February 9, 2018 – Keep Calm and Carry On!

Charles Rothberg, MD - MSSNY President

Charles Rothberg, MD
February 9, 2018
Volume 18
Number 6

Dear Colleagues: 

While traveling the state over the last year, I have had the pleasure of talking to physicians from different specialties as well as medical students—who are the future of our society.  The unique element that unites MSSNY is the passion and expertise that every physician brings to our society. That is why MSSNY continues to be one of the premier physician organizations in the world.   If our organization is going to compete with other interest groups that will continue to undermine and hurt our profession, this passion and vigor must continue.

Many of you are aware that a statute of limitations expansion bill has been signed over the strong objections of MSSNY.  While there is no way to sugarcoat the fact that this bill is not the comprehensive malpractice reform we aimed to achieve, there is no mistaking that without our activism, phone calls, letters and op-eds, this bill would have been far more damaging.

I am disheartened to hear that some physicians want to take their ball and go home. Some have indicated that they will end their participation in the legislative and political process. I urge them instead to redouble our efforts!

This counterproductive mindset will not improve our ability to improve medical care delivery in New York. Instead, it will make it far more difficult.  Now, more than ever, it is important to be involved.  I kindly ask you to think of one part of your practice and profession that isn’t impacted by laws or regulations decided on the federal or state level.  Healthcare proposals are constantly being introduced and debated that would impact reimbursement rates, expand the scope of practice for various professions, increase unworkable mandates on physicians and change the delivery of patient care.

It is for these reasons that many physicians continue to be active in the legislative and political process. This week, I attended a political event with several key elected officials, staff, lobbyist and other stakeholders along with our Immediate Past President Dr. Malcolm Reid, New York County Medical Society President-Elect Dr. Naheed Asad Van de Walle, Past NY County President Dr.  Michael Goldstein as well as other physician members and leaders.  We discussed a myriad of issues with other stakeholders as to how we can achieve our common goals and interests.

MSSNY continues to work with the Governor and both houses of the legislature to achieve a number of important reforms, to reduce our exorbitant liability costs, and to enact reforms that address various health insurer hassles. As noted below, we still have several adverse proposals that we need to rally to defeat.

To achieve these efforts, we need all of your help.

While MSSNY’s input is valued by many of our elected officials, various interest groups and their lobbyists are also out in force lobbying hard for their respective interests.  War chests from the trial lawyers and corporate interests are funding tremendous portions of political activity.  MSSNYPAC continues to be outspent nearly 5-1 by the trial lawyers. Moreover, we are outspent almost 3-1 by the dentists!

We need to educate our legislators on the reform we aim to achieve.  In order to continue all of our efforts and to remain a force to be reckoned with, we need your help.  MSSNYPAC is what gives physicians the political clout and resources we need to make a difference.  It is imperative that we all do a better job of trying to recruit members to MSSNY and to MSSNYPAC.

It is your future.  Together we really can make a difference.  Please join us in our efforts to make New York a better place to deliver needed care to our patients.

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

Physician Advocacy Day in Albany March 7-  Just 3 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!

We thank the many physicians who have already committed to come to Albany that day to join us in our advocacy efforts to improve patient care delivery across New York State.  We also thank the New York State Osteopathic Medical Society for integrating their physician Lobby Day with MSSNY’s.  If you have not yet registered, we urge you to join your colleagues from all around New York State and come to Albany to speak with your legislators and key policymakers to ensure they’re making the right choices for New York’s physicians and their patients.

Here are some our top issues for March 7:

  • Rejecting the Inappropriate scope of practice expansions proposed in the Executive Budget
  • Preventing big-box store owned medical clinics that will hurt community primary care delivery
  • Reducing excessive health insurer prior authorization hassles that needlessly delay patient care
  • Reducing the high cost of medical liability insurance
  • Rejecting unfair and counterproductive proposed Medicaid cuts to Patient-Centered Medical Homes
  • Preserving 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. Please contact your 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)

Please Contact Your Legislators To Oppose Various Misguided State Budget Proposals
The Senate and Assembly have been holding joint budget hearings over the last few weeks to examine Governor Cuomo’s proposed budget.  On February 12th, MSSNY will testify before the Senate Finance Committee and Assembly Ways and Means Committee regarding healthcare issues contained in the proposed budget.

