December 15, 2017 – Opioids: A Challenge for All

PRESIDENT’S MESSAGE Charles Rothberg, MD December 15 2017 Volume 17 Number 46

Dear Colleagues: 

New York’s physicians continue to be on the front line of efforts to respond to the heroin and opioid abuse epidemic in New York and across the country.

This week, I, along with President Elect Dr. Tom Madejski and other MSSNY physician leaders and staff, met with the NYS Department of Health’s Bureau of Narcotics Enforcement (BNE) officials to discuss a number of issues regarding how best we can work together in confronting this problem.

One of the topics we discussed is streamlining the way by which physicians and their staff can check the I-STOP database.  New York is already a leader in these efforts.  For example, in 2016, physicians and other prescribers made over 18 million checks of I-STOP – a 9% increase from 2015.   As a result, the prescribing of opioids in New York State has decreased 13% from 2013-2016.  However, other states have simplified a sometimes cumbersome search process by inter-connecting the physicians’ EHRs and that state’s prescription database, saving valuable minutes (hours?) throughout the work day.  We are looking to create a similar system in New York.

I am happy to report that BNE has been working on a number of tracks to make this a reality, both in working with the local RHIOs to create a “single sign on” possibility but also obtaining a CDC grant that would facilitate a direct connection between the I-STOP database and physician EHRs.

Please stay tuned for more information on this exciting development.

We also discussed a letter the BNE sent out in September to many physicians across the State advising these physicians that they may have “engaged in high risk opioid prescribing.”   We noted that many physicians receiving these letters expressed concern that they felt at risk for OPMC prosecution despite treating their patients in a way they believed was medically appropriate to the patient’s condition.

Similar to statements made by NY DOH representatives Keith Servis and Dr. Gregory Young at a recent public forum in Buffalo convened by the Erie County Medical Society, BNE staff assured that the goal of the letter was not intimidation, but education for these physicians regarding the CDC’s chronic pain guidelines.

We offered our assistance in helping the DOH and BNE communicate to physicians regarding prescribing issues that could put them and their patients at risk, and will continue to work proactively with them.

The opioid abuse epidemic is a challenge to all of us.  The physician community has been and must continue to be a leader in responding to this challenge.  We will continue to push back against potentially overbroad enforcement efforts that may intimidate physicians from providing needed patient care.  At the same time, we will also continue to assure that physicians have the information and tools they need to assure their patients receive the most appropriate care.

Sincerely,

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

Please Urge Governor Cuomo to Veto Disastrous Liability Expansion Bill and Work for Comprehensive Reform Instead
Legislation (S.6800/A.8516) that would significantly expand the time to bring a medical malpractice lawsuit, in circumstances based upon an “alleged negligent failure to diagnose a malignant tumor or cancer” remains one of 7 bills that have passed both Houses of the Legislature, but have not yet delivered to the Governor for his approval or veto.

Because it has not been paired with badly needed medical liability reforms, if signed into law this measure is predicted to prompt an 11% increase in malpractice premiums at a time when New York already has by far and away the highest cumulative liability costs in the country.  Please urge the Governor to veto this bill and in support of needed comprehensive medical liability reform by sending a letter to the Governor here and call 518-474-8390.

This week the Empire Center for Public Policy released a report regarding the compelling need for liability reform in New York to make it more competitive, including highlighting the exorbitant costs for medical liability insurance compared to other states.  It was the subject of an article in Crains’ Health Pulse, featuring a quote from MSSNY President Dr. Charles Rothberg: “It is imperative that Gov. Cuomo veto this liability expansion measure and for the state Legislature to work with the governor to enact comprehensive medical-liability reform.

New Report: NY Doctors Pay Higher Liability Costs than Any Other US Doctors
Statement attributed to: Charles Rothberg, MD, MSSNY President,

“The Empire Center’s new report on tort liability confirms a reality that New York doctors (particularly those practicing in downstate New York) already know. New York physicians pay higher liability costs than physicians in almost every other state. For decades, reasonable proposals to bring some balance to our tort system have been systematically rejected by the New York Legislature. This year, not only were these needed reform proposals again not passed, our legislators voted to greatly lengthen the time to bring malpractice suits that are going to cause significant increases to our already exorbitant costs!

