February 2, 2018 – Turning Anger into Action

Charles Rothberg, MD - MSSNY President

Charles Rothberg, MD
February 2, 2018
Volume 18
Number 5

Dear Colleagues: 

Like you, I am angry at the final result of the Lavern’s Law malpractice issue.

As you have read, the final version addressed some problematic parts of the bill but it’s still a punch to the gut that many of our elected officials clearly do not understand how difficult it is be a doctor in New York, and how that affects availability of care in New York.

Our collective advocacy resulted in some needed changes to limit the retroactive impact and the cases to which the new rules apply, but it will still produce an increase in lawsuits and an increase in our already too-high liability premium costs.

Moreover, health care costs will go up as well because many physicians will believe they have no choice but to recommend to their patients additional diagnostic tests or referrals to specialists, beyond what they believe is clinically indicated, simply because such steps would need to be documented in the patient’s chart. We must re-double our efforts to be sure our policymakers are aware of New York’s physicians’ efforts to keep New Yorkers healthy, and to be an economic engine for our communities.  And to be sure—they are aware that there are practice opportunities in other states that are far more welcoming of doctors and of the services they provide to their communities.

There has never been a better time to step up our involvement in politics and advocacy. Please plan to be in Albany for Lobby Day on March 7 to demand needed liability reform as well as to assure that the Legislature address the problems we face assuring health insurers will cover the care our patients need.  Legislation has been introduced in the both the Assembly and the Senate to enact comprehensive reform including caps on non-economic damages similar to what has been enacted in many other states.

Please also be in Albany to help fight the numerous adverse proposals in the Governor’s proposed Budget that would jeopardize patient care by permitting independent practice for nurse anesthetists, patient drug management protocols between nurse practitioners and pharmacists, and medical care delivery by big corporations.

To register for Lobby Day, click here.

Whether you can attend the Albany event or not, we need more physicians involved in grassroots advocacy.  MSSNY has created a new program, the Physicians Advocacy Liaison (PAL) program, where physicians are “assigned” legislators to be their key contacts on pressing healthcare issues.  In fact, many of you may already have strong relationships with your local legislators that can aid us in our collective advocacy efforts. To join us in this important effort, please contact jbelmont@mssny.org

And, finally please join our PAC.  You may not want to hear it, but it must be understood that some of the challenges we face are the result of physician PACs being badly outspent by our adversaries.  Click here to join MSSNYPAC or to increase your contribution

There has never been a more important time to be involved in organized medicine.  Like me, you may be very angry at what’s transpired, but let’s turn that anger into action, and to make a difference in improving our practice climate.

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

Come to State Legislation Day! Let your voice be heard!

Capital Update

MSSNY’s Lobby Day (3/7) Just 4 Weeks Away! Register Today!
MSSNY’s “Physician Advocacy Day” will be held on Wednesday, March 7th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza, Albany NY. Click Here to Register!

Join your colleagues from all around New York State and come to MSSNY’s Physician Advocacy Day to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Join us to urge your legislators to:

  • Reject the Inappropriate scope of practice expansions proposed in the            Executive Budget
  • Prevent big-box store owned medical clinics that will hurt community primary care delivery
  • Reduce excessive health insurer prior authorization hassles that needlessly delay patient care
  • Reduce the high cost of medical liability insurance
  • Reject burdensome mandates that interfere with patient care delivery
  • Preserve opportunities for our medical students and residents to become New York’s future health care leaders

A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program. Physicians should coordinate with their County Medical Societies, which will be scheduling afternoon appointments for physicians to meet with their elected representatives.

If you have any questions/comments, please contact Carrie Harring at charring@mssny.org.  (HARRING)

MSSNY’s 2018 Budget Opposition Advocacy Priorities
Your participation in the legislative and political process remains critical.  While MSSNY’s input is valued by many of our elected officials, various interest groups will also be lobbying for their respective interest.  Please send a letter or call you legislators to urge them to oppose the following proposals contained in the proposed State Budget for 2018-19.

  • Expanding scope of practice for certified nurse anesthetists (CRNAs)

This provision would allow Certified Registered Nurse Anesthetists (CRNAs) to administer anesthesia without the supervision of a physician anesthesiologist or surgeon.  To urge your legislators to protect safe anesthesia care for patients please click here.

