October 11, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 11, 2019

Vol. 22  Number 38


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Colleagues:

The term “provider” has bothered me for a long time. And it should bother you as well.  ACP President Dr. Robert McLean posted Defining our identity does not include the ‘P word’ for his September President’s message. The central theme is a reminder that the practice of Medicine is a profession.  Physicians have a unique relationship with patients that is considerably more than the “Cable Guy” who comes to install your TV service. Dr. McClean writes:

… Such a fundamentally unique and sacrosanct relationship as that between patient and physician is not merely “providing” a health service. And that is why the term “health care provider” is so inappropriate. The patient-physician relationship does not consist of simple transactions where we provide and patients consume. That marketplace terminology implies that health care can be conceptualized as just another commodity.

The primacy of this relationship has been eroded with the commoditization of aspects of the health care delivery system. 

Dr. McClean is not the only physician upset by “provider creep.” Washington pediatrician, Dr. Niran Al-Agba goes one step further, writing in the Kitsap Sun: The sneaky cynicism of calling your doctor a ‘provider’. She traces the history of provider as a pejorative back to 1930’s Germany:

… According to Dr. Saenger, who wrote Jewish Pediatricians in Nazi Germany: Victims of Persecution, “the 1937 issue of the Reichs Medizinal Kalender, a directory of doctors, the remaining Jewish doctors in Germany were stigmatized by a colon placed before their names. Their medical licenses were revoked in 1938. They could no longer call themselves ‘Arzt’ or ‘doctor.’ They were degraded to the term ‘Behandler’ or freely translated, ‘provider.’  

She continues:

Insulting any person on the basis of their race, ethnicity or gender is morally wrong. Using the word “provider” to describe a physician is and will always be insulting, personally and professionally; it is demeaning and devalues the education and degree conferred upon every physician. Why are physicians forced to suffer repeated use of this derogatory professional insult? And why have physicians as one professional body not risen up in anger at this injustice? 

While I would not equate those who call physicians “the P word” with the Third Reich, people should realize that Provider is insulting and demeans our noble profession.

Dr. McClean concludes:

And by the way, this terminology issue was raised through the ACP Board of Governors way back in 2008. Hence, it has been ACP policy since 2009 to eliminate use of the term “provider” and “prescriber” in lieu of “physician” in all publications and communications. Pass it on. 

I would add that this has been MSSNY policy since 2011:

Professionalism in Terminology 207.956

The leadership and staff of the Medical Society of the State of New York shall not in written or spoken word, use the term “provider” in referring to physicians

With that, I give you the inimitable Aretha Franklin.

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

Arthur Fougner, MD
MSSNY President



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eNews

DFS Proposes Regulation to Ensure Patients Have More Detailed Notice of New York’s Surprise Bill Law
New York Department of Financial Services (DFS) Superintendent Linda Lacewell announced this week a proposed regulation to assure patients that receive a claim for the services from a non-participating physician or a non-participating referred healthcare provider receive notice from their health plan and non-par treating physician about the protections of New York “surprise bill” law.  This action follows a recent report of a Long Island patient on “CBS This Morning” who received surprise bills totaling hundreds of thousands of dollars that weren’t covered by his healthcare plan.

“We are taking this action to strengthen the law so that New Yorkers have all the information they need to avoid surprise medical bills,” said Superintendent Lacewell. “After hearing about − and resolving – a recent issue, we know that if it could happen to one consumer; it could happen to others.”

The proposed regulation would require health plans that receive a claim for the services of a non-participating physician or a non-participating referred healthcare provider that could result in a surprise bill to provide additional notice to the insured consumer.

The notice would advise that the insured consumer may receive a surprise bill based on the claim and would include a description of surprise bills and the New York Out-of-Network Law’s Independent Dispute Resolution (IDR) process for surprise bills, as well as instructions on how to submit a dispute, a copy of an assignment of benefits form, and the healthcare plan’s designated addresses for submitting the form. The notice would be included on or with the explanation of benefits.

