August 4, 2017 – Hospital Consolidations and Med Staff Independence

Charles Rothberg, MD
August 4, 2017
Volume 17
Number 30

Dear Colleagues:

With the announcement last week that John T. Mather Memorial Hospital in Port Jefferson has signed a letter of intent to join Northwell Health, it’s imperative that we contemplate the impact of hospital consolidation on the independence of the medical staff.

There is an inherent value in the independence of the medical staff. According to NY State law, “the medical staff shall be organized and accountable to the governing body for the quality of the medical care provided to all patients…and establish objective standards of care and conduct.” Additionally, the law requires that the medical staff monitor patient care performance, including monitoring practitioner compliance with bylaws of the medical staff.

Physicians as a rule have a strong commitment to their institutions—and want to see them thrive—so they tend to be supportive when consolidations are proposed, as they often include an infusion of funds for hospital infrastructure and medical services that benefit patients and the community.

But a relatively small medical staff has little leverage in arguing with a huge health system over rules and policies that affect medical care and medical decision-making.

Do these hospital consolidations constrain the medical staff so much that the needs of the community are not being served?

A constant theme of the Organized Medical Staff Sections of MSSNY and the AMA has been the necessity to have strong medical staff bylaws.  In consolidation, a staff could lose hard-won provisions protecting due process rights for physicians and clinical decision-making authority.

Those who object to rules that they feel impede care can be labeled as disruptive, or subject to sanctions that will harm their careers.

Might pressure be applied to interfere with long-standing referral patterns and require that referrals be made within the overall system?

Consolidation can include many benefits for the institution, the physicians and the patients they both serve, but care must be taken to ensure that the medical staff does not lose sight of its responsibility to ensure the best possible care for patients.

Charles Rothberg, MD
MSSNY President

Please send your comments to

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In Syracuse Post-Standard, Onondaga County Medical Society President is the Latest Voice Calling for Comphrehensive Liability Reform
In a letter published in The Post-Standard in Syracuse on Tuesday, Onondaga County Medical Society President Dr. Mary Abdulky writes, “If signed by Gov. Andrew Cuomo, this bill (S6800/A8516) could worsen the exodus of physicians leaving New York to practice in other states that are more economically advantageous. We already lose 55 percent of the resident physicians trained here to other regions of the country, and face some difficulty attracting new physicians to the area due to the excessive medical liability premiums that our physicians must pay.”

Physicians: Tell Gov. to Reject Liability Expansion Bill/Call for Comprehensive Liability Reform
All physicians are urged to continue to call Governor Cuomo at 518-474-8390 and send a letter here urging that he veto a so-called “cancer only” medical liability statute of limitations expansion bill (S.6800/A.8516) that passed the Legislature over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.

Please urge that legislation be enacted that provides for comprehensive medical liability reform. This ambiguously drafted bill, introduced in the final days and passed in the final hours of the 2017 Legislative Session, would expand the medical liability statute of limitations for cases involving “alleged negligent failure to diagnose a malignant tumor or cancer”.   The bill would permit lawsuits 2.5 years from the “date of discovery” of such alleged negligence, up to an outside limit of 7 years.  Actuaries have estimated that this legislation could increase already exorbitant premiums by 10-15% at a time when no increases can be tolerated.

Again, please urge the Governor to veto this bill and encourage your colleagues to do the same! Please let the Governor know how this bill will harm patient care and exacerbate existing physician shortage issues in your community.

Senate Confirms Dr. Jerome Adams as Surgeon General
The US Senate has approved Jerome Adams, MD, to be the next surgeon general. Pledging to take on the nation’s opioid epidemic, he wrote in his nomination committee statement: “The addictive properties of prescription opioids is a scourge in America and it must be stopped.”

Over the past weeks, numerous publications across the country included quotes from MSSNY President Charles Rothberg, MD regarding Dr. Adams’ nomination, including this from the New York Times: “Charles N. Rothberg, president of the Medical Society of the State of New York, said Dr. Adams reminded him of C. Everett Koop, who was surgeon general through much of the 1980s. ‘Dr. Adams has a proven track record to make public health a priority despite political hurdles,’ Dr. Rothberg said in an email. ‘Dr. Adams is in touch with the public needs.’”

