MSSNYeNews: October 25, 2019 – Surprises

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

October 25, 2019

Vol. 22  Number 40



It’s not the surprise that matters, it’s how you react to it.
Innocent Mwatsikesimbe, Author

This week’s epistle concerns two unrelated surprises. The first is a new law about the performance of pelvic examinations under anesthesia (see story below). For years, one way medical students learned to perform this necessary skill was in the operating room immediately prior to surgery. Concerns were raised (and rightly so) by women who later learned of this unwanted “surprise,” no matter how clinical it might have been. In 2011 (reaffirmed in 2017), ACOG released a Committee Opinion that explicitly states: 

Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery.

Still, sporadic reports indicated that this practice was ongoing which then prompted legislative action. Hospital legal teams are now huddling to draft appropriate consent language. In the meantime, the best way to deal with this (as always) is simply to discuss the matter with your patient ahead of time, eliminating any surprise.

Surprise Bills

As for the second surprise, Surprise Bills are still the subject of furious debate in Congress. Because of your efforts and those of medical societies across the country, the prospect of handing over to insurers, the power to set the benchmark for all fees is no longer a done deal. In fact, the House Bill HR 3630, which would do just that, has but 3 cosponsors while HR 3502, which resembles New York’s law, has 100. Of course, this fight is far from over as the insurers are waging their fight on many fronts. One thing you can do is go here to send a letter to your members of Congress. I urge everyone to do so as this issue is critical to all physicians.

So are these two surprises really unrelated? Perhaps in a way, they are not. There are indeed wheels within wheels. Individually, we may not be able to exert sufficient pressure but together, with everyone’s hand on the needle, we may move it sufficiently to achieve the desired end.

Once again, I leave you with Benjamin Franklin:

We must indeed all hang together or, most assuredly, we shall all hang separately.

Comments?; @sonodoc99

Arthur Fougner, MD
MSSNY President

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Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still nearly 500 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just a few months left in the year, the flurry of bill signings/vetoes has begun.

Physicians can quickly and easily send a letter to the Governor here on the following:

  • Support ending 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 urge the Governor to sign this bill into law here.
  • Support 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.
  • Oppose liability expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, 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 urge the Governor to veto these bills here.

New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
As recently reported, 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. The law was designed to respond to reports of medical students being asked to perform such exams, without express patient consent, as part of their medical training in teaching hospitals.

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.”

It would also make violation of such provision an element of physician misconduct. 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.  The American College of Obstetricians & Gynecologists have issued an ethical opinionthat “Pelvic examinations on an anesthetized woman that offer her no personal benefit and are performed solely for teaching purposes should be performed only with her specific informed consent obtained before her surgery”. The law takes effect on April 4, 2020.

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Physicians Welcome to Provide Public Comments on DSRIP at 10/30  in Syracuse Public Forum
Next Wednesday, October 30, the New York State Department of Health (NYSDOH) will be holding a Public Comment forum for New York’s 1115 waiver  at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.   A similar forum was held today in New York City.

The open comment period for both forums will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to 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.

NYDOH to Offer Free Coaching, Nicotine Replacement Therapy to Vapers
The New York State DOH has announced new services for e-cigarette users seeking help to stop vaping, including free quit-coaching and nicotine replacement therapy through the New York State Smokers’ Quitline. The quitline is available for New Yorkers of all ages, including adolescents.

The DOH added the service to the quitline to address the growing need to help users of e-cigarettes break their dependence on vaping. The New York “Department of Health announced Monday that it has expanded services available through the New York State Smokers’ Quitline in response to a nationwide outbreak of vaping illnesses that has killed 33 people and hospitalized nearly 1,500 more. Those interested can contact the quitline by calling 1-866-NY-QUITS (1-866-697-8487) any day of the week beginning at 9 a.m. A specially trained quit coach will assess users of e-cigarettes for type of product, frequency of inhalation, and dependence.

Based on the assessment, a user may be eligible to receive complimentary patches, gum, lozenges or a combination of these products. Quit coaches also will help users develop a personalized quit-plan and guide them to consult their health care professionals and health insurance plans for additional stop-smoking medication and support.

Similar to the eligibility guidelines for cigarette users, users of e-cigarettes who qualify for the quitline’s free NRT will receive a starter kit with a minimum two-week supply and can receive up to two kits per year – the second after 90 days from the first shipment. More information about eligibility is available online at


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It’s Tomorrow: New York Will Accept Vaping Devices on Drug Take Back Day
New Yorkers will be able dispose of their vaping devices and cartridges at more than 200 locations across the state as part of National Prescription Drug Take Back Day for the first time on Saturday, Gov. Andrew Cuomo announced this morning.

With nearly 150 vaping-related lung illnesses reported in the state, New York will partner with the Drug Enforcement Administration to collect e-cigarette devices and cartridges in addition to prescription drugs and other medications.

New Yorkers can dispose of medications and vaping devices at 223 locations across the state. More than 400 health care facilities will also dispose of their unused and expired medications as part of the national Take Back Day.

Study: How Physicians’ Belief in Treatment Effectiveness Can Impact Patients
The NPR (10/21, Vaughn) “Shots” reports that a study shows “that patients can pick up on subtle facial cues from doctors that reveal the doctor’s belief in how effective a treatment will be,” which “can have a real impact on the patient’s treatment outcome.” The article adds, “Researchers randomly assigned undergraduate students to play the role of a patient or a doctor.”

The study “found that during the administering of the pain stimulus, the doctor group showed measurably less pain expression in their faces when they believed that the patient actors had been given a cream that provided actual pain relief.” Within “trials where the doctor group believed the cream was effective, patients reported that they found the doctors more empathetic.” The results were published in Nature Human Behavior.

