February 10, 2017 – Victory! Aetna-Humana Merger Nixed!
Dr. Malcolm Reid
|February 10, 2017
As you may be aware, some of our physicians in the Central New York and Adirondack area have received letters from the Medicaid Fraud Control Unit (MFCU) of the NYS Attorney General’s Office.
These letters are the result of investigations conducted by MFCU concerning billing agents (and the providers that utilize their services). Our physicians are being asked to refund money based on MFCU’s decision of fraudulent billing stemming from contracts that are perceived to be allowing fee splitting.
MFCU points out that billing services that charge medical professionals a percentage of costs for claims submitted is in violations of Medicaid rules. MFCU also mentions that this form of billing is in violation of NYS Education Law. MSSNY is advising our member physicians to review their billing vendor service contracts. If your contract appears to allow this type of percentage billing, it is urged that you share these two documents with your billing service:
It is important that you seek to amend the fees you pay your biller for Medicaid claim submissions to either payment based on time or a flat fee for claims submitted.
Again, these letters are coming from MFCU and are not generated by NYSDOH, OMIG, NYS Education Department or OPMC. From our understanding, this recovery activity will impact fee for service and Medicaid fee for service and managed care.
If you have questions, please call Regina McNally at 488-6100 ext. 339.
Anthem Cigna Merger Blocked
Wednesday’s decision to block the mega-merger between insurance giants Anthem and Cigna is an important development for patients and their physicians. While many regions of New York State and across the country continue to be dominated by a few large insurers, this proposed merger would have made this problem even worse. Indeed, many patient and physician advocacy organizations raised concerns regarding the potential impact of this merger proposal on patient care, including MSSNY and the American Medical Association during a public hearing (where I testified) held by the New York Department of Financial Services (DFS) last September. We thank New York DFS Superintendent Maria Vullo for publicly articulating the huge market impact of this proposed merger had it been permitted to go forward, and New York Attorney General Eric Schneiderman for joining the US Department of Justice’s action to block the merger.
The ruling, by Judge Amy Berman Jackson of the Federal District Court for the District of Columbia, came two weeks after another federal judge blocked a proposed $37 billion merger between Aetna and Humana on antitrust grounds.
As expected, the day after the decision, Anthem Inc. appealed the federal judge’s decision to block its acquisition of Cigna, but the future of the deal was unclear amid discord between the two partners.
Apparently, it’s not over yet.
As a personal endnote, my family and I would like to sincerely thank everyone for the outpouring of sympathy regarding the death of my mother last Sunday.
SAVE THE DATE! Physician Advocacy Day in Albany March 8!
Please send your comments to firstname.lastname@example.org
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
Please Contact Your Legislators to Express Concerns with Several State Budget Proposals
Physicians are urged to continue to contact their elected officials regarding a number of State Budget proposals listed below. While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery. Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made. For example:
- We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels. However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians. To send a letter to your legislators, click here.
- Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization. While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols. To send a letter to the Legislature, click here.
- “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements. To send a letter to your legislators, click here.
- The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.
- The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including “modernizing” Certificate of Need laws, and changing scopes of practice for non-physicians. Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval.
- Giving overbroad discretion to state officials to drop physicians and other prescribers from the Medicaid program based upon the “inappropriate prescribing of opioids.
Court Ruling Blocks Anthem-Cigna Merger from Moving Forward
A US Federal court issued a ruling this week blocking the proposed merger between health insurance giants Anthem and Cigna. The proposed merger had been challenged by several patient advocacy and physician advocacy organizations including the American Medical Association and MSSNY because of the very significant market impact the merger would have had in various regions across the country, including in Long Island and New York City. Last fall, MSSNY President Dr. Malcolm Reid testified at a New York Department of Financial Services (DFS) hearing to express strong concerns with the proposed merger.
The judge found that the merger would have substantially lessened competition for the sale of health insurance to national employers resulting in higher prices and diminished prospects for innovation. In a historic, stunning affirmation of the position urged by the AMA and consequently adopted by the government, Judge Jackson concluded that an enhanced ability to coerce physicians to accept lower reimbursement is not a merger efficiency defense. She determined that it would not benefit consumers and “would erode the relationship between insurers and providers” and “reduce the collaboration” that is essential to innovation in payment and delivery.
