January 20, 2017 – Positive Provisions in the Proposed $153B Budget

Dr. Reid - MSSNY President
Dr. Malcolm Reid
January 20, 2017
Volume 17
Number 3


Dear Colleagues:

This week, our Government Affairs Division outlines Governor Cuomo’s proposed budget for 2017-2018 highlighting items that relate to New York State physicians.

Malcolm Reid

Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org

Governor Proposes $152 Billion Budget for 2017-18
This week Governor Cuomo released his proposed $152.3 billion spending plan for the 2017-18 Fiscal Year.  The Budget proposed is to address a $3.5 billion budget deficit and a proposed increase of $1 billion in education aid in part by retaining the “millionaires’ tax” for an three additional years. At the same time the Governor proposes to reduce income taxes for those with incomes of $300,000 or less.  The budget would also extend for an additional three years the health financing mechanisms of the Health Care Reform Act (HCRA) for a variety of public good programs.

Among the positive provisions in the proposed Budget:

  • Funding for the Excess Medical Malpractice program would be continued at its historic level of $127,400,000;
  • Funding for MSSNY’s Committee for Physicians Health would be continued at its historic level of $990,000;
  • Re-appropriating $300,000 for MSSNY’s Veterans Health Care Initiative.
  • E-cigarettes would be taxed in the same manner as tobacco cigarettes.
  • Requiring the registration and regulation of Pharmaceutical Benefit Manager (PBMs)

Some of the items of significant concern in the proposed budget include:

  • Physicians would be required to receive a “tax clearance” as a pre-condition to receiving Excess Medical Malpractice Insurance coverage;
  • “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;
  • Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage and adjust the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.
  • Creating a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including: modernizing Certificate of Need laws; “creating more flexible rules on licensing and scope of practice for clinicians and caregivers” and “increasing flexibility of state agency regulations governing the delivery of and reimbursement for telehealth programs;
  • Making the “inappropriate prescribing of opioids” an unacceptable provider practice in the Medicaid program, giving the State discretion to remove a physician or other prescriber from the program.

Other items of note within the proposed Budget include:

  • Reducing prescription drug costs by making drug companies pay a surcharge when costs exceed a certain benchmark to be determined by a Drug Utilization Review Board within the NYS Department of Health;
  • $150 million for a life sciences laboratory public health initiative;
  • Increase cost-sharing for certain enrollees in the State’s Essential Plan;
  • Requiring the testing of public water systems every 3 years for contaminants

MSSNY staff is continuing its review of the thousands of pages of budget documents and will follow up with further information.  The state Senate and Assembly have scheduled a February 16 public hearing to receive comments regarding concerns with the proposed Health Budget, at which MSSNY will testify.

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

A full slate of legislators and key policymakers have been invited to dialogue with Advocacy Day participants including:

  • Jason Helgerson, NYS Medicaid Director;
  • Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief luncheon to which members of each House are invited to speak with their constituents will follow the morning program.  County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Shifts in Medicare and Medicaid payment methodologies are producing enormous changes in our health care delivery system that is affecting how patients receive care.  These changes are profoundly affecting the daily lives of physicians and the patients they serve.  At the same time, actions are being taken by the health insurance industry to greatly shrink their networks at the expense of long-standing physician-patient relationships, and increasing burdensome prior authorization requirements.

Adding to this uncertainty are the consequences to New York State’s extensive health insurance coverage programs if proposals under consideration by Congress to repeal the Affordable Care Act were to be enacted.

Please come to Albany to make your legislators aware of these challenges!

Bill Introduction Update
Over the last several weeks, the State Legislature has introduced thousands of bills.  The Governmental Affairs team will continue to monitor and advocate where legislation will  have an impact on physicians and medical services in New York State. Several scope of practice bills have been introduced that MSSNY opposes:

  • Licensing of genetic counselors (A.2275 Rosenthal / S.1323 LaValle)

This bill would allow the licensing of genetic counselors and providing them with a scope of practice, which includes communication to and education of clients, their families, other health care professionals and the general public with regard to genetic testing, individual family histories, or other genetic, medical, and technical information associated with the occurrence , risk of occurrence or recurrence, of a genetic or hereditary condition or birth defect in a comprehensive, understandable, ethical manner.  The Medical Society believes that there should be a connection to a physician required, such as requirement of a referral from the physician or other health care provider who is treating the patient, specifying the reason for the referral.  

