December 11, 2015 – MSSNY Aids Physicians in Taking Control of Their Practices

 Dr. Joseph R. Maldonado
December 11, 2015
Volume 15, Number 46

Dear Colleagues:

First of all, Happy Chanukah to all who are celebrating the miracle of the holiday.

This year, the MSSNY HOD called for the creation of a Task Force that would explore and recommend options to assist MSSNY’s physicians in independent practice to remain viable in that environment. After a call for interested MSSNY members to participate, I put together a team of physicians from various specialties and geographic locations that had an interest and/or expertise in the subject.  Some physicians have business degrees while others have engaged in entrepreneurial projects transforming how they deliver health and wellness care to the residents of New York.  I selected Drs. Tom Lee and Paul Lograno to lead the effort.  To date, the group has had two meetings and has begun developing various options to help a broad spectrum of physicians in different practice environments. In the next few months, you will be hearing more about options available to you that many of your colleagues have embarked on that have helped them be happier physicians thriving in the turbulent environment of healthcare reform.

In addition to this effort, I have asked a group of MSSNY Councilors to develop guidelines that will guide how we collaborate with other groups of physicians who are seeking to remain out of network or who wish to engage in advocacy that relates specifically to their specialty practice. A Task Force to address physician burnout and stress will begin its deliberations in January under the leadership of Dr. Michael Privetera from the University of Rochester.

Tipping Point

The recent events concerning disenrollment of physicians from Emblem Health and United Healthcare as well as the Health Republic fiasco have become the tipping point.  WE WILL NOT SIT BACK AND TAKE THIS ANY LONGER.  If we cannot get collective negotiation or be assured that the private practice model will be supported by government legislative and regulatory reforms, then we must take matters into our own hands and develop mechanisms for group survival/individual survival.  For some, it will mean creating new physician-owned-and-run groups or IPAs.  For others, it will mean dropping out of many insurance products and establishing direct care practices. For others, there may be other models that some of you have developed.  MSSNY is working on highlighting successful options to opt out of the madness being foisted upon us.

Do you have an interest in getting involved?  Do you have a successful alternative model of delivering healthcare that is working for you?  Have you changed how you practice and become a happier and less stressed out physician while remaining in private practice?  Are you a young physician engaged in an innovative practice model?  We want you to get involved in our grassroots led effort.  Let us know.  We are bringing together talented and successful colleagues who have been quietly engaging successful strategies.

Contact Eunice skelly @

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to

MLMIC Physianns Insurance

Senate Health Committee Chair Urges Emblem to Reconsider Dropped Physicians
Noting that he has “heard from a number of physicians as well as the Medical Society of the State of New York” regarding Emblem’s decision to not renew contracts with approximately 750 physicians, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani this week to ask for “further clarity on this issue.”   MSSNY had written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services in addition to contacting the State Legislature.

Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that 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; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Physicians can send a letter to their legislators urging their efforts to reverse Emblem’s action from here.

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.

Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to  If you can scan the check into an email that would be helpful.

If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount. We will share this information with the HR monitor.  Again, please email you for your patience while we continue to work to assist you in the process.

Western New York Congressman Presses CMS to Assure That HR Claims Are Paid
Noting the several physicians he has heard from, Representative Chris Collins (R-Western New York) pressed CMS Acting Administrator Andy Slavitt this week to identify what steps the federal government could take to assure physicians and other health care providers are fully paid for the care that they have provided to their patients insured by collapsed co-op health insurer Health Republic.  The questioning occurred as part of a US House of Representatives Energy & Commerce Committee hearing into the functioning of state Exchanges.  MSSNY had written to the entire New York Congressional delegation late last week to share with them the numerous articles from papers in nearly every region across New York State highlighting the consequences of the collapse of Health Republic, and asking for their assistance to assure, once the full accounting and distribution of the assets of the Health Republic is completed, that health care providers are made whole.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  Physicians can send a letter to their state legislators and Governor Cuomo to urge that steps are taken, including the creation of a special state fund, to assure that these claims are fully paid.

Moreover, this week, the New York State Association of Health Underwriters announced its support for a special fund to assure Health Republic claims are paid.

