MSSNYeNews: November 22, 2019 – California Dreamin’

Arthur Fougner MSSNY Presiident

Arthur Fougner, MD
MSSNY President

November 22, 2019

Vol. 22  Number 44



The AMA Interim Meeting in San Diego was interesting. A major issue discussed concerned Scope – NOT the mouthwash. The meeting highlighted the confusion that often arises among patients as to the credentials of the person who is treating them.

Table of doctors

For example, 88% of those surveyed were clear that an Obstetrician-Gynecologist is a physician, 12% either thought an Ob-Gyn was not a physician or were unsure. About one in five thought a Nurse Anesthetist was a physician. More folks than not thought Optometrists were physicians.

Therefore, in NY, we have the requirement to wear identifiers to reduce the confusion. However, there are Doctors of Nursing with PhD degrees. Therefore, they are doctors but not physicians. No wonder patients get confused.

To be clear, we all need each other. Patients clearly fare best when their care is team-based. There should be no room for either – or. No remonstration, no finger pointing allowed. However, when I learn that a physician is being bullied so as not to give a vanilla presentation on the differences in education and training among the various healthcare professionals who treat patients in the area, I am deeply troubled.

To that end, MSSNY has set up an ad hoc Scope of Practice committee.

In the end, it’s the patient who counts.

Please let us end the confusion.

There is a “physician” and then there is “not exactly”.

All the leaves are brown and the sky is gray
I’ve been for a walk on a winter’s day
If I didn’t go, I could leave today
California dreamin’ on such a winter’s day

-John and Michelle Phillips

Comments?; @sonodoc99

Arthur Fougner, MD
MSSNY President

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Please Take Our Survey Re Prior Authorization —A Major Physician Concern
MSSNY has worked together with numerous physicians and patient advocacy groups in support of multiple pieces of legislation to reduce physicians’ administrative burden to ensure that their patients can receive the medications they need. Please click here to complete the survey.

Our success includes a recent law that gives physicians greater authority to override a health insurer “step therapy” or “fail first” prescription medication protocol in certain circumstances.

However, MSSNY continues to work for additional laws that reduce the need for unnecessary and repetitive prior authorizations that take time away from patient care delivery.

Please take just a few minutes to complete the survey.

Physicians: Urge Governor to Sign Legislation to Permit Partial Filling of Opioid Prescriptions
Please urge Governor Cuomo to sign into law legislation (A.3918/S.1813) presented for his consideration this week that would permit a physician to stagger a patient’s short-term opioid prescription, so as to prevent the accumulation of unused opioids in patient medicine cabinets.  You can send a letter from here:  Specifically, the legislation 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.

The Governor has until November 30 to decide whether to veto or sign. MSSNY President Dr. Art Fougner issued a statement this week calling on the Governor to sign this bill into law, noting that “We know that one way opioid abuse starts is by persons other than the patient accessing unused medications left in medicine cabinets or other parts of a patient’s home.  By enabling the staggered filling of the prescription, this measure will help to reduce the amount of pain medicines left unused. This will limit the risk of these medications being diverted.”

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 opinion that “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.

It’s Crunch Time – Please Make Sure Congress Doesn’t Let the Insurance Industry Write the “Surprise Bill” Solution
With just a few weeks left in the year, Congress is continuing to have extensive discussions about legislation to address “surprise” out of network medical bills.  It is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution to this issue that protects patients’ access to needed care, and does not grant huge new powers to the health insurance industry.  By clicking here, you can send a letter, and tweet at your legislators.

Please remind them of the successes of New York’s law.  In September, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.   According to a May Georgetown University report, there has not been any adverse premium impact attributable to our law.  

At the same time, please remind them of the grave concerns have been raised about insurance company friendly legislation (H.R.3630 Pallone/Walden, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.  When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.   

Large market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not let Congress make this worse.  Please contact your Senators and Representatives today!

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NYDOHMH Confirms Second Vaping-Related Death
The AP (11/20) reports New York’s Department of Health “has declared the state’s second death linked to a vaping-associated illness.” Gov. Andrew Cuomo “said on Wednesday that the person who died was a man in his 30′s from Manhattan with a reported history of using e-cigarettes and vapor products.” The first death, on Oct. 4, “was of a 17-year-old boy from the Bronx.”

