Dr. Malcolm Reid
Aug. 26, 2016
The following letter to the editor was sent to the Buffalo News to clarify several misstatements in an article about I-STOP.
The Medical Society of the State of New York (MSSNY) staunchly supports the need to reduce, prevent, and eliminate opioid addiction.
Several points of the Buffalo News article, (“I-STOP Supporters Urge Cuomo to Veto Bills They Say Would Weaken Pill Prescription Legislation”) at http://bit.ly/2bvehjU need clarification. In fact, the efforts of physicians across New York State complying with I-STOP are a major reason for the huge decrease in “doctor-shopping.”
Current law requires prescribers to consult the State’s prescription medication registry before they prescribe ANY controlled substance. This assures that patients are not “doctor shopping” for controlled substances from multiple prescribers. This I-STOP component of the law has been in effect since August 27, 2013 and remains unchanged by proposed legislation.
On March 27, 2016, an additional component of the I-STOP law took effect. This portion of the I-STOP law mandates that all prescriptions for both controlled and non-controlled drugs be electronically filed to all pharmacies located in New York. There were allowances for a few exceptions to this mandate, such as: a power failure; or, the script would be filled by a pharmacy out of NYS; or, it would be impractical for a patient to obtain an electronically prescribed drug in a timely manner, and the delay could adversely impact the patient’s medical condition.
However, the law requires that any time a paper or oral prescription is used, the prescriber is obligated to send an email to the NYS Department of Health containing a burdensome amount of information.
MSSNY supported legislation that will ease the administrative burden resulting from the patient’s need for expeditious relief, the patient’s need to fill a script out of state, and/or transmission failures. Electronic transmission of prescriptions have a 3% to 6% failure rate. Since 255 million prescriptions are filled each year in NYS, between 7.6 and 15 million are subjected to technological failure. It is unrealistic to expect prescribers to send an email each time an electronic failure causes a prescription to be handwritten or phoned into the pharmacy.
I would not want to be the patient waiting for a necessary prescription and caught in the limbo of today’s technology. In addition, if patients are traveling out of state, they may need a paper prescription to take with them to be filled when they reach their destination.
Again, the original purpose of I-STOP— the duty to consult the State’s registry before prescribing any controlled substance— has NOT been modified by the new legislation.
Twelve additional exceptions were announced by the Department of Health that do not require reporting to the DOH— which include compounded drugs, prescriptions that contain long or complicated directions, prescriptions for patients in nursing homes and residential health care facilities as defined in Article 28 of the Public Health Law.
Malcolm Reid, MD, MPP
President, Medical Society of the State of New York
Briarcliff Manor, NY
Thomas Madejski, MD
Vice-President, Medical Society of the State of New York
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DOH: New Report re Use of Marijuana under Compassionate Care Act
The recommendations in a new report, “Medical Use of Marijuana Under the Compassionate Care Act,” published by the DOH this week, stated that New York’s medical marijuana program should double in size and include a broader range of authorized health providers.
Since the program began operations in January, more than 5,000 patients have been certified with the program while more than 600 physicians were registered across the state. The DOH said that’s more than other states whose programs have been in existence for significantly longer than New York’s program.
The DOH made three recommendations tied to increasing access:
· Doubling the number of suppliers by registering five more organizations over the next two years; allowing nurse practitioners to certify patients
· Evaluating the possibility of home-delivery services to allow for expanded distribution
· Recommended exploring ways to make it easier for health-care facilities and schools to possess and administer medical marijuana for patients.
Among the 10 qualifying medical conditions, neuropathies and cancer make up the two largest categories of patients, with 1,704 or 34.1 percent and 1,238 or 24.8 percent, respectively. Pain is cited by 53.5 percent or 3,737 patients as the qualifying complication, while severe or persistent muscle spasms accounts for another 21.1 percent, or 1,477 patients.
AG: HealthNow Revising Mental Health/Nutritional Counseling Coverage
New York Attorney General Eric Schneiderman announced a settlement with HealthNow this week to address the company’s “wrongful denial of thousands of claims for outpatient psychotherapy and more than one hundreds of claims for nutritional counseling for eating disorders”. The wrongful denials totaled more than $1.6 million in patient claims. The agreement requires HealthNow to pay members for the wrongfully denied claims, revise its policies, and eliminate a company policy that subjected all psychotherapy claims to review after a member’s 20th visit.
To read the AG’s press release, click here.
According to the press release, the AG’s Health Care Bureau initiated an investigation last year after receiving patient complaints that HealthNow was improperly requiring all outpatient behavioral health visits be preauthorized after the first 20 visits per year, and by excluding coverage for nutritional counseling for eating disorders. The investigation revealed that since 2012, HealthNow conducted thousands of wrongful reviews in outpatient behavioral health cases under its 20-visit threshold. As a result, they denied coverage for outpatient behavioral health services for approximately 3,100 members, even though HealthNow generally did not impose the same type of utilization review process for outpatient medical services.
