Dr. Malcolm Reid
April 22, 2016
I became an active member of MSSNY soon after I graduated from medical school in 1987. I became engaged in organized medicine at the national level by going to the AMA on my own when I was a resident. Many of the issues that plagued us then are the ones we have now. We beat them back, and like crabgrass and weeds, they come back every year no matter how many times we try to kill them.
The perennial issues of tort reform, malpractice rates and frivolous lawsuits and regressive liability are still with us. Insurance company abuses, insurance giants taking over lesser giants, unfunded mandates, and regulatory interference in the practice of medicine are on MSSNY agenda in Albany every year.
All these issues, vexing as they are, have not killed us yet. While there is much wrong with the state of medicine today, there is also much that is right with medicine. We still have the joy of healing patients and we have more and more patients than ever to treat.
If physicians can rise above their denial, anger and lethargy and join together to fight for their profession and their patients, we can overcome these challenges. We must be at the table when decisions are being made, not after we have been forced to swallow the outcome. Clearly, to avoid being victims, we must arm ourselves with numbers—data, a larger membership and more funding.
As our very effective Government Affairs Division tells us, they can only do so much. Legislators want to hear directly from the doctors. They really do want to talk to you, especially in your own districts. You are not just a voter but you are also a business owner, employer, community leader and patient advocate. Legislators will listen.
The truth is that we have had many tort reform victories. I believe that we can obtain collective negotiation and meaningful tort reform and I will work toward those goals. We will hammer away at the big issues. We need to be out in front of the issues and bring the fight to them, and not just punch wildly when we are on the ropes.
On the Agenda
With their help and yours, here are some of the other things I hope to accomplish:
- Improve the outreach to MSSNY members, non-members, patients and government
- Increase membership and income of MSSNY. I challenge each of you to bring in at least ONE new member. (I have had many mentors to whom I gave tribute at my inauguration—you can and should mentor a fellow physician, too.)
- Increase our PAC funding and focus support on our allies.
- We have to unite specialties, collaborate with other professions, hospitals and insurance companies whenever possible.
- We must build new alliances and help physicians in private practice.
Physicians have to give more to our PAC. We have to turn words into action. We have to turn conflict into collaboration and self-interest into mutual cooperation. Unity of purpose will strengthen all of us.
Whether you are a new physician, mid-career or retiring, we need you and you need us.
The message for you and your colleagues—Get active and stay active in MSSNY.
Malcolm Reid, MD, MPP
Please send your comments to email@example.com
Physicians – Let Your Legislators Know that Legislation to Increase Your Liability Risk Could Be Detrimental to Patient Access to Care!
All physicians must contact their legislators to urge them to oppose legislation (A.285-A, Weinstein/S.6956, DeFrancisco) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule. The letter can be sent from here.
If enacted, this legislation could increase your premiums by nearly 15%. In light of the huge financial pressures prompted by excessive government mandates and abusive insurer practices that already are threatening the viability of physician practices, it is essential that you express to your elected representatives that “stand-alone” legislation driving further liability increases cannot be tolerated and could seriously impact access to care for patients.
We anticipate the Trial Lawyers and their allied front groups will be making an out all out push to enact this legislation when the Legislature returns to Albany on March 3 for the final 7 weeks of the Legislative Session. It is imperative that you make these contacts to your legislators NOW!
In response to this threat, MSSNY and other groups have publicly highlighted the huge liability burden already assumed by New York physicians. Recently, the Lawsuit Reform Alliance of NY wrote to the Syracuse Post Standard in support of badly needed medical liability reform to preserve access to specialized physician care. And MSSNY has joined the Greater New York Hospital Association (GNYHA) and Healthcare Association of New York State (HANYS) in an ad in the Albany Times-Union and City & State calling for reduction in these exorbitant costs.
Physicians Must Send Letter to Their Elected Representatives to Urge Elimination of Requirement to Electronically Inform DOH Concerning the Issuance of a Paper Script
Physicians are encouraged to send a letter accessible through MSSNY’s grassroots action center to urge that they support legislation (S.6779, Hannon/A. 9335A, Gottfried) to ease the onerous reporting burden on physicians every single time that they need to issue a paper prescription.