  • Certification of certified registered nurse anesthetists (CRNAs) (A.442 Paulin / S.1385 Gallivan)

This measure would provide for the certification by the education department of certified registered nurse anesthetists (CRNAs).  This bill fails to define a scope of practice consistent with existing New York State standards.  Under NYS Health Code (10 NYCRR 700.2), CRNAs are already required to register with the NYS Education Department and are prohibited from practicing nurse anesthesia without meeting specific education and testing requirements.

  • Podiatric scope of practice (A.1880 Pretlow)

This bill would expand the scope of practice of podiatrists to allow podiatrists to “diagnose, treat, operate or prescribe for cutaneous conditions of the ankle to the level of the distal tibial tuberocity” (knee). The bill would eliminate existing law that currently limits a podiatrist’s treatment of wounds to those relating or originating on the foot.

Several other reform bills have been introduced that MSSNY supports: 

  • Continuity of Care (A.256 Dinowitz)

This bill would extend the time period which health plan enrollees may continue to receive services from a health care provider who is not a member of the plan’s network from 60 or 90 days to one year, or in the case of terminal illness, until the time of the enrollee’s death within three years.

  • Coverage for “Dually Eligible”(A.1435 Cahill)

This proposal ensures health care services are accessible to the elderly and people with developmental disabilities that are dually eligible for Medicaid and by restoring full “crossover” payments.  The bill provides Medicaid reimbursements for 100% of any Medicare deductible and co-insurance amounts for services and items provided to individuals “dually eligible” for Medicaid and Medicare.

Restores “Prescriber Prevails”(A.700 Rodriguez / S.2919) Carlucci This bill would require Medicaid managed care (MMC) and Child Health Plus plans to adopt the procedures of the Preferred Drug Program and restores “prescriber prevails” for all drugs.              (BELMONT)

AG Announces Settlements to Resolve Inappropriate Prior Authorization and Drug Price Change Allegations
Attorney General Eric Schneiderman announced the following settlements with various health care entities this week:

  • A settlement with Anthem, the parent of Empire BlueCross BlueShield, to end prior authorization requirements for Medication Assisted Treatment (MAT) for opioid use disorders. According to the press release, Anthem required providers to submit a prior approval form for MAT coverage requests, which required the providers — who had already received specific training regarding MAT and federal authorization to prescribe these drugs — to answer numerous questions about the patient’s current treatment and medication history.   This subsequently caused significant delays in patients obtaining treatment for addiction – or patients never obtaining the treatment at all.  The press release noted that, in contrast to its policy for drugs to treat opioid use disorder, Empire does not require prior authorization for the majority of drugs it covers for medical conditions.

Under the agreement, Empire will also launch an initiative to expand access to MAT for members in its New York service area. Empire BCBS will conduct provider outreach and education regarding the benefits of MAT, informing qualified health care providers how they can obtain certification from the Substance Abuse and Mental Health Services Administration (“SAMHSA”) to prescribe buprenorphine and buprenorphine/naloxone as part of MAT for opioid dependence. Empire BCBS will provide the Attorney General with a list of MAT providers who have joined its network as a result of this initiative.

  • A $100 million settlement with drug manufacturer Mallinckrodt and its U.S. subsidiary, formerly known as Questcor Pharmaceuticals (“Questcor”), to resolve allegations of preventing competition for its drug H.P. Acthar Gel, which is typically used as a last resort to treat certain life-threatening diseases, including infantile spasms and multiple sclerosis.   To read the press release, click here.

House Advances Resolution to Consider ACA Repeal Legislation
By a 227-198 vote, the US House of Representatives approved a resolution to enable the consideration of legislation that would repeal much of the funding mechanisms under the Affordable Care Act (ACA).  The resolution, which enables the repeal to be considered via the process of “reconciliation”, had been passed by the US Senate the week before.  All but 9 House Republicans voted in favor of the resolution, with eight of the nine republicans from the New York Congressional delegation voting in favor.   All 189 Democrats in the US House voted against the measure, including 18 Democrats from New York Congressional delegation as well as Rep. John Katko (R-Syracuse).

Last week, President Donald Trump said that Republicans will introduce proposals to repeal and replace the ACA as soon as Health and Human Services secretary, Tom Price, is approved.  MSSNY recently wrote to the New York Congressional delegation to express concerns with proposals that would repeal ACA funding streams for insurance coverage without simultaneously specifying what they will be replaced with, as well as concerns with the impact to New York patients and the New York State Budget.

