March 29, 2019 – March Madness

Thomas J. Madejski, MD MSSNY President
Thomas J. Madejski, MD
MSSNY President

March 29, 2019
Volume 22  Number 13




Happy Doctor’s Day, tomorrow, March 30! 

On behalf of MSSNY, I want to thank you for your devotion to your patients and our profession.  Your commitment to caring for your patients helps to improve our communities and our society in general.

It’s been a busy week.  I had hoped to spend a little time watching my favorite NCAA teams, the Syracuse Orange, and the University at Buffalo Bulls charge into the Sweet Sixteen of the NCAA Basketball tournament.  Alas, it was not meant to be.  Both suffered crushing defeats accompanied by much wailing and gnashing of teeth by me and the other diehard fans in the Madejski family room.

Marijuana and Science

Proposals to legalize the recreational use of Marijuana continues to be an issue of statewide and national concern.  I have received comments from a few readers questioning why we are spending time on this issue.  I’ve responded to them individually, but thought it might be worth reviewing where we’ve been and where we are going.  To begin with, we are very sympathetic to the goals of many seeking legalization regarding the unfair and arbitrary application of current laws. We agree with the concept of decriminalization.  However, we are spending time on this issue because MSSNY (and the AMA) policy is based on science and advocates for the best care of our patients, and prevention of reasonably avoidable harms to our citizens.  We are very concerned that the push for legalization of recreational marijuana has been funded by an evolving industry that has been given a pass on proper testing of their pharmacological products with regards to usual standards of efficacy and clarification of risk. We are watching Big Tobacco attempt to morph into Big Marijuana before our eyes and create a new generation of users of an addictive product.  This industry has also draped itself in specious arguments that wider access and use will result in a panacea for multiple disease states and economic benefits to state governments.  The emerging data from states that have legalized recreational marijuana is disturbing at best.  Harms are clear, benefits less so.  Most physicians understand the importance of dealing with this complicated substance in a scientific fashion.  Potential harms could be avoided by obtaining better data on the benefits and risks of both medicinal and recreational use. I also want to make clear that we are in favor of decriminalizing marijuana.

New York should use the data from the ongoing state experiments to inform our policy creation in New York with regards to a product with well-defined harms.  Importantly, this means we need to change federal law to reschedule marijuana to allow more, higher quality research to answer the many questions about medicinal and recreational use.

Again, this need to be based on science, not anecdote.

New York is not alone in dealing with this question.  While, there is a furious, well-funded push by the marijuana/ tobacco industry to push recreational marijuana through before our society wakes up to the potential harms, we have our own allies. We have been working with county health officials, PTAs, school administrators, and substance abuse councilors who share our concerns.

If you will forgive my Hamilton reference, we don’t have Laurens, Mulligan and Marquis de Lafayette, but we have reached out to our friends in New Jersey, Connecticut and Delaware .Thanks to Dr. Poole, Dr. Gruss and Dr. Dahlke for their leadership and courage.

New Jersey was scheduled to pass a bill for recreational marijuana this week.  The vote wasn’t taken, in part due to the advocacy of the Medical Society of New Jersey in concert with MSSNY and our allies.  We are hopeful that New York has taken legalization out of its soon to be finalized State Budget, but one never knows until the last Budget bill is passed. Connecticut remains under pressure for a revenue fix which, if based on marijuana as opposed to tolls, will have much greater financial and societal costs down the road.

It is our duty to speak as physicians to evaluate the available information, seek out the answers to the known unknowns, and then speak out on behalf of our patients, fellow citizens, and ourselves. Thanks to all for your contributions to the conversation.

Together we are stronger!

Quicumque damnantur praeteritis memoria repetere

Comments?; @mssnytweet; @TomMadejski

Thomas J. Madejski, MD
MSSNY President

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Capital Update

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Legislature, Governor Trying to Finalize State Budget
At press time, while several of the Budget bills were printed, there were still multiple outstanding issues that were complicating a final agreement between the Assembly, Senate and Governor for a State Budget due by April 1. Here is a quick synopsis of some of the top issues being advocated by your Medical Society.

LEGALIZING RECREATIONAL MARIJUANA – Reports were that the legalization of “adult use” or “recreational” marijuana use was not going to be in the final State Budget, as had been urged by MSSNY and several other groups.

EXCESS INSURANCE – Reports were that the historical funding the Excess Medical Malpractice Insurance Program that had been proposed in the Governor’s Budget and supported by MSSNY was to be included in the final Budget.