MSSNY members are urged to continue to contact their legislators, and make phone calls, Facebook and Twitter updates, e-mail blasts and other forms of activism.  Please contact your 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.          
    • Patient-Centered Medical Home cuts
      This proposal would, for the period of 5/1/18-6/30/18, slash from $7.50 PMPM to $2 PMPM the Patient-Centered Medical Home (PCMH) add-on Medicaid payment that many primary care practices receive to help manage and coordinate needed patient care services.  Moreover, it would potentially require all PCMH primary care practices to have a Level 1 Value-Based payment contract on July 1, 2018, or face further steep cuts in PMPM payments. MSSNY together with the NY Academy of Family Physicians, NY Chapter of the American Academy of Pediatrics, and NY Chapter of the American College of Physicians, as well as the Community Health Care Association of New York, have expressed great concerns with these proposed changes.
    • 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.  (DIVISION OF GOVERNMENTAL AFFAIRS)

Congressional Budget Bill Repeals IPAB, Extends CHIP and Reduces 2019 Medicare Increase
The Continuing Resolution passed overnight Thursday into Friday by the US House and Senate to keep the federal government operating until March 23 contained a number of important health care provisions to help with with multi-year implications, including

  • Repeal of the Independent Payment Advisory Board (IPAB) – The IPAB was a Medicare cost-cutting Board that MSSNY, the AMA and many other physician associations had urged be repealed;
  • Extending the Medicare Geographic Index (GPCI) floor until 2020, which helps to prevent Medicare physician payment cuts to services provided across much of Upstate New York;
  • Extending funding for states for the Child Health Insurance Program for an additional 4 year. On top of the 6-year extension in funding that was enacted two weeks ago.
  • Extending flexibility to CMS in MIPS implementation, including:
    • Excludes Medicare Part B drug costs from MIPS payment adjustments;
    • Eliminates improvement scoring for the cost performance category for the second, third, fourth and fifth years of MIPS;
    • Allows CMS to reweight the cost performance category to not less than 10 percent for the second, third, fourth, and fifth years of MIPS;
    • Allows CMS flexibility in setting the performance threshold for years two through five to ensure a gradual and incremental transition to the performance threshold set at the mean or median for the sixth year;
    • Allows the Physician Focused Payment Model Technical Advisory Committee (PTAC) to provide initial feedback on models regarding the extent to which they meet criteria and an explanation of the basis for the feedback.
  • Extending funding for Community Health Centers for 2018 and 2019
  • Preventing cuts to Disproportionate Share Hospital (DSH) Funding for 2018 and 2019
  • Increases funding for Graduate Medical Education for 2018 and 2019

The final package also contains a problematic “pay-for” that would reduce the Medicare Part B conversion factor increase slated for 2019 from +0.5% to +0.25%. However, that is an improvement from a more adverse proposal that had been close to adoption earlier this week that could have produced Medicare physician payment cuts in both 2019 and 2020 as well as future years as a result of a direction to CMS to reduce “Mis-Valued Codes” in Medicare.  After extensive physician advocacy to their members of Congress, including from many MSSNY and County Medical Society leaders, this compromise provision for 2019 only was adopted. (AUSTER)

Bill to Prohibit Mid-Year Formulary Changes Passes Assembly
Legislation (A.2317-B, Peoples-Stokes) passed the Assembly this week supported by MSSNY and several other patient advocacy groups that would protect patients from unforeseen changes in prescription drug formularies during a health insurance policy year.  This bill would protect New Yorkers by preventing the imposition of higher out of pocket costs due to formulary and tier changes after the policy year begins.  The bill would prohibit a mid-year formulary switch or change to a higher cost-sharing tier  unless a) an AB-rated generic equivalent drug is added to the formulary at the same time; or b) the drug has been removed from the market.   In addition, it requires insures to provide notice to policyholders of the intent to remove a prescription drugs from a formulary or alter deductible, copayment or coinsurance requirements in the upcoming plan year, 30 days prior to the open enrollment period for the consecutive plan year.

