February 17, 2017 – Overreaching Prosecution re Opioids?

Dr. Reid - MSSNY President
Dr. Malcolm Reid
February 17, 2017
Volume 17
Number 7

MLMIC Insurance

Dear Colleagues:

Several physician leaders of the Erie County Medical Society and MSSNY met with the Buffalo News editorial board this week to express concerns about the impact to patient care as a result of statements made by various prosecutorial agencies regarding their intention to prosecute more physicians for inappropriate prescribing of opioids. The participants included: MSSNY Vice President Dr. Thomas Madejski, Erie County Medical Society President Dr. Timothy Gabryel, former MSSNY House of Delegates Speaker (and former AMA President) Dr. Nancy Nielsen and Medical Society of Erie County Executive Director Christine Nadolny.

The physicians emphasized the extensive efforts of the medical community to respond to the opioid abuse crisis. They also recognized the appropriateness of criminal prosecution in certain instances where prescribers are intentionally writing prescriptions for diversion purposes.  However, they also emphasized that it is wrong to prosecute physicians for medical decision-making, as such efforts could intimidate physicians into greatly limiting their prescriptions for necessary medications, which in turn would greatly narrow treatment options for patients.

It is yet another reason for physicians to come to Albany for MSSNY’s Physician Advocacy Day on March 8 to make sure their legislators are aware of the possible narrowing of treatment options for patients due to potentially overly aggressive efforts to prosecute.

SAVE THE DATE!  Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

MSSNY Lobby Day Scheduled for March 8TH – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 8th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.

Physicians are urged to come to Albany to participate in MSSNY’s lobby day to give firsthand accounts on the current needs in health care, lobby for the positive provisions included in the proposed state budget and stop several proposals that could have an adverse impact on physician care delivery.

If you plan to attend, please register here.

The morning program will begin at 8 AM, after which physicians will have the opportunity to have meetings with their local Senators and Assemblymembers.   A full slate of legislators and key policymakers have been confirmed to participate in the morning program including:

  • NYS Senate Majority Leader John Flanagan;
  • Jason Helgerson, NYS Medicaid Director;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and top health care staff at DFS have been invited.

A brief informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.   In addition to registering here please contact your county medical societies, as they will be scheduling appointments for physicians to meet with their local Assemblymembers and Senators.
(DIVISION OF GOVERNMENTAL AFFAIRS)                                                      

MSSNY Testifies at Health Budget Hearing
Division of Governmental Affairs’ Senior Vice President / Chief Legislative Counsel Moe Auster testified at a joint public hearing on the health care budget this week.

MSSNY stressed the need for lawmakers to reduce burdensome prior authorization hassles and not increase already overwhelming overhead costs borne by physicians.  In this regard, the testimony included support for the continued funding for the Excess Medical Liability Insurance program while stressing our opposition to the proposed tax clearance obligation as a condition for Excess coverage which could serve as an impediment to timely issuance of the Excess policy.

MSSNY also expressed support for budget proposals that call for the regulation and taxation of E-cigarettes in the same manner as tobacco cigarettes, and the registration and regulation of Pharmaceutical Benefit Manager (PBMs).

MSSNY outlined concerns with a proposal that would allow pharmacists to enter into “comprehensive medication management protocols” with nurse practitioners to manage, adjust and change the medications of certain patients. While similar collaborative drug therapy programs exist in the hospital environment, only physicians are currently permitted to enter into these protocols.

Additionally, MSSNY expressed concerns regarding the Health Care Regulation Modernization team proposal that would be empowered to review and propose fundamental restructuring of statutes, policies and regulations including certificate of need rules and clinician scope of practice laws.  Of greatest concern, the proposal appears to allow various state agencies the ability to implement “demonstration programs” to test and evaluate procedures and processes for organizing, financing and delivering health care services that are not permissible under current statute or regulation.

MSSNY also urged that outstanding Health Republic claims be paid in full.  DFS Superintendent Maria Vullo gave a presentation at the hearing regarding her extensive efforts to oversee the liquidation of HR including the possible initiation of litigation to collect “Risk Corridor” payments as other states have done.

To read MSSNY’s full testimony, please click here.                                           (DIVISION OF GOVERNMENTAL AFFAIRS STAFF) 

MSSNY OFFERS 3 Hour CME Program on Pain Management, Palliative Care and Addiction; NYS Requires Every Prescriber to Take 3 Hour Course By July 1, 2017
The Medical Society of the State of New York announces a series of three one-hour CME webinars on pain management, palliative care and addiction.  New York State statute requires all prescribers holding a DEA license to complete three hours of coursework no later than July 1st, 2017.   These webinars are being offered FREE OF CHARGE to MSSNY members with a discount code.  The discount code has been provided to MSSNY members.  Non-MSSNY members will be charged $150 for the series.