MEDICAID – There has not been a final determination on several Medicaid proposals, including the proposed $80/patient Medicaid cut for deductibles for patients covered by Medicare and Medicaid that the Assembly and Senate had rejected in its one-House Budgets and strongly opposed by MSSNY.

BEHAVIORAL HEALTH PARITY – There is momentum towards strengthening New York laws that assure comprehensive health insurance coverage for mental health conditions and substance abuse services.   MSSNY working together with the NYS Psychiatric Association supported these proposals. These include provisions that would remove prior authorization for MAT, and strengthening New York’s “gag” laws that provide important legal protections to physicians and other health care providers who file complaints with state agencies about potential insurer violations.

WORKERS’ COMP (see related article)–  The Legislature and Governor reached agreement on a modified proposal that expands the use of certain health care providers in WC that also seeks to address some carrier-imposed barriers to patient care and preserves the historical peer review role played by the county medical societies. MSSNY had raised concerns with this proposal.

OPIOID TAX – Reports were that a revised $100 million tax on opioid manufacturers and distributors would be included in the final Budget.  Earlier this week, MSSNY, the NYS Academy of Family Physicians and the NY Chapter of the American College of Emergency Physicians joined patients, pharmacists and several legislators to raise concerns with the aspect of this proposal that would permit the cost to be passed on to pharmacies, hospitals and, in some cases, patients.

PUBLIC HEALTH– Last week the Senate and Assembly passed legislation to create a Maternal Mortality Review Board (A.3276, Joyner/S.1819, Rivera) instead of acting on the Governor’s Budget proposal. MSSNY supported this proposal.

Instead of including in the State Budget, the Senate has advanced to the floor legislation (S.2833, Savino) to raise the age of tobacco/e-cigarette sales from 18-21. The Assembly recently passed identical legislation on this issue (A.558, Rosenthal). MSSNY supported this proposal.

PBMs – There was progress being made towards the inclusion of language in the State Budget to increase the transparency of financial arrangements made Pharmaceutical Benefit Managers (PBMs), and its connection to health insurer formulary and tier development.

Please stay tuned for further updates.

State Budget to Include Workers Compensation Package
With a new medical fee schedule to begin Monday, April 1 that will provide long-overdue increases to physicians treating their patients covered by Workers’ Compensation (WC), the Legislature and Governor agreed to a WC package of reform in one of the State Budget bills (– pp.16-32) that would expand the types of practitioners who can treat and be reimbursed for treating injured worker patients while at the same time seeking to reduce some of the carrier-imposed barriers to injured workers receiving needed medical care and treatment.

The bill would expressly permit injured workers to receive treatment by Nurse Practitioners (NPs), Social Workers, Physician Assistants (PAs), acupuncturists, Physical Therapists (PTs) and Occupational Therapists (OTs) acting within their statutory defined scopes of practice.  For example, this means that a NP will no longer need to be employed by a physician to provide care to an injured worker.

MSSNY raised concerns during these negotiations regarding the lack of express requirement for some of these professionals to coordinate with a specialized physician for the care of injured workers.  However, that concern was not fully addressed.  We note that the bill would prohibit these newly listed health care professionals from performing Independent Medical Examinations.  It would also specify that Acupuncture, PT and OT care could only be provided pursuant to a referral from a physician, podiatrist or NP, and that the report of a PA, PT, OT or acupuncturist could not be used as evidence to determine that a particular injury or illness is work-related.

Importantly, the bill also contains provisions designed to reduce delays in injured workers receiving needed treatment, and physicians being paid for delivering this care:

  • With regard to the list of pre-authorized procedures required to be maintained by the WCB, a new provision is added to specify that the purpose of this pre-authorized procedures list is for “expediting authorization of treatment of injured  workers” and that it “shall not prohibit varied treatment when the treating  provider  demonstrates  the appropriateness and medical necessity of such treatment.”
  • Expressly prohibiting an employer,  carrier, or third-party  administrator  from attempting to interfere with the selection by the  injured  employee  of an authorized medical provider, including attempting to direct that the injured employee seek treatment from a specific provider or type of provider selected by the employer,  carrier, or third-party administrator.
  • Eliminating the 3-arbitrator panels for review of disputed medical bills, so that every dispute would only need to be reviewed by a single arbitrator in the same profession as the professional bringing the dispute (the arbitrator can continue to be a physician recommended by MSSNY).