In response to the court’s ruling, Dr. Reid gave the following statement.
Yesterday’s decision to block the mega-merger between insurance giants Anthem and Cigna is an important development for patients and their physicians. While many regions of New York State and across the country continue to be dominated by a few large insurers, this proposed merger would have made this problem even worse. Indeed, many patient and physician advocacy organizations raised concerns regarding the potential impact of this merger proposal on patient care, including the Medical Society of the State of NY (MSSNY) and the American Medical Association (AMA) during a public hearing held by the New York Department of Financial Services (DFS) last September.
We thank New York DFS Superintendent Maria Vullo for publicly articulating the huge market impact of this proposed merger had it been permitted to go forward, and New York Attorney General Eric Schneiderman for joining the US Department of Justice’s action to block the merger.
Several Health Insurance Reform Initiatives Advanced to Assembly Floor
Several bills supported by MSSNY to address inappropriate health insurer practices were favorably reported from various Assembly committees to the Assembly floor this week:
- Legislation (A.2704, Lavine) to assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company is non-renewed, similar to protections provided when a physician is terminated from network participation;
- Legislation (A.2539, Gottfried) to prohibit a health insurer from denying care unless it is reviewed by a physician in the same or similar specialty, and licensed in New York State.
- Legislation (A.2389, Gottfried) to require health insurers to use uniform credentialing forms for reviewing applications to participate in a health insurer’s network; and
- Legislation (A.2370, Gottfried) to prohibit health insurers from imposing certain requirements on their participating providers, including prohibiting referrals to out of network physicians, and “Most Favored nation” clauses (AUSTER)
Physicians Action Needed March 8th
MSSNY’s Annual Physician’s Advocacy Day – physician’s Urged to Attend and Wear Your White Lab Coats
Join MSSNY and your colleagues to lobby your elected leaders at this year’s annual “Physician’s Advocacy Day” on March 8th! Encourage your Senators and Assembly members to support legislation that is crucial to your practice and oppose the bills that place restrictions and add unreasonable burdens. This year’s event will be held at the Lewis Swyer Theater at The Egg in Albany from 8am to 12noon, ending with a catered lunch and the opportunity to speak more directly with your legislators. If you are interested in attending, please register here or contact Carrie Harring at email@example.com.
The morning program will begin at 8 AM, after which physicians will have the opportunity to have meetings with their local Senators and Assemblymembers. A full slate of legislators and key policymakers have been confirmed to participate in the morning program including: NYS Senate Majority Leader John Flanagan;Jason Helgerson, NYS Medicaid Director;Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and top health care staff at DFS have been invited. A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.
County medical societies will be scheduling appointments for physicians to meet with their elected representatives. Come meet with your legislators to urge that they:
- Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
- Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into “medication management protocols” with nurse practitioners;
- Reject changes to increase physician prior authorization requirements contained in the proposed State Budget;
- Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
- Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
- Reject legislation that would impose costly and time consuming mandates on physician practices.
Dr. Tom Price Confirmed as HHS Secretary
By a 52-47 vote, the US Senate this week confirmed Dr. Tom Price to become the next Secretary of the US Department of Health and Human Services (HHS). Dr. Price, an orthopedic surgeon from Georgia, was a Congressman and a Georgia delegate to the AMA House of Delegates.
Dr. Price was the long time sponsor of the Medicare Patient Empowerment Act, legislation supported by many organizations that would enable seniors to have partial coverage to receive care from a physician who does not participate in Medicare program. He has also opposed various Medicare bundled payment demonstration programs, such as for joint replacement and cardiac surgery, that have been implemented by CMS in several regions across the country. (AUSTER)
Assembly Health Committee Advances Retail Clinic Legislation to Codes Committee
Assembly Bill 958, sponsored by Assemblywoman Amy Paulin, passed out of the Assembly Health Committee to the Codes Committee. This legislation would authorize the establishment of clinics in corporate-owned retail stores. MSSNY believes that by permitting this practice, NYS will infringe upon the independence of medical decision-making and the integrity of the doctor-patient relationship.