CMS Sanctions UnitedHealthcare Plan: 3 Things to Know
One of UnitedHealthcare’s Medicare Advantage plans will face enrollment restrictions for 2020 due to compliance issues.

Three things to know:
1. CMS sanctioned the UnitedHealthcare plan because for the third year in a row, the plan did not adhere to a rule requiring it to have a medical loss ratio of at least 85 percent. A medical loss ratio measures how much of an insurer’s revenue goes toward medical claims versus overhead costs.
2. UnitedHealthcare said despite added benefits, the plan fell out of compliance because of a federal legislation reducing the health insurer’s tax liability for 2018.
3. Enrollment for the affected plan will be suspended for the 2020 contract year. The health plan is sold in nine states to less than 1 percent of UnitedHealthcare’s Medicare Advantage members. Becker’s Hospital News Payer Issues (October 15)

Could Your Practice Use Some Professional Help?
MSSNY’s IMG Subcommittee, through its Clearinghouse Opportunities Program, is looking for physicians who can offer IMG candidates meaningful experiences that will help them become familiar with the US healthcare system and prepare for residency training. Many IMG candidates have previous experience in their own countries as faculty members, practicing physicians or researchers, and they need a way to stay involved in health care as they wait for residency training opportunities. Others have recently graduated from medical school abroad.

IMGs who are ECFMG certified may be asked to assist with computer work, data collection, shadowing you while you treat your patients, help with research and special projects, and assist in any non-clinical activities in physician’s offices. Physicians in any specialty who have a position to offer are encouraged to contact MSSNY. Please send a brief description of the work with which you could use help, your requirements and any compensation that may be available, to Ruzanna Arsenian ( 

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Pro Publica: Doctor Payments from the Drug Industry
Sunshine laws may seem stringent, but doctors continue to benefit from the biopharma industry. A ProPublica investigation has found more than 700 doctors who have earned at least $1 million from drug makers or medical device companies over the past five years alone. Another 2,500 made at least $500,000.

The ProPublica analysis found that Xarelto, a blood thinner made by Janssen, generated the most payments to doctors — with $29.2 million dropped in 2016 alone.

Of the top 20 drugs with the most annual spending on doctors from 2014 to 2018, six made the list in each of the years: Invokana to treat type 2 diabetes, the blood thinners Xarelto and Eliquis, the antipsychotic Latuda, the immunosuppressive drug Humira and the multiple sclerosis drug Aubagio. Another three drugs were on the list for four years: Victoza to treat type 2 diabetes, psoriasis treatment Otezla and the cholesterol-lowering drug Repatha. (Research funding and royalties are not included.)

Xarelto topped the list in spending for four years, totaling more than $123 million in payments from 2014 to 2018. In March, its makers, Johnson & Johnson and Bayer AG, agreed to pay $775 million to settle about 25,000 lawsuits claiming that the companies had failed to warn patients that Xarelto could cause fatal bleeding.

CDC Report: Teen Suicide Rate Spikes
A new CDC report shows suicide rates among youths and young adults ages 10 to 24 spiked over a decade, outpacing the suicide rate of other age groups and ending years of relative stability. Yet, researchers say they are not sure what is driving the jump in suicide rates among youth and young adults.

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TO: New York State Residents and Fellows
MSSNY Announces the 15th Resident/Fellow/Medical Student Poster Symposium 

When:    Friday, April 24, 2020
Where:   Westchester Marriott
Tarrytown, New York
Time:      1:30 pm – 4:00 pm

Click here for detailed guidelines. Deadline for abstract submission is 4:00 pm, Monday, February 3, 2020. We welcome your participation. Participants must be MSSNY members, and membership is free for first-time resident/fellow members. Join online.

Still Time for NY Ambulatory Clinics to participate in the AHRQ Safety Program!
Beginning in December 2019, this program combines evidence-based guidance with strategies to address the attitudes, beliefs, and culture that often pose challenges to improving antibiotic prescribing.

Participation in this AHRQ program will help clinics meet the Centers for Medicare and Medicaid Services Merit-based Incentive Payment System (MIPS) requirements and can demonstrate compliance with the new Joint Commission Ambulatory Antimicrobial Stewardship Standard as many of the concepts are similar.

Continuing education credits including Maintenance of Certification (MOC) for ABIM, ABP, and ABFM will be offered at no charge for participants. 

Benefits of participating include:

  • Reduce unnecessary antibiotic use and increase appropriate antibiotic use

       Enhance teamwork and communication around diagnosis and treatment of infections and antibiotic prescribing in your practice
       Improve patient safety and safety culture

  • Improve workflow, especially during the busy cold and flu season
  • Maintain and improve patient and family satisfaction

Eligible Clinics
Clinics that care for children and/or adults and are:

       Primary care clinics
       Urgent care clinics
       Student health clinics
       Community-based health clinics (e.g., Federally Qualified Health Centers or FQHCs)
       Outpatient specialty clinics that provide primary care (e.g., OB/GYN)

How Can I Learn More?
Attend an Informational Webinar (all times listed are Eastern Time):

October 30 1 p.m.
November 5 at 2 p.m.
November 14 at 2 p.m.
November 26 at noon
December 2 at 2 p.m.

Visit or email

This program is funded and guided by the Agency for Healthcare Research and Quality and led by Johns Hopkins Medicine and NORC at the University of Chicago.


“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Be sure to sign up for Medical Matters: When is the Flu not the Flu? on November 20 at 7:30am. 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.  Please click here to view the flyer for this program.

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

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.

Register Now for 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 2 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.  To view the program flyer, please click here.

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.



Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
Please call or text 929 316-1032

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:


Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to :

Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.
Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Chemung                Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Dutchess                 Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                 Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*             Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                      Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington            Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: Contact: or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at:

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:  Fax: (1-516) 833-4760 Equal Oppty Employer M/F