Identical legislation has been introduced by Senator Sue Serino (S.5022-B), and has referred to the Senate Insurance Committee. (AUSTER)

Governor’s Budget Amendment Adds 11 Fentanyl Analogs to the Controlled Substance List
Governor Andrew M. Cuomo announced a 30-day budget amendment will be advanced to add 11 fentanyl analogs to the state controlled substances schedule and provide the New York State Health Commissioner the authority to add any new drugs that have been added to the federal schedule, to the state controlled substances schedule.  In recent years, fentanyl analogs have been increasingly found pressed into pill form to resemble name-brand prescription opioids, and in heroin and cocaine being sold in New York State.  The  30-day budget amendment will add these fentanyl analogs to Schedule 1 of the controlled substance schedules of New York State Public Health Law §3306. The 11 types of fentanyl to be added include: AH-7921; Acetyl Fentanyl; ButyrylFentanyl; Beta-Hydroxythiofentanyl; Furanyl Fentanyl; U-47700; and Acryl Fentanyl (or Acryloylfentanyl); N-(4-fluorophenyl)-N-(1-phenethylpiperidin-4-yl)isobutyramide; Ortho-Fluorofentanyl; Tetrahydrofuranyl Fentanyl; Methoxyacetyl Fentanyl.  The amendment also includes a provision to allow the New York State Health Commissioner has the authority to add to the state controlled substances schedule any new drugs that have been added to the federal schedule.  The proposed budget, including these amendments, must be voted on by the New York State Legislature. (CLANCY)

Learn More on Reducing Your Patients’ Risk of Radon Exposure
Health care providers play a key role in reducing their patients’ exposures to unnecessary radiation. With the rate of medical imaging and related radiation exposure increasing, it is even more crucial to reduce radiation exposure from other sources, including radon.  NYSDOH announces a new Radon guide for Healthcare Providers titled Reducing the Risk From Radon: Information and Interventions.  Please take a look at this valuable guide and help increase your patient’s knowledge about radon exposure. (HOFFMAN)


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)

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.  To share your current knowledge of the diabetes prevention program, click here to take a quick survey.

Live Webinar: Bending the Diabetes Curve
Tuesday, February 20th at 7:30am
Registration for this webinar is required, click 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-Registration for this live seminar is strongly suggested, click 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)

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  

CMS Rule Change Reduced Physicians’ Medicare Opt-Outs
The D Healthcare Daily (TX) (2/8) reports that after 7,400 physicians submitted paperwork to opt-out of Medicare in 2016, “the number cut in half last year, according to new data from the Centers for Medicare and Medicaid Services.” The piece attributes the decrease “to the end of a stipulation that required providers to renew their opt-outs every two years.” Dr. Charles Rothberg, president of the Medical Society of the State of New York, says clinicians, in wealthier areas, feel they can opt out because they can fill their practice with patients who have commercial insurance or can pay out-of-pocket.

CDC Data: One in Four Aged 45/Older Who Made 2015 ED Visits Had Diabetes
Findings published in the CDC’s National Center for Health Statistics Data Brief No. 301 state, “About one in four people aged 45 and older who made emergency department (ED) visits in 2015 in the United States had diabetes,” data from the 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) indicate. In fact, “an estimated 12 million ED visits that year were by patients aged 45 and older, representing 24% of ED visits by people in that age group and 80% of all ED visits by people with diabetes,” the data reveal.

Life Expectancy Falls for Second Consecutive Year: Substance Use and Suicides
“Life expectancy in the US has fallen for the second year in a row, thanks to a combination of drug and alcohol use and suicides, according to a study released online Feb. 7 in the British Medical Journal The drop in life expectancy was especially “large among middle-age white Americans and those living in rural communities, experts” found after examining “2016 data from the World Bank.”

AMA Warns Not to Divulge Social Security Number to Physicians

According to a 2016 annual survey from the Ponemon Institute, “about half of all health care organizations had little or no confidence that they could detect the loss or theft of patient data, and the majority lack the budget to secure their data.” The American Medical Association states on its website, “Our AMA policy is to discourage the use of Social Security numbers to identify insureds, patients, and physicians, except in those situations where the use of these numbers is required by law and/or regulation.” According to the Department of Health and Human Services, in 2015, “113.2 million health care-related records were stolen.”