Furthermore, many are concerned that corporately owned and operated retail clinics will open the floodgates to conflicts of interest as retail clinics could directly profit from the very prescriptions that are written there , and treatments they recommend—all under the very same roof. Voting against this measure was: Assembly members Kevin Cahill, Aileen Gunther, Ellen Jaffe, Thomas Abinanti and Edward Ra. The measure now goes to the Assembly Codes Committee for its consideration. To send a letter in opposition, click here.
Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team. Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee. Registration is now open for this webinar here just click on “Upcoming”.
The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from an active shooter/bombing event in the healthcare setting. 2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event. 3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.
The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains. Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.
Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.
The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
MSSNY 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. (CLANCY, HOFFMAN)
Assemblyman Schimminger Introduces Proposals Strongly Supported by MSSNY
Assemblyman Schimminger introduced two bills strongly supported by MSSNY.
- 5648 – The “medical liability reform act” would implement a number of important reforms to the medical liability adjudication system to reduce the exorbitant and rapidly rising cost of medical liability insurance. This bill would require an attorney for a plaintiff in a medical, dental or podiatric malpractice case to include with the certificate of merit, an affidavit from a physician stating that there is a reasonable basis for such malpractice action. The failure to file would result in the dismissal of the suit. The bill also limits noneconomic damages in such causes of action to $250,000 has been adopted by several other states. Additionally, the bill requires enhanced and comprehensive disclosure of expert witnesses to be used by any party in medical, dental and podiatric malpractice cases.
4914 – would prohibit a hospital from requiring board certification as a condition of having staff privileges, and prohibit a health insurance company from requiring board certification as a condition of being a participating physician in such plan. The legislation is designed to alleviate some of burdensome costs & time demands associated with Maintenance of Certificate (MOC) requirements.
For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
BMJ: IMGs Seem to Perform At Least as Well as U.S.-Trained Physicians
Hospitalized patients in the U.S. who are treated by attending physicians who received their medical training abroad fair just as well — and in some cases better — than those treated by domestically trained physicians, suggests a study in The BMJ.
The authors examined data on 1.2 million Medicare beneficiaries who were admitted from 2011 to 2014 and treated by 44,000 general internists. Roughly 44% of the internists were international medical graduates.
After multivariable adjustment, patients of international medical graduates had significantly lower 30-day mortality rates than those of U.S. graduates (11.2% vs. 11.6%). The mortality differences were similar across numerous clinical conditions. However, international graduates had higher costs of care ($1145 vs. $1098). Readmission rates were similar between the groups.
The authors write: “Taken together, our findings should reassure policymakers and the public that our current approach to licensing international medical graduates in the US is sufficiently rigorous to ensure high quality care.” The BMJ article
Weekly Charting Tip:
Remember when you were bad in 2nd grade and your teacher told you it was going on your permanent report card? Well, your National Practitioner Data Bank profile is that permanent report card for health care professionals. Most any malpractice settlement or judgment, hospital privilege loss, being terminated by a managed care company, being disciplined by your state board; all of these and more can be found in your NPDB profile. Request a copy via going on line to the NPDB and initiate a “self-query.” It is only a few dollars. Don’t you want to know what every inquiring entity knows about you? You also want to make sure it is accurate. While patients and plaintiff attorneys cannot access this, a hospital where you applied for privileges, a medical group doing a due diligence prior to hiring you or a managed care company, can certainly access it. Also be warned that if you settle a case, your state board will have access to this information if they want to investigate the matter. Forewarned is forearmed! – Larry Kobak, Esq., Kern Augustine
Governor Announces $20 Million Fund to Expand/Upgrade Healthcare Facilities
The AP (2/3) reports New York Gov. Andrew Cuomo announced the creation of the Community Health Care Revolving Fund, which aims to “help community health organizations that might not be able to expand otherwise.” The state has set aside almost $20 million for the fund in order “to assist local health care providers looking to expand or upgrade their facilities.” The money will be awarded in the form of low-cost loans.