Moreover, unlike some previous versions, the budget provision preserves the historical role of the county medical societies to provide to the WCB peer review of physician applications to participate in the Workers’ Compensation program.  It also preserves language that permits a county medical society to designate another county medical society to perform this function on its behalf.  While it reduces from 60 to 45 days the time to review these applications and to make a recommendation to the WCB, it starts the clock upon receipt of a “completed and signed” participation application. The new provisions will take effect January 1, 2020.  There will likely be follow up communications from the WCB regarding how these provisions will be implemented.                                                                      (AUSTER, AVELLA)

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NY State Education and Health Departments Meet with MSSNY on Student Health Form, Progress Being Made
Progress is being made on efforts to reduce some of the hassles physicians have identified with the new student health form. Staff from the New York State Education Department (SED) and the Department of Health met this week with MSSNY physicians and physicians representing the NY Chapter of the American Academy of Pediatrics to discuss revising this form.   This was the second meeting of MSSNY and AAP NY with SED on the school health form.  At this meeting information was provided by staff from SED and DOH indicated that both departments were amenable to the following:

  • All school health forms data would need to be in the same order (yet to be determined), thereby allowing various EHR systems to generate the form instead of having to force a mandated form into the EHR system. There was also discussion about MSSNY and AAP reaching out to physicians about whether their systems would allow for formatting in the designated order.
  • The use of ICD codes would be optional, but would remain on the form
  • An explanation of the heart rate and respiratory rate to recognize congenital heart disease would be placed in the SED cover sheet explaining how the form is to be filled out
  • The last lead level at ages 1 and 2 and whether it was greater than 10 would be identified if known
  • There was also discussion about another school year delay in use of the form until a cover sheet and a final format for the form has been agreed upon.
  • There will be an implementation plan once format and cover sheet is agreed upon.

In 2016, the Board of Regents adopted amendments to the form that required physicians and other providers to use.  However, physicians indicated that the revised form was problematic for complying with their EHR systems.   In September, MSSNY and AAP physicians were able to delay implementation of the form for the 2018-19 school year and SED issued the following letter to schools:
Joseph Sellers, MD, incoming Vice President for the Medical Society, moderated the meeting and Gail Schonfeld, MD, from the NYS Chapter of the American Academy of Pediatrics was also in attendance.  Dr. Schonfeld has been working closing with SED to make the health form compatible to EHR systems.   Additional meetings are planned  over the next several months. (CLANCY, AUSTER)

Assembly Passes Measure to Standardize Credentialing and Referrals
Assemblymember Richard Gottfried’s A.3077 passed the Assembly on Tuesday and Senator Julia Salazar’s companion S.4335 is currently in the Senate Health Committee awaiting action. If enacted, the policy would require the creation and use of uniform credentialing, re-credentialing and referral forms for physicians and other providers to use for the purposes of applying for and being maintained on a health care plan’s provider panel and hospital’s staff. The intent of this legislation, which is supported by MSSNY, is to streamline administrative processes, reducing the time physicians and their staff spend on the paperwork and administrative tasks necessary to obtain and maintain participation in an insurer’s network and to refer patients to a specialist.

During credentialing, physicians present documentation of their professional privileges, licensure, evidence of malpractice insurance and malpractice history to such health care plan or hospital for their review.  While many use a shared system, there are still situations where insurers use different forms and methods for credentialing and referrals. A uniform method, created with collaboration from all stakeholders would reduce redundancies and would alleviate some of the cumbersome burdens on physicians and their staff.

For more information, you can watch the Assembly debate at the 01:49:49 mark here.      (AVELLA)

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SED Issues Emergency Regulations to Allow Nurses to Provide Immunizations Under a Non-Patient Specific Script Due to Measles Outbreak
In light of the measles outbreak in New York State, the State Education Department has issued emergency regulations giving nurses authority to provide immunizations pursuant to a written non-patient specific order and protocol prescribed or ordered by a licensed physician or a certified nurse practitioner.  The nurse needs to be certified in CPR and ensure that anaphylactic agents, syringes and needles are available at the location whether the immunizing agents are being administered.   Currently there a two major measles outbreaks in New York State communities with very low vaccination rates. Thus, it is critical to make such vaccines available to as many children and infants as possible to protect them from this disease. According to the CDC, measles is a highly contagious virus.  The emergency regulations expand access to seasonal influenza and measles vaccines for infants, children and adults effective beginning with the current influenza season and measles outbreaks.