The Medical Society of the State of New York has worked with the New York State Office for Alcoholism and Substance Abuse Services in the development of this program.   Following the webinars, the course will be offered on-line on the MSSNY CME site.   The program will be offered to MSSNY members free of charge and there is a non-member fee of $150 for the on-line series.

The three webinars cover all issues required in the New York State statute and participation is only by computer, or with the Webex app.

Webinars will be held on:

Thursday, March 9, 2017—7:30-8:30am

Understanding the Current Legal Landscape in New York State for Prescribing Controlled Substances

Faculty: Patricia Bruckenthal, PhD, APRN-BS, FAAN & Trishia Allen, Esq.

Educational Objectives:

Understand New York State and Federal Requirements for Prescribing Controlled Substances

Discuss Guidelines for Chronic Pain

Register for this webinar here 

Tuesday, March 14, 2017—7:30-8:30am

Rational Opioid Prescribing for Chronic Pain Conditions

Faculty: Charles Argoff, MD & Patricia Bruckenthal, PhD, APRN-BS, FAAN

Educational Objectives:

Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessments and documentation

Describe palliative medical care and end-of-life care

Register for this webinar here 

Tuesday, March 21, 2017—7:30-8:30am

Patients with Opioid Use Disorders: Identification, Treatment, and Management of Co-occurring Pain

Faculty: Jeffrey Selzer, MD, Charles Morgan, MD & Frank Dowling, MD

Educational Objectives:

Describe the Potential for Addiction, Patient Screening, Diagnosis and Subsequent Treatment or Referral.

Recommend Tools to Assist in the Identification of High-Risk Patients for Whom Opioids are Indicated and Prescribed.

Describe Strategies for Treating Pain in Patients with Substance Use Disorders.

Register for this webinar here 

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 Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Additional information or assistance with registration may be obtained by contacting Pat Clancy at pclancy@mssny.org

Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!

Physician Uproar Over Kinney Drugs’ New Strep and Flu Testing Program
This week MSSNY alerted state Department of Health and State Education Department officials to the concerns raised by several physicians regarding a new program from Kinney Drug Stores in 10 Onondaga County locations to conduct “rapid tests” of customers for strep and influenza and facilitate telemedicine treatment for these customers if these initial tests are positive.  These physicians’ concerns were extensively documented on a local Syracuse television station this week.

Several physicians have been in contact with Kinney officials directly questioning whether Kinney has legal authority to do this, as well as whether this could adversely impact patient health because of the possibility of “false positives” and “false negatives”.  These initial conversations have resulted in Kinney increasing from 13 to 18 the minimum age of customers who could be rapid tested for strep and flu.  Kinney representatives have noted that its actions are legal because these sites have been approved by New York State to perform rapid strep and flu tests under the supervision of a physician medical director as these are “CLIA waived tests”.

MSSNY staff has also been in touch with Kinney representatives, and will be facilitating dialogue between local county medical society physician leaders and Kinney representatives to discuss how best to assure patients’ health.

Details on Federal Health Care Changes Start to Emerge
House Republicans have released an outline of how they would repeal and replace the Affordable Care Act.  Their plan would include giving states the power to design their own plans, increasing the amount individuals can put in their Health Savings Accounts and allows individuals and families to spend money from their HSA on “over-the-counter” health care items.  Their plan also includes a monthly portable tax credit that can be used to buy a health insurance plan that would be based on age. Of greatest significance to New York State, it would phase out the Medicaid eligibility expansion contained in the ACA.

The Centers for Medicare & Medicaid Services (CMS) also issued a proposed rule this week that would make the following changes, with the goal of helping to stabilize the individual and small group market.

  • Expand Pre-Enrollment verification of eligibility
  • Allowing an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year’s plan with the same issuer.
  • Provide greater flexibility to insurers to offer varying coverage options.
  • Give states the authority to assess issuer network adequacy.
  • Shorten the upcoming annual open enrollment period for the individual market.

