September 28, 2018 – Back to the Future

Thomas J. Madejski, MD MSSNY President

Thomas J. Madejski, MD
MSSNY President

September 28, 2018
Volume 20  Number 36



Last week I felt like the Flux Capacitor of the Delorean from the film Back to the Future –on a journey from the shores of Lake Erie to the North Shore of Long Island.

On Tuesday, I  joined the Erie County Medical Society at their golf outing in Hamburg, New York—and was pleased to stick a pitching wedge 5 feet from the pin on our second last hole to secure a birdie for our team and get to 8 below par.  We still ended up fourth.

The satisfaction of a well hit golf shot is substantial, but more important was the discussion I had with two of our prominent MSSNY members, Dr. Richard Vienne, a member of our AMA delegation and a medical director for Univera Health Care and Dr. Raghu Ram, a regional medical director for Landmark Care.  We discussed improving the care of our patients on an individual and population basis—from advancing communication across various sites and transitions of care to creating a collaborative team.

Innovative Ways to Improve Care

Dr. Ram and his colleagues explained some novel interventions they are attempting, using large data sets and analytics to improve care and avoid hospitalizations.    I think we also need to have further discussions with insurers on how to improve that interaction, particularly with a move to capitation in Western New York by some insurers that may paradoxically incentivize physicians to drop higher cost or more complex patients.

Challenges remain on integrating additional care without disrupting patients’ established care, but as I drove home that day I felt hopeful that there are opportunities to continue to refine and improve that approach.

Continuing Medical Education

Later in the week, I had the pleasure to meet with Dr. Graham McMahon, MD—MMSc  President and CEO of the Accreditation Council for Continuing Medical Education (ACCME)—along with our MSSNY CME Committee and staff.  We had an informal dinner on Thursday, and I provided opening remarks for our 2018 MSSNY CME Provider Conference on Friday.

I snuck in part of a teleconference with our MSSNY Committee for Physician Wellness and Resilience Committee prior to the opening of the CME conference.

Back to the Future

The various discussions of the multiple groups addressed issues that intersect in various, complicated ways.  Continuing professional development, MOC, quality improvement, a complex and fatiguing practice environment and value based care all affect patient care and physician satisfaction.

These streams of organizational activity flow to our Office of the President (the flux capacitor allusion) much faster than the 88 mph required to accelerate the DeLorean of the movie through time.  Our goal is to travel together to improve care for patients, and the practice environment for physicians.  I’ve tasked both our CME Committee and Wellness and Resilience Committee to focus on those goals with some new offerings to improve the professional and personal lives of our members.

I’d appreciate your thoughts and comments, and am always looking for active participation in achieving our mission.  Please contact me at

Thomas J. Madejski, MD 
MSSNY President

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New York DFS Raises Concerns With CVS-Aetna Merger
New York Department of Financial Services (DFS) Superintendent Maria Vullo issued a letter this week expressing ‘significant concerns’ with the proposal of pharmacy and PBM behemoth CVS to acquire health insurer behemoth Aetna.  The letter was sent to Connecticut Insurance Department Commissioner Wade in advance of the Connecticut hearing examining this transaction next Thursday, October 4.

Among the concerns that Superintendent Vullo identified in her letter:

  • If approved, the proposed transaction “would create an incredibly large market share in the health care market for the combined company, in an already concentrated marketplace, and is likely to increase prices for members and reduce options for consumers, without any discernable increase in quality.”
  • CVS minute-clinics “might provide unfair competition to other medical providers and hospitals, which when combined with CVS’ proposed ownership of a major health insurer creates significant concerns for consumer choice and cost”; and
  • The $40 billion in debt that CVS is taking on to finance the transaction “could affect operating performance”, “will create pressure on Aetna to raise premiums or take other actions that negatively impact consumers”, and “impacting Aetna policyholders and providers alike”.

As MSSNY has made several public statements expressing its opposition to this merger, MSSNY President Dr. Thomas Madejski issued a statement thanking Superintendent Vullo for her comments.

The DFS also announced this week that it will be holding a public hearing on this proposed transaction on October 18 in New York City.  MSSNY will likely present testimony at this hearing, and has invited the American Medical Association to also present testimony.

Earlier this year, the AMA submitted to the US Department of Justice its own comprehensive analysis of the adverse impact of this proposed merger, and urging the DOJ to work to block the merger.

The merger has also been opposed by the California Insurance Department and the American Antitrust Institute.