The Bureau of Narcotics Enforcement announced that when a physician invokes one of the three statutory exceptions and write a paper script because: their technology or power has failed; the prescription will be filled outside of New York; or it would be impractical for the patient to obtain medications in a timely manner, they must electronically submit to the department an onerous amount of information about the issuance of the paper prescription. DOH asks that each time a paper prescription is written, the prescriber must electronically inform the DOH of their name, address, phone number, email address, license number, patient’s initials and reason for the issuance of the paper prescription (referencing the appropriate section of law.) This creates an onerous burden for all physicians, particularly in situations where there is a protracted technological failure, and the physician needs to report dozens upon dozens of paper prescriptions. In fact, Surescripts has stated publicly that there is a 3-6% e-prescription transmission failure rate. This means that in the state of New York anywhere between 7.6M to 15M e-prescriptions will fail every year and each prescriber involved with these failures who subsequently write a paper prescription will need to file this information with the state. In some small communities, even the patient’s initials can convey information that will enable others who access this information to identify the patient who will receive the medication.
A much more preferable alternative is to allow physicians and other prescribers to make a notation in the patient’s chart indicating that they have invoked one of the three statutory exceptions. It is important to know that the 12 exceptions released by the DOH Commissioner 10 days before e-prescribing went into effect, do not require reporting to the DOH. The same should hold true for the issuance of paper prescriptions when one of the three statutory exemptions apply. This legislation has passed the Senate twice and remains stalled in the Assembly Codes Committee. In order to re-invigorate legislative interest in this proposal physicians must send the letter located on the MSSNY grassroots action center. (DEARS, AUSTER)
Urge Passage of Legislation to Enable Override of Insurer “Fail First” Medication Policies
Concerned about health insurer policies that require your patients to “fail first” on certain prescription medications before they are able to take the medication that you believe is most medically appropriate to improve their health? MSSNY is working together with a number of patient advocacy groups in support of legislation (A.2834-A, Titone/S.3419-B, Young) to provide physicians with an expeditious manner to override an insurer “fail first” policy when it is in the best interest of their patients’ health. To send a letter in support of this legislation click here.
We strongly encourage physicians concerned about this issue to participate in an upcoming May 23 Albany Advocacy Day in support of this legislation. MSSNY representatives will be participating along with many other patient advocacy groups. Moreover, MSSNY Immediate Past-President Dr. Joseph Maldonado recently appeared on the YNN Statewide news program Capital Tonight along with National Alliance on Mental Illness’ Matthew Shapiro to discuss the importance of the legislation. To watch the broadcast, click here. (AUSTER, DEARS)
Health Care Organizations Urge Inclusion of E-Cigarettes In Clean Indoor Air Act—Advocacy Day to Be Held May 24th
A group of health care organizations, including the Medical Society of the State of New York, have come together to advocate for the placement of E-Cigarettes under the New York State Clean Indoor Air Act. The group, comprised of national and state organizations includes the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Roswell Park Cancer Institute, New York State Association of County Health Officials, Campaign for Tobacco-Free Kids, New York State Public Health Association, and the Medical Society of the State of New York, among others.
Despite containing carcinogens and toxic chemicals, including those found in anti-freeze, E-Cigarettes are currently unregulated by the FDA, and are not subject to tobacco laws as they do not contain tobacco. While New York State has prohibited the sale of E-Cigarettes to minors under the age of 18, indoor use of E-Cigarettes in public places is still permitted. MSSNY supports legislation and urges its members to support legislation (A.5955, Rosenthal/S.2202, Hannon) to place E-Cigarettes under the New York State’s Clean Indoor Air Act. (CLANCY, MCPARTLON)
Physicians Invited to Particpate In Medical Specialties Lobby Day – May 17, 2016
Physicians from all localities will join forces in the State Capital on May 17th to advocate for their patients and profession during the annual Medical Specialties Lobby Day. Collectively, MSSNY and the specialty societies participation in this event represent physicians in specialty practices across New York State and together we stand committed to battling inappropriate allied health provider expansion legislation and advancing bills of importance to all of medicine.
The day will kick off with a breakfast, legislative briefing and Q&A session in the Empire State Plaza. Immediately following, physicians will meet with their elected representatives in the Senate and Assembly.
Attendees will be paired with physicians of other specialties and provided with easy to understand talking points so they can effectively present their arguments and positions.
We hope that you will reaffirm your commitment to your colleagues, your profession and your patients by joining us in Albany on May 17. To register here.
All registrants will be emailed a confirmation and additional details closer to the event.