MSSNY also continues to hear from dozens of physicians that reimbursement checks issued by Health Republic have been returned by the bank for insufficient funds.   If you have received notice from your bank that an HR check bounced, please let us know by sending an email to

Cadillac Tax, Meaningful Use Relief Under Consideration in Year End Congressional Budget Talks
As Congress scrambles to pass a year end Budget bill, a number of health care issues of great importance to physicians continue to be under strong consideration for incorporation into the package.  This includes additional provisions that could provide some needed hardship exceptions to overly burdensome meaningful use requirements, as well as a delay in the implementation of the so-called “Cadillac Tax” on comprehensive health insurance coverage scheduled to go into effect in 2018.  The Cadillac Tax, a component of the ACA, imposes a 40% excise tax on group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage.  It would undoubtedly have a greater impact in higher cost states such as New York, and would further discourage employers form offering comprehensive health insurance policies to their employees.   MSSNY adopted policy at its 2013 House of Delegates meeting calling for legislation to repeal this tax.  Please remain alert for further updates on these items. 

Take this AMA Survey re Meaningful Use
In the AMA’s ongoing efforts to improve EHRs and interoperability of EHRs, the AMA is assisting the Office of the National Coordinator (ONC) with gathering information to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use. The following is a link to a 5-10 minute survey that will help ONC create a new standard that will reduce the number of pages in the summary of care, thus making it easier to find relevant information.  Please share the link with your members and encourage them to take the survey. The Office of the National Coordinator (ONC) has extended the survey deadline to December 23. Survey link 

BNE Sends Letter Reminding You of E-Prescribing Requirement that Becomes Effective on March 27, 2016
The New York State Department of Health’s Bureau of Narcotic Enforcement has emailedl a letter to about 110,000 prescribers, through the Health Commerce System, reminding practitioners about the e-prescribing mandate that will take effect on March 27, 2016.  The letter encourages practitioners to begin E-prescribing if they have already implemented an E-prescribing software application or to begin the process to acquire an E-prescribing software application if they have not started the process.   A copy of that letter can be found here. BNE has also developed a patient brochure on e-prescribing and it can be found on BNE’s website.

New York State’s e-prescribing requirements for non-controlled and controlled substances will go into effect on March 27, 2016.   The NYS Department of Health’s Bureau of Narcotic Enforcement has provided information to physicians and other prescribers to assist them in their transition to electronic prescribing.   Practitioners should continue their efforts to become compliant with the law, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances (EPCS), and registering their certified software applications with the Bureau of Narcotic Enforcement.   According to state officials, over 35,000 prescribers have registered their systems with DOH.   This represents only about 1/3 of the prescribers in New York State.

For physicians who prescribe controlled substances, there are additional steps to complete in order to electronically prescribe controlled substances.  These include the following:

  • First, the software you currently use must meet all the federal security requirements for EPCS, which can be found on the Drug Enforcement Agency’s (DEA) web page.

Note that federal security requirements include a third party audit or DEA certification of the software.

  • Second, you must complete the identity proofing process as defined in the federal requirements.
  • Third, you must obtain a two-factor authentication as defined in the federal requirements.
  • Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found here.

EPCS systems must be registered through the ROPES system.  ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

  • Login to the Health Commerce System (HCS) at
  • Under “My Content” click on “All Applications”
  • Click on “R”
  • Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

EPCS became permissible in New York State and over 90% of the pharmacies can now accept e-prescribing for controlled substances, according to officials from BNE.

DrFirst and MSSNY have partnered to bring MSSNY members the industry’s leading e-prescribing solution at a special discounted price and information on this program can be found here. There are additional venders that now have software available to e-prescribe both non-controlled and controlled substances and information on these can be found at this link.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so shortly. The waiver process will be electronic. Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance.  DOH has indicated that more information on the waiver process will be available shortly.

E-prescribing of non-controlled substances is also required under the law; however, registering of this system with the state is not necessary. 

Bureau of Narcotic Enforcement’s Physician Info on Medical Marijuana Program
The New York State Department of Health’s Bureau of Narcotic Enforcement announces the availability of the required four hour medical use of marijuana course.  Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course. The Compassionate Care Act, signed into law on July 5, 2014, authorized the Department of Health to implement a Medical Marijuana Program in New York State. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must:

  • be qualified, by training or experience, to treat patients with one or more of the serious conditions eligible for medical marijuana;
  • be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law, in New York State;
  • possess a Health Commerce System (HCS) Medical Professions Account user ID and password;
  • possess an active Drug Enforcement Administration (DEA) registration number; and
  • complete the four hour Department-approved medical use of marijuana course.