Paying For Ridesharing Services May Not Reduce No-Shows
The findings published in JAMA Internal Medicine found that paying for poor patients to use “ridesharing services like Uber and Lyft” to reach “doctor appointments doesn’t make them any less likely to become no-shows than patients who have to find their own way there.”

2018 House of Delegates

Any 2018 HOD Resolutions Not in by Today Will Go to Convention Committee
Resolutions to be considered at the MSSNY House of Delegates meeting are due this week on FRIDAY, (FEBRUARY 9) AT 5 PM. This is a firm, no excuses deadline. Any items of business received after 5 PM will be forwarded to the Convention Committee on Rules, Credentials and Order of Business.  Authors, or their duly appointed representatives, must then attend the Rules Committee meeting on Thursday, March 22 at 3:00 PM, to explain why the resolution was submitted after the deadline.  The merits of the resolution are not discussed. Resolutions should be sent to lmayer@mssny.org, as an electronic document in WORD format.  Pdf files are not acceptable.  For guidance on the proper formatting of resolutions, see the MSSNY website under the 2018 HOD tab.

OTHER DEADLINES you may want to be reminded of:

    • Hotel reservations must be made by Sunday, February 18 in order to be assured of the MSSNY rate.
    • Dinner Dance reservations need to be made by Friday, March 9.
    • Information for booking your hotel room and making a reservation for the dinner dance is included on the MSSNY website.

Questions should be directed to Laurie Mayer lmayer@mssny.org

MSSNY Poster Symposium at HOD in Buffalo Needs Judges
We are looking for volunteer judges for MSSNY’s 13th annual Poster Symposium, which will be held on Friday, March 23, 2018, from 2:00 – 4:00 pm at the Adam’s Mark Hotel in Buffalo.

Each judge evaluates 10 posters among the 70 exhibited. Evaluation is based on a scoring system and generally takes about 1½ hours. Judges who wish to help choose the final winners may also attend a meeting at 4:30. You need not be an HOD delegate to be a judge. For guest judges who arrive before 1:30, lunch will be available.

Please contact sbennett@mssny.org or 516-488-6100 x 383


Medical Professionals’ Conference on Opioid Medication-Assisted Treatment

Including buprenorphine waiver training for MDs, NPs, PAs

When:        SATURDAY, MARCH 17

Where:       Cold Spring Harbor Laboratory, Cold Spring Harbor, NY

Program:   10:00-12:00 Overview of overdose prevention & MAT

                   12:00-1:00 Lunch & networking

                   1:00-5:00 Buprenorphine waiver training

                   1:00-3:00 Collaborative workshop for waivered prescribers


Across Long Island and across the United States, opioid users are dying because of the

inadequate infrastructure for buprenorphine and other medication-assisted treatments. More medical professionals are urgently needed who are committed and qualified to provide MAT –and more education and support are needed for these practitioners. This conference will include training that fulfills 4 hours of the in-person requirements for medical professionals to receive a DEA waiver to prescribe buprenorphine. Speakers and workshop Presenters: Lloyd Sederer, MD, Medical Director, NY State Office of Mental Health; Michael Delman, MD, President-Elect, NY Society of Addiction Medicine; Patrick O’Shaughnessy, MD, Medical Director, Catholic Health System of L.I.;  Adam Bisaga, MD and  Leslie Marino, MD, Columbia University Medical Center,

For more information, contact Dr. Marino at leslie.marino@nyspi.columbia.edu


FDA Commissioner: “Kratom Is an Opiate”
The FDA launched the latest attack on February 6 in a drawn-out war between regulators and patients over the safety of a popular herbal supplement called kratom, branding the plant a dangerous drug.

“Compounds in kratom make it so it isn’t just a plant — it’s an opioid,” FDA commissioner Scott Gottlieb declared in a statement.