  • Authorizing Health Services Offered In Big Box Stores

This provision authorizes the delivery of health services in a retail setting such as a pharmacy, grocery store, or shopping malls.  Sponsors could include a business corporation.  Services to be offered would include treatment of minor episodic illnesses, episodic preventive and wellness services such as immunizations, administration of opioid antagonists, lab tests, and limited screening and referral for behavioral health conditions.

With the recently announced proposal of drugstore chain giant and PBM operator CVS to purchase health insurance giant Aetna, this could result in an explosion of retail clinics at the expense of community physician practices. To urge your legislators to reject corporate owned retail clinics, please click here. 

  • Comprehensive Medication Management Protocols

This proposal allows nurse practitioners and pharmacists to provide comprehensive medication management to patients with a chronic disease or diseases who have not met clinical goals of therapy and are at risk for hospitalization.  Urge your legislators to reject this inappropriate scope of practice expansion.  Click here to send a letter to your legislator.

  • Community Paramedicine

This proposal would allow emergency medical personnel to provide non-emergency care in residential settings.  While a laudable goal, the bill language only includes general references to collaboration with the patient’s treating providers, rather than specific requirements to communicate with actively treating physicians and other care providers.  To protect proper continuity and coordination of patient care with treating providers, please click here to send a letter to your legislator.

Other issues of concern in the proposed Budget for which MSSNY will be opposing:

  • Repealing “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.
  • Eliminating the Empire Clinical Research Investigator Program (ECRIP).
  • Consolidating 30 public health appropriations into four pools, and reduce overall spending by 20 percent. (BELMONT)

Governor, Legislature Agree To Revised Lavern’s Law Statute of Limitations Expansion
This week, the Governor and the Legislature reached an agreement and enacted “chapter amendments” to the “Lavern’s law” legislation (S.6800) that had passed the Legislature last June to expand the date to bring a malpractice lawsuit based upon an “alleged failure to diagnose cancer or a malignant tumor”. While under current law the plaintiff would have 2.5 years from the date of alleged negligent act to bring a lawsuit, under the new law, a patient would have 2.5 years from the date they discover or should have reasonably discovered the alleged negligence to file a malpractice lawsuit, up to 7 years from the date of the alleged negligent act.

After substantial advocacy from MSSNY, hospital associations, specialty societies, MLMIC, and individual physician and hospitals all across the State, amendments were made to lessen the adverse impact of the bill by a) fixing ambiguous language in the bill that could have greatly expanded the time to bring lawsuits for all potential medical malpractice cases, not just cancer cases; and b) to limit the retroactive impact of the bill.  However, despite the urging of MSSNY and other allied associations of the need to include needed reforms to our tort system, no such reforms were included in the final agreement.

While the changes to this legislation will help lessen the cost impact of this legislation, MSSNY President Dr. Charles Rothberg issued a statement calling the passage of this one-sided legislation that will still drive up physician liability and “Defensive Medicine” costs, a “lost opportunity by the Legislature and the Governor to address our longstanding dysfunctional medical malpractice adjudication system”.  His critical comments of the final result were reported in numerous papers, including the Daily News, Crains Health Pulse, and Politico-NY

Specifically, the amendments:

  • Clarify ambiguous language that would have applied the expanded the Statute of Limitations for all potential claims of malpractice, not just the alleged failure to diagnose cancer; and
  • Eliminate provisions that would have allowed plaintiffs to revive already-expired claims based on alleged acts of negligence that occurred up to 7 years prior to suit being filed. Instead, the effective date is for acts or occurrences up to 2.5 years prior to the effective date (January 31, 2018) – in other words, claims which had not yet expired. It would, however, provide a limited re-opener for claims that expired after March 31, 2017 under the old non-“Date of Discovery” rules, which must be filed by July 31, 2018.

MSSNY thanks the many physicians who took the time to send a letter or call the Governor, or write one of the numerous op-eds or Letter to the Editor that appeared in papers throughout the State raising concerns with the enactment of one-sided legislation when New York physicians and hospitals already pay exorbitant medical liability costs.