NYS Medical Specialties Lobby Day Organizations
Medical Society of the State of NY NYS Ophthalmological Society NYS Society of Physical Medicine and Rehabilitation NYS Society of Plastic Surgeons NYS Society of Orthopaedic Surgeons NYS Society of Otolaryngology – Head and Neck Surgery American College of Surgeons of NYS NYS Psychiatric Association NYS Society of Anesthesiologists
MSSNY AMA Urge Congress to Push CMS to Withdraw Proposed Revisions to Part B Medications Payment
MSSNY together with 20 other health advocacy organizations have written to the entire New York Congressional delegation urging that they request CMS to withdraw a proposed rule that would implement a new Medicare Part B medication payment model. The proposal would change the reimbursement methodology of Part B drugs from the current 6% add-on to the “Average Sales Price (ASP)” to 2.5% plus a flat fee.
The letter to the New York Congressional delegation highlights that these proposed payment changes could have a serious adverse impact on the care and treatment of New York Medicare patients with complex conditions, such as cancer, macular degeneration, hypertension, rheumatoid arthritis, Crohn’s disease and ulcerative colitis, and primary immunodeficiency diseases. The American Medical Association has also written a detailed letter to Congressional leadership urging that they request CMS to withdraw the proposed rule, noting in particular that “the proposal could threaten Medicare beneficiaries’ continued access to care in their local community and lower cost delivery sites depending on where they live”. The proposal has also generated strong opposition from the American Society of Clinical Oncology. (AUSTER)
PTSD and TBI in Returning Veterans: May – June Webinars
MSSNY will be holding a series of CME webinars on PTSD and TBI in returning veterans on five dates listed below from April through June. The faculty presenters will be Frank Dowling, MD and Joshua Cohen, MD.
- Explore the two most prevalent mental disorders facing American veterans today, their causes, symptoms, and comorbidities;
- Outline treatment options including evidence-based psychotherapy and pharmacotherapy;
- Discuss barriers to treatment, including those unique to military culture, and how to overcome them;
- Outline the process of recovery and post-traumatic growth.
To register for this program, click on a date below and fill out the registration form.
NYS DOH To Conduct Zika Virus Webinar: An Update on Microcephaly for Healthcare Providers on April 27th
The New York State Department of Health will conduct a Zika Virus webinar on April 27, 2016 from 12-1 p.m. to discuss the relationship between prenatal Zika virus infection and microcephaly and other serious brain abnormality. Registration is required. Physicians are strongly encouraged to participate.
Presenters will be Deborah Campbell, MD, FAAP, Professor of Clinical Pediatrics, Albert Einstein College of Medicine, Chief, Division of Neonatology, Children’s Hospital at Montefiore and Deborah Fox, MPH, Director, Congenital Malformations Registry, New York State Department of Health. The webinar will discuss other factors that can cause microcephaly in a fetus, describe how to determine if a fetus or newborn is microcephalic, and describe how your efforts and reporting to the NYSDOH’s Congenital Malformations Registry will help to accurately document the prevalence of microcephaly in New York State and Zika virus infection’s contribution to it.
MSSNY’s Opioid Webinars Are Now Available On Its CME Online Site
The Medical Society has archived its opioid webinar series on its continuing medical education website at http://cme.mssny.org/
The webinars are: Webinar 1 Pain Management at the Crossroads: A Tale of Two Public Health Problems; Webinar 2 Rational Opioid Prescribing: Is this Possible for Chronic Pain?; Webinar 3 Treatment of Opioid Use Disorders and Webinar 4 Pain Patients w/Substance Use Disorders
Physicians and other prescribers can earn up to one hour of continuing medical credits by viewing this webinar and completing the test. The MSSNY CME site requires new users to register, but once registered physicians and other health care providers will have a personalized training page to take the webinars and other course work located on the site. New registrants to the site will create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page. Click on the tool bar menu located at the top of the page and click on “My training” to view and take the various courses. MSSNY has over 50 programs at this site and physicians are able to earn continuing medical education credits for each course.
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. MSSNY’s online continuing medical education sites has numerous programs of varying length, but the majority of the programs are for 1.0 AMA/PRA Category 1 credit™. Further information on all these programs may be obtained by contacting Pat Clancy at firstname.lastname@example.org.
View Zika Webinar; Program Archived on MSSNY’s CME Site
The Medical Matters program, entitled “Zika Virus—An Evolving Story” is now archived to the MSSNY CME website and physicians and other health care providers can view this program free of charge by logging into http://cme.mssny.org.
