Dr. Malcolm Reid
|February 24, 2017
On February 17, CMS awarded approximately $20 million to 11 organizations for the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 clinicians or fewer. These local, experienced, community-based organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas, including rural areas, health professional shortage areas, and medically underserved areas.
The training and education resources will be available immediately, and will be provided at no cost to eligible clinicians and practices. CMS also launched a new telephone helpline for clinicians seeking assistance with the Quality Payment Program at 866-288-8292 or firstname.lastname@example.org. For more information, visit the Quality Payment Program website. IPRO, with whom we have partnered with on several projects in the past, is one of the 11 recipient organizations. Questions can be sent to IPRO at email address: NY-QPP@atlanticquality.org or you can call IPRO at 1-866-333-4702.
We will keep you apprised of exactly how this will roll out and really assist physicians who, to date, have not gotten on board with Quality Payment Program.
National Advocacy Conference in DC
Next week is the AMA’s National Advocacy Conference in Washington. Due to a prior commitment, I cannot attend, but we have excellent representation from our MSSNY leadership that includes President Elect Dr. Charles Rothberg, Past Presidents Dr. Robert Goldberg and Dr. Robert Hughes, and Speaker Dr. Kira Geraci, as well as Executive Vice President of Government and Regulatory Affairs Moe Auster and our Executive Vice President Phil Schuh.
We will be meeting with our Senators Schumer and Gillibrand to outline our issues and identify how they can directly help MSSNY. At the actual conference we will be discuss medicine’s “big issues,” including prescription drug pricing, which has been a consistent concern for patients and their physicians. This problem has caught the bipartisan attention of Congress. The panel will discuss the rising costs and projected growth in spending on pharmaceuticals, the impact they have on patient access and adherence to medically necessary prescription drugs and suggested solutions. The AMA’s health care reform objectives highlight key elements that will guide continuing discussions with Congress and the Trump Administration.
Among these objectives are ensuring that low/moderate income patients are able to secure affordable and adequate coverage and ensuing that Medicaid, CHIP and other safety net programs are adequately funded. This week, Governor Cuomo warned that an ACA repeal could cost the state $3.7 billion in funding and throw 2.7 million New Yorkers off the healthcare rolls. Clearly, the potentially devastating impact this would have on health care delivery in New York State will certainly be raised by our leadership.
SAVE THE DATE! Physician Advocacy Day in Albany March 8!
Please send your comments to email@example.com
MSSNY Lobby Day (3/8) is Quickly Approaching! Register Today!
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, Albany NY. The program begins at 8 AM. If you have not already, please register here:. Joint hundreds of your colleagues from across the State who are coming to Albany on this day to meet with their local Senators and Assembly members, as well as hearing from New York’s top health care policymakers including:
- Senate Majority Leader John Flanagan;
- Assembly Majority Leader Joseph Morelle;
- Senate Health Committee Chair, Kemp Hannon; Assembly Health Committee Chair, Richard Gottfried: Senate Insurance Committee Chair, James Seward; Assembly Insurance Committee Chair, Kevin Cahill;
- Jason Helgerson, NYS Medicaid Director;
- Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services
Come meet with your legislators to urge that they:
- REJECT burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the Governor’s proposed State Budget;
- REJECT inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners;
- REJECT changes to increase burdensome physician prior authorization requirements contained in the proposed State Budget;
- SUPPORT legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
- SUPPORT legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up costs; and
- REJECT legislation that would impose costly and time consuming mandates on physician delivery of patient care.
A brief informal luncheon to which members of each House are invited to speak with their constituents will follow the morning program. In addition to registering here please contact your local county Medical Societies who will be scheduling appointments for physicians to meet with their elected representatives. If you have any questions/comments, please contact Carrie Harring at firstname.lastname@example.org or call 518-465-8085.