Once again, this highlights how essential it is for physicians to be part of the advocacy and political process.  Many physicians participate in grassroots efforts, but far more need to participate.  MSSNY has created a new program for physicians, the “Physicians Advocacy Liasion” for physicians to be assigned legislators to maintain ongoing grassroots contact.  Please contact jbelmont@mssny.org for more information.  Moreover, it is essential for physicians to be involved politically to help elect candidates for political office who better understand the concerns of physicians and the patients they serve.  Please click here for more information and to join MSSNYPAC.  (DIVISION OF GOVERNMENTAL AFFAIRS)

Governor, AG, Announce Lawsuit Against Federal Government To Protect Essential Health Plan Funding
Governor Andrew Cuomo and New York Attorney General Eric Schneiderman announced a lawsuit this week against the US Department of Health and Human Services (HHS) for ending $1 billion in federal funding for New York’s Essential Plan, which provides health insurance coverage for over 700,000 lower income New Yorkers who earn too much to qualify for Medicaid.  The lawsuit was also joined by the Attorney General of Minnesota, the only other state in the country with a similar health insurance coverage program.  The lawsuit, filed in the U.S. District Court for the Southern District of New York, alleges that HHS withheld legally-required funding owed to New York and Minnesota to operate their insurance program without adequate justification and in disregard of lawful procedure.

New York’s Essential Plan provides comprehensive health insurance coverage to over 700,000 New Yorkers who earn between 138% and 200% of the Federal Poverty Level.  Depending on income, some enrollees do not pay any premiums for this coverage, while others pay at most $20 per month.   There is no deductible for this coverage, and the plan covers preventive care without cost sharing.

MSSNY has written to the New York Congressional delegation on numerous occasions, both individually and in conjunction with other provider and patient associations, to urge continued funding for this program.  Bi-partisan legislation sponsored by Senator Lamar Alexander (R-Tennessee) and Senator Patty Murray (D-Washington), has been introduced that would continue necessary cost sharing reduction (CSR) health insurance subsidies including those that support New York’s Essential Plan. (AUSTER)

Commissioner’s Grand Round on Antibiotic Use and Resistance to Be Held Feb 28
New York State Department of Health Commissioner Howard A. Zucker, MD, JD, will host a Commissioner’s Grand Rounds on “Antibiotic Use and Resistance for the Practicing Physician”  on Wednesday, Feb. 28, 2018 from 8-10 a.m. at the Conference Center, Maria Fareri Children’s Hospital, Westchester Medical Center Campus, 100 Woods Road, Valhalla, NY 10595.   The presentation will strengthen clinicians’ understanding of antibiotic resistance, review recommended guideline-based approaches to antibiotic use for common outpatient adult and pediatric conditions, and describe evidence-based tools and approaches to assist providers in communication to patients about optimal antibiotic use. 

Faculty are:  Jeffrey Gerber, MD, PHD, Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine, Division of Infectious Diseases, Children’s Hospital of Philadelphia; Saul R. Hymes, MD, Medical Director, Pediatric Antimicrobial Stewardship, Assistant Professor of Clinical Pediatrics, Stony Brook University School of Medicine, Stony Brook Children’s Hospital and Belinda Ostrowsky, MD, MPH, Field Medical Officer, NY Division of Healthcare Quality Promotion (DHQP) Centers for Disease Control and Prevention.  Advance registration is requested and additional information and a link to the flyer can be found here(CLANCY)

MSSNY and AMA Working Together to Educate Physicians on Prediabetes
The Medical Society of the State of New York has partnered with the American Medical Association to bring its Prevent Diabetes STAT initiative to New York. MSSNY has created two free CME programs to educate New York State physicians on prediabetes prevention and the CDC’s National Diabetes Prevention program.

Live Webinar: Bending the Diabetes Curve
Tuesday, February 20th at 7:30am
Register for this webinar HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

House of Delegates Live Seminar: Bending the Diabetes Curve
Thursday, March 22nd, 2-3pm
Adams Mark Hotel, Buffalo, NY, Grand B
Pre-Register for this live seminar HERE.
Faculty: Geoffrey Moore, MD & Sarah Nosal, MD

* Must attend in person at the House of Delegates.