The webinar was conducted by MSSNY and the New York State Department of Health and featured Dr. William Valenti, chair of MSSNY’s Infectious Disease Committee and member of the MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee, and Dr. Elizabeth Dufort, Medical Director, Division of Epidemiology from the New York State Department of Health.
The MSSNY CME site requires new users to register, but once registered physicians and other health care providers will have a personalized training page to take them to this webinar and other course work located on the site. New registrants to the site will create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page. Click on the tool bar menu located at the top of the page and click on “My training” to view and take the various courses. MSSNY has over 50 programs at this site and physicians are able to earn continuing medical education credits for each course. 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 online program has various programs with the number of continuing medical education credits, but the majority of the programs are for 1.0 AMA/PRA Category 1 credit™. Further information on all these programs may be obtained by contacting Melissa Hoffman at email@example.com.
Please Join Us – MSSNY to Have Team at the 2016 CDPHP Workforce Race
For the first time, MSSNY will have a team at the CDPHP Workforce Team Challenge! May 6 is the deadline to register for the 2016 CDPHP Workforce Team Challenge. This year’s 3.5-mile race is on Thursday, May 19, 2016, and both runners and walkers are highly encouraged to participate. The race begins at 6:25 PM at Empire State Plaza in Albany. MSSNY members who would like to join the team are invited to sign up at http://www.cdphpwtc.com/; please choose “Medical Society of the State of New York” from the team drop-down list. Registration is $22.00, and a portion of the registration fees go to this year’s “Charities of Choice,” Girls on the Run and Schenectady ARC. For more information, please contact Miriam Hardin (firstname.lastname@example.org).
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CMS Publishes Data for 2015 Open Payments
Since 2013, CMS Open Payments program (also known as the Sunshine Act) has collected data from drug and device manufacturers and group purchasing organizations (GPOs) about payments they make to physicians and teaching hospitals. The program also collects information about ownership and investment interests of physicians and their immediate family members in drug and device manufacturers and GPOs. CMS publishes this data on its website, so it is important for physicians and teaching hospitals to check and confirm the accuracy of the financial transactions reported about them.
Last June, CMS published payments and ownership records for more than 607,000 physicians and 1,122 teaching hospitals valued at $6.45 billion for 2014. Payments were attributed to medical research, conference travel and lodging, gifts and consulting. CMS has collected data for all of Calendar Year 2015 and will publish it on its website on June 30, 2016.
To review any payments attributed to them, physicians—including doctors of medicine or osteopathy, dentists, chiropractors, optometrists and podiatrists—and teaching hospitals need to register on the Open Payments website.
CMS encourages physicians to review data reported about them so applicable manufacturers and GPOs can resolve any disputes before the data is published. There are instructions and quick reference guides located on the Resources Page to help. The review period for the June 30, 2016 publication opened on April 1, 2016, and will end May 15, 2016.
CMS Launches Largest-Ever Multi-Payer Initiative for Primary Care
New Affordable Care Act initiative, designed to improve quality
This week, CMS announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.
“Strengthening primary care is critical to an effective health care system,” said Dr. Patrick Conway, CMS deputy administrator and chief medical officer. “By supporting primary care doctors and clinicians to spend time with patients, serve patients’ needs outside of the office visit, and better coordinate care with specialists we can continue to build a health care system that results in healthier people and smarter spending of our health care dollars. The Comprehensive Primary Care Plus model represents the future of health care that we’re striving towards.”
Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model will benefit patients by helping primary care practices:
- Support patients with serious or chronic diseases to achieve their health goals
- Give patients 24-hour access to care and health information
- Deliver preventive care
- Engage patients and their families in their own care
- Work together with hospitals and other clinicians, including specialists, to provide better coordinated care
Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs, including, as appropriate, a systematic assessment of their psychosocial needs and an inventory of resources and supports to meet those needs.
CPC+ will help practices move away from one-size-fits-all, fee-for-service health care to a new system that will give doctors the freedom to deliver the care that best meets the needs of their patients. In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for Evaluation and Management services, will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design will allow greater flexibility in how practices deliver care outside of the traditional face-to-face encounter.
To promote high-quality and high-value care, practices in both tracks will receive up-front incentive payments that they will either keep or repay based on their performance on quality and utilization metrics. The payments under this model encourage doctors to focus on health outcomes rather than the volume of visits or tests.