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Governor Signs Legislation to Permit Medical Marijuana as Alternative to Opioids
This week Governor Cuomo signed into law legislation (A.11011-B/S.8987-A) that would permit physicians to certify patients for medical marijuana use as an alternative to prescribing opioids to patients who are experiencing “pain that degrades health and functional capability”, or substance abuse disorder.  Earlier in the year, the NYS Department of Health adopted similar regulations.  MSSNY had expressed strong concerns with these proposals, noting that while we “appreciate the extensive efforts being undertaken to be responsive to the opioid epidemic…MSSNY is very concerned that there is no evidence that using marijuana to treat opioid use disorder is an effective medical treatment for this condition”.  Instead, MSSNY advocated for a pilot program to be undertaken to determine what place if any there may be for medical marijuana for those with opioid use disorder.

Click here for more information about New York’s medical marijuana program.

MSSNY Member Dr. Mell, Age 33, Passed Away Suddenly
Thomas Mell, MD, 33, passed away suddenly on September 14.  A resident of Brooklyn, he was an anesthesiologist and affiliated with SUNY Downstate Medical Center University Hospital. Dr. Mell was a member of MSSNY and served as the Associate Treasurer and member of the Board of Censors for the Medical Society of the County of Kings. He had a strong interest in legislation, which was strengthened after attending his first MSSNY Advocacy Day in 2017.

Dr. Mell is survived by his wife Kacie McFarland, MD, Vascular & Intervention Radiology and currently a Fellow in year 3 of 4 of the DIRECT Pathway at SUNY Downstate Medical Center and their nine month old son, Maximus William Mell. Also a MSSNY member, Dr. McFarland served on MSSNY’s Committee on Emergency Preparedness and Bioterrorism.

In memory of Dr. Tom Mell, the family requests that in lieu of flowers donations be made to his son, Maximus William Mell. To donate, please go here.

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House, Senate Negotiators Agree to Compromise Opioid Addiction Package
The United States Congress is expected to pass comprehensive legislation (HR 6, the Support for Patient and Communities Act) to combat the opioid abuse epidemic across the country.  The 660-page bill is the product of a bi-partisan compromise between the US House and Senate, which had advanced separate proposals earlier in the year.

Please remain alert for a more in-depth summary, but among the noteworthy items in the agreed upon package include:

  • Expands Medicare coverage to include Opioid Treatment Programs (OTPs) for the purposes of delivering Medication-Assisted Treatment (MAT) to expand access to treatment options for Medicare beneficiaries.
  • Better enables states to share prescription monitoring program data with each other
  • Requires by 2021 e-prescribing for Schedule 2,3, and 4 controlled substances for Medicare Part D prescription (with exceptions);
  • Requiring FDA guidelines for prescribing for acute pain;
  • Authorizes clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to prescribe MAT for five years; codifies the ability for qualified physicians to prescribe MAT for up to 275 patients;
  • Authorizes grants to support the development of curriculum that will help health care practitioners obtain a waiver to prescribe MAT.
  • Requires the Secretary of HHS, no later than two years after effective date, to annually notify prescribers that they have been identified as an outlier prescriber of opioids compared to other prescribers in their specialty and geographic area.
  • Requires the Secretary of HHS, no later than two years after effective date, to annually notify prescribers that they have been identified as an outlier prescriber of opioids compared to other prescribers in their specialty and geographic area.

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Please Plan to Participate in NYS “Listening Sessions” on Legalizing Recreational Marijuana Use
As previously reported, New York Governor Andrew Cuomo has called for a series of “listening sessions” across New York State to receive public comment regarding a proposal to legalize and regulate the recreational use of marijuana in New York State.  As noted below, there are forums coming up next week on Monday (10/1) in Newburgh, Tuesday (10/2) in Binghamton, Wednesday (10/3) in Buffalo and Thursday (10/4) in Hempstead.   Local physician leaders are expected to testify at these forums.

This week, MSSNY President-elect Dr. Art Fougner testified at the Queens forum, and Nassau County Medical Society Vice President Dr. David Podwall testified at the Hempstead forum, to raise public health concerns with this proposal.  Dr. Fougner’s testimony noted MSSNY’s support for de-criminalizing marijuana possession, but also significant concerns with motor vehicles spiking in Colorado after legalization in 2014.  He also noted the need for investment in readily available emergency care, mental health as well as addiction resources to handle anticipated demand that will inevitably arise from legalization.  In addition, Dr. Fougner, an OB-GYN, noted that “systematic reviews reveal that marijuana use during pregnancy is associated with lower birthweight and increased admission to Special Care Nurseries. Moreover, there are also reports of increased risk of stillbirth.”

Last week, the New York State Association of County Officials (NYSACHO) – representing 58 local Health Departments across New York State – sent a letter to Governor Cuomo expressing their opposition to proposals to legalize recreational marijuana use. Their letter noted that “both research and experience of states with legalized marijuana (such as Colorado) have substantiated these concerns”.