Educational Objectives:

  • Describe the trends in Type 2 diabetes and implications for clinical practice
  • Review evidence that supports referring patients with prediabetes to lifestyle change program
  • Outline the considerations for implementing a diabetes prevention initiative in a physician practice
  • Describe NYS specific incidents of prediabetes and diabetes in adult population
  • Understand the reimbursements mechanisms for DPP

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 each of these live activities 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 Carrie Harring at charring@mssny.org.                                                                        (HARRING, CLANCY)

NYS Osteopathic Medical Society and CEI Will Present Four Programs at Annual Conference
The NYS Osteopathic Medical Society, the NYS Department of Health, and Mount Sinai Institute for Advance Medicine  will present four discussions at the Osteopathic Medical Society’s Conference on April 15, 2018.   The four topics are:  “The Role of the Primary Care Clinician in HIV Care”; “PrEP for Women: Prevention Opportunities in Clinical Practice”; “Cirrhosis: What Clinicians Need to Know” and “Naloxone: Preventing Opioid Overdose in the Community”.  The programs will be held from 8 a.m. – 1:15 pm. At the Hyatt Regency Long Island, 1717 Motor Parkway, Hauppauge, NY  11788.  Registration is available here.

Further information is available by contacting nysoms@nysoms.org or (800) 841-4131 or Robert Walsh at robert.walsh@mountsinai.org or (212) 731-3791.  (CLANCY)

MSSNY’s CME LIVE Seminar “Current Concepts in Concussion in Pediatric and Adult Populations” in Syracuse on February 15th @ 6:30pm Registration Now Open
The Medical Society of the State of New York will hold a live Continuing Medical Education (CME) seminar entitled “Current Concepts in Concussion for Pediatric & Adult Patients” on Thursday, February 15, 2018 at 6:30pm, with light refreshments at 6:00pm, for all physicians and other health care providers.  Registration for the webinar is now open HERE, or contact Onondaga Medical Society at oncms@oncms.org or call (315) 424-8118.

Faculty for the course will be Robert Dracker, MD, MHA, MBA, CPI.

Educational objectives are:

  • Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology;
  • Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol;
  • Describe methods for the primary and secondary prevention of concussion;
  • Identify patients who would benefit from referral to a concussion specialist.

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.

For assistance in registering, please contact Melissa Hoffman at mhoffman@mssny.org      (HOFFMAN, CLANCY) 

Substance Use Disorders in Veterans” and “Suicide in Veterans” CME webinars on February 27 and March 26, 2018 Registration Now Open
Did you know that in a recent report, the New York State Health Foundation discovered that nearly HALF of veterans prefer to receive their care OUTSIDE of the VA system?

The Medical Society has created a free CME program series entitled Veterans Matters to assist New York State physicians in recognizing the unique health problems faced by veterans and the best way to provide care to veterans.  Two webinars are scheduled.

Register for Veterans Matters: Substance Use Disorders in Veterans on February 27th at 7:30a.m. here
Faculty: Frank Dowling, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention, and treatment options
  • Identify barriers to identification and treatment in military culture and methods to overcome them

March 26th at 7:30am – Veterans Matters: Suicide in Veterans
Register for this webinar here
Faculty: Jack McIntyre, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention and treatment options
  • Identify barriers to identification and treatment and methods to overcome them

To view all of MSSNY’s scheduled programs, click here and select “Upcoming”.

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 each of these live activities 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 Melissa Hoffman at mhoffman@mssny.org.                                                                  (HOFFMAN, CLANCY)

Nuclear Radiation and Blast Injuries” CME Webinar on February 21, 2018; Registration Now Open
The next Medical Matters continuing medical education (CME) webinar program is: Nuclear Radiation and Blast Injuries”.  This webinar will take place on Wednesday, February 21, 2018 at 7:30 a.m.   Arthur Cooper, MD, MS, Professor of Surgery at the Columbia University College of Physicians & Surgeons, Director of Trauma & Pediatric Surgical Services at the Harlem Hospital Center, and Affiliate Faculty at the National Center for Disaster Preparedness of the Columbia University Mailman School of Public Health will serve as faculty for this webinar.  Register for this webinar here. 

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

Educational objectives are:

  • Acquire a basic understanding of nuclear radiation and blast injuries.
  • Identify different types of nuclear exposure and blast injuries.
  • Describe the pathophysiology of nuclear exposure and blast injuries.
  • Explore treatment methods for blast injuries and nuclear radiation exposure. 

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.                          (HOFFMAN, CLANCY)

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  


DSRIP Networks Reap More Than $3B
Participating in DSRIP, the state’s multibillion-dollar Medicaid reform effort, had earned performing provider systems a total of $3.01 billion as of Sept. 30, according to a summary of results through DSRIP Year 3 released by the state Health Department on January 30. The 25 performing provider systems were awarded 95% of all available funds during that period and 81% of all performance-related funds.