The amendment will authorize more registered professional nurses to immunize infants, children and adults against additional infectious diseases, in accordance with current recommendations from the United States Centers for Disease Control and Prevention (CDC). The emergency rule is set to expire on June 9, 2019 but it is anticipated that the amendment will be presented to the Board of Regents at its regular July meeting for adoption into the normal regulatory process.  A copy of the emergency regulations can be found on page 12 here.                                                                                (CLANCY)

New York AG’s Office Releases Report Detailing Health Care Bureau Intervention in 2018
The New York Attorney General’s Health Care Bureau released a report summarizing the results of its Health Care hotline from 2018.  Specifically, the report noted that the hotline handled nearly 2,000 consumer complaints and another 2,400 were referred to other agencies with appropriate jurisdiction.

Among the notable cases in the report where AG intervention led to a positive result for the patient:

  • A reversal of an insurer Medical Necessity denial for coverage for an Amyotrophic Lateral Sclerosis (“ALS”) medication;
  • A reversal of a denial of coverage for an anti-cancer drug;
  • A Health Plan incorrectly processed coverage for fertility treatments as an Out-of-Network Benefit.
  • A health plan error delays payment for Emergency Surgery.
  • A health plan delay in updating credentials leads to incorrect claim processing
  • An In-Network Ambulance provider improperly bills a consumer
  • A physician improperly coded a “preventive” colonoscopy as “diagnostic”.

Specifically, the report noted that, among the complaints:

  • 41% were related to Provider billing;
  • 15% were related to health plan claim processing/payment complaints, which include health plan mistakes in preparing, processing, or paying claims;
  • 13% were related to health plan denials of care or coverage, such as denials based on the treatment not being “medically necessary” or the care provided not being a covered benefit;
  • 10% were related to misleading advertising and other business deceptions;
  • 9% were related to problems obtaining and keeping health insurance coverage, including helping 216 consumers in having their health insurance coverage re-instated;

6% were related to problems accessing prescription medications.                       (AUSTER)   

Expedited Partner Therapy Bill Passes Both Houses
The New York State Legislature has passed a measure supported by MSSNY that would allow for expedited partner therapy (EPT) for sexually transmitted infections.    A. 2988/S.1799, sponsored by Assemblywoman Rodneyse Bichotte and Senator Gustavo Rivera, would allow EPT when the Centers for Disease Control and Prevention recommend it for the sexual partner or partners of someone having been diagnosed with a sexually transmitted infection.   EPT is currently used for the treatment of Chlamydia Trachomatis and gonorrhea.   EPT has been shown to be highly effective in decreasing infections rates with STIs.  In 2013, the Medical Society of the State of New York House of Delegates passed policy supporting the use of EPT.   The measure will now go to Governor Andrew Cuomo for his approval. (CLANCY)

Association Health Plan Ruling Struck Down in Federal Court
Federal District Court Judge John D. Bates issued a decision this week that struck down a United States Labor Department rule that would have expanded access to Association Health Plans (AHPs) – insurance plans for covering the employees of independent employers that would not be required to conform to ACA mandates, such as essential benefits coverage requirements and annual and lifetime limits. MSSNY and the American Medical Association had joined the New York Attorney General as an amicus to the successful lawsuit that was filed by a group of attorneys general representing 11 states plus Washington, DC. The lawsuit contended that the administration’s ruling violated Affordable Care Act (ACA) and Employee Retirement Income Security Act (ERISA) provisions.

In December, MSSNY President Dr. Thomas Madejski had given the following statement supporting the concept of the AHP rule while also raising strong concerns: “MSSNY supports efforts to expand the availability of health insurance through a wide variety of options, including through increased options for employers to band together to obtain insurance coverage for their employees.  However, we are concerned that these AHP plans authorized in the federal proposal would not be subject to state regulation and enforcement, which could make it difficult to ensure that patients receive coverage for the care they need and physicians to be timely paid for providing this care.”                       (AVELLA, AUSTER)

Measles Outbreak in New York State Continues: Measles Educational Programs Available Online at MSSNY CME Website
The measles outbreak in New York State continues to be one of the worst in recent history.  There have been extreme measures taken in Rockland County where, according to the New York Times, only an estimated 72.9% of the population is vaccinated.  Since October of 2018, there have been 214 confirmed measles cases in the lower Hudson Valley and New York City.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” in December.  This webinar is available at the MSSNY CME website.  Also be sure to check out The Importance of Herd Immunity, another Medical Matters program that is pertinent to the current measles outbreak.  Please check it out and keep yourself informed about the ongoing measles outbreak in New York State.  You can also have patients listen to MSSNY’s brief podcast on the Measles, Mumps and Rubella vaccine at: Click here.                                   (HOFFMAN)

Health Matters for Women on Endometriosis Webinar To Be Held April 23. 