Departmental officials anticipate that the four hour department approved online course is available to practitioners through the  TheAnswerPage, an established online medical education provider here.

The course will include the following topics, which are required in the regulations: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence.  The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course. Additional information regarding the practitioner registration process is available on the Department’s Medical Marijuana Program webpage, which can easily be accessed via the following link.

It is also expected that DOH will announce the process that physicians may be able to “certify” patients for receiving marijuana under the medical marijuana program.   It is anticipated that this process will be through the Health Commerce System.

Please monitor this webpage frequently for updates and the department may be contacted with any questions:New York State Department of Health, Bureau of Narcotic Enforcement,

Medical Marijuana Program, Riverview Center,50 Broadway,Albany, NY 12204

Call 866-811-7957 or email

Letter Re E-Prescribing from Director of Bureau of Narcotic Enforcement

Dear Prescriber:

Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.  This mandate does not apply to veterinarians.  Electronic prescribing of both controlled and non-controlled substances is currently permissible in New York. 

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements.  Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health (DOH), Bureau of Narcotic Enforcement (BNE). 

Please be aware that implementation timelines for EPCS software vary and may be lengthy.  If you have not already begun this process, BNE strongly recommends that you begin immediately.   

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper, to allow for time to resolve technical or workflow issues prior to the mandate’s effective date. 

Useful information related to electronic prescribing, including frequently asked questions, information regarding the EPCS registration process, and a downloadable patient-centered brochure to help your patients better understand electronic prescribing can be found on our website at 

If you have any questions about the electronic prescribing mandate, please call 1-866-811-7957, option 1.

Joshua Vinciguerra
Bureau of Narcotic Enforcement

The NY Society of Addiction Medicine to Host 12th Annual Conference Feb. 5 & 6
The NY Society of Addiction Medicine (NYSAM) will host its annual conference February 5 and 6 at the Crowne Plaza Times Square Hotel, 1605 Broadway, NYC. The conference entitled, “Critical Role of Addiction Medicine in Healthcare Reform: Best Practices,” is designed for physicians, medical students/residents, and addiction professionals.  Registration is required and the cost is as follows: Full conference price—Before January 15, 2016  NYSAM Member Rate: $350 Non-Member Rate: $425 Non Physician Rate: $225.  Residents/Fellows/Medical Students are free. Registration may be made by visiting the NYSAM website here or by contacting Elisabeth Kranson at (518) 689-0142 or via email: 

Adelphi University MBA Program for Suffolk/Nassau County Medical Societies
The Nassau and Suffolk Medical Societies cordially invite all physicians to attend one of the MBA Information Sessions to learn more about how an MBA degree can give you the tools necessary to be an effective leader, critical thinker, negotiator and problem solver. Mark your calendar now and plan to attend.

Where: Suffolk County Medical Society, 1767-14 Veterans Highway, Islandia

  • Tuesday, December 8, 2015
  • Tuesday, December 15, 2015
  • Friday, December 18, 2015

Come in between 4:00 pm to 6:00 pm

Where: Adelphi University, 55 Kennedy Drive, Hauppauge- 11788

  • Monday, December 7, 2015
  • Wednesday, December 9, 2015
  • Monday, December 14, 2015

Come in between 8:00 am to 3:00 pm

Don’t miss out on this opportunity to learn more about how you can successfully position yourself in today’s healthcare system.

RSVP Maureen Leslie at 516 237-8607 or or SCMS at 631 851-1400.

Consumers Warned About Raw Milk Listeria Risk in Allegany County
Food Safety News (12/11) reports “consumers in New York’s Allegany County and surrounding area were told not to consume ‘unpasteurized’ raw milk from the Gerald E. Snyder Farm due to possible Listeria contamination.” The notice “came from the New York Department of Agriculture and Markets.”

The public health warning came from the New York Department of Agriculture and Markets.The Gerald E. Snyder Farm is located at RD#1, 1444 Randolph Rd., Alfred Station, NY. The department has not yet associated any illnesses with the product that is subject of the public health warning.


Office Space–Sutton Place
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Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 /

Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742