April 13, 2018 – NO Aetna/CVS! NO Walmart/Humana!

Thomas J. Madejski, MD MSSNY President

Thomas J. Madejski, MD
MSSNY President
April 13, 2018
Volume 18
Number 14


Dear Colleagues:

Physicians should be leading patient care delivery, not corporations.

Last Saturday’s New York Times included a lengthy article analyzing the proposed health care mega-mergers such as CVS-Aetna and Walmart-Humana that touched upon concerns that many physicians have with the significant encroachment of corporate interests into medical care delivery.

MSSNY has been outspoken in its opposition to the proposed takeover of insurance behemoth Aetna by retailer and PBM owner CVS.  Our concerns about the impact of this proposal have been reported in several media outlets, and were heard loudly and clearly by the State Legislature, which rejected a proposal originally contained in the State Budget that would have authorized corporate owned retail clinics.

And we were pleased that the AMA echoed our concerns in its recent testimony to the US House of Representatives Judiciary Committee that set forth its very serious concerns with this transaction.  Having led efforts to defeat the Anthem-Cigna and Aetna-Humana mergers, the AMA can be a powerful voice in opposition to excessive market concentration that harms our patients.

With recent reports of a similar proposed takeover of insurance giant Humana by ubiquitous big box retailer Walmart, MSSNY again sent a letter to the New York State Attorney General and issued a press release urging federal and state antitrust enforcement agencies to undertake a careful investigation of this proposed cross-sector mega-merger that would likely have adverse consequences for physicians and patients.

Our concerns with these mega-mergers are numerous and include:

  • The adverse impact to patient care that could result from the loss of physician-led medical homes.
  • Further reduction of patient choice of pharmacy, as it may become harder for pharmacies not affiliated with CVS or Walmart to be incorporated into these merged entities’ pharmaceutical networks.
  • Enabling PBM’s to impose even more burdensome prior authorization hassles for physicians and their staff as a pre-condition for patients receiving needed prescription medications.
  • The proliferation of so-called “retail clinics,” owned by an insurance company/retailer that could have great incentive to steer patients to these sites instead of a community based primary care practice that typically serves as a patient’s medical home.   This will result in the fragmentation of patient care instead of helping to better coordinate it.
  • Loss of physician advocacy for the best treatment for their patient, not the corporate bottom line.

While careful review by our state and federal investigatory agencies of these cross-sector consolidations is one avenue, another is legislative. If these entities are permitted to merge, independently practicing physicians should then have the power to counter such consolidation by being permitted to come together to negotiate on behalf of their patients against these corporate behemoths. MSSNY continues to advocate for legislation (A.4472, Gottfried/S.3663, Hannon) that would enable this. Please add your voice of support to this legislation by clicking here. Our patients’ ability to continue to receive needed care from the physician of their choice depends upon it.

Thomas J. Madejski, MD 
MSSNY President


HIT MLMIC Symposium

Capital Update

AMA Study: More Than 9 in 10 Physicians Believe Prior Authorization Programs Harm Patient Care Delivery
MSSNY has shared with the State Legislature the results of a recent AMA survey that showed that a staggering 92% of physicians believe that prior authorization programs have a negative impact on patient clinical outcomes.   The information was shared with legislators in support of legislation advocated for MSSNY, the NY-ACP, and the New York State Academy of Family Physicians (A.9588, Gottfried/S.7872, Hannon) that seeks to reduce some of the prior authorization hassles experienced by physicians when they seek to assure their patients can receive the treatment or medications they need.The survey also showed that 84% of responding physicians said that burdens associated with prior authorization were high or extremely high; and that 86% reported that these PA requirements had increased in the last 5 years.  Moreover, every week a medical practice completes an average of 29 PA requirements per physician, which take an average 14.6 hours to process.Among the provisions of A.9588/S.7872 that would address these hassles:

    • Requiring health plan utilization review criteria to be evidence-based and peer reviewed;
    • Reducing the time frame for reviewing prior authorization requests from 3 business days to 48 hours (and to 24 hours for urgent situations);
    • Assuring that a prior authorization, once given, is enduring for the duration of the medication or treatment.
    • Prohibiting mid-year prescription formulary changes; and

  • Assuring that once a prior authorization is given, it cannot be withdrawn if eligibility is confirmed on the day of the service.                           (AUSTER)

MSSNY Urges for Extension of Committee for Physicians Health Program
As the Legislature returns to Albany next week after a brief post-Budget break, MSSNY is advocating for legislation (A.10221, Gottfried, S.8093, Hannon) that would extend for an additional 5 years the continued operations of the MSSNY Committee for Physicians Health (CPH) program.  Authorization for several key components of the program expired on March 31, 2018.