Physicians are urged to register to participate and testify at these upcoming forums from the links below:

  • Newburgh – Monday, October 1, 2018 – Register
  • Binghamton – Tuesday, October 2, 2018 – Register
  • Buffalo – Wednesday, October 3, 2018 – Register
  • Rochester – Thursday, October 4, 2018 – Register
  • Syracuse – Tuesday, October 9, 2018 – Register
  • Utica – Wednesday, October 10, 2018 – Register
  • Watertown – Thursday, October 11, 2018 –Register
  • Ronkonkoma – Tuesday, October 16, 2018 – Register
  • New Rochelle – Wednesday, October 17, 2018 – Register

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4th Columbia Psychosomatics Conference – Oct 20-21, 2018 NYC (13.5 CME Category 1 credits)
If you can’t see this image please go to 4th Columbia Psychosomatics Conference website HERE.

4th Columbia Psychosomatics Conference

The Bureau of Psychiatric Services & Research Institute Support (BPSRIS) is accredited by the Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians. The Bureau of Psychiatric Services & Research Institute Support (BPSRIS) designates this live activity for a maximum of 13.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ADA and Your Medical Practice’s Website
MSSNY has been alerted to a serious concern for our physicians that have websites for their medical practices.  Recently, many health care providers in New York have been sued in the United States District Court, Southern District of New York, for alleged violations of the Americans with Disabilities Act concerning their websites.  MSSNY contacted our General Counsel, Garfunkel Wild, P.C., for advice and guidance.  Please refer to this link for the educational material.

New York’s Life Expectancy Has Decreased Past Two Years, Report Says
Crain’s New York Business (9/21, Henderson) reports the life expectancy of New York residents has decreased over the past two years in an “alarming reversal,” according to a report from the NYS Health Foundation. The report said that the state’s life expectancy is still above the national average, but the “increasing trajectory of death rates for most major causes of death, rising obesity rates and growing rates of so-called deaths of despair” are all cause for concern.

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Continuing Medical Education

Cybersecurity: A Daily Threat for Healthcare: CME webinar on November 14 at 7:30am Registration now open
Studies show that 88% of all ransomware attacks in 2017 occurred within the healthcare industry and 89% of studied healthcare organizations experienced a data breach.  Learn how to protect yourself, your patients and your workplace on November 14th at 7:30am.  Register here for Medical Matters: Cybersecurity: A Daily Threat for Healthcare.  Mahesh Nattanmai, Deborah Sottolano, MD of New York State Department of Health and Peter Bloniarz of the New York State Executive Chamber will serve as faculty for this program.

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

Educational objectives are:

  • Describe vulnerabilities within medical practices, hospitals and daily life
  • Identify methods to increase protection from cyberattacks
  • Review methods for reporting and responding to a cybersecurity incident

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Influenza 2018-19: CME Webinar on October 17
Did you know that the World Health Organization (WHO) is predicting two new strains of influenza for the 2018-2019 season?  Learn about this and more at the first of MSSNY’s 2019 Medical Matters continuing medical education (CME) webinar series: “Influenza 2018-19” on Wednesday, October 17, 2018 at 7:30 a.m.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

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

Educational objectives are:

  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
  • Describe clinical and laboratory diagnostic features and treatment specific to each flu season
  • Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated

The Medical Society of the State of New York is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Member Benefit

Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!
MSSNY is pleased to announce our newest member benefit!  Our new Abenity App provides members with exclusive perks and over $4,500 in savings on everything from restaurants, City Pass, AMC movie tickets, theme parks, hotels, car rentals, mortgage savings, auto care and much more!

Popular Features Include:

  • Nearby Offers: Use our show and save mobile coupons to quickly access savings on the go.
  • eTickets On Demand: Save up to 40% with no hidden fees.
  • Showtimes: Find movies, watch trailers, and save up to 40% at a theater near you.
  • Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!


Click on the following link: and then create a unique user name and password.



Magnificent Medical Suites for Lease 184 East 70th St. New York, NY
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital, Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A: one consultation room plus 2 exam rooms. $6000 per month
Space B: One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500. other combination may work as well. Available for sharing For full details and photos see listing at or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com184 East 70th St Waiting Room 184 East 70th St Front Desk

184 East 70th St Patient's Room 184 East 70th St hallway

West 57 St. – Shared Office Space to Rent
Lovely Garden view office with natural light. Located near Columbus Circle in a beautiful Art Deco building. Recently renovated office with additional exam room/ room with a sink. Wi-Fi, medical waste pickup and cleaning included.  Ideal location in desirable neighborhood. Contact Jason Faller 914-393-6583

Rare Find — Great Office Share
Wonderful office share in terrific location at great price. 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) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.

58th Street Waiting Room 58th Street Patient's Room 58th Street Doctor's Office


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:


Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.

Physicians Wanted to Help Shape the Future of Primary Care
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Interested? Learn more and apply today at