The AG settlement requires HealthNow to eliminate utilization review for outpatient behavioral health treatment based on set thresholds that trigger review, including but not limited to the 20-visit threshold it has applied since 2010. HealthNow will also cover nutritional counseling for eating disorders, including anorexia nervosa and bulimia nervosa. HealthNow will also reimburse members who paid out of pocket for treatment after their claims were denied under the 20-visit threshold or nutritional counseling exclusion, and retrain its staff regarding these reforms.
Consumers with a complaint regarding health insurance coverage for behavioral health treatment, or any other health care-related complaint, may always contact the Attorney General’s Office Health Care Helpline at 800-428-9071.
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
If You Are Thinking of Retiring, Notify All Participating Plans
For doctors who are considering retirement, please be aware that you should notify any plans that you have done business with of your retirement date.
For Medicare, only:
Please be aware of the following:
SE1617 – Timely Reporting of Provider Enrollment Information Changes
Reviewing your Medicare provider enrollment in the Provider Enrollment Chain Organization System (PECOS) system, takes about 10 minutes. https://pecos.cms.hhs.gov
Your password for this system is the one you would have obtained when you created your National Provider Identifier (NPI) number. If you don’t know your password, please call the National Plan & Provider Enumeration System. The NPI Enumerator may be contacted at the following: NPI customer service: 800.465.3203 |800.692.2326 (TTY); or, you can email them here.
…..end/terminate my enrollment with the Medicaid Program Send a letter to Computer Sciences Corporation, PO Box 4610, Rensselaer, NY 12144-4610, which includes your NPI (if appropriate) and a contact name and telephone number for questions. When your file has been closed, you will receive a notification letter. Questions? Contact CSC at 800-343-9000.
For any other insurance plans, you should notify them of your retirement date.
Plans should be able to update your provider record with the retirement date; but, still pay you for any dates of care provided before that date.
Regina McNally, VP MSSNY Div. Socio-Medical Economics
Sept. 15 Deadline to Apply for Advanced Primary Care Medical Home Model
Comprehensive Primary Care Plus (CPC+), a multi-payer program that will include 5,000 primary care practices nationwide, begins in January 2017. CPC+ is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support delivery of comprehensive primary care. CPC+ builds upon the CPCI demonstration and offers 2 primary care practice “tracks” with incrementally advanced care delivery requirements and payment options to meet the diverse needs of practices.
CPC+ is specifically identified in the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) as an advanced Alternative Payment Model (APM). Most practices that qualify for CPC+ will receive significant additional payment and, by qualifying as an advanced APM, will be excluded from the upcoming Merit-Based Incentive Payment System (MIPS).
Comprehensive Primary Care Plus (CPC+), the CMS Innovation Center’s new national advanced primary care medical home model, is now accepting applications. New York State is one of only 14 regions selected for this initiative. The deadline to apply is Sept. 15.
Who can apply: CPC+ targets primary care practices with varying capabilities to deliver comprehensive primary care. In order to participate, all CPC+ practices must demonstrate multi-payer support, use Certified EHR Technology (CEHRT), and demonstrate other capabilities. CPC+ will provide financial support and educational resources to assist practices with elements such as data collection and team based care that can have an impact far beyond CPC+. Participants from CPCI are eligible and encouraged to apply. Not all practices who apply will be selected, so this webinar is crucial to obtaining the information you to need to apply.
Why CPC+ is important: Besides the additional payments tied to CPC+, practices that participate in CPC+ and meet certain requirements will be excluded from MIPS and will receive the 5% Advanced APM bonus payment on their fee-for-service payments starting in 2019, as per the MACRA law.
CMS is conducting Open Door Forums throughout August and September, featuring Question and Answer sessions, overviews of key model elements, and step-by-step instructions for completing the CPC+ Practice Application. For more information, go here.
This webinar is being conducted specifically for the designated NYS Region to discuss CPC+ with state officials, those who participated in CPCI, and the payers who will be participating in this initiative.
New Report on Protecting New Yorkers from Zika Virus
NYC’s public advocate, Letitia James, released a report, “Protecting New Yorkers from Zika Virus” on protecting New Yorkers from the Zika virus. Recommendations included allowing Medicaid coverage of mosquito repellent when prescribed by a doctor. As of July 29, there were 387 reported cases of Zika virus, including 45 cases involving women who were pregnant.
The Wall Street Journal (8/25) reports that a survey of state and local laboratories suggests that the US has the capacity to perform between 3,500 and 5,000 Zika tests weekly, considerably less than what is required under the Center for Disease Control and Prevention’s worst-case scenario of a Zika outbreak. According to the WSJ, the survey’s findings are likely to spark a rush to expand lab capacity as Zika continues to spread in the US.
Nursing Homes: Sept. 20 Webinar re Challenges/Successes of Quality Initiatives
During a webinar on September 20, from 11 a.m. to 12:30 p.m., three ETTA leadership teams will discuss their journeys, successes, and challenges implementing very different quality improvement initiatives: communicating effectively with hospital emergency departments, reducing psychoactive medications, and respiratory rounding in the nursing home.