CDC: 40,000,000 Have Some Hearing Loss Due To Noise Outside Workplace
In a Feb. 7, 2017, media briefing with Anne Schuchat, MD, acting director, U.S. Centers for Disease Control and Prevention regarding the Feb. 7, 2017, Morbidity and Mortality Weekly Report, “40,000,000 American adults have lost some hearing because of noise, and half of them suffered the damage outside the workplace, from everyday exposure to leaf blowers, sirens, rock concerts and other loud sounds.” Researchers found that “24 percent of adults had ‘audiometric notches’ – a deterioration in the softest sound a person can hear – in one or both ears.” The data “came from 3,583 people who had undergone hearing tests and reported the results in the 2011-2012 National Health and Nutrition Examination Survey.
The report is available at http://bit.ly/2kAsqlQ
Jan 28 NYSDOH Report: Four Deaths This Influenza Season
The NYS Department of Health (NYSDOH) reports in their Influenza Surveillance Report for the week ending January 28, 2017 that influenza activity level was categorized as geographically widespread:
- This is the sixth consecutive week that widespread activity has been reported.
- There were 5,235 laboratory-confirmed influenza reports, a 20% increase over last week. Of the 1,873 specimens submitted to NYS WHO/NREVSS laboratories, 406 (21.68%) were positive for influenza.
- Of the 66 specimens tested at Wadsworth Center, 41 were positive for influenza. 31 were influenza A (H3), 2 were influenza A (Not Subtyped), 4 were influenza B (Yamagata) and 4 were influenza B (Victoria).
- Reports of percent of patient visits for influenza-like illness (ILI3 ) from ILINet providers was 9.19%, which is above the regional baseline of 3.00%.
- The number of patients hospitalized with laboratory-confirmed influenza was 961, a 4% increase over last week.
There was one influenza-associated pediatric death reported this week. There have been four influenza-associated deaths this season. https://www.health.ny.gov/diseases/communicable/influenza/surveillance/2016-2017/flu_report_current_week.pdf
SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details
NY State of Health Report on Number of Insured by County
Nearly one-quarter of New York City residents have purchased health insurance on New York State of Health, the exchange created by the Affordable Care Act. See the county results here.
Obese People May Be Less Likely To Receive Hospice Care, Research Suggests
Research suggests that obese people are less likely receive hospice care “and more likely to die at home.” The study authors “tracked the experiences of almost 5,700 Medicare beneficiaries who died between 1998 and 2012.” The investigators “looked at weight levels and whether or not someone died in hospice care.” Overall, about “35 percent of those in the study received hospice care, but just 23 percent of the severely obese did. In addition, the severely obese spent four fewer days in hospice care than those with a BMI of 20.” The findings were published online Feb. 6 in Annals of Internal Medicine.
Attest to 2016 EHR Incentive Requirements by March 13 to Avoid Pay Adjustment
The Centers for Medicare & Medicaid Services (CMS) has extended the attestation deadline for providers participating in the Medicare EHR Incentive Program to Monday, March 13, 2017, at 11:59 p.m. PT.
Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by March 13, 2017 to avoid a 2018 payment adjustment. If you are participating in the Medicaid EHR Incentive Program, please refer to your state’s deadlines for attestation information.
If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.
- Registration and Attestation System
- Eligible Professional (EP) and Eligible Hospital and Critical Access Hospital (CAH) Attestation Worksheets
- EP and Eligible Hospital and CAH Attestation User Guides
- EP and Eligible Hospital and CAH Registration Use Guides
- Attestation Batch Upload Webpage
For More Information
For questions about the Registration and Attestation System, contact the EHR Information Center at 1-888-734-6433 (press option 1). The EHR Information Center is open Monday through Friday from 6:30 a.m. to 5:30 p.m. ET, except federal holidays
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Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D. 110 E 66th Street.
A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to email@example.com. No recruiters please.
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to firstname.lastname@example.org. No recruiters please.