April 20, 2018 – Medical & Non-Medical Marijuana?

 

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE
Thomas J. Madejski, MD
MSSNY President
April 20, 2018
Volume 18
Number 15

Dear Colleagues:

The use of marijuana to treat medical conditions is a very complicated topic that merits further in-depth study.

While MSSNY has policy (MSSNY Policy 65.985 MSSNY Opposes Recreational Marijuana Legalization) that opposes legalization of marijuana, I salute Governor Cuomo’s efforts to ensure that the health, criminal justice, and economic  impacts of marijuana be fully examined should New York State move to a regulated marijuana program in the state. Our Governor understands fully that there could be public health and economic impacts as more and more of New York’s surrounding states move to legalize marijuana. The governor also acknowledges and recognizes recent action by the United States Attorney General Jeff Sessions to rescind the Obama Administration guidelines that allowed states that had authorized the use of marijuana under state law to operate without fear of federal prosecution.

Governor Cuomo has charged the New York State Department of Health with the formation of an interagency task force to consider the health, criminal justice, public safety, economic and education effects of non-medicinal use of marijuana.  His newly developed website indicates the  task force will look at:

  • the benefits and consequences of a regulated marijuana program
  • Public Health Impact on individual populations from a social justice perspective

The task force will also look at the impact on public safety; the overall financial impact, economic development and revenue, and education of the public with public health and public safety messaging.

Increased availability of marijuana has contributed to marijuana becoming the number one illicit substance detected in motor vehicle accidents.

One of MSSNY’s top concerns with New York’s medical marijuana law has been with the possibility of federal prosecution for physicians who are participating in New York’s marijuana program for medicinal use.  With the US Attorney General’s action increasing the possibility of such prosecution, New York must gain a greater understanding of how this could affect prescribers.

There is still a relative dearth of knowledge about the usefulness and potential harm associated with medicinal and recreational use of marijuana. At MSSNY’s recent House of Delegates, we reaffirmed our call for moving marijuana from Schedule I to Schedule II.  Reclassification to Schedule II will remove major barriers to research on marijuana and whether marijuana is a safe and effective treatment for pain and other medical conditions. Due to a lack of evidence based medicine and studies, particularly longitudinal studies that can evaluate the long term consequences of marijuana use, we don’t know the long term impact upon adults and children from continued use of marijuana.

Most importantly, New York State does not want to create a new type of industry, similar to the tobacco industry that addicted millions of adults and children. We have spent a lifetime trying to combat the scourge of tobacco. Our current opioid crisis was fueled in part by poor data, misguided regulatory advice to treat pain more aggressively, and perhaps overly aggressive marketing efforts by some opioid drug manufacturers.

Certainly, a “go slow approach” is the correct way to approach any type of legalization of marijuana and I applaud Governor Cuomo efforts on this.

Those who cannot recall history often re-experience it.

I’d appreciate hearing your thoughts at comments@mssny.org

Thomas J. Madejski, MD 
MSSNY President


HIT MLMIC Symposium


Capital Update
Please Urge Your Legislators to Enact Legislation to Address Prior Authorization Hassles and Expand Patient Choice of Physicians
Physicians are urged to express their support for several health insurance reform bills strongly supported by MSSNY that would reduce administrative barriers imposed by health insurance companies that interfere with patient care, and expand patient choice by limiting the ability of health insurers to narrow their networks. These bills include:
  • 3663 (Hannon)/A.4472 (Gottfried) – would permit independently practicing physicians to collectively negotiate patient care terms with market dominant health insurers under close state supervision. In addition to the ability to push back against exorbitant administrative hassles imposed by insurers, it would also help to protect physicians to have a stronger option to remain in independent practice. The bills are is in the Senate Health Committee, and the Assembly Ways and Means Committee. Please send a letter to your legislators in support please click here.
  • 3943 (Hannon)/A.2704 (Lavine) – would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract. The bill is on the Assembly floor and in the Senate Health Committee. Please send a letter in support please click here.
  • 5675 (Hannon)/A.7671 (Rosenthal) – would require health insurers to make out of network coverage options available through the New York Health Insurance Exchange. Currently, there are no out of network coverage options in the Exchange in downstate New York, despite Exchange officials strongly encouraging the offering of these options by insurers. The bills are in the Senate Health and Assembly Insurance Committee. Please send a letter to your legislators in support please click here.
  • 7872 (Hannon)/A.9588 (Gottfried) – would reduce prior authorization hassles by 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.

