Oct. 19, 2018 – CVS/MLMIC/Warren Buffet

Thomas J. Madejski, MD MSSNY President

Thomas J. Madejski, MD
MSSNY President

October 19, 2018
Volume 20  Number 39



Last week, the US Department of Justice announced it had given preliminary approval to the proposal of CVS to purchase Aetna for $69 billion, with the condition that Aetna divest itself of its Part D prescription drug plan. MSSNY as well as the AMA and other physician advocacy organizations spoke in strong opposition to the merger of health care behemoths on many occasions.

Of particular concern is the clear financial incentive of the merged entity to steer patients to their own sites rather than other community-based health care providers, including physician-led medical homes. The premise behind this consolidation is that CVS – using their retail clinics and their stores – is going to make health care more accessible.  However, there’s really not much data to support that. They may be able to make it more accessible, but that really has not translated to any improvement in outcomes nor to better patient care. And, actually, there are some studies that show that retail clinics actually cost more without any improvement in care.

Yesterday, organizations representing the physicians and community pharmacies testified at a hearing held by the State Department of Financial Services (DFS) related to the acquisition. In their testimonies, MSSNY, the Pharmacists Society and Chain Pharmacy Association each expressed dire warnings about the impact of the approved acquisition on health care costs and access to care by patients in the state.

My statement was as following: “…As stated in the DFS letter to the Connecticut Insurance Department, this merger will create an entity with an incredibly large market share that will adversely impact consumers and their physicians, without any discernable increase in quality.  Our concerns are numerous but include: reduced community pharmacy access for our patients; the potential for increased prior authorization hassles; and marginalization of community-based physician-led medical homes.  This transaction should not be approved unless these patient access issues are truly addressed.” (See first story below to read Immediate Past President Dr. Charles Rothberg’s compelling testimony to DFS at the hearing in Manhattan.)

MLMIC and Berkshire Hathaway

Berkshire Hathaway subsidiary National Indemnity Co. closed its $2.5 billion purchase of MLMIC on Oct. 1 after receiving approval from the state Department of Financial Services and MLMIC policyholders. Checks to the policyholders have started to go out to policyholders this week. Please keep in mind that the cash consideration resulting from the conversion will be paid out only to policyholders with policies in effect from July 15, 2013 through July 14, 2016 (or their designees). They are going out in sequential order. Buffett appeared Wednesday on a live-stream video from Omaha, NE., with Dr. James Reed, MLMIC chairman, to discuss the transaction and the health care industry. The acquisition gives physicians insured by MLMIC the financial backing of a company worth more than $520 billion.

Buffet said he views medical malpractice coverage as particularly important because, unlike home or auto coverage, the insurer is defending a physician’s reputation.

“We’re going to defend the physicians,” he said, “even if sometimes it makes sense to settle and pay the lawyer’s fees and move on.” Dr. Reed said changes in the health care industry, including the consolidation of medical practices and hospitals, have stoked fear among physicians. “There’s a lot of uncertainty in New York State,” he said. “What we want to do is take this uncertainty off the table.” One issue doctors are watching closely, he said, is the health care partnership between Amazon, Berkshire Hathaway and JPMorgan Chase. Buffett continued to keep details scant about the venture. The size of all three employers will be helpful in achieving their goals of promoting better care at a lower cost, Buffett said.

Please contact me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance


MSSNY’s Dr. Rothberg to DFS – Do Not Let CVS-Aetna Move Forward
MSSNY Immediate Past-President Dr. Charles Rothberg delivered testimony at a Department of Financial Services hearing this week examining the proposed acquisition of Aetna by CVS.  Dr. Rothberg expressed the medical community’s strong concerns with this transaction, particularly with its potential adverse impact on patient access to community pharmacies and community physician-led medical homes.   Dr. Rothberg also praised DFS Superintendent Maria Vullo for her recent comments to the Connecticut Insurance Department expressing strong concerns with this transaction.

In Superintendent Vullo’s opening comments for the hearing, she further elaborated on these concerns, taking issue with the recent action of the United States DOJ to give its preliminary approval noting “unfortunately the Justice Department has taken a very myopic view and failed to address the substantial impacts that this vertical integration would have on consumers across the country.”

