MSSNY eNews: Watching the Detectives – September 20, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 20, 2019

Vol. 22  Number 35


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Colleagues:

On Monday, MSSNY applauded Gov. Cuomo’s emergency executive action to ban the sale of flavored e-cigarettes in the state. Flavored vaping products like “cotton candy” and “Captain Crunch” are obviously targeted to entice teens to vape. The health of our children is at stake. It’s time to address this head on before it affects an entire generation.

Vape Lung, VALI (Vaping-Associated Lung injury), Allergic Pneumonitis, Lipoid Pneumonia – these are all names for an acute and sometimes fatal lung injury which leaped into our lexicon as summer was coming to an end.  Seven deaths and over 400 cases have been reported thus far in 36 states and the US Virgin Islands. Presentation is often fulminant, yet cases with slower onset have been reported. While clinical presentation resembles lipoid pneumonia, imaging is not typical for that disorder. Reports have been associated with street level THC products.

NY’s Department of Health issued an update on September 5th:

As of September 5, 2019, the Department has received 34 reports from New York State physicians of severe pulmonary illness among patients ranging from 15 to 46 years of age who were using at least one cannabis-containing vape product before they became ill. However, all patients reported recent use of various vape products.

Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing.

At our meeting with NY State’s Commissioner of Health Dr. Howard Zucker on Tuesday, we were assured the Wadsworth Laboratory had not isolated any vitamin E acetate in any of NY’s Dispensary Medical Cannabis product.

Other investigators are not so sure Vitamin E is the only etiologic factor in vape lung, suggesting some patients have not fit the street pot Vitamin E pattern.

Curiously, the cases appear to be limited to the US and its territories. For example, Canada, despite its proximity, has reported no cases. There have been no cases thus far in the UK as well. The UK had banned certain flavored nicotine vaporizer oils because they contained diacetyl which had been linked to lung disease. Michigan and now New York have banned flavored e-cigs. We can only hope this makes a dent in the incidence of these cases.

Eerily reminiscent of the 1980’s Tylenol murders, the FDA has launched a criminal investigation. (See story below.)

For now, the take home message from WarGames applies – “The only winning move is not to play.”

We’ll all be watching the detectives.

Late-breaking news: Governor Andrew M. Cuomo and State Department of Health Commissioner Dr. Howard Zucker today re-issued a warning to New Yorkers to continue to refrain from using e-cigarette or vaping products as the number of vaping-associated illnesses sharply increases both nationally and in New York State. https://www.governor.ny.gov/news/governor-cuomo-and-health-commissioner-zucker-issue-renewed-warning-vaping-associated-illnesses

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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FDA Launches Criminal Probe as Vaping-Related Illnesses Top 500
In an update on the vaping crisis, federal health officials said today that, as of September 17, the number of confirmed and probable cases of lung injury associated with e-cigarettes and vaping products has climbed to 530 in 38 states and one territory, prompting the FDA to launch a criminal investigation into the possible causes.

“Sadly,” seven patients from six states have died as a result of their illness and “we do expect others,” Anne Schuchat, MD, principal deputy director, US Centers for Disease Control and Prevention (CDC), told reporters in a telebriefing.

She said the CDC will update case counts every Thursday going forward.

Earlier this week, the CDC activated its emergency operations center to help coordinate the investigation into the growing number of cases of severe lung illnesses linked to e-cigarette use.

The exact cause of vaping-related lung illness remains elusive. This investigation is “dynamic and complex and I wish we had more answers,” Schuchat said. “States are classifying cases and reporting them to CDC on a regular basis.”

She emphasized that “no consistent e-cigarette or vaping product, substance, additive, or brand has been identified in all cases; nor has any one product or substance been conclusively linked to lung injury.” Many patients reported using multiple types of products, some containing tetrahydrocannabinol (THC), THC plus nicotine, or nicotine only.

Based on available data, Schuchat said three quarters of the cases are males, two thirds are in people 18-34 years of age, 16% are younger than 18 years of age, and 17% are age 35 years or older. In all, more than half of the cases are under 25 years of age. Patients typically have reported cough, shortness of breath, and/or chest pain, gastrointestinal symptoms (nausea, vomiting, or diarrhea) as well as fatigue and fever.

The CDC continues to recommend that people consider not using e-cigarette products while investigations are ongoing.