The Medical Society of the State of New York is proud to announce a live continuing medical education (CME) webinar on a women’s health topic entitled “Health Matters for Women: Endometriosis” on Tuesday, April 23rd, 2019 from 7:30 AM to 8:30 AM for all physicians and other health care providers. To pre-register for “Health Matters for Women: Endometriosis,” please click here.

Tuesday, April 23rd, 2019
Faculty: Lisa Eng, DO

Educational Objectives:

  • Review potential causes of pelvic pain and discuss how to identify endometriosis
  • Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis
  • Discuss implementation of individualized endometriosis treatment plans and options

The Medical Society for 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 credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


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CME at MSSNY 2019 House of Delegates
MSSNY is proudly offering the following CME seminars at the 2019 House of Delegates in Tarrytown on Thursday April 11th and Friday April 12th:

Thursday April 11th 1:00-2:00pm:

Medical Matters: What’s Your Diagnosis? Infectious DiseasesRegister here

Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers 

Thursday April 11th 2:00-3:00pm:

Veterans Matters: The Special Mental Health Needs of Women VeteransRegister here

Faculty: Malene Ingram, MD, Lt. Col. US 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 and treat them

Identify the barriers that women veterans face in getting the specific care they need

Friday April 12th 1:00-2:00pm

Health Matters for Women: Myalgic Encephalomyelitis and FibromyalgiaRegister here

Faculty: Florence Shum, DO

Educational Objectives:

Review potential causes of chronic diffused pain and fatigue

Discuss how to accurately diagnose fibromyalgia and myalgic encephalomyelitis

Discuss treatment options for fibromyalgia and myalgic encephalomyelitis

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 creditsä.  Physician should only claim credit commensurate with the extent of their participation in the activity.

Friday April 12th 2:00-4:00pm

Improving Maternal Mortality Trends in New York State – Seminar and Panel Discussion – Register here

Faculty: Linda Clark, MD, Lisa Eng, MD, Kenyani Davis, MD & Lauren Tobias, Director, Division of Family Health, NYS DOH

Educational Objectives:

Review maternal mortality trends in NYS

Examine racial disparities around maternal morbidity and mortality

Identify potential practice models to improve patient outcomes 

Friday April 12th 4:00 – 6:00 PM

Physician Wellness: Moving from Resilience to System Culture ChangeRegister here

Faculty: Arthur Hengerer, MD, Maria Basile, MD, Brian White, MD

Educational Objectives:

Understand the impact of organizational attempts to address physician stress

Envision large-scale changes in our health care system that can protect against physician burnout

Participate in needs assessment for institutional intervention strategies

Review survey tools to help measure the health of medical staffs

Identify and prioritize actionable strategies for institutional wellness

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 2.0 AMA/PRA Category 1 creditsä.  Physician should only claim credit commensurate with the extent of their participation in the activity.

Registration Now Open for Medical Matters webinar on April 17, 2019 @ 7:30am

What’s Your Diagnosis? Infectious DiseasesRegister here

Be sure to register for the next Medical Matters interactive webinar, What’s Your Diagnosis? Infectious Diseases  This program will include interactive components for participants.  You will be asked to answer questions about a case and discussion will follow.  Find out if you’re fully prepared to diagnose and treat an infectious disease.

Faculty: William Valenti, MD

Educational Objectives:

Identify the modes of transmission of infectious agents

Discuss presumptive treatment of infectious diseases in advance of diagnostic testing results

Describe two scenarios and review questions and answers

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 creditsä.  Physician should only claim credit commensurate with the extent of their participation in the activity.

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NYS DOH Launches Prevention Agenda Website for 2019-2024
The NYS Department of Health has launched its prevention agenda for 2019-2024 and has announced the creation of a new website.  The Prevention Agenda 2019-2024 is the state’s health improvement plan and it is designed to improve the health of New Yorkers.  The Prevention Agenda was developed in cooperation with various stakeholders, including the Medical Society of the State of New York.   This is the third cycle for this statewide plan and MSSNY has been involved since 2008.   The agenda includes five major health areas that include:  1) Prevention of Chronic Diseases 2) Promotion of Healthy and Safe Environment 3) Promotion of Health Women, Infants and Children 4) Promotion of Well-being and Prevention of Mental and Substance Use Disorders 5) Prevention of Communicable Diseases.  A copy of the plan is here and a copy of the goals are here.