Last week, MSSNY shared with the entire State Legislature the results of a recent AMA survey (please click here.)

that showed that a staggering 92% of physicians believe that prior authorization programs have a negative impact on patient clinical outcomes. Moreover, 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.
(AUSTER)

WCB Announces Efforts to Expand Care Availability for Injured Workers by Addressing Physician Concerns with WC System
New York Workers Compensation Board Chair Clarissa Rodriguez announced this week that the WCB intends to pursue measures to “increase provider participation in the workers’ compensation system and improve injured workers’ access to timely, quality medical care”. To read the announcement please click here. The proposals would address a number of concerns raised by MSSNY regarding the functions of the WC program.

Specifically, she noted that the WCB will be advancing a regulation to increase medical care delivery fees and enable use of the universal CMS-1500 form in lieu of existing board forms to reduce administrative burden. According to the  written announcement, these proposals are being advanced to respond to “claimants’ challenges in finding treating providers, and concerns from health care providers around low fees and complexity that keep some from participating.”

With regard to the proposed fee increase, the WCB will advance a regulation in June to increase medical fees for  services provided after October 1, 2018. The proposal will include an overall statewide fee increase for all provider types, with additional increases for certain specialty provider groups that have an extreme shortage of authorized providers. The announcement noted that “these new fees will ensure providers in New York are receiving fair and reasonable reimbursement for prompt, quality treatment to our injured workers.” However it is not clear yet the manner by which these fees will be raised.

The announcement also noted that Board will propose replacing the current Board treatment forms (C-4 and C-4.2, and equivalent OT/PT and PS forms) with the CMS-1500. The Board will be working towards a January 1, 2019, implementation date.

The announcement also noted other efforts the Board is pursuing including:

  • Implementing an “electronic medical portal” which will allow physicians “to quickly and easily identify whether their course of treatment is consistent with the Board’s medical treatment guidelines and, if not, advise them that a variance is needed”; and
  • A comprehensive legislative proposal that would expand the types of providers that may treat injured workers. Including nurse practitioners, physician’s assistants, licensed clinical social workers, and other providers. It should be noted that MSSNY has expressed concerns with similar legislative proposals in previous years because it did not include provisions to require patient care coordination with a physician. MSSNY has also expressed concerns that such legislature proposals have removed the ability of county medical societies to credential physicians to participate in workers

Please remain alert for further updates on this issue.      (AUSTER, BELMONT)



Opioid Prescribing By Physicians Decreases 20% in New York State Between 2013-2017
Opioid prescribing by physicians and other health care professionals in New York decreased by 20.3% between 2013 and 2017 according to State and National Totals of Retail Filled Prescriptions: All Opioid Analgesics, 2013-2017 report issued by IQVIA. New York State opioid prescribing levels decrease by 8.4% in the 2016-17.

This reflects a nationwide trend — 22.2% fewer opioid prescriptions were filled in 2017 than had been filled in 2013. Every state in the nation has shown a significant reduction in opioid analgesic prescriptions since 2013, and every state showed a decline in the last year. Patrice A. Harris, MD, MA, chair of the AMA Opioid Task Force said that the fact that physicians and other health care professionals are increasingly judicious when prescribing opioids is “tempered by the fact that deaths related to heroin and illicit fentanyl are increasing at a staggering rate, and deaths related to prescription opioids also continue to rise.

These statistics again prove that simply decreasing prescription opioid supplies will not end the epidemic. We need well-designed initiatives that bring together public and private insurers, policymakers, public health infrastructure, and communities with the shared goal to improve access and coverage for comprehensive pain management and treatment for substance use disorders.” MSSNY’s is one of seven state medical societies that are on the AMA’s Opioid Task Force. A copy of the IQVIA report and its analysis can be found here: (CLANCY)

MSSNY Urges for Extension of Committee for Physicians Health Program
MSSNY continues to advocate 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 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 in 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. (DIVISION OF GOVERNMENTAL AFFAIRS)

MSSNY Participates in Interagency Workgroup on Organ and Tissue Donation
The Interagency Workgroup on Organ and Tissue Donation convened in Albany this week to discuss ways to increase the number of organ donors on the New York State Donate Life Registry. Representatives from multiple State agencies including the Department of Motor Vehicles and Department of Environmental Conservation worked alongside executives from HANYS, Greater NY, and MSSNY to discuss best practices and next steps.

Currently, there are over 10,000 New Yorkers waiting for a transplant, however only 32% of the eligible population is registered to be a donor. This means 1 person dies while waiting for a transplant every 19 hours. To learn more about organ donation, please click here: (CLANCY, HARRING)

Register now for the Medical Society of the State of New York’s May 2018 Medical Matters CME Webinar Program
The Medical Society of the State of New York is pleased to announce its free Continuing Medical Education (CME) webinar for May, 2018.  Participation in this webinar will earn physicians one CME credit free of charge.  

