MSSNYeNews: December 6, 2019 – Progressive or Regressive
NY State faces a significant budget deficit as 2020 approaches. Assembly Speaker Heastie knows it. Senate Leader Stewart Cousins knows it. Governor Cuomo knows it. This promises to be a Dickensian winter of discontent. Our Medical Society stands as it has always stood – ready to help.
One contentious area has been medical liability. Our governor at his birthday event announced that NY is the most progressive state in the country as he recounted a litany of accomplishments. However, what he failed to mention is that in the arena of medical liability, NY is the most regressive state in the country. NY pays out annually more than the next two highest states put together. NY’s liability environment is so toxic that in the 1980’s, in order to keep physicians’ practicing, NY began providing an excess layer of malpractice insurance.
Our state government perennially rails against waste, fraud, and abuse in the Medicaid system. Yet Albany refuses to address the obvious waste, fraud and abuse that is our medical liability system. By enacting even modest reforms, hundreds of millions of hard-earned taxpayer dollars could be reclaimed by the Medicaid system by disincentivizing the defensive practices that do nothing to enhance patient care.
Albany wants to fight climate change yet continues to drop lumps of coal into New Yorkers’ stockings every year. I say we embrace climate change – let’s change Albany’s medical liability climate once and for all.
Arthur Fougner, MD
It’s Crunch Time – Please Make Sure Congress Doesn’t Let the Insurance Industry Write the “Surprise Bill” Solution
As Congress reaches a critical juncture about whether to act on 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 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.
This week U.S. Rep Joe Morelle (D-Rochester) authored an op-ed in The Hill that made the case for federal legislation to address surprise medical bills based on New York’s model using an independent dispute resolution mechanism, and in opposition to an approach that would base payment on an insurer-determined median in-network payment.
Also this week, MSSNY sent a letter to the Congressional delegation to address some of the inaccurate statements about the impact of New York’s law. In particular, we highlighted that the New York DFS has commented on multiple occasions that there has been no adverse premium impact of New York’s surprise bill law. In the May report from Georgetown University analyzing New York’s law, it was noted that “state regulators report that there has not been, as yet, an indication of an inflationary effect in insurers’ annual premium rate filings.”.
Moreover, in a webinar hosted by Yale University professor Zach Cooper with NYDFS staff, it was noted that New York’s law “at least in the first years, was helping to save money”, and that it has “never been raised by any of the plans…as any significant cost driver in making premiums go up.”
It is clear why. The balance in New York’s law results in a dynamic where the dispute resolution is rarely used. From 2015 to 2018, there were just over 2,500 decisions, as compared to the over 7 million visits to New York emergency departments each year. A recent DFS report found that the law saved consumers over $400 million and reduced out-of-network billing by 34%.
Even the health insurance industry has praised New York’s approach. In a recent statement in support of legislation to extend New York’s law to out of network hospitals, the New York Health Plan Association (which includes representatives of the largest insurance companies in the country) commented that “The existing Independent Dispute Resolution process has worked well to ensure reimbursements for emergency services are fair and reasonable while holding individuals harmless.
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!
Listen to this Podcast to Hear Why You Need to Be in Albany on March 4
Please plan to be in Albany on March 4, 2020 for Physician Advocacy Day to hear from key health care policy leaders and to meet with your local legislators! To register, click here.
Want to learn more about why you should come to the State Capitol. Listen here to a 15-minute podcast featuring Suffolk County Medical Society President Dr. Richard Schoor, Suffolk County Medical Society Executive Director Dr. Aaron Kumar, and MSSNY Senior Vice-President Moe Auster discussing the importance of physician advocacy, including participating in the Albany Lobby Day.
Dutchess County Medical Society Physician Leader Praises Goal, Raises Concerns at Legislative Single Payor Hearing
On November 25, Poughkeepsie orthopedic surgeon and Dutchess County Medical Society Past President Dr. William Barrick delivered testimony to New York State Senate and Assembly Health Committee members at a Kingston hearing examining a proposal to create a single payor health care system in New York State. Dr. Barrick’s testimony at the hearing can be viewed here, at the 7:32 mark.
Dr. Barrick’s testimony praised the goals of the New York Health Act legislation to reduce insurance hassles and expand coverage while also raising the significant challenges inherent in implementing such a massive system. At one point, his testimony elicited a comment from Senate Health Committee Chair Gustavo Rivera regarding what the fee schedule of this system would likely be if this legislation were to be enacted, to which Senator Rivera characterized as “above Medicare”.