MSSNY physicians are encouraged to contact their county health department to determine what the local health goals are the localities and to discuss way that they may engage patients to help improve health.   The DOH Prevention agenda website is here.           (CLANCY)

Senate Finance Committee Moves Purchase Age For Tobacco to the Senate Floor
The NYS Senate Finance Committee has approved and move to the Senate Floor legislation that would increase the purchase age for tobacco products from 18 to 21 years of age.  The measure, S. 2833/A.558, sponsored by Senator Diane Savino and Assemblywoman Linda Rosenthal, has already passed the NYS Assembly.  Governor Andrew Cuomo has also made passage of increasing the purchase age to 21 a priority within in the context of his state budget.  The Medical Society of the State of New York supports this measure.                                                                                                                 (CLANCY)


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For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:



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Zocdoc Pricing Change; DOH Says Change is Not Illegal nor is It Fee Splitting
At the request of MSSNY, our General Counsel, Garfunkel Wild, P.C., met with the New York State Department of Health (DOH) to discuss DOH’s opinion concerning Zocdoc’s new pricing model scheduled to go into effect on April 1, 2019.

DOH had issued an opinion that Zocdoc’s change in pricing model from charging  customers a flat annual fee, to a reduced annual fee with per booking fees based on physician specialty, does not constitute an illegal referral business or fee splitting under New York law. After that meeting, DOH advised Garfunkel Wild that DOH’s opinion is still valid.

Zocdoc previously advised that it was also seeking guidance on its new pricing model from the federal government. To date, Zocdoc has not advised us that it has received such guidance.

However, Zocdoc had previously advised that it has modified its electronic scheduling platform to not accept appointment requests from patients who self-identify as Medicare or Medicaid beneficiaries. Whether to participate with Zocdoc under its new pricing model remains a business decision for physicians and their practices.  Any MSSNY member who requires specific guidance or has questions should contact MSSNY for further information.

Anthem Accused of Sending Checks to Patients to Force Providers in Network
San Clemente, Calif.-based Sovereign Health is suing Anthem and its Blue Cross entities for sending more than $1.3 million in payments to patients that is allegedly owed to facilities that treated them, according to CNN.

Three things to know:

  1. The lawsuit alleges Anthem is sending payments directly to patients after they seek out-of-network care to pressure providers into joining its network and accepting lower reimbursement, according to the report.
  2. The patients are supposed to send the money to providers, but some patients don’t. Arthur Caplan, PhD, director of medical ethics for New York University’s School of Medicine, told CNN it is “insane” to send reimbursement directly to patients. “I’m enormously surprised that anyone would think this is a doable approach,” he said.
  3. In court filings, Anthem does not dispute that checks are given to patients in some cases for out-of-network care. The insurer argues Sovereign Health’s lawsuit should be dismissed for lack of legal standing. The insurer also argues previous court decisions determined anti-assignment clauses that allow for payments to patients are legal, according to CNN. Becker’s Hospital Review 3/4)

Access the full CNN article here.

AMA: No Meaningful Progress on Prior Authorization
The majority of health plans aren’t “making meaningful progress” on prior authorization reforms, according to a physician survey released by the American Medical Association.

The survey took place in December 2018 and included responses from 1,000 physicians on their experience with prior authorization.
Five key takeaways from the survey:

  1. Just 8 percent of physicians said they work with a health plan that allows some providers to be exempt from prior authorization requirements.
  2. Phone and fax are still the most commonly used methods for prior authorization, according to the physicians. Only 21 percent of physicians said their EHR system completes electronic prior authorization for prescription medications.
  3. Most physicians (88 percent) said the number of drugs that require prior authorization has increased. Eighty-six percent said the same about the number of services requiring prior approval.
  4. Nearly 7 in 10 physicians said they find it difficult to determine if a prescription or medical service requires prior authorization.
  5. Eighty-five percent of physicians said prior approval processes interfere with care continuity.

Register Today for MLMIC’s Risk Management Program – April 11th in Tarrytown
April 11, 2019 at 9:00am
Westchester Marriott Hotel
670 White Plains Road
Tarrytown, NY 10591

MLMIC is pleased to invite you to attend its Risk Management Program on Thursday morning, April 11, 2019, at the Westchester Marriott Hotel in Tarrytown, New York. The program will run from 9:00 a.m. to 12:45 p.m.

This year’s program will address several topics including Top Risks of the Office Practice Setting, Effective Coordination of Hospitalist Care, and High Exposure Liability Cases.

Attendance at this complimentary educational event will enable physicians to earn 3.75 AMA PRA Category 1 CME Credits and provide the opportunity to complete a second component of the program online, at their convenience, to:

  • Earn additional CME credits;
  • Secure a 5% premium credit on their primary insurance policy, and
  • Qualify for participation in the “free” Section 18 excess medical malpractice insurance program.