She also noted her concerns that “Large corporate for-profit conglomerates do not have a good history of serving the public above their shareholders.  And, here, we have independent pharmacists, medical providers, the uninsured, consumers suffering from too high pharmaceutical costs, who may suffer from this transaction.  While we want to believe the benefits being advocated, it is important that companies are held to account for the advocacy that we are hearing in favor of this transaction – to ensure that it is not just puffery to get the transaction approved.  Regulators, including DFS, must have oversight going forward.”

She further noted the numerous considerations that DFS has to consider in deciding whether this transaction should be approved in New York, and that comments will continue to be received by the DFS until October 25, 2018 by sending an e-mail to public-hearings@dfs.ny.gov.

Also testifying at the hearing in opposition to this transaction was Assembly Health Committee Chair Richard Gottfried who stated: “If the term “anti-competitive” has any meaning at all, it must mean a deal like this. Entities seeking monopolistic power always claim that their size will somehow benefit the consumers and others who will be at their mercy. And it is never true. In this case, what is at stake is not only competition in the insurance market but the control, quality and accessibility of health care for millions of consumers.”

MSSNY also joined with the Pharmacists Society of the State of New York and the Chain Pharmacy Association of New York to together express their enormous concerns with this marriage of behemoths.

MLMIC Transaction Closes and MLMIC Announces Process to Resolve Cash Consideration Disputes
On October 1, 2018, Medical Liability Mutual Insurance Company (“MLMIC”) completed its conversion from a mutual insurance company to a stock insurance company, and closed the transaction by which MLMIC was acquired by National Indemnity Company (“NICO”), a subsidiary of Berkshire Hathaway Inc. MLMIC’s conversion and acquisition by NICO come after the September 6, 2018 approval decision by the Superintendent of the New York State Department of Financial Services (the “Superintendent”), and a September 14, 2018 vote of MLMIC policyholders with policies in effect as of July 14, 2016. The cash consideration resulting from the conversion transaction will be paid out to eligible policyholders (i.e. policyholders with policies in effect from July 15, 2013 through July 14, 2016) or to policy administrators or other designees.  MLMIC began sending out checks for such cash consideration earlier this week.

 For those instances when the distribution of cash consideration was objected to by a party claiming entitlement to such funds (an “objector”), the cash consideration has been placed by MLMIC in escrow in line with the Superintendent’s decision.  Any such disputed cash consideration shall remain in escrow until the dispute is resolved or until the Superintendent orders otherwise.  The Superintendent’s decision provides that policyholders and objectors have an initial period of 90 days from the closing of the transaction (October 1, 2018) to resolve their disputes. At the end of the 90 day period, the Superintendent may direct disbursement of all or any portion of the funds in the escrow. During the 90 day period, the parties are free to independently mediate or negotiate, initiate legal action, or take any other steps that the parties may believe necessary to resolve the dispute.

As an alternative, and as required by the Superintendent’s September 6 decision, MLMIC is required to provide and pay for an alternative dispute resolution (“ADR”).  The ADR process is a method for policyholders and objectors to resolve their disputes.  MLMIC is employing the services of National Arbitration and Mediation (“NAM”), an organization that specializes in mediation, for this purpose. To use the ADR process, both the policyholder and objector must agree to participate. On October 12, 2018, MLMIC sent out written notices describing the ADR process, which included a form to opt-in to the program.  Within 30 days of the October 1, 2018 transaction closing date, the policyholder and the objector must notify MLMIC of their intention to participate in the ADR Process by signing and returning to MLMIC an Opt-In Notice as instructed on the form.

Should you have any questions regarding these issues, please feel free to contact Kevin G. Donoghue of Garfunkel Wild, PC at (516) 393-2535.