Each presentation will include lessons learned about the vital role effective communication plays in achieving and sustaining success in nursing home quality improvement.
All nursing homes are welcome to register online for this free webinar.
Medical Direction and Medical Care in Nursing Homes Education, Training, and Technical Assistance (ETTA) is a quality improvement initiative funded by the Department of Health to educate nursing home leadership teams about and facilitate the implementation of Medical Director and Attending Physician Guidelines.
During the ETTA Successes from the Field: Part 2—More Quality Improvement Stories webinar on September 20, ETTA leadership teams from Smithtown Center for Rehabilitation & Nursing Care, Crown Nursing & Rehabilitation Center, and Maria Regina Residence will share stories of each of their quality improvement projects.
ETTA provides tools and resources that helped these teams strengthen communication among facility staff, and between the facility and outside partners, including nursing home medical directors and hospital physicians.
All ETTA project materials are easily used by any organization. ETTA tools, resources, archived webinars, and regional workshop learning materials are all available online.
This webinar is free and open to all nursing facilities across the state. Please register online.
Questions Contact our ETTA Program Director, Debbie LeBarron at firstname.lastname@example.org with any questions or concerns.
Unique Payment Opportunity for Physicians in the Hudson/Capital Region
MSSNY, along with the NYS Department of Health and participating payers, CDPHP, MVP and Empire Blue Cross Blue Shield, invites you join us on a one-hour webinar to learn more about a unique payment opportunity being offered by CMS.
Two options available:
Webinar 1: Tuesday, August 30th
Time: Noon- 1 pm
Webinar 2: Tuesday August 30th
Time 6:00 – 7:00 pm
CMS Proposes Expansion of Bundled Payments Program Including Cardiac Care Episodes
The CMS Innovation Center) will host a webinar next Wednesday August 31, 2016 from 12:00 to 1:00 PM to discuss its proposal to create a new Medicare bundled payment model for heart attacks and bypass surgery using 90-day episodes of care. To register for the important webinar, click here. MSSNY staff will be participating in this program.
CMS has proposed that the program be applicable in nearly 100 regions across the country, including in the New York City metropolitan statistical area (MSA), as well as in the Elmira, Rochester, Syracuse and Utica MSAs. The model would be tested for 5-year performance period, beginning July 1, 2017, and ending December 31, 2021.
At the same time, CMS is proposing to expand the existing Medicare Joint Replacement Bundled Payment program adopted by CMS last year (and implemented this past April) to cover surgical hip/femur fracture treatment. The Joint Replacement bundled payment program is currently applicable to 67 MSAs including the Buffalo and New York City MSAs.
To read the proposed regulation describing this proposal, click here.
To read the CMS fact sheet describing these new programs click here.
According to the CMS fact sheet, once the models are fully in effect, participating hospitals would be paid a fixed target price for each care episode, with hospitals that deliver higher-quality care receiving a higher target price.
While payment would still be made to hospitals and physicians on a fee for service basis, at the end of a model performance year, actual spending for the episode (total expenditures for related services under Medicare Parts A and B) would be compared to the target price that reflects episode quality for the responsible hospital. Hospitals that work with physicians and other providers to deliver the needed care for less than the quality-adjusted target price, while meeting or exceeding quality standards, would be paid the savings achieved. Hospitals with costs exceeding the quality-adjusted target price would be required to repay Medicare.
As with the current Medicare hip surgery bundle program, upside and downside risk would be limited initially but increase significantly by years 4 and 5 of the program.
According to the CMS Fact sheet, Downside risk to hospitals would as follows:
- July 2017 – March 2018 (performance year 1 and quarter 1 of performance year 2): No repayment;
- April 2018 – December 2018 (quarters 2 through 4 of performance year 2): Capped at 5%;
- 2019 (performance year 3): Capped at 10%; and
- 2020 – 2021 (performance years 4 and 5): Capped at 20%
Bonuses (payments from Medicare to hospitals) would be as follows
- July 2017 – December 2018 (performance years 1 and 2): Capped at 5%;
- 2019 (performance year 3): Capped at 10%; and
- 2020 – 2021 (performance years 4 and 5): Capped at 20%.
Importantly, the CMS proposal would permit these bundled payments in certain circumstance to qualify as an Alternative Payment Model (APM) as set forth in the MACRA law passed by Congress last year. Participation in an APM “pathway” could enable a physician to not have to participate in the Medicare Merit Based Incentive Payment System (MIPS) program as enacted through MACRA and further spelled out in a regulation proposed by CMS earlier this year.
Analysis of this proposal is ongoing and further updates regarding its impact upon patient care delivery will be provided.
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty). Space is located in concierge building on 3rd Avenue (3 blocks to Grand Central Station).
2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft). The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable. Serious inquiries only, may contact us at 201-615-6963 or email us: email@example.com
Office to Share/Rent
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week. Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.
Want to Rent your Medical Office? Need to Lease Space to Expand your Practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup. We take care of the rest!
Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman