November 16, 2018 – WSJ, AMA and Wild Fires

PRESIDENT’S MESSAGE Thomas J. Madejski, MD MSSNY President MSSNY eNews November 16, 2018 Volume 21  Number 42

Colleagues:

I spent last weekend in National Harbor, Maryland, at the Interim AMA Meeting with our hard working delegation. I am a member of the Council on Medical Service and at our meeting, the following item was discussed:

AMA’s CMS Report 4 addresses Site of Service Differential. The AMA supports Medicare payment for the same service routinely and safely provided in multiple outpatient settings (Office, HOPDs and ASCs) that are based on sufficient data regarding the actual cost in each setting. The AMA approved an amendment to its existing policy so that outpatient services are site neutral without lowering Medicare payments. 

Other major directives discussed are:

• Physicians again forcefully spoke out on gun-violence policy as AMA delegates adopted policy calling for a better background-check system for firearms purchases, a ban on 3D-printed firearms, and “gun violence restraining orders” for people arrested or convicted of domestic violence or stalking.

The AMA’s actions stem from comprehensive policy adopted in previous House of Delegates meetings to stem the deadly toll of firearm violence.

• Better data needed to guide suicide prevention efforts among physicians and medical students. Citing the high rate of suicide completion among medical professionals when compared with the general population and work-related stress as a risk factor for doctors, delegates want a better understanding of patterns linked to physician and medical student suicide. Long work hours are commonly cited as a reason for the prevalence of mental illness and burnout among physicians and medical students, but additional institutional factors can contribute to suicide.

• Sex education should include age-appropriate content on bullying, consent. More than 11 percent of high-school girls are victims of forced sex, along with 3.5 percent of high-school boys, says a 2017 Centers for Disease Control and Prevention survey. To encourage this approach, delegates directed the AMA to “support state legislation mandating that public middle and high school health education programs include age-appropriate information on sexual assault education and prevention, including but not limited to topics of consent and sexual bullying.”

• Help homeless people get the government ID cards often needed to access medical care. More than 3.5 million Americans will experience homelessness at some point in a given year—and nearly 80,000 are chronically homeless. Lack of government-issued identification remains a major barrier to seeking medical care. Delegates adopted new policy to: Recognize that among the homeless population, lack of identification serves as a barrier to accessing medical care and fundamental services that support health. Support legislative and policy changes that streamline, simplify and reduce or eliminate the cost of obtaining identification cards for the homeless population.

Other important issues:

• Prescription-drug importation from Canada.
• Improved access to preventive care.
• Rural health disparities.

California Doctors

Our hearts go out to all those who have suffered tremendous losses in the California wild fires. Past President of the California Medical Association President Dick Thorpe, lost his house in Paradise, where his internal medicine practice is also located. They have kept their doors open by temporarily moving it to Chico. You can help our friends in California at their website.

Wall Street Journal and Marijuana

Finally, I made it into the Wall Street Journal. It was not for the usual reasons, but they actually published my letter to the editor regarding MSSNY’s stance on marijuana in response to an editorial from former Speaker of the House of Representatives, John Boehner, a consultant to the marijuana industry.

Contact me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President

NYU Langone to Open New Medical School on Long Island by September 2019
NYU Langone plans to open a new medical school on Long Island by September 2019 that would exclusively train primary care physicians, NYU President Andrew Hamilton announced at a University Senate meeting on Thursday.

“We have the opportunity to create a new medical school that would focus exclusively on primary care physicians,” Hamilton said. “It will be a three-year program focused on training physicians to become practicing doctors in primary care in communities.”

Over the last two years, Langone has merged with Winthrop Hospital on Long Island, and this would be the site of the new medical school. Hamilton mentioned an existing infrastructure of dormitories and educational facilities at Winthrop Hospital, which would make a transition into a full-blown medical school easier. There are several steps still to go before the medical school could be deemed official, such as receiving state approval. If approved, the school would enroll 40 students per semester, potentially by as early as September 2019 according to Hamilton.

FDA Increasing Scrutiny of Drug Manufacturing Processes In Light of Recalls
FDA Commissioner Scott Gottlieb, M.D., announced “the agency is increasing its focus on drug quality to guard against impurities such as the potentially cancer-causing chemicals that have been found in three commonly prescribed blood pressure medications.” Following the recall of valsartan, irbesartan, and losartan, Dr. Gottlieb said the FDA has recruited “dozens of chemists to review pharmaceutical companies and monitor for any changes in manufacturing techniques” to help “prevent drug impurities that may be harmful to consumers.” The article points out that the agency is currently “investigating the scope of the manufacturing problem that led to the recalls.” USA Today (11/14)

Older Age and Lack of Experience with Transgender May Hinder Caring
Findings published in the Annals of Family Medicine.(11/12,Subscription Publication) reports, “Older age and lack of personal experience with transgender individuals may correlate inversely with a clinician’s willingness to care for transgender patients,” The authors of an accompanying editorial write that transgender people often report feeling stigmatized or misunderstood by healthcare” professionals. The editorialists “use a hypothetical case scenario to show how physicians and their office staff can communicate with transgender patients in sensitive and respectful ways.”