Aetna-Humana Calls off Its Merger and Cigna Sues to End Merger with Anthem
While Aetna and Humana announced that they were ending their proposed merger this week, a federal judge temporarily blocked Cigna from immediately terminating its proposed merger agreement with Anthem, after Cigna earlier this week sued Anthem seeking to end the agreement.  These actions follow recent rulings blocking these proposed mergers from moving forward.  These proposed mergers had been challenged by several patient advocacy and physician advocacy organizations including the American Medical Association and MSSNY because of the very significant market impact the mergers would have had in various regions across the country, and in New York.  Last fall, MSSNY President Dr. Malcolm Reid and AMA representatives testified at a New York Department of Financial Services (DFS) hearing to express strong concerns with the proposed merger of Anthem and Cigna.                        (AUSTER)

DOH Provides Information on New Breast Cancer Screening and Diagnostic Imaging
In July 2016, Governor Andrew M. Cuomo signed legislation to help more women get breast cancer screening and diagnostic imaging. The legislation prohibits insurers in New York from requiring cost-sharing for women who get these services. A copy of the letter that the New York Department of Financial Services sent to insurers about the new requirements can be found here.

No cost-sharing means that women who have health insurance policies covered by this law do not have to pay any out-of-pocket costs for breast cancer screening and diagnostic imaging. This means that insurers cannot apply the services against annual deductibles and also cannot charge patients a co-payment or coinsurance.  Important note: no cost-sharing applies only when services are delivered by a provider in your health plan’s network. Services may not be covered at all if delivered by a provider outside of your health plan’s network. The law removes cost-sharing for mammograms, including:

a single, baseline mammogram for women 35 to 39 years old, yearly mammograms for women 40 years of age or older, and mammograms for women at any age who are at an increased risk of breast cancer because they have a prior history of breast cancer, or they have a first degree relative (e.g., parent, sibling, child) with breast cancer. The law also removes cost-sharing for women in need of imaging tests other than standard mammograms – such as diagnostic mammograms, breast ultrasounds, and breast magnetic resonance imaging (MRI) for the detection of breast cancer.  Additional information can be found here.  (CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, March 15, 2017 at 7:30 a.m. with Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now open for this webinar here just click on “Upcoming”.

The educational objectives are: 1) Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

MSSNY designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity.  (CLANCY, HOFFMAN)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:

pschuh@mssny.org mauster@mssny.org         pclancy@mssny.org   jbelmont@mssny.org

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MSSNYPAC – The Political Voice for New York’s Physicians
Supporting MSSNYPAC with a financial contribution is an important investment in the preservation of our noble profession.   You can help to strengthen the physician’s political voice to help direct the shape of healthcare policy.  Physicians face opposition on many fronts.  Therefore, we need to be prepared with a well-funded MSSNYPAC to support the candidates who truly understand the concerns of physicians trying to assure their patients receive the best possible care.  In light of what’s at stake, isn’t it time you lent your voice to our efforts?  Join or increase your support and participation today at www.mssnypac.org/contribute

MLMIC Shares Anticipated Timeline for Berkshire Hathaway Transaction

Dear MSSNY Member:

As you know, in July of 2016, your endorsed carrier MLMIC announced its intention to be acquired by Berkshire Hathaway. We’re pleased to advise you that the transaction is on track and progressing forward in accordance with the measures and actions required under New York Insurance Law Section 7307 (NYIL §7307), designed to protect “the interests of the policyholders and the public.” We are, however, disappointed that the process is taking slightly longer than anticipated.  As you know, we anticipated a culmination of the process in the third quarter of 2017. We are now hopeful that the process will be completed by year end 2017.  As such, policyholders can expect several major milestones to occur between now and the expected close of the transaction.  The estimated timeline for these milestones is currently as follows:

  1. In accordance with NYIL §7307, MLMIC is being examined by the NYS Department of Financial Services (DFS) to assess the financial condition of the Company. That examination is expected to be completed during the second quarter of 2017.
  2. In accordance with NYIL §7307, the DFS will also conduct an independent valuation of the Company to assess the fairness of the cash consideration to be paid by Berkshire to owners of eligible MLMIC policies from July 14, 2013 through July 14, 2016. This valuation is expected to be completed during the third quarter of 2017.
  3. In accordance with NYIL §7307, once the examination and independent valuation are done, MLMIC’s Board will request permission from the Superintendent to submit a Plan of Conversion for approval by DFS. MLMIC will then prepare and disseminate detailed information regarding the Plan of Conversion to all of those who are eligible to vote (i.e. those who were policyholders on July 14, 2016) on this transaction.  The Superintendent will then hold a public hearing regarding the Plan of Conversion.  Following this hearing, the Superintendent will review the Plan of Conversion, and if approved, will authorize MLMIC to conduct a vote.
  4. In accordance with NYIL §7307, we expect to hold a vote of those eligible to vote on this transaction during the fourth quarter of 2017. If two-thirds or more of those voting elect to proceed with the transaction, the transaction will close and Berkshire will authorize distribution of payments shortly thereafter.