Additionally, the proposed regulation requires health plans that determine that services billed by a healthcare provider as emergency services are not emergency services to notify the consumer that the consumers may receive a surprise bill for such services and that consumers may be protected from any such surprise bill.  The notice would include the healthcare plan’s contact information as well.  If a health plan receives an assignment of benefits form and determines that a disputed bill is not a surprise bill, they would be required to notify the consumer in writing of the procedures for filing a grievance or appeal and provide information on how to file a complaint with DFS.

It is also important to note that the proposed regulation would require non-participating physicians who bill consumers for emergency services or a surprise bill to inform the consumer of the IDR process, along with providing the claim form and assignment of benefits form which non-participating physicians already must send with surprise bills.

Click here to view a full copy of the proposed amendment, which will be published in the October 23, 2019 State Register and subject to a 30-day notice and public comment period.


MSSNY President, Dr. Fougner, Comments in Crain’s re Surprise-Billing Amendment Proposes More Requirements for Insurers and Physician
Dr. Arthur Fougner, president of the Medical Society of the State of New York, said that the society is “supportive of efforts to assure patients are notified by insurers of the limitations of their coverage, and the protections available to them under our surprise bill law,” in a statement provided to Crain’s. “We are continuing to review the new proposal and will seek to provide feedback to DFS regarding the contents of the proposed disclosure form.”


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Urge the Governor to Support Formulary Protection Legislation!
MSSNY joined AARP and over thirty various health and consumer organizations in sending a letter to urge Governor Andrew Cuomo to approve S.2849/A.2969 that would protect health plan members from increases in out-of-pocket prescription drug costs in the middle of a contract year.

In a press release by AARP, Dr. Arthur Fougner, President of MSSNY said: “MSSNY strongly urges that this formulary protection bill be signed into law as it would provide significant protection from the adverse consequences many patients face as a result of non-medical switching of prescription drugs. If a treatment is working, it should not be changed due to financial constraints. In medicine as in sports, you don’t change a winning game; it’s unreasonable to force patients to change a successful course of treatment for any reason other than medical need.”

MSSNY encourages physicians, as well as their families, friends and other sympathetic individuals to send these letters to their lawmakers.

Protect your patient’s prescriptions! Urge the governor to sign formulary protection bill into law by clicking here.

Click Here to view the full letter!


Medical Society Raises Concerns About Trump’s Order on Medicare
Although the Medical Society of the State of New York supports the goal of President Donald Trump’s executive order on Medicare, it is concerned with several policy directions the order advances, according to a statement issued Tuesday by Dr. Art Fougner, president of the society.

“In particular, we are concerned with the apparent goal to expand the Medicare managed-care program, which likely could include efforts to disincentivize continued or new enrollment in the Medicare fee-for-service program,” Fougner said. “This is especially problematic in light of multiple instances in recent years where Medicare managed-care plans dropped huge numbers of physicians from their Medicare Advantage networks. This, in turn, significantly reduces care options for our patients.”

The society also takes issue with proposals to expand “already cumbersome Medicare value-based payment programs,” Fougner said. Specifically, many smaller physician practices have reported challenges with the Medicare Merit-based Incentive Payment System, such as burnout from spending more time on health-tech systems than on treating patients “to meet well-intended but often overreaching value programs.”

Additionally, Fougner said that some proposals in the order seem to focus on expanding the scope of other types of health practitioners. The combined care of a team headed by a physician is what is best for patients, he said.

Trump’s executive order states that it is focused on empowering patients to “select and access the right care, at the right time, in the right place, from the right provider.” Another focus is to help the fiscal sustainability of the Medicare program through alternative payment methodologies linked to value, increased choice and lower regulatory burdens for providers.

Dr. Fougner said, “We look forward to working with medical associations across the country to work with the administration toward preserving and strengthening the Medicare program so that our seniors continue to have timely access to the quality care they need and deserve.” (Crain’s Health Pulse Oct 8)


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Physicians – Beware of Fake Letters Claiming to be from NYS Board for Medicine
Please should be aware that the New York State Board for Medicine has advised of a scam where physicians have received a bogus letter claiming to be from the “NY State Education Department, Office of the Professions” indicating that their license has been suspended for “Illegal Drug Trafficking Under Section 33(c) of The Aviation Drug Trafficking Control Act of 1984”.