With New York potentially facing huge cuts and significant tax changes from the federal government, the need for balanced comprehensive medical liability reform is more important than ever. New York State has already received the dubious distinction of being the worst state to practice medicine, in part due to our excessive liability costs.

It is imperative that Governor Cuomo veto this liability expansion measure, and for the State Legislature to work with the Governor to enact comprehensive medical liability reform that addresses systemic deficiencies that plague doctors, hospitals, and in turn, hurt our patients.”

NY Files $575M Lawsuit against Federal Govt. to Help Pay Health Republic Claims
As part of the liquidation process for the dissolution of Health Republic, the New York Department of Financial Services (DFS) has initiated a lawsuit against the federal government seeking to recover over $575 million owed to Health Republic under various ACA programs, such as Risk Corridor payments, Reinsurance, Risk Adjustment payments, Advanced Premium Tax Credits, and Cost-Sharing Reduction payments.  The lawsuit was noted as part of the Order to Show Cause filed by the attorney for the Department of Financial Services (DFS) overseeing the dissolution of Health Republic.  Health Republic was shut down in the fall of 2015 after it was determined it was unable to pay its claims, and it has been in liquidation proceedings since that time.

A report shows that, as of September 30, 2017, Health Republic had total assets of approximately $40 million and total liabilities exceeding $700 million. The liquidator began issuing explanations of benefits (EOBs) to members and providers with policy claims from August to October 7.  It was noted that there are over $211 million in outstanding claims to providers to be paid.

Possible Delay in Jan. 1 Requirement for OBS Practices to Report Procedural Info
Earlier this year MSSNY reported in its e-news and News of New York regarding a DOH proposal that would have, starting January 1, 2018, required physicians with Accredited Office-Based Surgery (OBS) practices to electronically report extensive information by CPT code of the total number of procedures performed in the physician’s office.  However, this week we received word from DOH staff that it was not moving forward with the January 1 reporting requirement, examining whether it may be necessary to impose this reporting requirement with a formal regulation.  However, reporting could still be required later in 2018.

Past-MSSNY President Dr .William Rosenblatt had raised concerns at meetings of the NYS Office-Based Surgery Advisory Committee that such a burdensome reporting requirement was unnecessary when much of this information is already collected by one of the major OBS accrediting bodies.

Moreover, MSSNY Board of Trustees member Dr. Andrew Kleinman, together with representatives of MSSNY, New York State Society of Plastic Surgeons and the New York Chapter of the American College of Physicians recently met with NYS DOH representatives to echo these concerns about the potentially burdensome nature of the requirement, and in support of obtaining the needed information from the accrediting bodies.

As this issue remains fluid, please remain alert for further updates as MSSNY and its General Counsel, (the Garfunkel Wild law firm) continue to dialogue with DOH staff on this issue.

NYS Department of Health: 1,800 Cases Confirmed; 54 Hospitalized
The New York Health Department said the flu has grown prevalent throughout the state, meaning healthcare workers who have not been vaccinated must don procedural masks around patients. The Health Department has confirmed more than 1,800 cases of flu in 54 counties and all of New York City’s boroughs, more than 600 of which “required hospitalization.”  The NYS Weekly Surveillance Report is available here.

The Regulation for Prevention of Influenza Transmission went into effect during the 2013-14 influenza season.  It requires unvaccinated health care workers in Article 28 facilities regulated by the NYSDOH to wear surgical or procedure masks during those times when the commissioner declares that influenza is prevalent in NYS.  Amendments to the regulations allow for the removal of masks when health care workers are accompanying patients in the community, providing speech therapy services, or communicating with persons who lip read. This influenza season, New York has had 1,820 laboratory-confirmed cases of influenza in 54 counties and all boroughs of New York City. There have been 612 influenza-related hospitalizations reported, and no reports of pediatric deaths from influenza. Over the last three seasons, there have been 19 pediatric influenza deaths in New York and an average of 11,183 influenza-related hospitalizations each season.

Dr. Monica Sweeney Represents MSSNY at Hearing on Immigrant Access to Care
This week Dr. Monica Sweeney, Co-Chair of MSSNY’s Committee to Eliminate Health Disparities and Vice-Dean and Clinical Professor at SUNY Downstate, delivered testimony at a NYS Assembly hearing examining Immigrant Access to Health Care.