New York AG files suit against Juul

New York Attorney General Tish James filed suit against e-cigarette maker Juul Tuesday alleging the company marketed to underage users and misrepresented the product as a healthier alternative to traditional cigarettes. In the 38-page complaint, the AG’s office says that Juul engaged in “deceptive business practices when marketing and advertising its products, and illegally sold its products to minors through its websites and in third-party retail stores throughout the state.”

“There can be no doubt that JUUL’s aggressive advertising has significantly contributed to the public health crisis that has left youth in New York and across the country addicted to its products,” James said in a statement. “By glamorizing vaping, while at the same time downplaying the nicotine found in vaping products, JUUL is putting countless New Yorkers at risk.”

The suit makes it illegal to sell nicotine products to minors. About 220,000 of the 1 million e-cigarette users across the state are under the age of 18, according to an estimate from the state health department. The federal government has reported 2,172 cases of vaping-related illness — though many cases have been tied to vitamin E acetate found in THC cartridges — and 42 deaths as of Nov. 13.

Canada May Have Found New Vaping Complication: Popcorn Lung
Canadian physicians may have identified a new type of lung injury linked to vaping. In CMAJ, they report a potential case of vaping-associated bronchiolitis obliterans, a form of which is known as “popcorn lung.”

Previously, a number of workers in factories making microwave popcorn developed “popcorn lung” after inhaling the flavoring chemical diacetyl, which is also used in e-liquids.

An otherwise healthy, 17-year-old male with a history of heavy, daily vaping presented with cough, dyspnea, and fever. Tests for infectious agents were negative. Computed tomography revealed a diffuse tree-in-bud pattern, which differs from what has been observed in patients with e-cigarette, or vaping, product use associated lung injury (EVALI).

The patient developed refractory hypercapnia and required extracorporeal membrane oxygenation, but he improved with corticosteroids. He was hospitalized for 47 days and still had impaired lung function at 4 months.

Separately, a correspondence in the New England Journal of Medicine describes autopsy findings from a young man who died from untreated EVALI.

CMAJ article editorial (

NEJM correspondence on pathology of vaping-related lung illness

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Three LI Children Contract Polio-Like Disease Acute Flaccid Myelitis
Newsday (NY) (11/17) reports on the “rare polio-like disease” acute flaccid myelitis “that has struck at least three Long Island children since a nationwide outbreak began in 2014.” The CDC “has confirmed nearly 600 cases of the disease – mostly in young children – since it began tracking cases in 2014.”

Survey: Women More Likely to be Warned Away from Surgery Careers
Findings were published in Annals of Surgery regarding a recent survey that “punishing hours and concerns about having little time to marry and have children deter both male and female medical students from choosing careers in surgery, but more women say they’ve been warned away from the field because of their gender.” Researchers “sent surveys to roughly 720 students at Harvard Medical School.” Among the 261 who responded, “similar proportions of both genders intended to become surgeons – roughly one in four men and one in five women.”

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Plan Legal Challenge against Health-Pricing Disclosure Rule
The Wall Street Journal (11/20) reports that the hospital industry is planning a legal challenge to block the Trump Administration’s new health-pricing disclosure rule, which would require the disclosure of secret rates negotiated by hospitals with insurers for all services.

CMS Flags Nursing Home Citations
CMS on its Nursing Home Compare website has added a new icon—a red circle with a white stop hand in the center—to ratings for 760 facilities, indicating that the facilities have been cited for an incident of abuse, neglect, or exploitation. Consumer advocates have applauded the move, but some in the nursing home industry say the alerts are misleading. (Wall Street Journal, 11/19)

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Incontinence is Increasingly Common Though Few Seek Care
The Wall Street Journal (11/17, Subscription Publication) reported on incontinence and efforts to improve bladder health, adding that according to the Urology Care Foundation one-third of Americans 40 or over have urinary incontinence at least some of the time, though many do not seek care.