(DIVISION OF GOVERNMENTAL AFFAIRS)
Please Contact Your Legislators To Express Concerns With Several State Budget Proposals
The month of March brings with it an intensification of negotiations between the Assembly, Senate and Governor to meet the April 1 State Budget deadline. As these negotiations ensue, physicians are urged to continue to contact their elected officials regarding a number of State Budget proposals listed below. While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery. For example:
- We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels. However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians. Send a letter to your legislators here.
- Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or who have not met clinical goals of therapy. While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols. Send a letter to your legislators here.
- “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements. To send a letter to your legislators, click here.
- The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here.
- The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including “modernizing” Certificate of Need laws, and changing scopes of practice for non-physicians. Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval. Over a dozen specialty societies have joined MSSNY in a letter to the entire Legislature to urge that this proposal be removed from the budget, or remove the provision that enables these demonstration programs.
- Giving overbroad discretion to state officials to drop physicians and other prescribers from the Medicaid program based upon the “inappropriate prescribing of opioids”. (DIVISION OF GOVERNMENTAL AFFAIRS)
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
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.
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
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
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 email@example.com.
New York Physician Leaders to Head to Nation’s Capital Next Week
Several MSSNY physician leaders from across New York State will travel to Washington DC next week to join thousands of physicians across the country meeting with their Representatives and Senators fighting for needed improvements in health care delivery, and in opposition to proposals that would jeopardize health care access and coverage for their patients. The Hill visits are in conjunction with the AMA’s Annual National Advocacy Conference.
Specifically, physicians will be urging the enactment of legislation to ease some of the burdens associated with the new Medicare Merit-Based Incentive Payment System (MIPS), and to reduce hassles associated with Medicare audits initiated by Recovery Audit Contractors.
MSSNY will also be advocating for carefully considered reforms to the Affordable Care Act (ACA). Last month, MSSNY President Dr. Malcolm Reid wrote to New York’s entire Congressional delegation to express concern with efforts to repeal funding for coverage expansions authorized under the ACA without simultaneously specifying how it will be replaced.
Dr. Reid’s letter acknowledged the many concerns physicians have expressed with the impact of the ACA, but also noted that “the ACA has provided the opportunity for hundreds of thousands of New Yorkers to obtain affordable health insurance coverage that previously was not available to them” and that “elimination of the funding currently provided to New York State through these programs could drive a huge hole in our State Budget, and prompt untenable cuts affecting millions of more New Yorkers.” Therefore, he urged “that any legislation that threatens the availability of affordable health insurance options for our patients simultaneously specifies how these currently available coverage options will be replaced with improved coverage options”.
DFS Announces Comprehensive Investigation Into Insurer Contraceptive Coverage Compliance
Superintendent Maria Vullo announced this week that the New York State Department of Financial Services (DFS) is conducting a comprehensive investigation of health insurer compliance with contraceptive coverage requirements under New York Insurance Law, following an undercover sting of 15 insurers. The press release, noted a report that describes how DFS discovered that certain New York health insurers are providing consumers with incorrect information about contraceptive coverage.
The press release notes that, in its undercover sting, DFS identified 11 New York health insurers that had provided consumers with incorrect information about contraceptive coverage. Some health insurers were incorrectly telling callers that the consumer must pay for contraceptive drugs and devices, when both New York law and the ACA mandate such coverage. In addition, several health insurers incorrectly stated that a particular contraceptive drug or device is not covered, or that co-payments are required when they are not. The press release further noted that, as part of this comprehensive investigation, DFS will take several steps to correct any violations they find, including:
- Taking all necessary action to ensure that all health insurers in New York cover the full range of FDA-approved contraceptive delivery methods at no cost-sharing;
- Requesting a corrective action plan and related relief from health insurers found to have failed to provide accurate or complete information;
- Requesting information and documentation from health insurers regarding their coverage and reimbursement of contraceptive drugs and devices under health insurance policies. Specifically, DFS will be requesting information about contraceptive claims submitted and whether the claims were appropriately paid, with no cost-sharing imposed. DFS will also be requesting information about complaints and appeals involving contraceptive coverage.