Some users have argued that kratom is a safe way to treat pain and wean oneself off opioids, but the agency concluded otherwise — based on case reports and a computer analysis of the molecular structure of kratom ingredients. “Claiming that kratom is benign because it’s ‘just a plant’ is shortsighted and dangerous,” Gottlieb said. “After all, heroin is an illegal, dangerous, and highly-addictive substance containing the opioid morphine, derived from the seed pod of the various opium poppy plants.”

Gottlieb warned of side effects that could be caused by kratom, such as changes in neurological and cardiovascular function. He also cited 44 reported deaths “associated with the use of kratom.” In the past, advocates for the herbal supplement have argued that many of these cases involved other drugs besides kratom. While the DEA has already received the report it had requested from the FDA, this newly released evidence may influence the decision as to whether the substance should remain legal, the agency said Tuesday. A spokesperson could not say when that would be determined. “For any substance that goes through this process, it can be months, or it can be years,” said spokeswoman Katherine Pfaff. She added that a number of states have banned kratom, but for the time being, “federally, it is still a legal substance.”

2018 Adult Immunization Schedule for Includes Changes for Shingles/MMR

The CDC’s Advisory Committee on Immunization Practices has released its 2018 immunization schedule for adults in the Annals of Internal Medicine. Among the notable changes from last year:

  • Shingles: Two doses of the newly approved, recombinant zoster vaccine (RZV; Shingrix) is recommended for adults aged 50 and older regardless of their zoster or vaccine history. Those who’ve received the live zoster vaccine (Zostavax) may receive their first RZV dose at least 2 months later. Adults aged 60 and older may receive either vaccine, but RZV is preferred.
  • Mumps: Adults who have received two or fewer doses of a mumps-containing vaccine and are at risk for contracting mumps during a local outbreak should receive a dose of the measles, mumps, and rubella (MMR) vaccine.

Immunization schedule in Annals of Internal Medicine

Physician’s First Watch coverage of 2017 adult immunization schedule

CMS Proposal: Initial Opioid Scripts Limited to Seven Days
CMS is proposing that beginning in 2019, initial opioid prescriptions for acute pain be limited to 7 days. The agency is also suggesting in the 2018 Draft Call Letter that Medicare Part D prescription drug plans monitor patients who take medications considered to be “potentiators” of opioid misuse and opioid-related adverse events — specifically, gabapentin and pregabalin.

Noting an alarming increase in gabapentin use to treat pain and concurrent opioid and gabapentin use, CMS is asking for comment on whether it is useful to more closely monitor beneficiaries receiving these prescriptions.

The CMS proposal came as a US House committee took a closer look at Medicare’s oversight of opioid use. At the February 6 hearing, members of the Ways and Means Health Subcommittee said there are few data on opioid use among older Americans and that Medicare has done a poor job of encouraging prevention and treatment.

The agency said in its latest announcement that the system has reduced “very high risk overutilization of prescription opioids in the Part D program,” but “given the urgency and scope of the continuing national prescription opioid epidemic, we will propose new strategies to more effectively address this issue for patients in Part D.”

CMS proposes the following:

  • To have the OMS identify high-risk beneficiaries who use “potentiator” drugs (such as gabapentin and pregabalin) in combination with prescription opioids to ensure that plans provide appropriate case management. The agency noted in its proposal that in just 2 years (2015 to 2017), the rate of gabapentin users in Part D plans increased by 14%: from 93 to 108 users per 1000 enrollees. Opioid users had even higher gabapentin use.
  • To create a new quality measure that would track how well Part D plans flag concurrent use of opioids and benzodiazepines. The OMS already flags concurrent benzodiazepine use, but there is no follow-up mechanism. According to CMS, in late 2016, when the OMS began tracking concurrent use, 64% of beneficiaries flagged as potential opioid overusers had a benzodiazepine prescription. In 2017, after monitoring, the number had dropped to 62%.
  • That Part D plans to have a pharmacy point-of-sale edit that prohibits dispensing of any prescription that is more than a 90 morphine milligram equivalent, or a 7-day supply.
  • That all sponsors implement soft point-of-sale edits that alert when there is duplicative therapy of multiple long-acting opioids.

CMS is taking comments on the proposal until March 5 and will publish the final requirements on April 2.



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