MSSNYeNews: July 19, 2019 – The Final Frontier
Congress is continuing to work on legislation that aims to deal with “surprise bills.” Keep your eyes peeled to your email inbox for updates. I realize this may seem tiresome but if the wrong legislation is passed, the Uniteds and Aetnas of the world may get handed the ability to set benchmark payments for everyone. Believe me, it won’t be pretty. Attention is soon moving to the House Ways and Means, where we have a shot. NY Reps Tom Suozzi (downstate) and Brian Higgins (western NY) are on Ways and Means and are also cosponsors of HR 3502 which would set up an independent arbitration system similar to NY’s to resolve disputes. Please take a moment and Call Rep Suozzi 202-225-3335 and Rep Higgins 202-226-0347, asking them to oppose HR 3630 and support the bill they co-sponsor— HR3502.
Perhaps contemplating the alternative should Congress get it wrong will get you to dial that much faster.
Now, please allow me to digress.
This weekend marks the 50th anniversary of that “one small step for man, one giant leap for mankind” as the first humans walked on another galactic body. Just three years before in 2016 was another 50th anniversary – that of arguably the most famous split infinitive of all time – as the voyages of the Starship Enterprise embarked on its five-year mission. This now celebrated Science Fiction series made the Science Fact of the moon mission all the more incredible. July 20, 1969 was the day the Impossible became Possible.
Space has been the dream of all humanity from the day the first sentient primate climbed down out of that tree, looked up, saw the night sky and wondered what was out there. Now, folks from all over the world are preparing to return to space. There will no doubt be missteps as there have been in the past – Apollo One and Challenger come to mind – but in the not too distant future, we will once again see explorers, as Ronald Reagan put it in another, more somber context, slip “the surly bonds of earth to touch the face of God.”
Oh, when I look back now
That summer seemed to last forever
And if I had the choice
Yeah, I’d always wanna be there
Those were the best days of my life
Back in the summer of sixty-nine
–Bryan Adams, Summer of Sixty-Nine
Arthur Fougner, MD
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US House Committee Advances Surprise Billing Legislation Opposed by Physician Community
This week the US House Energy and Commerce Committee reported out by voice vote surprise billing legislation (HR 3630) strongly opposed by MSSNY and other medical associations. The legislation would limit out of network payment for surprise hospital bills to a median in-network rate, for which MSSNY and the medical community has raised strong concerns that it would give enormous new powers to already market dominant health insurers. An amendment to HR 3630 offered by Rep. Dr. Raul Ruiz MD (D-CA) and Rep. Dr. Larry Bucshon MD (R-IN) was adopted to add an appeals provision. Appeals would be restricted to complex cases with a payment above $1,250 (indexed to inflation).
Arbitrators would be permitted to consider median contracted in-network rate, provider’s level of training, experience, quality and outcomes measurements and acuity of care/services rendered. In order to hold down the budget score of the amendment, the arbitrator would be prohibited from considering billed charges.
The AMA has reported that the addition of an appeals process, while imperfect, represents progress on this issue, noting that there will be opportunities with two other House committees (Ways &Means/Education& Labor) to make further improvements on this and other elements in the legislation both before and during floor action in the House and Senate. While this legislation would protect New York’s law for state regulated health insurance products, it would establish this insurer determined default rate for plans governed by ERISA.
Amendments were also adopted by the E&C Committee for HHS and the GAO to conduct studies to assess impact of the legislation on access to providers, network adequacy, premiums and patient out of pocket costs. In addition, a requirement to conduct an audit of at least 25 health plans to assure that in-network median rates are being properly calculated was also adopted.
MSSNY will continue to work with the federation of medicine to fight for a law that is consistent with New York’s acclaimed approach, rather than bills such as HR 3630, which is essentially a gift to the health insurance industry wrapped in a consumer protection package. We thank the many physicians have who have contacted their respective members of Congress, and urge physicians to continue doing so by clicking here.
Physician Action Needed on Bills Awaiting Governor’s Signature
Bills that passed during the 2019 session must now be sent to the governor in order to be enacted into law. There are still a few outstanding pieces of legislation that passed both houses this year that MSSNY has taken strong positions on, and as such it is incumbent upon MSSNY members to take a moment to let the governor know where we stand on these issues. There is power in numbers; the more physicians that reach out to the governor, the louder our message will be heard.
Physicians can quickly and easily send a letter to the Governor here on these issues:
- Malpractice expansion – two bills passed the legislature that will further tip the scales in lawsuits against physicians and others, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please let the governor know how destructive these bills would be by clicking here.
- Mid-year formulary changes – would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year. Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please reach out to the governor and let him know how helpful this bill would be by clicking here.
- Partial prescription fills – would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
Gov. Signs Law Raising Tobacco Sales from Age 18 to 21
This week Governor Cuomo signed into law legislation (A.558/S.2833) that would raise the statewide tobacco purchase age from 18 to 21, legislation long supported by MSSNY. The new law will take effect on November 13, 2019. MSSNY President Dr. Art Fougner offered the following statement praising the Governor and legislators for taking this action:
“This major public health advancement will help to prevent a generation of New Yorkers from becoming addicted to smoking by delaying children and young adults’ access to tobacco products. Data shows the earlier a child begins to smoke the more severe the addiction is likely to be and 90% of all smokers begin before age 20. This new law will reduce the likelihood they ever start smoking and therefore create a healthier state. We thank Governor Cuomo for signing this legislation into law, and Assemblywoman Rosenthal and Senator Savion for advancing this important legislation”
New York Insurer Opens Office in Hospital
CDPHP, a New York health insurer, opened a branch inside Ellis Medicine in Schenectady, N.Y., to connect patients directly with insurance staff if they have questions during treatment and post-discharge, according to the Albany Business Review.