NYS Controller Report: Health Care Employment Gains Across New York State

  • Private-sector health care employment, which comprises 90% of all health care jobs in the State, grew by 18.1% from 2007 to 2017, adding nearly 216,000 jobs. Total wages increased by $23.2 billion, while average annual wages increased by over $10,400
  • For all health care occupations, doctors and dentists had the highest annual average wages in 2017, at $152,650, while the average for nurses was $79,240

With over 548,000 jobs, or 43.7 percent, ambulatory services had the largest share of industry employment in 2017. As it concludes that 21.3% of the total jobs are in ambulatory care sites, which translates to 247,132 jobs in these locations.

ASC Symposium BannerMedical Society State of New York Members Receive Discounted Rate
Why should you attend?

The New York Metro ASC Symposium is devoted to ambulatory surgery centers in the tristate area. It is focused on the most pressing business, technological, regulatory, legal and clinical issues facing ASCs on a daily basis. More than 250 people including physicians, ASC developers, financiers, healthcare executives, and clinical representatives are expected to be in attendance this year. The 5th Annual NY Metro ASC Symposium will take place

November 2, 2018, at the Marriott Marquis, in the heart of Time Square.

Gain valuable knowledge. Participate in insightful discussion. Engage in dynamic networking.

Who is eligible for the discounted rate?
As the Medical Society State of New York General Counsel, Garfunkel Wild is offering members of the chapter a discounted conference registration rate of $285. Use couponcode: NYM18MS during registration at https://www.nymetroasc.com/register-now

For additional information please visit our website at nymetroasc.com or call 516-393-2294 www.garfunkelwild.com

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UnitedHealth to Debut “Fully Portable” EHR in 2019
UnitedHealth Group revealed plans to debut a “fully individualized, fully portable” EHR in 2019, CEO David Wichmann said on the company’s third-quarter earnings call Oct. 16.

Mr. Wichmann didn’t provide specifics about the product, but repeatedly noted that the insurer’s digital capabilities are a key component of its long-term growth strategy.

He added that UnitedHealth may offer its members a personal health record through an expansion of its mobile wellness platform Rally. Rally currently has about 20 million registered users.

The health record would be a “deeply personal” tool for UnitedHealth members and could be used to help members identify gaps in care and highlight “next best actions,” Mr. Wichman said on the call. UnitedHealth’s new tool could also attract providers by looking “a little more like their EHR,” while also using predictive analytics. (Becker Hospital Review, 10/16)

UnitedHealth reported revenue was up 12.4 percent year over year at $56.6 billion for its third quarter.

Anthem’s $16M HIPAA Settlement Related to Cyberattacks Is Largest in History
Anthem will pay HHS $16 million to settle potential HIPAA violations related to cyberattacks that compromised the health information of nearly 79 million people in 2015, HHS said Oct. 15. The payment is the largest settlement the Office for Civil Rights has seen, eclipsing the previous $5.5 million high the office received in 2016.

“The largest health data breach in U.S. history fully merits the largest HIPAA settlement in history,” said OCR Director Roger Severino. “Unfortunately, Anthem failed to implement appropriate measures for detecting hackers who had gained access to their system to harvest passwords and steal people’s private information.”

In January 2015, Anthem discovered cyberattackers gained access to the health insurer’s IT system through phishing emails sent to an Anthem subsidiary. Between December 2014 and January 2015, cyberattackers stole the ePHI of almost 79 million individuals. Compromised information included names, Social Security numbers, medical identification numbers, addresses, dates of birth, email addresses and employment information.
(Becker’s Hospital Review, Oct 16)

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Many Employers Now Offering Coverage for Telemedicine, Survey Indicates
The New York Times (10/12) reported that more employers are utilizing telemedicine, adding that around “three-quarters of large firms that offer health insurance now cover” telemedicine according to a survey conducted by the Kaiser Family Foundation.

The survey involved almost 160 companies which “collectively employ about 13 million people.” Additionally, about half of the employers surveyed “said adopting virtual solutions was their ‘top initiative’ in 2019.”