Free Buprenorphine Training for Provides to Be Held February 25 on Long Island
The New York State Department of Health’s  AIDS Institute is sponsoring a free buprenorphine waiver training for clinical providers.  The training will be held on Saturday, February 25, 2017 from 8 a.m. to 1 p.m. at the Farmingdale State College, 2350 Broadhollow Road, Roosevelt Hall, Room 111; Farmingdale NY 11735.

On-line registration is required here.

Physicians, nurse practitioners and physician assistants are welcome and highly encouraged to attend this training.   Five hours of Continuing Medical Education (CME) will be provided.

Under current regulations, physicians are required to obtain a ‘waiver’ to prescribe buprenorphine. Physicians can acquire this waiver by attending and completing standardized and required 8-hour training. This training is offered in a half-and-half format [4 hours of online training followed up by 4 hours of in-person training]. NPs and PAs are required to complete an additional 16 hours of training. Upon completion, providers will meet the requirement of the DATA 2000 to be qualified to prescribe buprenorphine for opioid-dependent patients. (Prerequisite: additional information about required online training will be sent out to registrants). 

Faculty for the training is Sharon Stancliff, MD, from the Harm Reduction Coalition, New York, NY and Ray Harvey, MD, Institute for Family Health, Kingston NY.  Directions to Farmingdale State College can be found at here.

More information on this program can be found here:(CLANCY)                                                                                                                                                            

Register Now for a January 26 Lunchtime Program to Discuss the Medicare MIPS Program
The Medicare MACRA/MIPS program has now gone into effect.  Do you and your staff want to learn more regarding what you need to know to comply with this new program that could have a significant impact on your revenue from Medicare?  Please join us for a webinar this Thursday January 26, from 12:30 – 1:30, where you will hear from Frank Winter of New York Regional Office for CMS present important information about this new program for physicians and their staffs.  To register Click Here. 

Upon your registration, you will receive a confirmation e-mail with instructions for joining this session either by webinar or conference call.                                                                                                                (AUSTER)

Register Now for Medical Matters 2017 CME Webinar Series Upcoming
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.  

The educational objectives are: 1) Describe the psychological problems and stress symptoms that can result from caring for victims of an active shooter/bombing event.  2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is 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.

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.

A copy of the flyer can be accessed here.  Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org. 

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

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

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

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

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

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MA Insurers Warned of Fines if They Don’t Correct Provider Directory Errors
Kaiser Health News (1/18) http://bit.ly/2jDycTs reports Federal officials warned earlier this month “21 Medicare Advantage insurers with high rates of errors in their online network directories that they could face heavy fines or have to stop enrolling people if the problems are not fixed by Feb. 6.” The warning comes after the first in-depth review by the government “of the accuracy of Medicare Advantage provider directories, which consumers and advocates have complained about for years.”

MSSNYPAC – The Political Voice for New York’s Physicians
The Governor’s proposed budget includes many provisions which impact physicians.  Advocacy on these and a myriad other health care reform proposals will be necessary.  Your voice and support matter as they enable physicians as a group to have political power.  It is critically important for the physician to have a meaningful seat at the table in shaping these proposals. Through MSSNYPAC, physicians are a force for change in New York State healthcare policy.   Join or increase your support and participation today at www.mssnypac.org/contribute

Physician Judges Needed for HOD Poster Symposium
Doctors: If you’re coming to the House of Delegates in Westchester– or just live in the neighborhood – and are free on Friday afternoon, April 21, from 2 – 4:30 pm, please consider participating as a judge at the MSSNY Resident and Fellow Section Poster Symposium. It’s always an exciting, lively event! Please contact sbennett@mssny.org or 516-488-6100 extension 383 if you’re interested.  

Governor Cuomo Discusses Potential Impact of Repealing ACA with Trump
Reuters (1/18) http://reut.rs/2kaRX67 reports Gov. Andrew Cuomo said that he discussed how the potential repeal of the Affordable Care Act could impact residents of New York with President-elect Donald Trump. Cuomo said the repeal of the law could leave 3 million New Yorkers without health insurance.