The Board for Medicine has advised MSSNY that, should any physician receive such a letter, that they be aware that they would not receive such a letter from the NYS Board for Medicine or NYSED.


New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

  • the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
  • the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has already given oral or written consent; or
  • the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

Several other states have passed similar laws expressly banning this practice without clinical justification. MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.


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Bronx Teen Is First to Die in New York from Vaping
A teenager from The Bronx became the first New Yorker to die from vaping last week, state officials said Tuesday. The 17-year-old boy treated at Montefiore Hospital is among nearly two dozen people across the nation whose deaths have been linked to the use of electronic cigarettes, officials said.

“Parents have to know, young people have to know: You are playing with your life when you play with this stuff,” Gov. Andrew Cuomo said at an unrelated news conference at his Manhattan office.

The boy was first treated for a “vaping-associated respiratory illness” early last month and was hospitalized again in late September before his Oct. 4 death, according to the Democratic governor’s office. The teen’s death was reported Tuesday to the state Department of Health, which is investigating the case, officials said.

The boy may be the 20th person in the United States to die from a vaping-related illness amid an outbreak of lung ailments linked to the habit.

The U.S. Centers for Disease Control and Prevention had confirmed 18 vaping deaths in 15 states as of Oct. 1, and another was reported in Massachusetts on Monday.

Some 110 people across the Empire State — including 21 in New York City — have come down with serious lung illnesses after using at least one vape product, according to the state health department. Officials have attributed most of those cases to black-market cannabis vape devices rather than nicotine-based e-cigarettes sold in stores.

The spate of sicknesses nonetheless spurred state authorities to ban flavored e-cigarettes, but a pending lawsuit blocked the measure from taking effect last week.


Poll: New Yorkers Back Ban on E-Cigs
A majority of New Yorkers support Gov. Andrew Cuomo’s emergency ban on flavored e-cigarettes and think vaping is a serious public health problem, according to a poll published Monday.

The Siena College Research Institute found that 78% of the more than 800 New Yorkers surveyed believe e-cigarette use and vaping represent either a very serious or somewhat serious public health problem. Nearly two-thirds (61%) of New Yorkers support banning flavored e-cigarettes, and 52% support banning the sale of all e-cigarette and vaping devices.

The poll found that 12% of New Yorkers vape on a regular basis.

The poll—which has a margin of error of 4.3 percentage points—was conducted between Sept. 22 and Oct. 1. That means the final results came in two days before a state court temporarily blocked Cuomo’s prohibition on flavored e-cigarettes in response to a lawsuit from the industry.

Health Commissioner Howard Zucker vowed after the court’s decision that the state will use “every tool at our disposal to address this crisis.” More than 1,000 people have been diagnosed with vaping-related illnesses in the U.S., with 18 reported deaths, according to data from the U.S. Centers for Disease Control and Prevention.


 

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Physicians Welcome to Provide Public Comments on DSRIP at 10/25 NYC and 10/30 Syracuse Public Forums
The New York State Department of Health (NYSDOH) will be holding Public Comment Days for New York’s 1115 waiver program on:

  • October 25th 2019 at Baruch College, 55 Lexington Ave. (Corner of 24th St. & Lexington Ave.), Room 14–220 (14thFloor), New York, NY 10010.
  • October 30th 2019 at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.

The open comment period for both forums will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Specifically, the NYS Health Department is seeking from the federal government a continuation of DSRIP for the 1-year balance of the 1115 waiver ending on March 31, 2021 and to extend an additional 3 years from April 2021 to March 31, 2024.   Click Here to view the Amendment Proposal.

Background on the DSRIP Program

The roughly $6 billion Delivery System Reform Incentive Payment (DSRIP) program provides incentives for Medicaid providers to create and sustain an integrated, high-performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving the quality of care, improving the health of populations and reducing costs.

The DSRIP program promotes community-level collaboration and aims to reduce avoidable hospital use by 25% over the 5-year demonstration period. A total of 25 Performing Provider System (PPS) were established in different regions of the State to implement innovative projects across three domains: system transformation, clinical improvement and population health improvement (New York’s Prevention Agenda).