The CPH is a program designed to confront and assist physicians thought to be suffering from alcoholism, substance abuse or mental illness.   Since the inception of this program, CPH has assisted thousands of physicians in returning healthy to medical practice.  The work of the CPH program is an important public service both to our health care system as well as the general public. As a result, the State Budget annually includes an appropriation of $990,000 for the program, which is generated from a $30 assessment on all physicians’ biennial registration fees.

The program has traditionally been extended by the Legislature in 3 or 5 year “demonstration programs” with the most recent extension in 2013.  The recently enacted State Budget included a provision to create another “demonstration program” until 2023.  However, it unintentionally omitted other provisions historically extended at the same time that are essential to its functioning that could greatly impair its operations unless immediate action is taken.

These includes provisions that set forth the CPH program’s reporting requirements to the Office of Professional Medical Conduct (OPMC), provisions to ensure liability protections for the physician Committee members for work performed within the scope of CPH, and necessary confidentiality protections for the program given the sensitivity of the work they perform.   These protections are absolutely essential to the continued functioning of the program to ensure that physicians with the appropriate expertise are willing to serve on the Committee, as well as to assure that the program has the ability to report sensitive information to OPMC when warranted by the circumstances.              

Cross-Sector Health Care Mega-Mergers of Growing Concern to Health Care Delivery
Following last Sunday’s New York Times article about the proposed health care “mega-mergers” of Aetna by CVS, and of Humana by Walmart, MSSNY President Dr. Thomas Madejski issued a press release reiterating the concerns that many physicians have with the significant encroachment of corporate interests into medical care delivery.

At the same time, MSSNY has written to the New York State Attorney General’s office urging that they assess the potential antitrust implications of these potential acquisitions and, as appropriate, convey these concerns to the federal agencies such as the Department of Justice reviewing these proposed transactions.   Among the concerns of these proposed “mega-mergers” include:

  • Further reduction of patient choice of pharmacy, as it may become harder for pharmacies not affiliated with CVS or Walmart to be incorporated into these merged entities’ pharmaceutical networks;
  • Enabling subsidiary PBMs to impose even more burdensome prior authorization hassles for physicians and their staff as a pre-condition for patients receiving needed prescription medications.
  • The potential proliferation of so-called “retail clinics,” owned by an insurance company/retailer, that could have great incentive to steer patients to these sites instead of a community based primary care practice that typically serves as a patient’s medical home, and the adverse impact to patient care that could result from the loss of physician-led medical homes.

“It is imperative that our state and federal investigatory agencies carefully review the impact of this cross-sector consolidation on patient care delivery and access before any such consolidation is permitted to move forward,” stated Dr. Madejski, “We also urge the enactment of measures that would enable independently practicing physicians to counter such consolidation by being permitted to come together to negotiate on behalf of their patients against these corporate behemoths.”  Legislative (A.4422/S.3663 to permit physician collective negotiation has been introduced by Assemblymen Gottfried  & Senator Hannon. (AUSTER)

New AAMC Study Concludes a Significant Physician Shortage by 2030
The United States could see a shortage of up to 120,000 physicians by 2030, according to new data published this week by the Association of American Medical Colleges (AAMC). The study estimates a shortfall of between 14,800 and 49,300 primary care physicians, as well as a shortage in non-primary care specialties of between 33,800 and 72,700 physicians.

Importantly, the press release notes that the shortages will continue to exist despite modeling that takes into account the use of other health professions and changes in care delivery.

Much of the increased demand comes from a growing, aging population. The U.S. population is estimated to grow by nearly 11%, with those over age 65 increasing by 50% by 2030. Additionally, the aging population will affect physician supply, since one-third of all currently active doctors will be older than 65 in the next decade. When these physicians decide to retire could have the greatest impact on supply.