Hard-to-Use EHRs Tied to Physician Burnout
Physicians who find their electronic health records (EHRs) difficult to use are more likely to report symptoms of burnout, according to a study in Mayo Clinic Proceedings.

Nearly 900 physicians answered a questionnaire about burnout and completed the System Usability Scale (SUS), a 10-item survey assessing how usable they found their EHR (see second link below). SUS scores range from 0 to 100, with higher scores denoting better usability.

Overall, the mean SUS score was 45.9, which is considered “not acceptable.” Additionally, nearly half the cohort reported at least one burnout symptom. SUS scores were associated with burnout in a dose-dependent manner. After multivariable adjustment, the odds of burnout were 3% lower with each 1-point increase in SUS score.

Dr. Patrice Harris, president of the American Medical Association, said in a statement: “The findings will not come as a surprise to anyone who practices medicine. … It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function — helping physicians care for their patients.” Mayo Clinic Proceedings article; System Usability Scale;

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Survey: Practices Spend One Staff Day Each Week on Provider Directory Upkeep
Modern Healthcare (11/14) reports a new Council for Affordable Quality Healthcare survey reveals “maintaining provider directories is an expensive, time-consuming task that takes up the equivalent of one staff day per week for physician practices.” The not-for-profit health plan alliance “found directory maintenance costs practices nationwide $2.76 billion annually, or $999 per practice per month.”

Additionally, “the cost to practices rises in accordance with the number of providers and plan contracts,” and “practices with more than 25 providers spent an average of about $2,500 per month maintaining provider directories, while those with fewer than five providers spent $319 per month on average.” In its report of the results, CAQH suggests “a seemingly simple solution: health plans adopting a single, streamlined platform where practices can enter, update and review their practice information and share it with multiple plans at once.”

Young Physicians at Interim AMA Meeting

Young Physicians at Interim AMA Meeting. (from left) Charles Lopresto, DO; Ryan Schlobach, MD (in rear); then Ray Lorenzoni, MD (in rear); Carlos Zapata, MD; Anita Ravi, MD; Jocelyn Young, DO; Daniel Choi, MD; and Carlo Milani, MD


Go Live Date Approaching for NY Workers’ Compensation Formulary
The New York Workers’ Compensation Board Drug Formulary (NY WC Formulary) becomes effective on December 5, 2019 for all new prescriptions. Starting that day, all new prescriptions for injured workers in New York State must be listed within the NY WC Formulary unless an alternative medication has been approved through the NYS Workers’ Compensation Board’s new prior authorization process. The new electronic prior authorization process will soon be available through the Board’s Medical Portal; please watch for the notification.

Please visit the Board’s Drug Formulary Overview webpage for:

  • An overview of the NY WC Formulary and the prior authorization process
  • The latest version of the NY WC Formulary (effective 11/5/19)
  • A video overview for Medical Providers
  • A Quick Guide to the NY WC Formulary
  • An NY WC Formulary Dashboard Guide for Medical Providers

Information and resources related to requesting prior authorization through the Board’s Medical Portal, can be found on the Board’s Medical Portal Overview webpage.

For more information or assistance:


The CY 2020 MPFS is Now Available
The CY 2020 Medicare Physician Fee Schedule (MPFS) is now available. You can view the new fees using the Fee Schedule Lookup tool page on the website.


MSSNY hosted a webinar, “How to Maximize Success and Maintain Control & Ownership of Your Physician Group,” featuring Roy Bejarano, Co-Founder & CEO of Scale Physician Group, and Andrew Blustein, Partner/Director and Vice Chair of Garfunkel Wild, P.C. on November 12, 2019.

Roy shared the lessons and best practices learned from his experience working with over 1,200 physicians across the country and Andrew facilitated Q&A during the presentation. Listen to the replay for Scale’s insights on the benefits of scale, barriers to building sustainable growth, and how to approach a private equity transaction for physician groups.



Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email for information and showings.

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 :

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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)
Columbia*             Hudson Correctional Facility (antiquing, arts & collectables)
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)
Orleans                  Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
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)
Wyoming               Wyoming Correctional Facility (waterfalls, family farms, natural beauty)

NYS Corrections Personnel Ad

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