There is no charge to attend however, pre-registration is required.

Click on the link below to register

A Conversation with Assemblyman David Buchwald Friday, April 12 3-5pm in Tarrytown
All are welcome to come learn about the importance of getting involved in physician grassroots advocacy and effective messaging from local Assemblymember David Buchwald representing parts of Westchester County. Assemblymember Buchwald worked to bring ethics reform to Albany through amending the NYS Constitution to include pension forfeiture for public officials convicted of corruption.  Experienced politically active physicians will discuss the many tools MSSNY offers physicians to assist them in engaging in strategic community and state-wide advocacy efforts on behalf of their patients and for the profession of medicine in New York State.  For as long as you will be a physician, local community involvement and grassroots advocacy on behalf of your patients and your profession will be essential.  Event is free to MSSNYPAC members. Download flyer.  Join online at or donate at the event. RSVP to

CVS Asks 60 Drugmakers to Suspend Drug Price Hikes
CVS Health sent letters to 60 drugmakers asking them not to increase the net costs of their drugs in response to a proposed rule that would overhaul the rebate system, according to an Inside Drug Pricing news report. HHS proposed a rule Jan. 31 that would eliminate rebates — the discounts drugmakers pay to pharmacy benefit managers. The rebate ban, which is expected to be finalized before health plans’ deadline to submit 2020 Medicare bids in three months, would cut profits for PBMs and health insurers.

The ban also would make it hard for insurers to accurately set Medicare Part D premiums.

Medicare plans rely on drugmakers’ existing prices to design plans for the upcoming year, and they would need to redesign those plans if drugmakers increased drug prices.

Rebates also been have been used to keep insurance premiums low, but if rebates are instead passed along to patients at the pharmacy counter, patient premiums could go up.

HHS officials said health plans will do all they can to keep these increases as small as possible.

“In the best possible scenario, this would give the Part D Plans just 26 days to adjust their bids in response to any final rule,” CVS said in a letter to drugmakers, according to Inside Drug Pricing. “We require assurances that, regardless of the issuance of any final rule, you will, at a minimum, honor the financial value of your current offer and continue to provide to the Part D plans the same or lower net effective drug price for calendar year 2020.”

Sign Up for CME Courses at the Westchester Marriott April 11-12
The following is a list of CME courses that will be presented at the Westchester Marriott

You don’t want to miss these! REGISTER NOW at

  • Thursday, April 11, 2019, 3:00 – 4:00 pm, Grand Ballroom D/E, Westchester Marriott, Tarrytown

Protect Your Patients, Your Practice, and You!*

Join us at the OMSS Annual Meeting for an interactive presentation by Garfunkel Wild on MEDICAL RECORDS, including the impact on records of the controlled substances “epidemic,” what to consider when emailing and texting, dealing with non-compliant patients, additional areas of exposure from EMRs, and what to include in a telemedicine record.

Business meeting to follow, 4:00 – 6:00, Putnam Room

  • Friday, April 12, 2019, 5:00 – 6:30 pm, Grand Ballroom B, Westchester Marriott, Tarrytown 

Women in Medicine: Reaching Your Potential Now!**

A panel presentation at the Women Physicians Caucus on PAY, PROMOTIONS and CAREER ADVANCEMENT in Academic Medicine, Private Practice and Organized Medicine

Gender imbalance in medicine and academic sciences still exists. Hear three women physicians who have achieved significant leadership positions describe their own pathways, provide advice on how to achieve success, and show how to overcome gender bias, gender pay gaps and system-wide barriers to career advancement. Learn how to achieve success in your career!

* 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.

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. 

** 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.

The Medical Society of the State of New York designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Calling All IMGs! Symposium on April 18 at Jacobi Medical Center in the Bronx
Essen Health Care will host an IMG Symposium on April 18 from 5-8 pm at Jacobi Medical Center in the Bronx. MSSNY member Parag Mehta, MD, Senior Vice Chairman, Department of Medicine at NYP Brooklyn Methodist Hospital will speak about Pre-Residency Preparation. Other topics include Residency Application and Interview Tips, Primary Care Pathway and Externship Opportunities. RSVP at or by calling 646.876.0141. Click here for more information on the symposium.