The press release calls for a number of approaches to address this shortage including: legislation sponsored by Rep. Joe Crowley (D-NY) and Senate Minority Leader Charles Schumer (D-NY) that would increase federal support for an additional 3,000 new residency positions each year over the next five years, as well as federal incentive programs such as the National Health Service Corps, Public Service Loan Forgiveness, the Conrad 30 Waiver Program, and Title VII/VIII workforce development and diversity pipeline programs. (AUSTER)

Medical Society of the State of New York Announces its Spring Medical Matters CME Webinar Schedule
The Medical Society of the State of New York is pleased to announce its free Continuing Medical Education (CME) webinars for April and May.  Participation in the webinars will earn physicians one CME credit free of charge.   The Medical Mattes webinar schedule for April and May is as follows:

April 18th at 7:30amMedical Matters: Plague & Q Fever

Register for this webinar here.

Faculty: Kira Geraci-Ciardullo, MD, MPH

Educational Objectives:

  • Describe the epidemiology of Plague and Q Fever
  • Describe the transmission of Plague and Q Fever
  • Describe the diagnosis and treatment of Plague and Q Fever
  • Explain the use of Yersinia pestis and Coxiella burnetii as a biologic weapons(s)
  • Identify infection control procedures
  • Identify resources for reporting.

May 16 at 7:30am – Medical Matters: Chemical Overview
Register for this webinar here.
Faculty: Arthur Cooper, MD

Educational Objectives:

  • Acquire a basic understanding of physically and biologically derived chemical agents
  • Identify types of physically and biologically derived chemical agents used as chemical weapons
  • Understand the indicators of each type of chemical agent
  • Describe the treatment of each type of chemical agent
  • Identify local and state resources

To view all of MSSNY’s scheduled programs, click here and select the Training Center tab and click on “Upcoming”.

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.

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

“Bending the Diabetes Curve” Webinar is Now Available Online!
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has created a free CME program to educate New York State physicians on prediabetes prevention and the CDC’s National Diabetes Prevention program.

Webinar: Bending the Diabetes Curve
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD
Click here to view the webinar!

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

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.

Additional information may be obtained by visiting our diabetes webpage or by contacting Carrie Harring at charring@mssny.org.                                                  (HARRING) 

A Big Thank You for Physician Advocacy Efforts, But More Advocacy Needed
Throughout the budget season, MSSNY shared its concerns and input on the many State Budget proposals that impacted upon physicians and their patients. MSSNY staff and leaders worked around the clock while the State Budget was being finalized in helping to ensure that many adverse proposals were completed eliminated, or substantially improved.

The newly created Physician Advocacy Liaison (PAL) program was instrumental in helping to achieve our numerous Budget victories, by helping us in quickly responding to legislators who wanted to hear the physician perspective on a number of issues. As always, thank you for the work all of you do on a daily basis and taking the additional time to be active in the legislative and budgetary process.  There is no doubt that your efforts were a major contributor to our successes.

While another budget has wrapped up in Albany, several items MSSNY is championing need your help, including in support of legislation to address health insurer hassles and needed liability reforms, and in opposition to inappropriate scope of practice changes and practice mandates that interfere with patient care delivery.

When issues arise, it takes collective action to impact change. It cannot just be left to a few individuals. Every rank and file legislator needs to be informed of our issues.  Legislators are often bombarded with paper, phone calls, emails and meeting requests.   We need to cut through the clutter with our elected officials by establishing personal relationships with every member of the legislature so that they will be better informed how legislative proposals will impact the care received by their constituents.

If you are not a member of the PAL network, but would like to join, please e-mail jbelmont@mssny.org (BELMONT)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org   mauster@mssny.org  pclancy@mssny.org  

Please Note: The January 2019 Council Meeting has been rescheduled for Thursday, January 24th. Also, the Board of Trustees meeting has been rescheduled for Wednesday, January 23rd. The revised MSSNY meeting schedule has been posted on the home page of the MSSNY website.


