurance plans seeking to remove drugs from their pharmacy benefit formularies, in the middle of a contract year. New York’s current law puts thousands of patients at risk of losing access to therapies for such chronic and life-threatening diseases as epilepsy, rheumatoid arthritis, multiple sclerosis, among many others. It also usurps decisions by physicians as to what the most effective therapy is to treat a patient’s condition.

The Governor vetoed the bill because of concerns that “Insurers would have to anticipate and set rates for hypothetical future drug price increases, causing higher premiums for everyone, while pharmaceutical companies would be able to raise their prices with impunity”.

MSSNY pushed hard for passage of both these bills and will continue to advocate for these patient protections in the new legislative session.

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Governor Signs MAT Access Bill for Commercial Insurers and Vetoes MAT Access Bill for Medicaid
As the year came to an end Governor Cuomo signed and vetoed bills that would expand access for patients to Medication Assisted Treatment (MAT), both bills that had been strongly supported by MSSNY and the American Medical Association.

The first bill (A.2904/S.4808) that was signed into law requires commercial health insurance companies to eliminate prior authorization requirements for all MAT.  A provision enacted earlier in the year removed prior auth requirements for formulary approved MAT, but not all forms of MAT.  This gap was particularly problematic if a patient was stabilized on a particular form of MAT, but switched insurance company coverage.  Medical evidence shows that MAT promotes recovery from opioid use disorders, saves the health care system money. Prior authorization requirements for MAT delay access to evidence-based care.

However, the Governor vetoed similar legislation (A.7246/S.5935) that would have required Medicaid and Medicaid Managed Care plans to cover all MAT without prior authorization requirements. The lengthy veto message noted concerns that  the bill would “provide  a  statutorily-authorized  unfair  competitive advantage to one pharmaceutical manufacturer” which failed to “offer  sufficient  competitive  pricing  to be included on the preferred drug list or on many  managed  care  organization  formularies,  and  in lobbying  for this legislation to eliminate prior authorization requirements, requires Medicaid plans and the State to pay whatever price  this manufacturer charges.”

MSSNY’s Lobby Day – Wednesday, March 4th, 2020
Please plan to join your colleagues in Albany for MSSNY’s ‘Physician Advocacy Day’, which will take place at the Lewis Swyer Theater at The Egg in Albany on Wednesday, March 4, 2020.

Physician participation in this event is critical.  With a $6 billion Budget deficit likely to produce a swath of adverse proposals in the name of achieving “savings”, it is imperative that physicians let their legislators know of the potential adverse consequences to patient care in their communities. As with past years, the morning program will provide 3.0 Continuing Medical Education hours for physicians. To learn more about MSSNY’s Lobby Day click here and to sign up for the event click here.

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Gov. Cuomo Proposes to Ban Flavored Nicotine Vaping Products in State of State
Governor Andrew Cuomo has proposed in his State of the State agenda to ban all flavored nicotine vaping product, including menthol flavors.  The governor has also proposed banning vaping advertisements aimed and youth and authorized the NYS Department of Health to regulate the sale of chemicals used in vaping-related products and ban the sale of vaping product carrier oils deemed a hazard to public health. His proposal also includes legislation that would prohibit the online, phone and mail order sale of e-cigarettes and would require that only registered retailers be allowed to purchase e-cigarettes using these methods.

On the federal level, the Trump Administration and the FDA announced a limited ban of flavored e-cigarettes and the sale of all sweet and fruity flavored vape pods and cartridges, but allows gas stations and convenience stores to continue to sells menthol cartridges and vapes.

MSSNY supports banning all flavored e-cigarettes, including menthol and supports legislation that would also ban all flavored tobacco products, such as chewing tobacco and cigarillos. In December, MSSNY has joined with other public health organizations that called upon the Governor, the Senate and Assembly leaders, and members to pass legislation that would prohibiting the sale of flavored nicotine and tobacco products which will protect our young people from the scourge of the myriad health problems and addictions caused by flavored tobacco products and e-cigarettes. Physicians are encouraged to send a letter through MSSNY Grassroots Action Center (GAC) at:

Additionally, MSSNY supported legislative efforts to increase the legal purchase age for tobacco and e-cigarette products and in November 2019, Governor Cuomo signed into law legislation that accomplished this goal.  In December, Congress passed the Federal Food, Drug and Cosmetic Act that raised the federal minimum age to purchase tobacco products from 18-19; President Trump signed the measure on December 20, 2019.  According to a statement on the FDA’s website, “it is now illegal for a retailor to sell any tobacco product—including cigarettes, cigars and e-cigarettes—to anyone under 21”.

Albany Memorial and Samaritan Hospitals Merge Albany Memorial Hospital and Samaritan Hospital in Troy, N.Y., merged Jan. 1.
Albany Memorial is now a third campus of Samaritan Hospital and has been renamed Samaritan Hospital-Albany Memorial Campus. The hospitals are part of Albany-based St. Peter’s Health Partners, which is a member of Livonia, Mich.-based Trinity Health. “The long-planned and previously announced merger of Samaritan and Albany Memorial represents the fulfillment of our always top-of-mind goal, which is to provide the highest quality, most compassionate, and most accessible care, to all who need it, in Albany, Troy and across the Capital Region,” Michael Finegan, president of acute care at SPHP, said in a news release.

Female Surgeons Face Fertility Issues; Radiation, Surgical Smoke, Exposures
The Telegraph (UK) (1/2) reports research suggests “female surgeons are more than twice as likely to suffer fertility problems due to radiation and the other hazards of operating theatres.”

The study published in JAMA Surgery indicates “there are direct medical risks from working as a surgeon, including from radiation, surgical smoke, anaesthetic gases and other toxic substances.” The researchers point “to a survey of 1,021 US females surgeons across different specialisms that found 32 per cent of respondents reporting difficulty with fertility, compared to 10.9 per cent in the general population,” and “the same study saw a pregnancy complication rate of 35.3 per cent, compared to 14.5 per cent generally.”

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Mysterious Pneumonia Cases in China Prompt International Concern
Infectious disease experts are keeping a close eye on a mysterious outbreak of pneumonia in central China that has sickened more than three dozen people, reports Bloomberg.

As of Jan. 3, 44 pneumonia cases have been confirmed in Wuhan, China, according to a statement from the city’s health agency cited by the publication.

The World Health Organization is working with the Chinese government to investigate the outbreak. Health officials have ruled out common respiratory illnesses like the flu, but the exact cause of the illness is still unknown.

Several of the sickened individuals worked at a local market that sold animals like birds and pheasants. This detail is prompting concerns that an unknown animal virus may have spread to humans, reminiscent of the 2003 SARS outbreak, which killed nearly 800 people.


“Doctor Are You Ready?” CME Webinar on January 15; Registration Now Open
Disasters big and small happen every day.  Be sure to find out how best to be prepared at MSSNY’s next Medical Matters webinar: Doctor Are You Ready? on January 15th at 7:30am.  Kira Geraci-Ciardullo, MD, MPH immediate past speaker of the house 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:

  • Explore core preparedness competencies every physician should possess
  • Describe emergency situations that arise on a regular basis
  • Identify resources to acquire preparedness training

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

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. 

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