Workers with Highest Suicide Rates Have Construction, Mining, and Drilling Jobs
On November 16, The Centers for Disease Control and Prevention published in their Morbidity and Mortality Weekly Report that “workers with the highest suicide rates have construction, mining and drilling jobs.”  The findings corrected “an earlier study that mistakenly said farmers, lumberjacks and fishermen killed themselves most often.” In arriving at these conclusions, investigators examined data on “22,000 people who died of suicide in 2012 and 2015, and what jobs they held.”

“Cybersecurity: A Daily Threat for Healthcare” CME webinar RESCHEDULED

There were multiple road closures leading into Albany from every direction, preventing MSSNY staff and program faculty from reaching the MSSNY offices.  This was additionally compounded by technical difficulties that prevented MSSNY staff from accessing email remotely.

MSSNY has rescheduled this program for November 28^th 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. 

“The Continued Public Health Threat of Measles 2018” CME webinar
December 12, 2018 at 7:30am – Registration now open

In lieu of the recent measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 schedule.  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 program here.

Educational Objectives:

• Increase physician’s awareness of the role of measles as re-emerging infection.
• Discuss strategies to improve vaccination rates.
• Explore herd immunity and the role it plays in recent measles outbreaks.

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. 

Alzheimer’s Disease Research Symposium at Stonybrook on November 19
Learn from key experts about the important research being conducted at Stony Brook Medicine in the field of Alzheimer’s disease. The Stony Brook Center of Excellence for Alzheimer’s Disease will present a symposium on Monday, November 19, from 12 pm to 2 pm in the Health Sciences Tower, Galleria, Level 3.

No registration is required. For more information, email Daphne.Perry@stonybrookmedicine.edu or call (631) 632-3074.

FDA Approved Supplemental Application for Gardasil 9
The US Food and Drug Administration (FDA) has approved a supplemental application for Merck’s 9-valent human papillomavirus vaccine (Gardasil 9) to include women and men aged 27 through 45 years.

The CDC has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90% of these cancers, or 31,200 cases every year, from ever developing. The CDC estimates that every year about 14 million Americans become infected with HPV. About 12,000 women are diagnosed with cervical cancer and about 4000 women die from cervical cancer caused by certain HPV viruses. HPV is also associated with several other forms of cancer affecting men and women.

In 2014, the FDA approved Gardasil 9, which covers the same four HPV types as Gardasil as well as five additional types (31, 33, 45, 52, and 58). Gardasil 9 was first approved for use in males and females aged 9 through 26 years.

According to the FDA, in a study in roughly 3200 women aged between 27 and 45 years followed for an average of 3.5 years, Gardasil was 88% effective in preventing the combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine.

The safety of Gardasil 9 was evaluated in a total of about 13,000 males and females. The most commonly reported adverse reactions were injection-site pain, swelling, redness, and headaches.

The FDA granted the Gardasil 9 application priority review status, a program that facilitates and expedites the review of medical products that address a serious or life-threatening condition.

Continuous Recruitment for NYS DUR Board Membership
Federal legislation requires States to maintain a DUR program and establish a Drug Utilization Review (DUR) Board.  The NYS Medicaid DUR Board provides recommendations to the Health Department associated with establishing clinical standards for Medicaid’s pharmacy program. The composition of the DUR Board can be found on pages 1 & 2 of the General Operating Procedures.

Responsibilities of the DURB include:

• The establishment and implementation of medical standards and criteria for the retrospective and prospective DUR program.
• The development, selection, application, and assessment of educational interventions for physicians, pharmacists and recipients that improve care.
• The collaboration with managed care organizations to address drug utilization concerns and to implement consistent management strategies across the fee-for-service and managed care pharmacy benefits.
• The review of therapeutic classes subject to the Preferred Drug Program.

CVs associated with interest in becoming a DUR Board member are accepted continuously and can be submitted to the DUR Board mail-box at dur@health.ny.gov. If no vacancies exist, CVs will be kept on file for consideration once a position becomes available. Questions on membership and candidacy can be directed to the DUR Board Member Liaison, Robert Sheehan, at dur@health.ny.gov or 518-486-3209.

For more information about the NYS Medicaid DUR Board please go here.