BCBS Releases Study on Children with Allergies and Allergic Reactions
The Blue Cross Blue Shield (BCBS) Association, in collaboration with Blue Health Intelligence, examines American children diagnosed with different kinds of allergies and allergic reactions. Nearly 1.7 million, or 18 percent, of children suffer from one or more allergy. This report specifically studies anaphylaxis, dermatitis and rhinitis. The study analyzes how many young BCBS members were diagnosed with any type of allergy and the number of emergency room visits those members made from 2010 to 2016. The scope of the research includes approximately 9.6 million commercially insured American children age 18 and under per year.  

NY’s Aging Mastery Program Improved Seniors’ Activity Levels/Eating Habits
The Health Foundation for Western and Central New York has partnered with the New York State Office for the Aging on a 30-month initiative to embed the National Council on Aging’s Aging Mastery Program® in all eight counties of Western New York (Erie, Cattaraugus, Chautauqua, Niagara, Wyoming, Orleans, Allegany and Genesee).

Preliminary results from pilot projects across the country show that after taking the 10 sessions, AMP participants significantly increased their physical activity levels, had healthier eating habits, increased their use of advanced planning, stayed more socially connected and participated in evidence-based self-management programs.

AMP is a nationally recognized, fun and interactive class for adults 55 and older that encourages developing sustainable behaviors that lead to health improvements, stronger economic security, enhanced well-being and increased participation in society. The 10-session program combines sharing knowledge in a classroom-like structure with goal setting, daily practice, peer support and small rewards. Expert local speakers lead a curriculum based on the challenges older adults may encounter as they age, and participants gain the skills and tools they need to master aging.

The Health Foundation will be working with the Population Health Collaborative to implement AMP across western New York over the next two years.To learn more about the Foundation, the programs and projects it is currently funding and the many other ways it is involved in the communities it serves, visit www.hfwcny.org.

No One Knows New York Better Than MLMIC!
For 40+ years, MLMIC has been providing New York medical professionals from Buffalo to the Bronx with localized risk management insights, claims protection, and 24/7 legal advice. Our policyholders enjoy benefits and expertise not found anywhere else – supported by concierge-level service every step of the way. For medical malpractice insurance in New York, nothing compares to MLMIC. Learn more at MLMIC.com/better or call (888) 996-1183. Brochure is available here.

CVS Health Will Offer Discount on Overdose Antidote for Uninsured Customers
CVS Health will provide a discount on the overdose-antidote Narcan for customers who are uninsured, the company announced Thursday. The coupon will bring the cost from a list price of $125 for two nasal sprays containing naloxone down to $94.99. The Narcan spray, manufactured by Adapt Pharma, reawakens someone who is overdosing from OxyContin, heroin or fentanyl. CVS’s announcement coincided with a public health advisory by Surgeon General Jerome Adams, who urged more people to stock the antidote so they could intervene when they see someone overdosing. 

IPRO Hosting 34th Annual Membership Meeting at Garden City Hotel

When :   Tuesday, June 5, 2018
Time  :   12:30 p.m.—3:30 p.m.
Where:  The Garden City Hotel – 45 Seventh Street, Garden City, NY

For further information, click here.

NYS’s First Memory Care Assisted Living Program for Medicaid Recipients Opens
Buffalo (NY) Business First (4/9) reports that Briarwood Manor, an assisted living company in Lockport, “has opened the state’s first memory care assisted living program for Medicaid recipients.” The company “will accept 20 Medicaid-eligible seniors with dementia or Alzheimer’s disease for the program, a new demonstration project through the New York State Department of Health.” A company official said this “offers an option for families” who cannot afford $5,000 to $6,500 per month for private care. 

DEA Warns Public of Extortion Scam by DEA Special Agent Impersonators
The Drug Enforcement Administration is warning the public about criminals posing as DEA Special Agents or other law enforcement personnel as part of an international extortion scheme.

The criminals call the victims (who in most cases previously purchased drugs over the internet or by telephone) and identify themselves as DEA agents or law enforcement officials from other agencies. The impersonators inform their victims that purchasing drugs over the internet or by telephone is illegal, and that enforcement action will be taken against them unless they pay a fine. In most cases, the impersonators instruct their victims to pay the “fine” via wire transfer to a designated location, usually overseas. If victims refuse to send money, the impersonators often threaten to arrest them or search their property. Some victims who purchased their drugs using a credit card also reported fraudulent use of their credit cards.

Impersonating a federal agent is a violation of federal law. The public should be aware that no DEA agent will ever contact members of the public by telephone to demand money or any other form of payment.

The DEA reminds the public to use caution when purchasing controlled substance pharmaceuticals by telephone or through the Internet. It is illegal to purchase controlled substance pharmaceuticals online or by telephone unless very stringent requirements are met. And, all pharmacies that dispense controlled substance pharmaceuticals by means of the internet must be registered with DEA. By ordering any pharmaceutical medications online or by telephone from unknown entities, members of the public risk receiving unsafe, counterfeit, and/or ineffective drugs from criminals who operate outside the law. In addition, personal and financial information could be compromised.

Anyone receiving a telephone call from a person purporting to be a DEA special agent or other law enforcement official seeking money should refuse the demand and report the threat using the online form below. Please include all fields, including, most importantly, a call back number so that a DEA investigator can contact you for additional information. Online reporting will greatly assist DEA in investigating and stopping this criminal activity.

Feinstein/NIH Recruiting Patients with Lupus/Active Joint Disease for Trial
Feinstein Institute, NIH launch Groundbreaking Clinical Trial Lupus Trial examines use of synthetic endocannabinoid mimetic with no psychotropic properties to treat lupus inflammation. Researchers at Northwell Health’s Feinstein Institute for Medical Research are leading a nationwide National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID) sponsored clinical trial testing the efficacy of a synthetic cannabinoid derivative with no psychotropic properties for the treatment of joint inflammation in lupus.

The 15-site, two-year study plans to recruit 100 patients in total. If you have a patient with lupus and active joint disease with at least moderate pain and are interested in finding out more about this clinical trial, contact Andrew Shaw at 516-562-2591 or Latchmin Persaud at 516-562-3814. This trial is supported by the (NIAID) under trial number NCT03093402.


CMS Releases 2018 MIPS Eligibility Tool
You can now use the updated CMS MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-based Incentive Payment System (MIPS).

Just enter your National Provider Identifier, or NPI, to find out whether you need to participate during the 2018 performance year.

Changes to Low-Volume Threshold

To reduce the burden on small practices, we’ve changed the eligibility threshold for 2018. Clinicians and groups are now excluded from MIPS if they:

  • Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule (PFS)


  • Furnished covered professional services under the PFS to 200 or fewer Medicare Part B -enrolled beneficiaries

This means that to be included in MIPS for the 2018 performance period  you need to have billed more than $90,000 in Medicare Part B allowed charges for covered professional services under the PFS AND furnished covered professional services under the PFS to more than 200 Medicare Part B enrolled beneficiaries.

Note: The 2018 Participation Lookup Tool Update for Alternative Payment Model (APM) participants will be updated at a later time. 

Find Out Today

Find out whether you’re eligible for MIPS today. Prepare now to earn a positive payment adjustment in 2020 for your 2018 performance.




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Beautiful NYC Medical Office — Long-term Share
Bright, big consultation room and one or two exam rooms in large,  tastefully furnished office in first-rate building. 58th Street between Park and Lexington. Near transportation.  Smaller, windowed consultation room and exam room also available. Rent by the day or week, beginning June 1 or sooner. $180 per day or $5500 per months. Perfect for internist, rheumatologist, physical medicine, ob-gyn and others. Superb front desk and office management available, along with many amenities including internet, ultrasound, EMG, kitchen, optional C-arm. Call Carol: 917-856-6402.

For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed build out 4 exam rooms with sinks and wall cabinets
Waiting and reception areas, windows throughout.
Street and private entrances, two bathrooms and storage/lab/staff room.
One block to bus and two blocks to Presbyterian Medical Center and subway.
$1900-$7900/ month for one to 4 exam rooms.
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For Share – Plastic Surgeon’s Office Facing Central Park Ground Floor Lobby Entrance/Private exit
One to three exam rooms, consult/private office and procedure room for full or part time use.
Elegant, modern and spacious secretarial, waiting and two exam rooms.
Accredited operating rooms and recovery rooms on site.
One block to bus and 20 feet to subways.
$1275-$3750/day monthly for one to three exam rooms.
Drdese@gmail.com or 917.861.8273

Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3
bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org




Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to jobs@hhchc.org. www.hometownhealthcenters.org