The idea came to CDPHP’s CEO, John Bennett, MD, after a recent hospitalization revealed some of the difficulties patients face when navigating the healthcare system. CDPHP opened its office July 16, which is staffed with representatives tasked with answering questions about what insurance will pay for at Ellis Medicine, among other discussions.
Ellis Medicine CEO Paul Milton told the Albany Business Review he expects to see improved patient satisfaction and readmission rates among CDPHP members because of the partnership. In addition, since Ellis Medicine houses CDPHP’s first hospital office, CDPHP members may seek out the hospital for care. Read the full article here.
Private Equity Investing Heavily in Physician Practices
Private equity is a big mover in the long-term care continuum, especially in the home care and hospice spaces where the platforms are looking to build growth through acquisition-heavy strategies, Providing’s Kyle Daly told Bloomberg Law (June 17).
Involvement by BDT Capital Partners and Gryphon Investors in deals in the physical therapy space demonstrated private equity’s continued interest in expanding its presence in key markets through add-on acquisitions, Daly said.
Private equity also is investing heavily in physician practices, Hirschman said. Radiology remains a hot practice area for consolidation, he said.
Private investors have shown the most interest in ophthalmology, gastroenterology, ear-nose-and-throat, obstetrics-gynecology, and orthopedics practices, Hirschman said. This is because those specialties have the greatest potential to increase revenues and profits through additional investments in new and expanded ancillary services, like ambulatory surgical centers, he said.
40% of Physicians Refuse New Patients Who Use Opioids for Chronic Pain
Researchers found that more than 40% of physicians refuse “to take on new patients who need opioids to control pain.” The study surveyed 194 primary care clinics in Michigan. The findings were published in JAMA.
Our State Fair is a Great State Fair…Don’t Miss it from August 21 to September 5!
Once again the Onondaga County Medical Society will staff the Medical Society of the State of New York/New York State Society of Anesthesiologists booth at the state fair. Medical Society physician members are encouraged to volunteer to work the booth during a time slot. This is a great opportunity to perform public health outreach, and to promote your practice or organization at the NYS Fair, free of charge. Those who work at the booth will receive free admission tickets and free parking (on a limited basis). Feel free to bring handouts about your practice or other timely medical information to share with fair goers. Please let us know if you have any ideas for exhibits, testing, etc., that you feel will be informative and help advance a positive image of the medical profession.
Contact us for available time slots remaining for the 13-day fair, which runs from Wednesday, August 21 – Monday, September 2, 2019 (Labor Day). You can work as little as two hours or the entire day if you’d like. We need only one physician-member group per time slot. This is being updated daily. Time availability is on a first-come, first-served basis. Contact Patty Corasaniti at (315) 424-8118, or send email to firstname.lastname@example.org for more information.
American Medical Women’s Association Hosts Congress July 25 in Brooklyn
The American Medical Women’s Association will be hosting the Centennial Congress of the Medical Women’s International Association MEDICAL WOMEN: AMBASSADORS OF CHANGE IN A CHALLENGING GLOBAL WORLD from July 25-28, 2019 at the Brooklyn Bridge Marriott Hotel (333 Adams Street, Brooklyn). Keynote speaker Gloria Steinem, author/co-founder of MS. Magazine and New York Magazine will address the audience of more than 1000 female physicians on Friday, July 26, 2019 at 11AM.
The hashtag for the 3-day conference is #MWIA100. The Centennial Congress will feature discussions on Digital Health, Innovation & Genomics, Gender Specific Medicine, Gender Equity, Global Health, Work-Life Balance, Violence Against Women, Obesity: A Global Health Crisis, Sex & Gender Specific Medicine, and Sexual Harassment, among other professional tracks and topics.To register for the Conference, please follow this link. For more information, please contact: Charlotte Tomic, 917-882-5243; email@example.com.
Frances Foy, Wife of Ret’d MSSNY EVP, Don Foy, Mother of Former Westchester EVP Brian Foy, Died on July 7; Services in St. Augustine FL on Friday, August 2
Frances M. Foy, age 82, of St. Augustine, FL, passed away on July 7, 2019 at her home with family at her side. She was the mother of four children; grandmother of nine; and great grandmother of two. Frances met her husband, Donald, in California where she was a former TWA flight attendant. They were married for nearly 59 years. A memorial mass will be held at 9:00 am on Friday, August 2, 2019 at St. Anastasia Catholic Church in St. Augustine, FL.
Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
For Lease – Buffalo Area Urgent Care / Primary Care Clinic
Upper East Side Medical Office Space for Rent Part–Time
Park Avenue Office Share-3 Days Per Week
Medical Office Space for Rent!
Beautiful Newly Renovated Medical Office on the Upper East Side between Madison and Park Avenue! Conveniently located near all public transportation and Mount Sinai Hospital. Consult and Exam room available for rent part time or full time (see pictures). Please call 212-860-0300 or email firstname.lastname@example.org <for further 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: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/
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. 212.371.0468 / email@example.com.
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.
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical office, shared your office space, buy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up
Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.
Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.
We have openings in the following counties offering a choice of urban, suburban or rural living:
Clinton* Clinton Correctional Facility (sporting and recreational outlets)
Dutchess Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin* Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene* Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca* Five Points Correctional Facility (heart of wine country)
St. Lawrence Riverview Correctional Facility (hiking, boating and museums)
Washington Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.
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: firstname.lastname@example.org Fax: (1-516) 833-4760 Equal Oppty Employer M/F
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355