Research Retraction from Prominent Cardiologist?
Harvard Medical School and Brigham and Women’s Hospital have determined that 31 papers published in prominent scientific journals contain potentially falsified and fabricated data from the laboratory of the prominent cardiologist Piero Anversa, MD, and have called for the research to be retracted. (STAT News, 10/14) The cardiologist, Dr. Piero Anversa, produced research suggesting that damaged heart muscle could be regenerated with stem cells, a type of cell that can transform itself into a variety of other cells. Although other laboratories could not reproduce his findings, the work led to the formation of start-up companies to develop new treatments for heart attacks and stroke, and inspired a clinical trial funded by the National Institutes of Health.

Medical Society of NY Classifieds

Majority of Older Adults Would Opt to Take Fewer Medications
Research published in JAMA Internal Medicine indicates that in a survey of “data collected from 1,981 adults covered by Medicare,” nine of 10 respondents age 65 and older “are willing to stop taking one or more medications if their doctor recommends this.” Researchers also found that “two-thirds of older adults would like to cut back on the total number of medicines they take.” 

Worker’s Compansation

NY Workers Comp Board Releases Revised Prescription Drug Formulary Proposal
The New York State Workers’ Compensation Board this week released substantial revisions to its previous proposal to establish a prescription drug formulary for Workers Compensation coverage.    Please click here to read the revised proposed regulations, and here (http://www.wcb.ny.gov/drug-formulary-regulation/NYS-drug-formulary.pdf) to read the revised formulary.  Comments will be received on the proposal until November 16.

The prescription formulary was required by legislation enacted in 2017.  According to an announcement from Board Chair Clarissa Rodriguez, “the Board substantially expanded the list of drugs on the Formulary, clarified the criteria for when certain drugs are on the Formulary and more fully defined the prior authorization process for drugs that are not listed on the Formulary.”

According to the Revised Drug Formulary proposal, the Formulary contains a list of drugs that are designated as either “Phase A”, “Phase B”, “Phase C” or “Perioperative”.

Phase A Drug List Drugs may be prescribed and dispensed when: (1) The drug is prescribed at the initial treatment visit following a disability event and such initial treatment is within seven days following a disability event, (2) The drug is dispensed within seven days of the initial treatment visit, and (3) The supply does not exceed seven days or, if an antibiotic or post-exposure medication, the normal course of treatment.

Phase B Drug List Drugs on this list may be prescribed and dispensed when: (1) The prescribing occurs between the eighth and thirtieth day following a disability event, which can be either the initial visit or a follow-up/second treatment, (2) The dispensing occurs within seven days of the date of treatment, (3) The supply does not exceed thirty days, and (4) The case has not been accepted by the insurer or established by the Board. When a case has not been accepted by the insurer, or the case has not been established, Phase B drugs prescribed and dispensed in accordance with Phase B criteria may be prescribed and dispensed for up to a 30-day supply. Following the insurer or self-insured employer’s acceptance of the injury or illness with or without liability, or establishment by the Board, all drugs must be prescribed and dispensed consistent with the Phase C drug list.

Phase C Drug List Drugs on this list may be prescribed and dispensed when: (1) A body part or illness has been accepted (with or without liability) or established, (2) The drug is prescribed in accordance with, as applicable, the adopted Medical Treatment Guidelines, (3) The prescription does not exceed a 90-day supply.

Perioperative Formulary Drugs listed on the Perioperative Drug List may be prescribed/dispensed when: (1) The drug is prescribed during the perioperative period (four days before through four days following surgery), and (2) Does not exceed a seven-day supply.

MSSNY is reviewing the revised proposal and will follow up with appropriate comments to the Workers Compensation Board.


CMS Proposes To Require Drug Manufacturers to Disclose Prices in Television Ads
On October 15, CMS issued a proposed rule aimed at increasing drug price transparency and reducing the price of prescription drugs and biological products to consumers by requiring drug manufacturers to include list prices in all direct-to-consumer television advertisements of prescription drugs and biological products for which Medicare or Medicaid reimbursement is available. The specific drugs that would require list price disclosure are those that are used for a 30-day regimen or for a typical course of treatment.

“Today, the Trump Administration made real progress toward ensuring consumers have the information they need to make the health care decisions that are best for them,” said the Campaign for Sustainable Rx Pricing, of which the AHA is a founding member. “Consumers have the right to know how much medicines cost, and providing drug pricing in advertisements will do just that. We must build off this and accelerate efforts to ensure affordable drug prices for American patients.”