Practices in both tracks also will receive data on cost and utilization. Optimal use of Health IT and a robust learning system will support them in making the necessary care delivery changes and using the data to improve their care of patients. Track 2 practices’ vendors will sign a Memorandum of Understanding (MOU) with CMS that outlines their commitment to supporting practices’ enhancement of health IT capabilities. These partnerships will be vital to practices’ success in the care delivery work and align with the Office of the National Coordinator for Health IT priority to ensure electronic health information is available when and where it matters to consumers and clinicians.
Under the CPC+ model, Medicare will partner with commercial and state health insurance plans to support primary care practices in delivering advanced primary care. Advanced primary care is a model of care with five key components:
- Services are accessible, responsive to an individual’s preference, and patients can take advantage of enhanced in-person hours and 24/7 telephone or electronic access.
- Patients at highest risk receive proactive, relationship-based care management services to improve outcomes.
- Care is comprehensive and practices can meet the majority of each individual’s physical and mental health care needs, including prevention. Care is also coordinated across the health care system, including specialty care and community services, and patients receive timely follow-up after emergency room or hospital visits.
- It is patient-centered, recognizing that patients and family members are core members of the care team, and actively engages patients to design care that best meets their needs.
- Quality and utilization of services are measured, and data is analyzed to identify opportunities for improvements in care and to develop new capabilities.
CMS will select regions for CPC+ where there is sufficient interest from multiple payers to support practices’ participation in the initiative. CMS will enter into a Memorandum of Understanding (MOU) with selected payer partners to document a shared commitment to align on payment, data sharing, and quality metrics in CPC+.
CMS will accept payer proposals to partner in CPC+ from April 15 through June 1, 2016. CMS will accept practice applications in the determined regions from July 15 through September 1, 2016.
In March 2016, the Administration estimated that it met the ambitious goal – eleven months ahead of schedule – of tying 30 percent of Medicare payments to quality and value through alternative payment models by 2016. The Administration’s next goal is tying 50 percent of Medicare payments to alternative payment models by 2018. The Health Care Payment Learning and Action Network established in 2015 continues to align efforts between government, private sector payers, employers, providers, and consumers to broadly scale these gains in better care, smarter spending, and healthier people.
For more information about the CPC+ model, including a fact sheet, please click here.
How to Apply
Payer solicitation and practice applications will be a staggered process. First, CMS will solicit payer proposals to partner with Medicare in CPC+ (April 15-June 1, 2016). The choice of up to 20 CPC+ regions will be informed by the geographic reach of selected payers.
Next, CMS will publicize the CPC+ regions, and solicit applications from practices within these regions (July 15-September 1, 2016). Practices will apply directly to the track for which they believe they are ready; however, CMS reserves the right to offer practice entrance into Track 1 if they apply to, but do not meet the eligibility requirements for Track 2.
Practices applying to Track 2 will need to submit a letter of support from their Health IT vendor(s) that outlines vendors’ commitment to supporting the practice with advanced health IT capabilities. CMS will sign a Memorandum of Understanding with those health IT vendors supporting Track 2 practices selected to participate in CPC+.
CMS releases Medicare Advantage Quality Data for Racial and Ethnic Minorities
CMS Office of Minority Health released data detailing the quality of care received by people with Medicare Advantage by racial or ethnic group.
The database presents HEDIS and CAHPS scores for different racial and ethnic groups at the level of individual Medicare contracts and is intended to be used to improve quality and accountability. The information provided by this database is not used to evaluate care through the star ratings program Medicare Advantage and Part D Star Ratings program nor is not it used for payment purposes.
A report summarizing the data accompanied the release. Analysis of the quality of care delivered to beneficiaries showed that Asians and Pacific Islanders typically received care that is similar to or better than the care received by Whites, whereas African Americans and Hispanics typically received care that is similar to or worse than the care received by Whites. African Americans and Hispanics also reported their health care experiences as being similar to or worse than the experiences reported by Whites. This data help to highlight the racial and ethnic disparities that occur within healthcare.
The data and summary report can be viewed here.