“One indicator of PPS efforts in implementing their DSRIP projects is the number of patient engagements reported in the PPS quarterly reports,” the Health Department said in its summary. More than 3 million Medicaid patients were engaged in the projects in some capacity through the second quarter of DSRIP Year 3, the state said.

PPSs have so far completed projects related to such goals as integrating behavioral and primary health care, developing a comprehensive strategy for reducing the transmission of HIV/AIDS and expanding a home-based self-management program for asthma. 

State Marketplace Enrollments Hit New Record
The state’s open enrollment period concluded Wednesday with a record 4.3 million New Yorkers signing up for insurance through the New York State of Health marketplace—about 700,000 more than were enrolled in marketplace plans on Jan. 31, 2017, the state reported Thursday.

“The marketplace worked to get its message out and counter consumer confusion about coverage and enrollment deadlines,” the state said in its announcement.

After dropping by 10.7% last year, enrollment in Qualified Health Plans crept back up by 4.2% to 253,102 this year. Of those who signed up for Qualified Health Plans, some 59% qualified for financial assistance.

Meanwhile, Medicaid enrollment reached nearly 3 million as of Jan. 31, up 22.2% from the previous year. Despite federal cuts to Essential Plan funding, the state has continued advertising the plan, which now boasts about 738,850 members, up 11.1% from the end of the 2017 open enrollment period. Child Health Plus, which faced threats to its federal funding in 2017, enrolled 374,577 as of Jan. 31, up 25.2% from the previous year.

Enrollment in Medicaid, the Essential Plan and Child Health Plus is open throughout the year. (Crain’s 2/2)

New York’s AG Accuses Insys of Deceptively Marketing Opioid
On February1, New York’s Attorney Genera Eric Schneiderman filed a lawsuit seeking at least $75 million from the Insys Therapeutics Inc., which he said deceptively promoted a fentanyl-based cancer pain medicine for unsafe uses. He alleged that the drugmaker recklessly marketed its product Subsys for wider uses than the U.S. Food and Drug Administration approved and bribed doctors to prescribe it. “At a time when the opioid epidemic was ravaging New York, Insys Therapeutics allegedly marketed a drug illegally by blatantly disregarding the grave risks of addiction and death that opioids pose,” Schneiderman said in a statement.

Insys said it sought to address the challenge related to the misuse and abuse of opioids that has led to addiction and unnecessary deaths around the country. “We intend to continue working collaboratively and constructively with all relevant authorities to resolve our outstanding governmental investigations,” the company said in a statement late Thursday.

Insys has found itself at the center of several lawsuits and investigations focused on Subsys, an under-the-tongue spray intended for cancer patients that contains fentanyl, a synthetic opioid. Federal prosecutors in Boston have accused seven former executives and managers at Insys including billionaire founder John Kapoor of participating in a scheme to bribe doctors to prescribe Subsys and to defraud insurers. Prosecutors said that beginning in 2012, Kapoor, former Insys Chief Executive Michael Babich and others schemed to bribe medical practitioners by paying them to participate in sham speaker program events. Insys has said it is in settlement talks with the U.S. Justice Department and has estimated the minimum amount it may have to pay is $150 million.

The company has said that it has taken steps to prevent past mistakes from happening again and has stressed that Subsys made up 0.02 percent of opioid prescriptions in 2016. Insys previously agreed to pay $9.45 million to resolve investigations by attorneys general in Oregon, New Hampshire, Massachusetts and Illinois. It also faces lawsuits by attorneys general in North Carolina, Arizona, New Jersey and New Mexico. (Reuters, 2/1)


CMS Issues Update on Transition to Medicare Beneficiary Identifiers
Beginning in October and continuing through the transition period for the new Medicare beneficiary identifiers, the CMS will return both the Health Insurance Claim Number and MBI on the remittance advice when a provider submits a claim with a valid and active HICN, according to new CMS guidance. CMS plans to begin mailing new Medicare cards to beneficiaries in April, which will replace the Social Security-based number on the current cards with an MBI. Providers will have until Dec. 31, 2019 to transition to the new identifier for billing and other Medicare transactions. For more on the initiative, see the AHA’s July Regulatory Advisory for members. 