While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as community physician practices, some have raised concerns that not enough funding has been made available to physicians who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.


Hassle Factor Form Now in Easy-to-Use PDF Format
MSSNY’s Hassle Factor Form has been updated.  The updated PDF version of the form can be found at the following this link.

Anyone can access the form by clicking on the drop-down box of RESOURCES from the MSSNY home page – www.mssny.org.  Then, scroll down to Payer Relations (SME).  Now, scroll to Hassle Factor Form and click.  This is a more user friendly form.

The County Medical Societies can send it to their members and add it to their websites.  The PDF version can be used by the county medical societies to gather data/information from the membership for interacting with DFS.



Doctor Sues Kaiser Permanente over Opioid-Related Patient Satisfaction Scores
An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

Eryn Alpert, MD, worked at Kaiser Permanente from 2012 to December 2017, when she was fired. The lawsuit alleges her dismissal stemmed from her failure to accept patient satisfaction scoring tools. It alleges these tools were structured to incentivize physicians to prescribe opioids, even when medically unnecessary. The lawsuit said this pressure was greater in the emergency department, where patients often went seeking prescriptions and would leave poor reviews if they didn’t receive them, according to the report.

In the lawsuit, Dr. Alpert alleges her resistance to prescribing unnecessary opioids created a high standard deviation in her patient scores, which in turn prevented her from gaining shareholder status three years in a row, according to the report.


CME

“Influenza 2019-2020” CME Webinar on October 16; Registration Now Open
Are you prepared for flu season?
The first of MSSNY’s 2020 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2019-2020” on Wednesday, October 16, 2019 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.

  • 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

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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.


“When Is the Flu Not the Flu?” CME Webinar on November 20 at 7:30am; Registration Now Open
.  This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  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.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

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.


Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm
The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2nd from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432.  Please click here to register.

Program schedule:

7:30—8:20 am:           Registration and Breakfast

8:20—8:30am:            Welcome and Opening Remarks

8:30—9:30am:            Health Matters for Women: Endometriosis *
 Faculty: Lisa Eng, DO

9:30—10:30am:         Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am:       Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm:       Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

* 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 each of these live activities 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 Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.  

The Academy of Medicine of Queens County designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä.  Physicians should only claim credit commensurate with the extent of their participation in the activity. 


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CMS

HHS Issues Opioid Tapering Guidance for Clinicians
The Department of Health and Human Services today released a guide to help clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain. Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the guide reviews issues to consider when changing a patient’s chronic pain therapy. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction,” said Adm. Brett Giroir, M.D., HHS assistant secretary for health.


NGS Notice : Errors Causing Incorrect Part A and Part B Claim Denials
Date Reported: 10/9/2019
Status: Open
Provider Type(s) Impacted: Part A, Part B, HH+H
Description of Issue

National Government Services (NGS), along with all Medicare Administrative Contractors (MACs), is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. NGS is informing providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. This is causing claims to incorrectly deny based on invalid beneficiary entitlement.
National Government Services Action

NGS is actively pursuing a solution to this issue which will be shared with providers as soon as possible.
Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.
Proposed Resolution/Fix Date TBD


Seal of Italian Medical SocietyCalling All Physicians of Italian Heritage: Join Morgagni Medical Society
The Morgagni Medical society of New York is comprised of physicians of Italian heritage, who meet for social, educational and professional meetings in NYC quarterly. It is a nonprofit 501c3 organization, and sponsors a medical school scholarship in conjunction with the Columbus Citizen’s Foundation. Interesting people and speakers, exceptional dinners, opera night, exclusive club and venue events.

Members can march with their families in the NYC Columbus day parade. New members, both of Italian descent as well as Italophiles, have a great opportunity to share culture and profession. Check out www.Morgagnimedicalsociety.com, email Morgagni.society@gmail.com for information and join today!


Classified

RENTAL/LEASING SPACE



Park Avenue – Private Street Entrance, Same Block as Subway
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


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: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES

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