MSK Reports $28M Health Republic Debt
Memorial Sloan Kettering reported $169.2 million in operating income last year, but still 30.3% less than it earned in 2014. MSK attributed the lower profit in part to bad debt related to the failure of Health Republic Insurance of New York, as well as to rising drug costs. The hospital wrote off $28.3 million in bad debt from patients who were insured by Health Republic, and said it would “continue to pursue collection for these charges.” That bad debt contributed to an 11.4% increase in operating expenses, to $3.5 billion. (Crains, 4/15)
Thursday, April 28, 2016 | 2:00 – 3:00 pm ET
Register for this event HERE for free
Are you interested in faster payment and remittance advice processing? Reductions in phone calls to health plans? Want to eliminate lost or stolen checks? The answer to all these questions is undoubtedly yes and the easiest way to do it is to switch from paper checks and EOBs to healthcare electronic funds transfers (EFT) and electronic remittance advice (ERA). CAQH CORE and the American Medical Association (AMA) will discuss the benefits of going paperless in healthcare financial transactions, highlighting available resources to help your organization with implementation efforts. The webinar will also showcase a real-world case study from the largest integrated healthcare system in the U.S., the Veteran’s Health Administration, and how they have benefitted from moving to electronic payments and remits.
Please Take Physicians Foundation Survey—MSSNY is a Charter Member
Merritt Hawkins, on behalf of The Physicians Foundation, biennially conducts one of the largest and most widely referenced physician surveys undertaken in the United States. The survey is intended to provide a “state of the union” of the medical profession and to give physicians a voice with policy makers and the public. Much of the information gathered in the past will be shared with your members during our presentation in May.
Take the survey here.
At this time, we only have 284 responses from New York. By encouraging more physicians from the state to complete the survey, we will acquire better insights into the practice patterns and perspectives of New York physicians, which we will be able to pass along to you. Also, a $5,000 grant will go to the state medical society with the most responses.
Bank of America Announces Enhancement to Affinity Card Program
Bank of America will be adding a new bonus earn category that will provide customers 2% bonus earn on Wholesale Club purchases (along with the current 2% on groceries and 3% on gas). In addition, the quarterly bonus earn cap will be increased from $1,500 to $2,500 in combined gas/grocery/wholesale club purchases. The target implementation date is June 1st, which will be around the time that Visa cards will begin to be accepted at Costco. With these enhancements, customers will enjoy bonus earn at all Wholesale Club merchants, including BJ’s Wholesale and Sam’s Club, as well.
AG Lawsuit Accuses CDPHP of Unlawfully Denying Coverage of HepC Treatment
This week, Attorney General Eric T. Schneiderman announced a lawsuit against CDPHP. The insurer has approximately 450,000 members in New York State and provides service to 24 counties throughout the Capital Region, North Country, Hudson Valley, Central New York, and the Southern Tier. The lawsuit, filed in New York Supreme Court, alleges that CDPHP unlawfully restricted coverage of treatment for chronic Hepatitis C infection, a potentially life threatening condition. Several medications are currently available that can completely cure Hepatitis C. The lawsuit alleges that CDPHP denied coverage for such treatment unless the member demonstrated advanced disease – such as moderate to severe liver scarring. Members diagnosed with early-stage chronic Hepatitis C infection must monitor their disease and wait until they develop liver scarring or other advanced disease before their treatment will be covered by CDPHP.
“When consumers purchase health insurance, they rightfully expect that if they are diagnosed with a serious, potentially life threatening disease like Hepatitis C, treatment will be considered ‘medically necessary’ and covered by their insurance,” said Attorney General Schneiderman. “Forcing patients to wait for care, risking internal organ damage, is unconscionable and, as we allege in our lawsuit, violates the law and the company’s own policies.”
Effective January 1, 2014, New York State has required medical providers to offer Hepatitis C screening to patients born between 1945 and 1965 and to provide or make a referral for follow-up health care to patients with a positive test result.
While the Food and Drug Administration has approved several medications to cure Hepatitis C, CDPHP has limited coverage of those medications to only those members with an advanced stage of the disease. This approach is, and has been, inconsistent with the prevailing treatment guidelines, which recommend treatment of nearly all individuals diagnosed with chronic Hepatitis C.