Council Notes—September 19, 2019
Council approved the following:

  • MSSNY will recommend that the AMA seek legislation to ban anti-assignment provisions in health insurance plans and to support legislation requiring health insurers to issue payment directly to the physician when the patient or patient representative signs an agreement that permits payment directly to the physician.
  • MSSNY will advocate for increased payment for office based afterhours CPT Codes.
  • MSSNY will advocate for legislation and regulation requiring ALL credentialed physicians (employed and voluntary) be equally included on their hospital websites and Find-a-Doctor sites of the hospitals and other health care facilities and will recommend the AMA do the same.
  • MSSNY commends the Governor and the DOH Commissioner for their action to protect patients by banning sale of flavored e-cigarettes; recommends a moratorium on dispensing of vaporized products to new certificate holders for medical marijuana until data on long term safety is available; recommends rescheduling marijuana to Schedule II; and recommends funding in the State Budget for study of efficacy and harms of the current medical marijuana program.
  • MSSNY will create a Scope of Practice Ad Hoc Committee with the following members: Rose Berkun, MD, Co-Chair; Lisa Eng, DO, Co-Chair; Inderpal Chhabra, MD; Atul Kumar Gupta, MD; Richard Wissler, MD.
  • MSSNY will adopt the Accreditation Council for Continuing Medical Education (ACCME) Menu of New Criteria for Accreditation with Commendation. This year marks the end of a transition period in which CME providers had a choice between demonstrating the old commendation criteria and the new.  Additionally, MSSNY will adopt the revised CME Annual-Reporting Requirements for MSSNY-accredited CME providers.

Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still 617 bills that passed both houses in 2019 that were awaiting delivery to the governor. In the past week alone, 59 bills were chaptered into law – the flurry of bill signings has begun. Of those 617, there are a few that stand out as priorities for MSSNY. When these bills arrive at the governor’s desk, he has to decide whether to sign them into law or to veto them and as such there is still a strong opportunity to influence the decision-making process.

Physicians can quickly and easily send a letter to the Governor here on these issues by using the MSSNY Grassroots Advocacy Center at http://tiny.cc/MSSNYGAC (direct links to these priority items are listed below). Please take a moment to voice your support/concerns on these very important issues!

  • 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.
  • 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.


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Please Continue the Fight for a Fair Solution to Surprise Medical Bills; NY Law a Great Success
Please continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair federal legislative solution to the issue of surprise medical bills.  By clicking here, you can send a letter, make a tweet and make a phone call to your elected officials. It only takes a few minutes and contains all of the details necessary to get our point across.

This week, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.  Moreover, it noted that there were a total of 2,595 IDR decisions reached.  With regard to IDR for out of network hospital “surprise” bills, 815 IDR decisions were rendered. Health plans prevailed in 13% of the cases, while physicians prevailed in 48% of the cases. There were split decisions in 39% of the cases.   With regard to IDR for out of network emergency care services, 43% of decisions were in favor of the health plan, 24% were in favor of the provider, and 33% were split between the health plan and provider.

While MSSNY together with physician groups across the country are working diligently to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of legislation that emulates New York’s successful model, such as H.R.3502, sponsored by Representatives Ruiz and Roe. At the same time, grave concerns have been raised about the alternative being pushed by insurance companies (H.R.3630, sponsored by Representative Pallone, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.

When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not give them any more power.  Please contact your Senators and Representatives today!


New York’s Opioid Tax Creating Concerns
Fortune (9/16) reports that New York “became the first state to place an excise tax on opioids sold to or within the state,” with supporters expecting “the tax to generate $100 million in revenue for the state, which Gov. Andrew Cuomo and his administration have said will be plowed into helping victims of the opioid crisis.”

The idea behind the tax “was to punish pharmaceutical companies for their role in the opioid epidemic,” but “the tax, which went into effect July 1, has already set off a ripple effect across the entire supply chain, as manufacturers and distributors have either stopped shipping to the state altogether or passed the tax onto each other.” Additionally, regarding the fear of social costs, health officials are concerned “the tax could drive patients to seek out opioids on the black market.”

If you have patients who are having difficulty obtaining their opioid prescriptions, MSSNY wants to hear from you so that we can ascertain how widespread this problem is. Please email mauster@mssny.org with any information you have regarding this situation.