Specifically, she highlighted MSSNY’s advocacy (together with many other health advocacy organizations) to New York’s Congressional delegation in support of continued funding for the Child Health Insurance Program and the Essential Health Plan—both of which provide low-cost health insurance coverage for many New Yorkers including immigrants.  Specifically, she noted that “Failing to assure this continued funding will almost certainly result in many New Yorkers, including many immigrants, waiting until a health care emergency to seek needed medical care.”  Moreover, she noted MSSNY’s support for continuing Congressional funding for community health centers, noting that many immigrants receive care at Federally Qualified Health Centers (FQHCs).

Furthermore, she highlighted MSSNY’s work with the AMA to urge Congress to support the continuation of the Deferred Action for Childhood Arrivals (DACA) program.  She noted that those with DACA status “help contribute to a diverse and culturally responsive physician workforce, which benefits all patients”, and that “Failure to continue this program could have significant consequences, for the healthcare workforce, and of course the patients who depend on their care”.

To view Dr. Sweeney’s testimony, please go here, and go to the 3:55 mark. 

MSSNY Member Dr. Anthony Szema’s New Book Unusual Diseases with Common Symptoms: A Clinical Casebook Is Now Available
Anthony M. Szema, MD, FCCP. FACAAI, FAAAAI, FACP, author of Unusual Diseases with Common Symptoms: A Clinical Casebook, details case reports of uncommon diseases that present with common symptoms, many of which have emerged in the past decade as a result of nature, advances in medical treatment, and increasing recognition of specific underpinnings of human biology and immunology. These rare diseases must now be considered when the mundane diagnoses do not exactly fit the patient’s clinical history or treatment fails. Some of these diseases include: eosinophilic esophagitis, blastocystis hominis infection, and paromyces allergic fungal sinusitis.

Chapters provide in depth clinical examples of a wide range of diseases affecting multiple organ systems. Each case is structured by: a vignette of the case, background/salient features of the case, diagnosis, treatment, key points, and questions to aid in critical thinking. Unusual Diseases with Common Symptoms: A Clinical Casebook is of great interest to practicing physicians and as a teaching resource for students and residents who will one day encounter conditions more complex than they initially appear. It includes historical context, reviews early and later literature, and makes recommendations for clinical care.
Dr. Szema is also the editor of World Trade Center Pulmonary Diseases and Multi-Organ System Manifestations.

His book is available here.

UnitedHealth Buys DaVita Unit for $4.9B
UnitedHealth Group has agreed to buy dialysis provider DaVita’s medical unit for $4.9 billion in cash to expand the national insurer’s outpatient care services, the company said December 13. DaVita Medical Group will be combined with UnitedHealth’s Optum, which runs the non-insurance portions of UnitedHealth’s business including primary and secondary care, consulting and data analytics. DaVita’s physician network provides care to approximately 1.7 million patients every year in Florida, California, Colorado, Washington, Nevada and New Mexico. The group also runs 35 urgent-care centers and six outpatient surgery centers.

Optum’s New York footprint includes the medical group ProHealth in Lake Success, Long Island. Westmed, a medical practice with locations in Westchester County, New York City and Fairfield County in Connecticut, collaborates with Optum on its Medicare Shared Savings Program accountable care organization. (Modern Healthcare) 

Another Opinion re CVS-Aetna Merger: Hazardous to Hospitals
As previously reports, CVS intends to expand its retail clinic model and will aim for one-stop shopping for wellness, clinical and pharmacy services, vision, hearing, nutrition, beauty and medical equipment. Its goal is for its locations to serve as “community-based health hubs” that can answer patients’ questions about prescription drugs, insurance coverage and their own health conditions. But Forbes contributor Bruce Japsen said this model may prove to be hazardous to the health of the nation’s largest hospital operators. Many hospitals admit they haven’t lowered costs enough to remain competitive to insurers and consumers, according to the article. And CVS already has a large geographic reach of 9,600 retail pharmacies that include 1,600 Target pharmacies. The megamerger will give the retail pharmacy 22 million health plan members who can take advantage of its 1,100 retail clinics, notes Forbes. Aetna’s network (PDF) includes 5,700 hospitals (out of 1.3 million providers total).