People Using Imodium to Get High: FDA Asking for Repackaging
Increasingly, people addicted to opioid painkillers are using dangerously high doses of the diarrhea drug Imodium (loperamide) either to get high or to help ease withdrawal.  On Tuesday the U.S. Food and Drug Administration said it’s putting new restrictions on the packaging of the medication, dubbed by some as “the poor man’s methadone.”

“When higher than recommended doses are taken we’ve received reports of serious heart problems and deaths with loperamide, particularly among people who are intentionally misusing or abusing high doses,” FDA commissioner Dr. Scott Gottlieb said in an agency news release.

Because opioid abusers are using the drug in greater numbers, the FDA is requesting that makers “change the way they label and package these drugs, to stem abuse and misuse,” Gottlieb said.

The FDA already slapped a warning on OTC loperamide labeling in the spring of 2017, cautioning users about the dangers of misuse. The latest changes relate to the drugs’ packaging. Specifically, packaging of Imodium should now only “contain a limited amount of loperamide appropriate for use for short-term [‘Traveler’s’] diarrhea according to the product label,” Gottlieb said. For example, that might mean a package would only contain eight 2-milligram capsules of the diarrhea drug in a blister pack, the FDA said. Taking more than prescribed or listed on the label can cause severe heart rhythm problems or death.

The new rules will also seek to eliminate the sale of loperamide in large bottles — sales that typically occur via the Internet, Gottlieb said.

Birth Defects Increased in U.S. Regions with Local Zika Transmission
The prevalence of birth defects potentially related to Zika virus increased in US areas with local Zika transmission in 2016, according to findings in MMWR.

Using birth defect surveillance systems in 15 U.S. jurisdictions, including Puerto Rico, researchers identified nearly 3000 infants and fetuses with birth defects potentially related to Zika in 2016. About half the defects were brain abnormalities such as microcephaly.

In areas with local Zika transmission, the prevalence of birth defects increased from the first to the second half of the year: After exclusion of neural tube defects (which aren’t strongly linked to Zika), the prevalence of defects rose from 2.0 to 2.4 per 1000 live births. This translated to 29 more defects than expected in those areas.

Increases were not seen in areas with only travel-related or no Zika transmission.

In a JAMA viewpoint, CDC director Dr. Brenda Fitzgerald and colleagues write, “The CDC continues to recommend that pregnant women not travel to areas with risk of Zika including US areas with endemic transmission. Furthermore, health care professionals should remain vigilant and consistently consider possible exposure to Zika virus during pregnancy.”

FDA Issues Educational Blueprint for Opioid Risk Mitigation Strategy
On, January 30, the FDA released a blueprint for educating health care providers that treat or monitor patients with pain under its forthcoming Risk Evaluation and Mitigation Strategy for companies that make opioid pain relievers. Accredited continuing education providers will use the blueprint to develop educational materials and activities for the REMS. FDA Commissioner Scott Gottlieb, M.D., said the revised blueprint includes more information on pain management and pharmacologic treatments for pain, including non-opioid pain relievers. 

DEA Targeting ‘Unusual or Disproportionate’ Opioid Dispensers Next 45 Days
The Drug Enforcement Administration will focus over the next 45 days on pharmacies and prescribers who are dispensing “unusual or disproportionate amounts” of prescription opioid drugs, Attorney General Jeff Sessions announced this week. “DEA collects some 80 million transaction reports every year from manufacturers and distributors of prescription drugs,” Sessions said. “These reports contain information like distribution figures and inventory. DEA will aggregate these numbers to find patterns, trends, statistical outliers – and put them into targeting packages. That will help us make more arrests, secure more convictions – and ultimately help us reduce the number of prescription drugs available for Americans to get addicted to or overdose from these dangerous drugs.” In August, Sessions announced the Opioid Fraud and Abuse Detection Unit, a new data analytics program focused on opioid-related health care fraud. 

ONC Webinar on the Draft Trusted Exchange Framework and Common Agreement (TEFCA)

February 15, 1:30-2:30 PM ET
Featured speaker: ONC Principal Deputy National Coordinator Genevieve Morris

Register here.