Dr. Barrick’s comments regarding possible prior authorization requirements prompted Assembly Health Committee Chair Richard Gottfried to praise MSSNY and the New York County Medical Society for engaging in a constructive dialogue, including highlighting specific areas of concern in the far-reaching proposal. As a result, changes were made to the legislation including limiting prior authorization requirements and providing stronger collective negotiation rights for physicians. Dr. Barrick also raised the importance of liability reform as an essential component if legislation were enacted to create a single payor system.
Data Exchange Incentive Program (DEIP) Step-By-Step
The Data Exchange Incentive Program (DEIP) offers a one-time incentive to help providers offset the cost of connecting to the SHIN-NY via a Qualified Entity (QE). Click here to view a DEIP step-by-step document that will help physicians know what to expect regarding the DEIP process and timeline.
Hospital Groups Sue HHS to Block Price Transparency Rule
Four organizations representing hospitals and health systems across the nation sued HHS Dec. 4, challenging a final rule that requires hospitals to disclose the rates they negotiate with insurers beginning in 2021.
The American Hospital Association, the Association of American Medical Colleges, the Children’s Hospital Association, and the Federation of American Hospitals filed the lawsuit in the U.S. District Court for the District of Columbia. The groups argue that HHS lacks statutory authority to require public disclosure of individually negotiated rates between commercial insurers and hospitals. The lawsuit further alleges that the rule violates the First Amendment because it requires “highly confidential” negotiated rates to be disclosed.
“America’s hospitals and health systems stand with patients and are dedicated to ensuring they have the information needed to make informed health care decisions, including what their expected out-of-pocket costs will be,” Rick Pollack, president and CEO of the AHA, said in a press release. “Instead of giving patients relevant information about costs, this rule will lead to widespread confusion and even more consolidation in the commercial health insurance industry. We stand ready to work with CMS and other stakeholders to advance real solutions for patients.”
Under the final rule, issued Nov. 15, hospitals will be required to disclose the standard charges, including payer-specific negotiated rates, for all items and services. Hospitals that fail to publish the negotiated rates online could be fined up to $300 a day.
(Becker’s Hospital Review, 12/5)
FDA Raises New CBD Concerns
FDA in a Consumer Update revised last week raised new safety concerns about products containing cannabidiol (CBD), particularly CBD-containing foods. In addition, FDA last week sent warning letters to 15 Companies that the Agency said are illegally marketing CBD Products.
HHS Moves to Provide HIV Prevention Drug to the Uninsured
HHS today launched a program to provide HIV prevention or PrEP drugs to an estimated 200,000 uninsured people at risk of HIV.
Officials intend to use Truvada that will be donated by Gilead Sciences in an annual arrangement through 2030. HHS Secretary Alex Azar said the department will cover the costs of dispensing the treatment through next March. After that, CVS, Rite Aid and Walgreens will donate pharmacy dispensing services.
The announcement comes nearly a year after President Donald Trump in his State of the Union address vowed to eliminate domestic HIV transmissions by 2030.
HHS has requested $291 million from Congress to support Trump’s plan. Both the House and Senate have committed to the HIV strategy, and Azar said officials are working to wrap funding into a short-term spending patch if fiscal 2020 appropriations measures aren’t finalized.
“We do need this money to get this moving,” Azar said.
Deaths from Alcohol-Related Liver Disease at Highest Levels Since 1999
According to Reuters (11/29), CDC data revealed that “U.S. deaths from alcohol-related liver disease (ALD) are at their highest levels since 1999 and have risen every year since 2006 in nearly every racial, ethnic and age group.”
After analyzing “causes of death for people aged 25 and older in the two decades since 1997,” investigators “found that 2017 had the highest rates of death from ALD, at 13.1 per 100,000 deaths in men and 5.6 per 100,000 in women,” which “compares to 1999 ALD mortality rates of 10.6 per 100,000 in men and 3.3 per 100,000 in women.” In particular, “mortality rates and recent increases in ALD diagnoses were…pronounced among middle-aged adults, Native Americans and non-Hispanic whites,” the study found. The findings were published online in the American Journal of Gastroenterology.
Health Foundation of Western/Central NY’s Health Leadership Program
The Health Foundation for Western and Central New York is now accepting applications from leaders in western and central New York who are interested in participating in Cohort 10 of the Health Leadership Fellows Program. The Fellows program is designed for executives and leaders from health-related non-profit organizations, safety net organizations and public agencies that address the needs of older adults and young children impacted by poverty.