HBO’s VICE News Video: Doctors Explain Why U.S. Healthcare Is So Expensive
VICE News visited several doctors—including MSSNY’s Dr. Donald Moore—in an attempt to make sense of our convoluted health care costs. What do the doctors say is needed to improve overall cost and care? Many of them shared the same solution. Watch the video here.

White House Opioid Panel Urges Trump to Declare State of Emergency
In an interim report released this week, the White House Commission on Combating Drug Addiction and the Opioid Crisis described the crisis as unparalleled and urged President Trump to declare the US opioid misuse epidemic a national emergency. The report states, “It would also awaken every American to this simple fact: If this scourge has not found you or your family yet, without bold action by everyone, it soon will. … You, Mr. President, are the only person who can bring this type of intensity to the emergency and we believe you have the will to do so and to do so immediately.”

Editing Human Genes
A team of biologists in Oregon have successfully edited genes in human embryos to correct a disease-causing mutation, according to a study published this week in Nature, a weekly international journal of science. The experiment is not the first of its kind, but it is the first such study completed in the US and goes beyond past research in both scope and findings. The study “marks a major milestone and…raises the prospect that gene editing may one day protect babies from a variety of hereditary conditions,” but also raises ethical concerns about human genetic engineering. (Source: New York Times, 8/2)

Letter to the Editor re: The Skinny on “The Skinny”
Dear Editor:

In the past two editions of Enews our President, Charles Rothberg MD, touched upon crucial issues that impel consideration of what role our medical society should play in advocacy for our patients and the practice of medicine.

The Department of Health and Human Services has embarked on a mission to cripple the effectiveness of the Affordable Care Act (ACA) using taxpayer money to create 23 videos disparaging “Obamacare” including several testimonials by physicians.  It is illegal for HHS and the executive branch to engage in direct advocacy, “purely partisan activity” or promoting legislation.   The current administration has also failed to offer assurances to insurers that key components of the ACA such as enforcement of the individual mandate and cost sharing subsidies will be carried out.

These policy decisions have served to imperil the stability of the insurance market and hence the health of our patients.  The executive branch is empowered to execute legislation, and until directed otherwise by Congress, has a responsibility, legally and morally, to work diligently in carrying out the provisions of the ACA.  Anything less places our patients and practices in harm’s way for partisan expediency.   The AMA endorsed Tom Price for Secretary of HHS and it is time we use or advocacy role to place pressure on Secretary Price, the administration and our congressman to act first and foremost to protect the health of our patients.

Despite the recent failure of attempts to repeal the ACA there will be continued efforts to either repeal, replace or reform the legislation.  This is appropriate as there are many areas for improvement.  During the continuing policy debates it is important that we as physicians are aware of the enormous beneficial impact the ACA has had to date for many our patients.   In May 2017 New York released the report on open enrollment for 2017.

More than 3.6 million people or about 18% of New Yorkers were enrolled in health insurance through the ACA (Marketplace and Essential Plans).  This corresponds to a decrease in the rate of uninsured New Yorkers from 10 to 5 % in the past 4 years.  Share of enrollees by region within New York is proportional to population indicating that this program is not one that is more beneficial to downstate versus upstate or within the urban, suburban, or rural regions of our state.

The collapse of proposed legislation to repeal the ACA during the past few weeks offers an opportunity for our state and national society to advocate for bipartisan initiatives to preserve the achievements within our state while addressing many of the still present shortcomings within our healthcare system.

What has become evident in the past few months, although still unspoken in some quarters, is a consensus that affordable healthcare is a right for which our government has a responsibility.  The way this right to healthcare is attained is a matter of partisan policy but the ideal of affordable healthcare for all guaranteed by our society through governmental action is no longer a partisan divide.