As we progress forward and achieve these milestones, we will provide an update via MSSNY E-News, and on MLMIC’s blog and the “Frequently Asked Questions” webpage. If you have any questions about the transaction, please call 1-888-998-7871.

Thank you for your continued support as we complete this exciting transaction that will deliver a significant financial benefit to those who owned an eligible policy from July 14, 2013 through July 14, 2016 and will enable us to continue to serve our policyholders with high quality liability insurance for many years to come.

Robert A. Menotti, M.D.
President, MLMIC


Physician Lobby Day in Albany
Wednesday, March 8th, 2017
Call Your County Medical Society for Details

New York Investigating Three Cases of Leptospirosis in Bronx Neighborhood
The New York Times (2/14) reported that the NYC Department of Health and Mental Hygiene “is investigating three recent cases” of the rare disease leptospirosis “that have occurred in the Grand Concourse neighborhood of the Bronx.” Leptospirosis “infections commonly occur through exposure to rat urine,” and the city has “taken ‘immediate measures’ to reduce the rat population in the area and” educate residents about the disease.


With the rising cost of healthcare today, families are in need of assistance.  The New York Rx Card can help with those prescription costs and is a free program available to all New York residents.  No eligibility requirements or forms to fill out, simply take the card into the pharmacy to receive savings of up to 75% on prescription medications for the whole family.  New York Rx Card is a proud supporter of Children’s Miracle Network.  A donation will be made to your local CMN hospital each time a prescription is processed through the New York Rx Card.  Go to www.newyorkrxcard.com and print your free card today.

Travel Ban Creates Uncertainty for Upcoming Match Day
The Chicago Tribune (2/11) reported that the “continuing uncertainty surrounding” President Trump’s travel ban “has international medical school graduates and teaching hospitals on edge.” According to the national Resident Matching Program, “about 14 percent of residents who matched through the main matching program – more than 3,700 people – were non-U.S. citizens who graduated from medical schools outside the U.S.” The article points out that the American Medical Association “has asked the Trump administration for guidance on Trump’s order to ensure it doesn’t keep out qualified med school grads or leave hospitals with unfilled training spots.”

AMA President Andrew W. Gurman said, “International medical graduates have been a resource to provide medical care to areas that don’t otherwise have access to physicians. With the current uncertainty about those physicians’ immigration status, we don’t know whether or not these areas are going to receive care.”

Over 65: Taking At Least Three Psychiatric Meds More Than Doubled in Nine Years
“The number of retirement-age Americans taking at least three psychiatric” medications “more than doubled between 2004 and 2013, even though almost half of them had no mental health diagnosis on record, researchers” found after analyzing “data from annual government surveys of office-based” physicians. In particular, investigators “focused on office visits by people 65 or older that resulted in the prescribing of at least three of a list of psychiatric, sleep and pain medications.” The findings were published online Feb. 13 in a research letter in JAMA Internal Medicine.

Two Upstate New York Medical Groups to Merge
The Schenectady Daily Gazette (2/9) reports that Community Care Physicians and CapitalCare Medical Group are planning to merge. When combined, the two “will offer urgent care, primary care and care in 30 specialties at more than 50 locations across the Capital Region.” The article reports that additional details will be released Friday “when Dr. Shirish Parikh, CEO of Community Care, and Joan Regan Hayner, CEO of Capital Care, make a formal announcement of the plans at a news conference.”

Pediatrics: Drunk Driving Contributes To More than One in Four Crashes among Young
Research suggests that drunk driving “contributes to more than one in four motor vehicle fatalities for children, teens and young adults [in the United States] – and nearly half of these deaths happen at night or on weekends.” Researchers “analyzed crashes that occurred from 2000 to 2013 and involved at least one driver with a blood alcohol level of at least 0.08 percent, the legal limit in most states.” People killed in motor vehicle crash fatalities involving alcohol were “predominantly male (73 percent) and most were at least 18 years old.” The findings were published in the journal Pediatrics.


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Modern/High End Office (Upper East Side)
Large and Modern office to share.  Located on the ground floor.  2+ treatment/exam rooms, large waiting room, private office, storage.  Price is negotiable for 1-3 day/week.  Call Dr. Austin 5189284819 or email ian@caneandaustin.com No broker fee.  Craig Austin, M.D. 120 East 64th Street, NYC 10065

Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Physician Opportunities

A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.