AG Settles Case with Oxford for Improper Denial of Infusion Services
New York Attorney General Eric Schneiderman announced an agreement with Oxford Health Plan this week requiring Oxford to provide refunds to hundreds of small group plan members in New York State for improperly denying coverage of infusion services, including necessary supplies and nurse visits, since November 2015. According to the press release, the investigation began after an Oxford enrollee complained to the Attorney General’s Health Care Bureau Helpline that she began to receive bills from a provider of infusion supplies, when the infusion supplies had been previously covered by her plan. As a result of the AG’s inquiry, Oxford acknowledged that hundreds of other members’ infusion services claims were also improperly denied as well as claims for nurse home healthcare visits for the administration of infusion medication.
Specifically, Oxford identified a total of 2,587 claims that were improperly denied, totaling nearly $500,000. The agreement requires Oxford to mail letters to members notifying that they may have paid too much for infusion services, and setting forth the steps to secure a full refund; Re-examine all infusion claims from October 1, 2015; and pay $35,000 to New York State.
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 firstname.lastname@example.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)
Register Now For Upcoming Veterans Matters CME Webinars
The Medical Society of the State of New York encourages you to register for its upcoming Veterans Matters webinars. These programs include CME presentations on PTSD and TBI, as well as Substance Use Disorders. Faculty for these programs are Frank Dowling, MD and John McIntyre, MD. Registration for all of these programs is open. Just click on any of the presentation dates below.
Faculty Presenter: Frank Dowling, MD
The educational Objectives for the SUDs program are:
1) Explain substance use disorders (SUDs), symptoms, warning signs, comorbidities.
2) Explore treatment options for veterans including evidence-based practices in psychotherapy and pharmacotherapy.
3) Identify barriers to identification and treatment, including those unique to military culture, and how to overcome them.
Faculty Presenter: John McIntyre, MD
The educational Objectives for the PTSD program are:
1) Describe the symptoms of PTSD and TBI.
2) Describe the treatment modalities of PTSD and TBI.
3) Describe military culture & how to overcome unique barriers to treatment intrinsic to military culture
Additional information or assistance with registration may be obtained by contacting Greg Elperin at email@example.com.
Veterans Matters is a CME series made possible through a grant from the New York State Office of Mental Health. 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 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 more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:
For Your Patients: MY DRUG IS NOT COVERED. NOW WHAT?
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.
January 2018: New Paid Family Leave Regulations in New York
On February 22, Governor Andrew M. Cuomo announced that the state has filed regulations for the implementation of New York’s paid family leave program, the most comprehensive paid family leave program in the nation. The new regulations provide guidance to employers, insurance carriers and employees about their rights and responsibilities under the law. New York’s Paid Family Leave Law will provide for 12 weeks of paid leave when fully phased-in for employees who seek to take care for a new child, a close relative with a serious health condition or relieve the pressures created when a family member is called to active military service.
The Governor launched a new helpline (844) 337-6303 and a new website to answer questions and provide New Yorkers with more information about the new program. The state also issued a Request for Information to solicit information from potential vendors and develop a leave plan for state employees. The new policy will be phased in over a four-year period, beginning on January 1, 2018.
Beginning January 1, 2018, the state’s paid family leave program will provide employees with wage replacement during time away from their job in order to bond with a child, care for a close relative with a serious health condition, or to help relieve family pressures when someone is called to active military service. Employees are also entitled to be reinstated to their job when their leave ends, as well as the continuation of their health insurance. The regulations filed today provide regulatory guidance to employers, insurance carriers, and employees to clarify their rights and responsibilities under the program so that they can plan accordingly when the new law goes into effect.
The regulations also address eligibility, coverage, the phase-in schedule of the new program, and more information on how employees, employers, and insurance carriers will interact to pay out benefits. The full Workers Compensation Board regulations are available here. DFS regulations for insurance companies are available here. Eligibility: To be eligible for paid family leave, employees must have been employed full-time for 26 weeks or part-time for 175 days by a covered employer, at the time they apply for benefits.