MSSNY Joins Other Physician Advocates to Urge Congress to Prevent Cuts to Medicare and Other Health Insurance Programs
As reported last week, MSSNY joined with several other physician advocacy associations in a letter to New York’s Congressional delegation urging continued funding for various health insurance programs as Congress debates a spending resolution required by the end of the year as well as the massive tax restructuring proposal.  This includes continued funding for the Child Health Insurance Program (CHIP), which helps to provide coverage for over 300,000 children in New York State, and continued authorization for health insurance subsidies including for New York’s Essential Plan, which provides low-cost “first dollar” coverage to nearly 700,000 New Yorkers who earn too much to qualify for Medicaid.   A report issued this week noted New York’s CHIP funding will run out by March if Congress does not allocate new funding.

Moreover, the physician associations’ letter urged our Congressional delegation to work to prevent potential further sequestration cuts to Medicare physician payments that could be imposed as a result of deficits potentially created through with the tax reform bill being negotiated between the House and Senate.   While several House and Senate leaders have stated that such sequestration cuts will be prevented, it is imperative that the physician and patient community continue to advocate assure that already inadequate Medicare physician payments are not even further reduced, and seniors’ access to care is not diminished.  Others joining on to the letter to New York’s Congressional delegation included the NYS Academy of Family Physicians, NYS Academy of Pediatrics, the New York County Psychiatric Association, the Doctors’ Council/SEIU and the local affiliate of the National Medical Association. 

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

Your patient data continues to be at risk. With new threats arising every day, cybersecurity needs to be part of your daily operations to maintain HIPAA compliance and patient trust.

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What you don’t know CAN hurt you.  We are here to help. GET STARTED TODAY.

In partnership with MSSNY, we’re offering MSSNY members an exclusive product & service package.  Please visit https://www.vecyber.com/mssny  to find out more or contact us at mssny@vecyber.com.

Caution to a New Scam; Caller Claims to Be from DEA and Requests Money
This week, MSSNY received a call from one our physician members in Huntington, NY.  He spent over an hour of his time dealing with a phone contact that was eventually deemed to be to a scam. The name the caller used was “Karl Kolder.” The physician was asked to confirm a shipment of drugs and the physician was informed of the need to send a bond. This was a rather sophisticated operation as the scam caller was from 1(800) 883-9539 (based on the caller ID),  which is the actual number of the Drug Diversion Unit of the US DEA.  When the physician did a “Google” search of the number it resulted in the name of the DEA Drug Diversion Unit. Please go here.

Regina McNally, VP Socio-Med Division, called the DEA. They responded, “This was a scam.  DEA confirmed that they would not telephone you to request anything like this.  These scammers try different ways to getting people/registrants to send money.  DO NOT EVER send money to DEA as they will never ask anyone to send money.”

The caller had the physician’s NPI number and the physician’s DEA number. We seriously urge physicians not to disclose any personal information to anyone over the phone unless the physician initiates the call.

On the DEA website under “Publication and Manuals,” there is a section named “Advisories.”  This is where the scams are listed.

DEA officials said that this scam in NOT currently listed but they are aware of it.

The DEA also advised: “To protect yourself you should also contact the local DEA office in your area to ask questions before giving out any information. The diversion of any controlled substance is a serious social and health-related problem in the United States. Always safeguard your personal and professional data. Always verify the need and authority of unusual requests for information.

AMA Reminds Physicians of Steps to Take Now to Avoid 2019 Medicare Penalties
The American Medical Association (AMA) issued a press release reminding physicians that if, if they have not done so already, they have until December 31, 2017, to take a few simple steps to avoid a Medicare payment penalty in 2019.  To read the full press release, click here.

The press release notes that, for those who were not prepared for full participation this year, reporting quality information on just one patient and one measure in 2017 will allow physicians to avoid a Medicare payment penalty in 2019. A full MACRA resource center is available on the AMA’s website, and to promote awareness of this option, the AMA launched the “one patient, one measure, no penalty” campaign, which offers a step-by-step guide to completing the process. The AMA has also produced a MACRA podcast series on ReachMD, including an episode with tips for small practices.

There is also information available from the Physicians Advocacy Institute (PAI) regarding how physicians can avoid a 2019 Medicare payment penalty, as well as information regarding steps they will need to take in 2018 to avoid Medicare payment penalties in 2020.  MSSNY is a board member of the PAI.