The Office of the National Coordinator for Health IT (ONC) recently released the Draft Trusted Exchange Framework for public comment. The 21st Century Cures Act requires ONC to develop or support a trusted exchange framework, including a common agreement among health information networks nationally. The Draft Trusted Exchange Framework focuses on policies, procedures, and technical standards that build from existing health information network capabilities.  The intent is to provide a single “on-ramp” to patient information regardless of what health IT developer, health information exchange or network is used, or how far across the country the patients’ records are located. Please join ONC for a webinar that will provide an overview of the Draft Trusted Exchange Framework and question and answer session with ONC Principal Deputy National Coordinator Genevieve Morris. Comments for the draft Trusted Exchange Framework need to be submitted to exchangeframework@hhs.gov before 11:59 pm ET on February 20, 2018. 




Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org

Medical Office Space Available – Levittown, NY
Prime location in a busy medical building at 2920 Hempstead Turnpike in Levittown, New York. 4,000 sq. ft. available on the first floor and 6,000 sq.ft. available on the lower level. Spaces can be rented together or divided. 64 parking spots, including handicap on premises.


  •  Large waiting area
  • 10 examination rooms
  • Spacious reception area with large file storage area
  • 2 bathrooms
  • Separate consult rooms
  • X-Ray ready room
  • Handicap accessible
  • Elevator to all floors
  • Security Cameras
  • Close to public transportation and major highways


    • Divided into 2 usable spaces; can be made into one
    • Private billing office space
    • 4 Bathrooms
    • 8 examination rooms
    • 3 consult rooms
    • 1 Kitchenette on one side of the space
  • 1 large kitchen and dining area on the other side of the space
  • Tenant to design open spaces to your liking

CONTACT:  Kathleen 631.833.4949 or kgunsberger@gmail.com

Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com

For Rent or Share (Half days or Full) – Union Turnpike, Queens
A brand new state of the art, beautifully appointed medical building has availability for turnkey share or rent on a busy artery of Queens.  Smartly located in the area bounded by the LIE to the north, Grand Central Parkway to the south, Clearview Expressway to the West and the Cross Island to the East, this office is easily accessible by car with ample parking available at all times of the day.  The building is located on the Q46 bus line with a stop only steps away.  Easy access to all major Queens and western Nassau county hospitals.  There is already in-house patient traffic so this is a great opportunity to build a satellite practice or to start a practice with potential cross-referral benefits.  Very reasonably priced starter options available. Please email queensmedicalhealth@gmail.com or call (917) 860-8307.


Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to jobs@hhchc.org. www.hometownhealthcenters.org

Pediatric Medical Director , NY State Office of Health Insurance Programs
The position of Medical Director of Pediatric Policy in the Office of Health Insurance Programs will focus on 4 primary initiatives over the next year, to include the First 1000 Days on Medicaid initiative, Value-Based Payment (VBP) Clinical Advisory Groups on Children’s Health and Maternity Care,  Children’s Health Homes and the Behavioral Health Transition into Managed Care, and Performance Measurement in the various quality programs. The Medical Director will collaborate with colleagues in the Department’s Office of Public Health and serve as a resource for Division staff who are seeking expert advice concerning medical and behavioral health issues involving children. For more information on how to apply, please go to this link: https://www.facebook.com/FuscoPersonnel/?sk=app_127890887255323&app_data=job-3059994

NYC Office of School Health PT and FT Positions for MDs and DOs
The New York City Office of School Health has both part-time and full-time job openings in the five boroughs for board certified/board eligible Physicians (MD, DO) specializing in Pediatrics, Adolescent Medicine, and Family Medicine with an emphasis on the school-aged population (K through 12) and/or Reproductive Health.

New York City School Health Physicians have flexible schedules (Minimum 20hrs/week to Maximum 35hrs/week).  Physicians working 20 or more hours per week receive comprehensive health insurance and other employment benefits.  Duties involve a balance of clinical work in New York City schools, administrative tasks, and public health assignments.  Work days are generally 9am to 5pm with no evening or weekend calls.  Physicians have the option to work or be furloughed during holidays and summers when schools are not in session. For more information, please send email inquiries to osh@health.nyc.gov. To apply directly online and for job descriptions, please upload your resume and cover letter to https://a127-jobs.nyc.gov. For the Field Doctor positions, School Health Physician (K – 8), enter Job ID 319959

For the CATCH Reproductive School Health Physician (High School) positions, enter Job ID 297081
For the Supervising School Health Physician Positions, enter Job ID 307390