Study Identifies New Zika Proteins That Explain Fetal Brain Abnormalities
A study published in the Proceedings of the National Academy of Sciences http://bit.ly/2iT04Ps “could contribute to Zika treatment efforts” by identifying two new Zika proteins that may help explain how the virus actually causes fetal brain abnormalities. The study builds on previous research using fission yeast that identified seven possible proteins. The earlier study had used a strain of the virus from 1947.

MLMIC: Monitoring Management Changes at PRI
On January 17, the Albany Times Union reported a new development in the struggles for one of New York’s major malpractice insurance carriers. You can access the article here under the Times Union headline, “Amid scandal and fiscal woes, insurance mogul steps aside.”

Instability of a large provider creates some uncertainty for the entire market, of course, but we want to assure MLMIC policyholders that their coverage is not at risk. By adhering to responsible underwriting practices from our beginning, MLMIC continues to demonstrate sound financial condition and is able, once again, to offer a policyholder dividend (20% for those insured by May 1 and continuously insured through July 1).

We’ll keep monitoring the situation in the market on your behalf and will apprise you of further developments. In the meantime, if you have questions, please call 1 (888) 488-9253.

One in Three Adults Diagnosed with Asthma – May Not Have It
An article published in JAMA suggests “as many as one in three adults diagnosed with asthma may not actually have the” condition. The study’s 613 participants, all of whom “had been diagnosed with asthma in the previous five years,” underwent “multiple tests and examinations to determine if they had signs of asthma.” Investigators “determined that 203 participants, or” about “33 percent, did not have baseline symptoms of asthma after the initial examination.”  LiveScience (1/17) reports, “When the participants without asthma were evaluated by the study” physicians, approximately “60 percent were diagnosed with other conditions, such as seasonal allergies, acid reflux or breathing difficulties that were due to obesity.”

Attest to 2016 Program Requirements by February 28
The Centers for Medicare & Medicaid Services Registration and Attestation System is now open. Providers participating in the Medicare EHR Incentive Program must attest to the 2016 program requirements by February 28, 2017 at 11:59 p.m. ET in order to avoid a 2018 payment adjustment. The EHR reporting period was any continuous 90 days between January 1 and December 31, 2016.

If you are participating in the Medicaid EHR Incentive Program, please refer to your states deadlines for attestation information.

If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the Medicare payment adjustment. You may demonstrate meaningful use under either Medicare or Medicaid.

Reminder: Remember to visit the registration tab in the Registration and Attestation system to ensure your personal information is accurate. For more information on registration, visit the Registration & Attestation page of the EHR Incentive Programs website.

Payment Adjustments and Hardship Exceptions

In January 2018, CMS will begin to apply payment adjustments for providers that did not successfully demonstrate meaningful use of EHR technology or apply for and receive a hardship exception for the 2016 program year. CMS will send a separate announcement with more information on the hardship exception application process, once available.

Attestation Resources

Eligible Professional (EP) and Eligible Hospital and Critical Access Hospital (CAH) Attestation Worksheets

EP and Eligible Hospital and CAH Attestation User Guides

EP and Eligible Hospital and CAH Registration User Guides

Attestation Batch Upload Webpage

For More Information

For questions about the Registration and Attestation System, contact the EHR Information Center at 1-888-734-6433 (press option 1). The EHR Information Center is open Monday through Friday from 6:30 a.m. to 5:30 p.m. ET, except federal holidays.

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


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

Prime Astoria Medical Office for Rent or Lease
23-15 Astoria Boulevard, Astoria, New York
Customizable Lower Level
7,500 Sq Feet Gross For Lease
Prime Location Close To Hospital and Other Medical Facilities.
Direct Street Access Private Elevator plus Direct Access From  
Street Level Stairs.
AB Building Management LLC
George Miltiadou
718-482- 7262

Upper East Side Medical Office for Sale
Suitable for a solo practice or shared multi- specialist group. Large unit, about 1100 Sq Ft, located on the ground floor of a cooperative building with own entrance to office, 2 or 3 equipped exam rooms with exam tables and work station areas, front waiting room with reception area with storage unit of shelves for medical charts, a consultation office, 1 and a half bathrooms and kitchenette. Lots of shelves throughout exam rooms, 2 EKGs, one PC computer that comes equipped with a PFT machine and operating software, an operating X-ray machine suitable for chest X-rays with film processor. No brokers, call office manager, Diana Peron @ 212-861-9012

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.

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

Physician Opportunities

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

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