The deadline to apply for the Health Leadership Fellows Program is Friday, April 3, 2020. Interviews will be held throughout the spring, and the program will begin in November 2020. For those interested in learning more about the program, the Health Foundation will hold the following informational webinar sessions. Log-in information for the webinars will be posted on the Fellows web page at a later date.
- February 13, 2020 at 2 pm
- March 10, 2020 at 11 am
More than 300 leaders in western and central New York have graduated from Health Leadership Fellows since the program began. Taking what they have learned from the expert faculty, residential sessions, leadership assessments and coaching sessions, fellows have used new information, relationships and ideas to improve health care for people in our regions.
California Surgeon: Prison Time for Role in $580M Billing Fraud
An orthopedic surgeon was sentenced to 30 months in federal prison Nov. 22 for his role in a healthcare fraud scheme that resulted in the submission of more than $580 million in fraudulent claims, mostly to California’s worker compensation system, according to the Department of Justice.
Daniel Capen, MD, was sentenced more than a year after pleading guilty to conspiracy to commit honest services fraud and soliciting and receiving kickbacks for healthcare referrals. He was one of 17 defendants charged in relation to the government’s investigation into kickbacks physicians received for patient referrals for spinal surgeries performed at Pacific Hospital in Long Beach, Calif.
Dr. Capen received at least $5 million in kickbacks for referring surgeries to Pacific Hospital and for referring services to organizations affiliated with the hospital. He allegedly accounted for $142 million of Pacific Hospital’s claims to insurers between 1998 and 2013, according to the Justice Department.
In addition to the prison term, Dr. Capen was ordered to forfeit $5 million to the federal government and pay a $500,000 fine. Becker’s Hospital. Review
Fed Legislation: States Must Maintain a DUR program and Establish a DUR Board The NYS Medicaid DUR Board provides recommendations to the Department of Health 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 Bylaws: https://www.health.ny.gov/health_care/medicaid/program/dur/docs/bylaws.pdf
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 mailbox at firstname.lastname@example.org. 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 email@example.com or 518-486-3209.
For more information about the NYS Medicaid DUR Board please visit: https://www.health.ny.gov/health_care/medicaid/program/dur/
Important News About WC Authorization/Re-Registration
Back in November 2017, MSSNY notified members that the WCB was updating its directory in 2018 and all WC authorized physicians had to re-register –
New Health Care Provider Registration Coming Soon
The Workers’ Compensation Board (Board) has initiated a registration process to update and maintain a current list of medical providers who are authorized to treat injured workers. The goal of this process is to enable an injured worker to easily and accurately identify Board-authorized medical providers.
You will be notified in November when registration opens for Board-authorized medical providers. Authorized providers are asked to register with the Board and update their office address(es) and contact information by January 15, 2018. This registration process will be an ongoing initiative every two to three years.
Medical providers who have not registered by January 15, 2018 will:
- be removed from the public directory of Board authorized providers, and
- become ineligible for the Board’s disputed bill process.
Creating an Account in the New York State Health Commerce System (HCS)
The Board will use the existing New York State Health Commerce System (HCS) for this registration process. For the initial registration and for future updates to your practice information, you will need to have an HCS account. If you don’t already have one, you can view directions to create an account on the New York State Department of Health website.
Q. If a WC physician did not re-register with the WCB to update the physician directory, what happened?
A. The physician was dropped from the directory of authorized WC physicians.
Q. What will occur moving forward?
A. Anyone who did not re-register with the WCB since 2018 will be dropped from WC authorization on or about 1/1/20. If a WC authorized physician doesn’t register by 1/30/20 their authorization status will be terminated.
Q. What if a physician wants to keep his/her WC authorization status?
A. Please have the doctors complete the registration process, click the link provided:
Back in November 2017, MSSNY notified members that the WCB was updating its directory in 2018 and all WC authorized physicians had to re-register –
MSSNY Podcast: DPT Vaccine
According to the CDC Provisional Pertussis Surveillance Report, there were 345 confirmed cases of pertussis in New York State in 2018. There is currently a case in Montgomery County, and in October 2019 Jefferson County had an outbreak. If pertussis is present in a community, it is possible for fully vaccinated people of any age the contract this highly contagious disease. Be sure to learn more by listening to MSSNY’s podcast on the Tetanus, Diphtheria & Pertussis vaccine here.
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 http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email firstname.lastname@example.org for information and showings.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Please call or text 929 316-1032
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 office, shared your office space, buy 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
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 : email@example.com
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)
Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov 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: 98point6.com/pcc/
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: firstname.lastname@example.org Fax: (1-516) 833-4760 Equal Oppty Employer M/F
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355