Neil Herbsman MD
Gastroenterology of the Bronx
1600 Hering Ave.
Bronx, New York

Check out MSSNY’s New CME Website and Listen to our Many Podcasts!
Did you know that we recently updated and completely revamped the MSSNY CME website?  Check it out here (Note: new users to the site will need to create an account).  You can earn free CME credits on emergency preparedness topics that range from our four-part Physician’s Electronic Emergency Preparedness Toolkit to Ebola, a Perspective from the Field or Mosquito Borne Diseases.  We also have a module on concussion in pediatric and adult patients as well as a CME accredited podcast on the same topic.

MSSNY also has more than ten informative podcasts that you can listen to here.  There are multiple brief podcasts on immunizations as well as others on Zika virus and MSSNY’s Physician’s Emergency Preparedness Toolkit.  Each podcast offers insight from medical experts on topics they are extensively well versed on.

Why I Joined MSSNY

Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!

Quality Payment Program Hardship Exception Application for 2017 Transition Year Now Open
Clinicians Can Now Submit Quality Payment Program Hardship Exception Applications

The Quality Payment Program Hardship Exception Application for the 2017 transition year is now available on the Quality Payment Program website.

MIPS eligible clinicians and groups may qualify for a reweighting of their Advancing Care Information performance category score to 0% of the final score, and can submit a hardship exception application, for one of the following specified reasons:

  • Insufficient internet connectivity
  • Extreme and uncontrollable circumstances
  • Lack of control over the availability of Certified EHR Technology (CEHRT)

There are some MIPS eligible clinicians who are considered Special Status, who will be automatically reweighted (or, exempted in the case of MIPS eligible clinicians participating in a MIPS APM) and do not need to submit a Quality Payment Program Hardship Exception Application.

About the Hardship Exception Application Process

In addition to submitting an application via the Quality Payment Program website, clinicians may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application.

To submit an application, you’ll need:

  • Your Taxpayer Identification Number (TIN) for group applications or National Provider Identifier (NPI) for individual applications;
  • Contact information for the person working on behalf of the individual clinician or group, including first and last name, e-mail address, and telephone number; and
  • Selection of hardship exception category (listed above) and supplemental information.

If you’re applying for a hardship exception based on the Extreme and Uncontrollable Circumstance category, you must select one of the following and provide a start and end date of when the circumstance occurred:

  • Disaster (e.g., a natural disaster in which the CEHRT was damaged or destroyed)
  • Practice or hospital closure
  • Severe financial distress (bankruptcy or debt restructuring)
  • EHR certification/vendor issues (CEHRT issues)

Please note: Once an application is submitted, you will receive a confirmation email that your application was submitted and is pending, approved, or dismissed. Applications will be processed on a rolling basis.

For More Information

MACRA/QPP: Pick Your Pace and New Resources
The AMA continues to hear from physicians who feel unprepared to participate successfully in Medicare’s new Merit-based Incentive Payment System, despite the transitional flexibility provided for 2017.  In particular, it seems that physicians who never participated in Medicare reporting programs before need basic information on how to avoid a payment penalty in 2019 through minimal reporting in 2017.

To help address this need, which we believe is particularly acute for physicians in smaller practices, the AMA is extending “Pick Your Pace” activities to run through the end of the year to disseminate simple instructions on how to report “one patient, one measure, no penalty.”    To help amplify our outreach for this educational effort, we are encouraging state medical societies and national medical specialty societies to participate and share this information from now through Dec. 31.

The AMA developed a short video, entitled “One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting,” which is accessible on the AMA web site at  Also on this web site physicians can find a sample CMS-1500 claim form, links to quality measures on the CMS web site, a link to the CMS MIPS eligibility tool, and other materials.   Please visit this page, view the resources, and consider joining us for a coordinated outreach to physician practices so that we can help as many physicians as possible avoid a negative 4 percent Medicare payment reduction in 2019.

MIPS Action Plan
The AMA has released a new customizable resource, the MIPS Action Plan, geared towards helping physicians think strategically about how to successfully implement MIPS in 2017. This resource will help physicians determine the right course of action for their practice, provide recommended steps to meet program requirements, and measure their performance against important milestones. DON’T DELAY – act now to avoid penalties and succeed in MIPS for 2017.


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