May 16 at 7:30am – Medical Matters: Physically and Biologically Derived Chemical Agents: An 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 “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)

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  


eNews

Five Million Organ Donors Enrolled in NYS Donate Life Registry
Efforts by the state and nonprofit organizations to boost the number of New Yorkers registered to donate their organs are paying off. Gov. Andrew Cuomo has announced that more than 5 million New Yorkers are now enrolled in the New York State Donate Life Registry as organ donors. The Governor said that organ donation rates have reached historic levels due to several coordinated efforts. Those efforts include the state Department of Health working with the group Donate Life New York State to create a more modernized and expanded registry that streamlined the process.

An executive order issued last year by Cuomo has also helped increase donors by allowing state agencies to provide opportunities for people to enroll in the registry when applying for government benefits, services and licenses. 

Insurer–PBM Mergers to Lower Medical Costs, Says Moody’s
Moody’s Investors Service issued a report Tuesday with an optimistic outlook on the impact of recent mergers on medical costs as well as on the credit ratings of the companies involved.

The recently announced Aetna–CVS Health and Cigna–Express Scripts mergers are likely to be credit-positive in the long term because of their ability to lower health care costs, Moody’s said. Cigna is likely to benefit incrementally from its purchase of Express Scripts by integrating Express Scripts’ ability to manage pharmacy costs, although Express Scripts does not have the benefit of CVS’ retail presence, Moody’s noted.

MSSNY has expressed concern that the CVS–Aetna deal will drive patients away from doctors’ offices and into the company’s local retail clinics.

Researchers Find Antibiotic-Resistant Bacteria and New Viruses in NYC Mice
The New York Times (4/17) reports that in two studies, a team of researchers found antibiotic-resistant bacteria and viruses in mice living in the basements of apartment buildings in New York City. The researchers “collected feces from more than 400 mice captured over a year in eight buildings in Manhattan, Brooklyn, Queens and the Bronx,” and “then analyzed the droppings for bacteria and viruses.

In one study, published in mBio, the researchers found that the mice carried dangerous bacteria, including antibiotic-resistant bacteria. In the other study, also published in mBio, the researchers identified 36 types of viruses. The study’s authors collaborated with researchers at the Centers for Disease Control and Prevention who “matched the strains of C. difficile from these mice to types known to cause infections in humans.” The researchers also identified six new viruses. The researchers found that 14 percent of the mice carried Shigella, 12 percent carried Clostridium perfringens, 4 percent carried C. difficile, 4 percent carried E. coli, and 3 percent carried salmonella.

Advocates Want NY to Take Action to Reduce Black Women’s Maternal Mortality
The AP (4/17) reports women’s health advocates are calling for New York to take action to reduce maternal mortality among black women. On Monday, “Planned Parenthood of New York leaders, state Assembly members and maternity health services providers held a news conference in Albany…to call for action to reduce the state’s national ranking of 30 out of 50 states when it comes to maternal deaths.”

MSSNY Is Accepting Nominations for the 2017 Albion O. Bernstein, MD Award
This prestigious award is given to: “…the physician, surgeon or scientist who shall have made the most widely beneficial discovery or developed the most useful method in medicine, surgery or in the prevention of disease in the twelve months prior to December, 2017.” The $2,000 award will be presented to the recipient during a MSSNY Council Meeting. Nominations must be submitted on an official application form and must include the nominator’s narrative description of the significance of the candidate’s achievements as well as the candidate’s curriculum vitae, including a list of publications or other contributions. To request an application, please contact: Miriam Hardin, PhD, Manager, Continuing Medical Education, Medical Society of the State of New York, 99 Washington Avenue, Suite 408, Albany, NY 12210 518-465-8085 mhardin@mssny.org. DEADLINE FOR NOMINATIONS: May 31, 2018

Researchers Find High Rates of T1D Near “Food Swamps”
Endocrine News (4/17) reports that research suggests “hot spots of type 1 diabetes in New York City are found in “food swamps,” areas with a higher proportion of fast food restaurants, for children and adults with type 1 diabetes.” The findings were published in the Journal of the Endocrine Society. One of the study’s authors, David C. Lee, MD, MS, said, “Our research suggests that an adverse food environment has an important influence in type 1 diabetes, and a more thorough investigation of genetics, health behaviors and cultural influences should be considered for type 2 diabetes.” Clinical Endocrinology News (4/17) also covers the story.

Ambulatory BP Monitoring May Be a Superior Predictor of Mortality
Ambulatory blood pressure monitoring may be a better mortality predictor than office-based monitoring, a study in the New England Journal of Medicine finds. Using registry data, Spanish researchers examined blood pressure readings from over 60,000 patients. During a median follow-up of 4.7 years, 6% of patients died. After adjusting for clinic blood pressure readings and other variables, increases in ambulatory blood pressure were associated with increased mortality risk (hazard ratio, 1.58 for each standard deviation increase), compared with normal blood pressure. Elevated clinic BP readings were associated with less increased risk after adjusting for ambulatory readings (HR, 1.02).  NEJM article

CMS

Visit the JIRA Website to Submit Official Comments by May 9, 2018
CMS technical clinical quality language (CQL)-based measure specifications for the Quality Payment Program is now available for public comment. CMS encourages all comments regarding the draft measure specifications for two measures currently under development, but is particularly interested in feedback on the technical CQL-based specifications. Specific questions to stakeholders about the PC-02 measure are included in the measure-specific framing document. To read the measure specifications and framing documents, please visit this link.

How to Submit Comments

Log in to your JIRA account here.

A JIRA account is required to submit a comment. If you are new to JIRA and do not have an account, sign up here. 

Comments will be accepted until 11:59 p.m. ET on May 9, 2018 

Apply to Participate in the 2018 CMS Study on Burdens Associated with Reporting Quality Measures to Receive Improvement Activity Credit for 2018
The CMS is conducting the 2018 Burdens Associated with Reporting Quality Measures Study, as outlined in the Quality Payment Program Year 2 final rule (CMS 5522- FC).

CMS is conducting this study to:

  • Examine clinical workflows and data collection methods using different submission systems;
  • Understand the challenges clinicians face when collecting and reporting quality data; and
  • Make future recommendations for changes that will attempt to eliminate clinician burden, improve quality data collection and reporting, and enhance clinical care.

Clinicians and groups who are eligible for the Merit-based Incentive Payment System (MIPS) that participate successfully in the study will receive full credit for the 2018 MIPS Improvement Activities performance category. Applications for this study will be accepted through April 30, 2018 and will be notified in spring of 2018 if selected.

Who Should Apply

MIPS-eligible clinicians participating in MIPS as an individuals or as part of a group.  Clinicians do not need any outside knowledge of MIPS to participate in the study; rather the study team is interested in learning more about clinicians’ experience participating in MIPS.

A limited number of clinicians who are not eligible for MIPS in 2018 will also be included in the study. To check you participation status please see the QPP Website.

Study Requirements

The study runs from April 2018 to March 2019.  Study participants will have to meet the following requirements in order to complete the study and receive full Improvement Activity credit. For participants reporting as a group, their entire group will receive credit.  For participants reporting as individuals, only the participating clinician will receive credit.

To Apply

Click here to begin your application.

Applicants will be notified by email of their status in spring of 2018.

For more information about the study, please visit the CMS website or email MIPS_Study@abtassoc.com.

Upcoming Webinar: APG Educational Series 2018, MIPS APMs to Advanced APMs: How to Make the Valuable Transition
This year, America’s Physician Groups (APG) is pleased to continue our webinar series with the Centers for Medicare and Medicaid Services (CMS) for physicians and physician groups implementing the Medicare Access and CHIP Reauthorization Act (MACRA) through the Quality Payment Program, focusing on Alternative Payment Models (APMs). Through a co-branding agreement with CMS, the sessions will combine CMS expertise on the regulation’s content with APG’s members’ knowledge of how clinicians are responding on the ground to these important changes and care models.

APG designed the series to provide physicians and physician organizations the “how-to” for APM implementation. Given America’s Physician Groups’ leadership with advanced payment models, we are well positioned to share best practices and lessons learned in this area. Each session will include Q&A time with the presenters. We hope the webinars will be a valuable resource to help you successfully participate in APMs in 2018 and beyond. Our next session in the series will focus on:

Title: MIPS APMs to Advanced APMs: How to Make the Valuable Transition

Date: April 30, 2018

Time: 9:00am -10:30am PT / 12:00pm – 1:30pm ET

Register:  http://eventcenter.commpartners.com/se/Rd/Rg.aspx?516875

Subject matter experts from CMS will review the MIPS APM model and requirements for qualifying to become an advanced APM. Additionally, CMS will answer specific audience questions on the final rule for 2018 and provide information and resources relevant to the transition from MIPS APM to advanced APMs.

For more information, please contact Dr. Amy Nguyen, anguyen@capg.org or 213.239.5051.


 

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RENTAL/LEASING SPACE

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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.
Drdese@gmail.com or 917.8618273


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


 PHYSICIAN OPPORTUNITIES


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355