MSSNY Officer/ Psychiatrist Speaks About Negative Consequences of Marijuana
WNYC-FM New York (3/25) reported on its website that while New York’s Democrat leaders are pushing to legalize marijuana, opposition appears to be growing. Critics of legalization concede that how the drug is “policed and prosecuted” should change, but also argue that proponents of legalization are ignoring the risks of the drug. For example, Dr. Frank Dowling, a psychiatrist in Long Island, and MSSNY Secretary said, “The consensus is that using marijuana regularly does alter areas of the brain that are involved in cognition and thought processes in memory and learning. And the long-term usage, especially as a teen or young adult, can lead to long-term cognitive issues, even if someone stops using later on in life.”

CMS Annual Survey for Medicare Contractors
CMS is once again conducting their annual survey of Medicare Administrative Contractors (MAC) performance and requesting feedback from the provider community we serve through the MAC Satisfaction Indicator (MSI).The MAC Satisfaction Indicator (MSI) is the best way to share your opinions of our service directly with the CMS. This survey should only take 10 minutes of your time and helps us understand how we can better serve you. To take the survey, click on the URL below:

Jurisdiction K (JK) providers may access the survey by clicking here:

2019 Jurisdiction K MSI Survey

Dr. Anthony P. Santomauro, 89, Former Chief Surgeon at Kenmore Mercy Hospital
Dr. Anthony Patrick Santomauro, retired chief surgeon at Kenmore Mercy Hospital, died March 2 in New Smyrna Beach, Fla., where he had lived for the past 20 years. He was 89. Born in Buffalo, the son of longtime Buffalo restaurateur Anthony V. Santomauro, he was a 1947 graduate of Amherst High School. He earned a bachelor’s degree from Denison University in Ohio and his medical degree from the University at Buffalo.

A vascular surgeon, Dr. Santomauro joined the staff at Kenmore Mercy Hospital in 1963 and retired with emeritus status in 1995. He was president of the hospital’s medical staff in 1977. He also practiced at DeGraff Memorial Hospital in North Tonawanda.

Active in the Medical State Society of New York, he was a former member of its executive board and for seven years was an MSSNY delegate to the American Medical Association. He had been an officer in the MSSNY Political Action Committee since 1993 and served for 14 years as chairman. He was past president of the Erie County Medical Society and the Buffalo Surgical Society.  Survivors include four daughters, Melissa Rush, Mary Pilat, Karen Albert and Susan; a son, James A; 14 grandchildren; and six great-grandchildren. Another daughter, Leslie Ann, died in November. A memorial service will be held at 10 a.m. May 11 in the UB Newman Center, 495 Skinnersville Road, Amherst.



Bronx Physician’s Office for Sale or Lease
Physician’s running office fully equipped for sale or lease. Effective immediately, retiring, Bronx, near Einstein Hospital, near subway. Call 914-882 3797 /

Park Avenue Medical Office for Sale
On Park Ave, for sale is a large medical office, in a beautiful full service co-op with two entrances, one of which is an impressive doorman in lobby entrance.The office has high ceilings, easily adaptable to any specialty and priced to sell. Three good size rooms easily converted to five exams, plus consult, bathroom, reception and large waiting room. Outstanding location. A must see. View floorplan Call Jeff Tanenbaum,  646-234-2226 or email for showings and more information.

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:

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.

5th Ave Medical Office for Share
Facing Central Park in exclusive building, ground floor, separate entrance.
Perfect for psychiatrist, physiatrist, osteopath, or other.
880 5th Avenue (between 69th and 70th Sts.), New York, N.Y.
Please call 917-715-2464

Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Available Monday, Wednesday, Friday and weekends. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington. Rent by day (about $180). Front desk and office management available if needed, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

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 officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up:


Seeking Executive Director of the Onondaga County Medical Society
 An exciting opportunity for the right person to provide leadership for physicians Salary: Commensurate with experience Job Description: Direct day-to-day operations of the Onondaga County Medical Society Some evening meetings, travel required. RequirementsExperience with leading political advocacy; political sophistication. Must know how to interface with government officials. Good networking and communication skills. Conversant with budgets and finance. Excellent media relations skills, including electronic, social media, and written communications. Familiar with medical issues and comfortable discussing them. Education: BA/BS required.  MPH or MBA desirable. We expect innovation and project initiation. The Executive Director will receive a contract that increases remuneration commensurate with membership growth. Application Instructions: Please direct your application to: Dr. Brian Johnson,

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:  Fax: (1-516) 833-4760 Equal Oppty Employer M/F

Pediatrician BC, P/T
Seeking motivated, enthusiastic pediatrician for P/T position in solo practice in Long Island. Coverage will increase over time. Great opportunity for those seeking part time hours in an established practice.   Fax resume to 516-858-2389.

Physician 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, the insights of forward-thinking physicians like you are invaluable. 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