According to the lawsuit, CDPHP restricted coverage of Hepatitis C treatment, including but not limited to requiring advanced liver scarring, in a manner that is inconsistent with its own policies. The Complaint further alleges that CDPHP may have restricted coverage of Hepatitis C treatment because of the potential expense to CDPHP, yet its plan documents never disclosed to current or potential members that it considered cost when deciding whether treatment for a disease would be covered by the plan By failing to disclose that cost is a consideration in making determinations as to whether and when treatment is deemed “medically necessary,” and by failing to cover treatment for Hepatitis C even when it meets the plans’ definitions of “medically necessary,” the lawsuit alleges that CDPHP is misleading its members about the scope of their coverage. The lawsuit further alleges that by failing to fully disclose the definition of “medically necessary” used in determining when benefits will be covered, CDPHP is violating the New York State Insurance Law and Public Health Law.
The lawsuit is part of a continuing investigation into numerous health insurers for improperly restricting coverage of Hepatitis C treatments and misleading their members about the scope of their coverage.
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Summerwood Pediatrics is a very progressive, large community-based private practice in the Syracuse area. We provide care for over 25,000 children from birth to 21. The practice also has a satellite office in Camillus, NY. Additionally, the practice operates adjacent to an independent outpatient infusion practice, which is alsoowned and operated by our medical director. We are looking to employ a bright, energetic and enthusiastic general pediatric or subspecialty-trained physician. Presently the practice employs seven physicians, two pediatric NPs and one PA . All providers share on-call responsibilities on a one-day per week basis. Weekend coverage and office hours are performed on a rotational basis by the physicians. Our offices encompass over 28,0000sq. ft. of state-of-the- art clinical space;on-site lab services. The position, either full or part-time, includes applicable benefits inclusive of health care, malpractice insurance, CME expenditures and retirement plan. To discuss this opportunity further, contact either Dr. Robert A. Dracker or Mr. Warren Ford at 315-457-9914…9-5 EST.
NORTHERN WESTCHESTER – Psychiatric Opportunities Part-time Psychiatrist (BC/BE/Child very desirable) wanted, to work in North Salem, N.Y., Suboxone DEA license helpful. Fax qualifications and availability to 914 669-6051 or call 914 669-5526 with questions..
Medical Director at CDPHP: Voted NYS “Best Company” by Our Employees!
CDPHP is more than a health insurer. We are a not-for-profit health value organization leading the way toward better, more affordable health care. CDPHP represents progress and innovation for more than 425,000 members throughout New York. A physician-founded and guided plan, our primary focus is the health and well-being of those we serve. While other insurers strive to create value for their shareholders, our efforts are centered on creating value for members, in part by providing employers with innovative solutions for managing health care. The Medical Director will assist the Vice President, Senior Medical Director and the SVP of Medical Affairs with the implementation of the Plan’s Medical Management, Quality Improvement and Resource Management initiatives in accordance with regulatory, accreditation, and corporate policies and strategic plan. The Medical Director will participate in the medical advisory committees, provide leadership to, and serve as a liaison between the physician community and the Plan’s management.
The ideal candidate will possess the following:
- Licensed physician with current, unrestricted license (preferably New York State); Board Certified to practice a medical specialty; ABMS specialty is required.
- If not licensed in New York State, eligibility for New York State licensure is required.
- Additional advanced degree(s) preferred.
- Minimum three to five (3-5) years clinical practice experience is required.
- Minimum of three (3) years managed care or practice management is preferred.
Please email firstname.lastname@example.org. Equal Opportunity Employer, females, minorities, disabled, veterans
Relieve Physician Burnout through Yoga Science (30 CMEs)
Change your perspective––change your experience. The 8th annual
American Meditation Institute Heart and Science of Yoga conference
is uniquely designed to offer you a refreshingly new, clearer and kinder
perspective on yourself and every personal and professional responsibility you face. This comprehensive training in Yoga Science as Holistic Mind/Body Medicine will provide easy-to-use, practical tools to prevent and reverse the debilitating causes and effects of physician burnout. Topics include: mantra meditation, diaphragmatic breathing, easy-gentle yoga, Yoga psychology, neuroplasticity, PTSD, trauma, resilience, the chakra system as a diagnostic tool, epigenomics, mind function optimization, Ayurveda, nutrition, functional medicine, and lymph system detoxification. Through engaging lectures by an accomplished faculty, instructive practicums and ongoing Q&A, you’ll gain experiential knowledge that will integrate Yoga Science into a dynamic self-care program. As a result of attending this conference, you’ll return home with a set of practical tools that can empower you to make conscious, discriminating and reliable choices to enhance your creativity, well-being, happiness and success. Regardless of how
challenging your circumstances might feel today, Yoga Science can help. Delicious gourmet vegetarian food(always including special dietary needs).