Weill Cornell: Free for Students Who Qualify
On Monday, Weill Cornell Medicine in New York City, announced that all students who qualify for financial aid will get a full ride: All costs will be covered by scholarships, including tuition, room and board, books and other educational expenses. “Student debt has been in the national discussion for a long time, and we have been planning, strategizing and raising money,” said Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine and provost for medical affairs at Cornell University. “It’s the right time to offer debt-free medical education.”

In 2017, Columbia University announced a new endowment that it said would eliminate the need for medical students to take out loans for tuition; the neediest would also have living expenses covered. The David Geffen School of Medicine at the University of California, Los Angeles, offers full rides to about 20 percent of its entering classes, though the awards are based on merit, not need. In August 2018, the New York University School of Medicine said it would cover tuition for all its current and future students.

Of Weill Cornell’s 373 students, 52 percent qualify for need-based aid. A single year at the school — which sits in one of America’s most expensive ZIP codes, on the Upper East Side of Manhattan — costs more than $90,000, according to Weill Cornell. With need-based grants for the last academic year averaging about $38,000, students often relied on federal loans to bridge the difference. The average debt for a graduate of the program this year was $156,851. (NYT Sept.16)


Zocdoc Gets Federal OK to Book Medicare and Medicaid Visits
Zocdoc would not violate the federal anti-kickback statue by charging physicians for each Medicare or Medicaid beneficiary who books an appointment through its website, according to an advisory opinion issued by the U.S. Department of Health and Human Services’ Office of the Inspector General.

The opinion does not mention Zocdoc by name but Dr. Oliver Kharraz, Zocdoc’s CEO, wrote a blog post sharing the opinion. Kharraz said Zocdoc will restore access to its appointment-booking service for all Medicare beneficiaries and Medicaid beneficiaries in certain states including New York on Sept. 18. Zocdoc began charging doctors per new patient booking earlier this year, frustrating New York doctors who had grown accustomed to paying a flat monthly fee for access to the services. At that time, it restricted Medicare and Medicaid beneficiaries from using the service to book appointments to avoid running afoul of federal law.

It has now received guidance from the state Attorney General, state Department of Health and HHS that its pricing policy wouldn’t violate the law with certain caveats. (Crain’s Sept.17)


Most Not Screening Patients for All Five Social Needs Recommended by Feds
Researchers found that “most U.S. physician practices and hospitals are screening patients for at least one social need, but only a small percentage are screening for all five social needs recommended by the federal government.” The five social needs are: Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence.

The findings were published in JAMA.


CME

Sign Up for the Morning Briefing on October 17 in Binghamton
Strengthening Community and Health Care Provider

Resiliency to Adverse Childhood Experiences

Thursday, October 17, 2019 • 12 – 2 pm
UHS Binghamton General Hospital
Russell Community Room
10-42 Mitchell Avenue
Binghamton, NY 13903

The session will also be archived on the Department of Health website. The event is free of charge and available to all interested providers throughout New York State. Participants are eligible for 2.0 CME credits. Flyer.


MLMIC Presentation: Hot Topics in Healthcare: LIVE CME EVENT
Presenters:  MLMIC and MAGNACARE

When:           Tuesday, September 24, 2019
Time:             9:00 AM to 12:30 PM

Where:          Long Island Marriott, 101 James Doolittle Blvd. Uniondale, NY 11553 

Register online at www.mlmic.com/exclusive or e-mail your full name to pjorge@mlmic.com


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CMS

The Deadline to Submit a MIPS Targeted Review Request is 2 Weeks Away
If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website. The MIPS payment adjustment you will receive in 2020 is based on your final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2020.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request for CMS to review their performance feedback and final score calculation through a process called targeted review. The deadline to submit your request is September 30, 2019 at 8:00 PM (EDT) – which is just 2 weeks away.

When to Request a Targeted Review

If you believe an error has been made in your 2020 MIPS payment adjustment factor(s) calculation, you can request a targeted review until September 30, 2019 at 8:00 PM (EDT). The following are examples of circumstances in which you may wish to request a targeted review:

Errors or data quality issues for the measures and activities you submitted

Eligibility and special status issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)

Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard

Note: This is not a comprehensive list of circumstances. CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by going to the Quality Payment Program website


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Location: New York, NY, United States
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Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643


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. 212.371.0468drdese@gmail.com.


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
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 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: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES


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.

View of a doctor's office waiting area View of a doctor's office lobby

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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: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355