The proposed paid family leave regulations are subject to a 45-day notice and public comment period following the publication in the New York State register before its final issuance. New York’s Paid Family Leave website, found at www.ny.gov/paidfamilyleave, has also been updated to reflect information based on the draft regulations. Information on the site will be regularly updated. The public is also encouraged to call the Paid Family Leave helpline at (844) 337-6303 with any questions.
To be eligible, employees must present certification from a health care provider treating the family member. For adoption and foster care of child, documentation is also required. Coverage: The program is included under an employer’s disability policy that all private employers must carry, and will be fully funded by employees through payroll deductions—beginning in July 2017. The program is mandatory for all private employers, and public employers may opt-in to the program.
SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details
United Accused of Overcharging Medicare through Medicare Advantage Program
UnitedHealth Group, one of the nation’s largest health insurers, is accused in a scheme that allowed its subsidiaries and other insurers to improperly overcharge Medicare by “hundreds of millions — and likely billions — of dollars,” according to a lawsuit made public at the Justice Department’s request. The accusations center on Medicare Advantage, a program through which people 65 or older agree to join private health maintenance organizations, or HMOs, whose costs the government reimburses.
The program was created in 2003 after UnitedHealth and other insurers said that managed care could help contain the overall cost of Medicare. Instead of slowing Medicare costs, UnitedHealth may have improperly added excess costs in the billions of dollars over more than a decade, according to the lawsuit, which was unsealed in Federal District Court in Los Angeles.
GOP Aims to Push HSAs to Consumers to Lower Healthcare Costs
The AP http://apne.ws/2mfijET reports the Federal government may begin pushing consumers to help reduce healthcare costs. While the fate of the Affordable Care Act remains uncertain, “Republicans indicated last week that they will encourage wider use of insurance that comes with a health savings account aimed at pushing patients to save and shop for care.” They are convinced that when consumers’ “money is on the line – and not the insurance company’s” – they will shop around for the best value and do their “part to curb national health care spending.”
CMS Streamlines ICD-10 Resources
To streamline your access to resources, CMS has merged all up-to-date content from our Road to 10 website to our main ICD-10 site, cms.gov/ICD10.
We are now phasing out the Road to 10 site, with an anticipated completion date of April 3.
Please be sure to update all your bookmarks and links for Roadto10.org to point to cms.gov/ICD10.
After the successful transition to ICD-10, we noted that:
- Visits to the Road to 10 website dropped sharply
- Most users were opting to visit cms.gov, not Road to 10, for ICD-10 information
MSSNYPAC – The Political Voice for New York’s Physicians
Significant victories have been hard won by physicians. Numerous administrative simplifications have been achieved. E-prescriptions will soon be permitted to be transferred from pharmacy to pharmacy! Reporting to the DOH is no longer necessary when you have to write a paper prescription! Health insurer step therapy medication protocols can be more readily overridden!
Health insurer credentialing times have been shortened! These and the many other victories the physician community achieves are possible when physicians work collectively on the three important fronts of advocacy – Lobbying, Grassroots and Political. If any one area lacks, all areas are weakened. Like joining MSSNY, or sending letters or making calls in support of important measures, Your support of MSSNYPAC is essential to our collective advocacy successes. Help pave the way for more victories!
Join or increase your support and participation today at www.mssnypac.org/contribute.
CDC Report: Season’s Flu Vaccine Has Been 48% Effective So Far
According to a report from the Centers for Disease Control and Prevention, the flu vaccine has been 48% effective so far this season.
Weekly Charting Tip: What is the cause of the vast majority of social media poor reviews? Poor patient service; NOT poor patient care. Return phone calls and attempt to realistically appoint your patients. If the physician is delayed due to an emergency, immediately explain this to the people waiting. Perhaps, proactively call the later patients that will be affected by the delay; like some airlines are now doing.
If you have any questions, please contact Kern Augustine, P.C. at 1-800-445-0954 or via email at info@DrLaw.com.
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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 firstname.lastname@example.org 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.
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 email@example.com. No recruiters please.
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 firstname.lastname@example.org. No recruiters please.