CMS will accept comments on the proposal for 60 days after publication in the Federal Register. For more information on the proposal, see the agency’s press release. AHA continues to advocate for policies that address high and rising drug costs, a summary of which can be found here.


CME Courses

Cybersecurity: A Daily Threat for Healthcare” CME webinar on November 14, 2018 at 7:30am Registration now open
Is your office protected against a cybersecurity event?  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, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program.

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

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. 

CME Activities that Count For Maintenance of Certification/Continuing Certification
The Accreditation Council for Continuing Medical Education (ACCME) currently is collaborating with the following American Board of Medical Specialties (ABMS) member boards to simplify and align the Maintenance of Certification (MOC) process to better meet the needs of physicians and educators:

  • American Board of Anesthesiology (ABA) MOCA
  • American Board of Internal Medicine (ABIM) MOC
  • American Board of Otolaryngology–Head and Neck Surgery (ABOHNS) MOC
  • American Board of Pathology (ABPath) Continuing Certification
  • American Board of Pediatrics (ABP) MOC

This collaboration enables CME providers that are accredited by ACCME or State Medical Society Accreditors (such as MSSNY) to provide to their learners CME activities that count for MOC(A)/Continuing Certification points without a separate process of having CME activity content approved by the individual boards.  When CME providers report attendance data to the ACCME via ACCME’s Program and Activity Reporting System (PARS), the system uses learner names, diplomate ID numbers, and month/day of birth to report participation to the applicable board.  Eligible learners quickly receive email confirmation from their board(s) regarding points earned.

In its capacity as an ACCME-accredited CME provider, MSSNY is in the planning stages of offering CME activities that count for MOC points.  MSSNY members can expect more information as the activities become available in 2019.

In its capacity as an ACCME-recognized intrastate accreditor of CME providers, MSSNY has been providing ongoing education and support to enable MSSNY-accredited providers to plan and implement CME activities with MOC points.

To assist learners in finding CME activities that offer MOC points, ACCME maintains the CME Finder website. CME providers that enter their CME MOC activities into PARS in advance of the activity date automatically have the activity added to the CME Finder site.

ACCME anticipates more ABMS-member boards will be entering into collaboration agreements as described above, and when they do, MSSNY members will be informed via eNews, News of New York, or other communication methods.

More information is available at ACCME’s “CME in Support of MOC” page.
 Questions on this topic may be addressed to Miriam Hardin at mhardin@mssny.org.

LI-CAN Hosting Program: Removing Barriers to Opioid Addiction Treatment
On Sunday October 28, from 3p – 4:30 at St John’s Episcopal Church on 25A in Cold Spring Harbor (behind the Fish Hatchery) LI-CAN leaders have been asking Governor Cuomo and his administration to prevent overdose deaths by removing the barriers to evidence-based opioid addiction treatment. After six months of pushing, it’s time to evaluate. O n Long Island and across America, opioid and other drug overdoses are killing people – our neighbors, friends and loved ones — in unprecedented numbers. Come and find out what needs to be done, and what is being done, by: Governor Cuomo, State Agencies and County Leaders. RSVP joemorris03@gmail.com

For more information: http://www.mssnyenews.org/wp-content/uploads/2018/10/October-28-flyer.pdf

LI-CAN’s work on the overdose crisis is made possible through funding from dues-paying member institutions: UJA-Federation of New York; Episcopal Diocese of Long Island; Individual Donors




All-Inclusive Medical Office Space for Rent-5 Locations: Elmhurst, Ozone Park, Lawrence, Lindenhurst & East Setauket
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For more information please log on to www.MedPlexLLC.com, Loop-Net/Co-Star, or call Carla Scalici, Operations manager, @ 516-797-7735, cscalici@MedPlexLLC.com

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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 http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.comnyc nyc room2

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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 goutmd@aol.com

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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.

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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


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com

Physicians Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology startup committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are compensated for their participation, which requires only a few hours annually.

Interested? Learn more and apply today at www.98point6.com/pcc