July 14, 2017 – Last Chance to Demand VETO!

Charles Rothberg, MD
July 14, 2017
Volume 17
Number 27

Dear Colleagues:

Bad week for medicine, law and money. Last week I wrote about the NYS legislature passing an over reaching and defective expansion of medical liability (“Lavern’s Law”) that seriously burdens all providers, but at the same time leaves an unsuspecting public nearly as unprotected as before.

This week, a discredited, convicted legislative leader— perhaps best known as an opponent of liability reforms, had his corruption conviction overturned on appeal.

And, in that leader, the medical connection extends beyond medical liability. Mr. Sheldon Silver was convicted of using his office to provide public money to a medical researcher in exchange for referrals of patients (also possible plaintiffs).  Mr. Silver was in turn paid for those referrals. He did no work—an activity illegal for doctors but—perfectly legal for lawyers.

For this, Mr. Silver was convicted in 2015. But in another case in 2016, the US Supreme Court narrowed the definition of corruption sufficiently to provide the technicality to overturn Mr. Silver’s conviction.

His story of conflicts regarding the legislature, the legal profession, and the medical profession illustrates the difficulty of obtaining a legislative solution to overcome the deficiencies of our medical liability system.  And while a stunning story, there persists within the legislature a cultural barrier to the best solutions.  Last year, in New York State, medical liability payouts were $700 million.  The public deserves better for the money.

When will our elected officials finally examine the adversarial trial process, its distortions, unintended consequences, and inefficiencies in order to institute reforms that return the process to its public purpose?

Meanwhile, I urge the Governor to veto this version of Lavern’s law instead of doubling down on this outrageous charade. Now, more than ever, we need comprehensive reform.

PHYSICIANS MUST CONTINUE TO CALL GOVERNOR CUOMO AT 518-474-8390 and send a letter from here

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

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We Can Assure the Stability of MLMIC
In today’s marketplace, stability is top-of-mind for many us. And given recent reports from July 6, 2017, by the Albany Times Union and Politico, that New York State has ousted the CEO of the state’s second largest medical malpractice insurance carrier, this is unsurprising.

However, MLMIC, our trusted partner and longstanding endorsed professional liability insurer, continues to maintain a sound financial condition. And for 40+ years, MLMIC has provided exceptional coverage, an unyielding defense, strong risk management programs, and high-quality legal counsel to the physicians of the State of New York.

MSSNY and MLMIC remain unwavering in our commitment to protecting you and your practice.

Please do not hesitate to contact our offices and/or reach out to MLMIC directly at mlmic.com or (888) 412-2012 should you have any questions or need additional information.

Senate Released Revised ACA Repeal/Replace Bill; Possible Floor Consideration Next Week
This week, the Senate released a revised version of the Better Care Reconciliation Act (BCRA), a bill designed to repeal and replace much of the Affordable Care Act (ACA).  While review of the new bill is ongoing, at first glance it does not appear to remediate concerns with the earlier version of this legislation that it could potentially significantly expand the number of New Yorkers who will face higher cost-sharing.

AMA President Dr. David Barbe issued the following statement in response: “The revised bill does not address the key concerns of physicians and patients regarding proposed Medicaid cuts and inadequate subsidies that will result in millions of Americans losing health insurance coverage. The additional funding to address the opioid epidemic is a positive step, however, those suffering from substance use disorder have other health care needs that are not likely to be addressed if they lose coverage through a rollback of the Medicaid expansion. While stabilizing the individual market is an initial step, more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of health care.”

According to the AMA, revised estimates by the Congressional Budget Office on the impact on spending and health insurance coverage are expected to be released on Monday.  Senate floor consideration is likely to begin on Tuesday or Wednesday.    However, Senators Rand Paul (R-KY) and Susan Collins (R-ME) have indicated they would oppose the “motion to proceed” to begin consideration of the bill, putting into question whether there will be enough votes to begin floor consideration.

Please stay alert for further updates.

Upstate Fatality in Case of Powassan Virus
Since 2000, only 24 cases of Powassan virus have been confirmed in New York.  Five of them were fatal. The most recent case was 74-year-old Charles Smith from Gansevoort. His family reported that he was bitten by a tick on April 28. He went to the doctor on May 1 and was sent home. However, by May 11, he had fever and chills and was hospitalized. He died June 6.

“Powassan is a serious illness,” said Bryon Backenson, New York State DOH’s Deputy Director of Communicable Disease Control. There is no cure for Powassan’s, which is deadly about 10-percent of the time because it affects the central nervous system in about half the cases. “You’re trying to do things to reduce swelling in the brain or reduce swelling on the lining of the brain,” explained Backenson. Symptoms of Powassan’s include headache, fever, vomiting, weakness, and confusion, loss of coordination, speech difficulty and seizures.

It can take up to four weeks for Powassan’s to be confirmed by blood and cerebrospinal fluid testing, making early treatment important when it’s suspected. “With a disease like Powassan that tick only has to be on 10 or 15 minutes before it has the potential to transmit what it’s carrying because Powassan is a virus,” warned Backenson.

Unlike Lyme disease which is a bacteria and can take up to 36 hours for infection to occur.

Without a specific treatment, the need to protect against tick bites is key. “This is a very severe illness. It’s an illness that can cause deaths, but it’s also one that’s extremely rare,” explained Backenson. (WNYT, July 12)


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

FDA To Implement Stricter Education Requirements for Opioid Makers
FDA Commissioner Scott Gottlieb “announced plans Monday to require manufacturers of painkillers to provide more extensive education for physicians and other health-care professionals who prescribe the drugs.” Previously, only manufacturers of extended-released opioids, which account for ten percent of opioid prescriptions, were required to provide the training. Dr. Gottlieb said the agency would also consider legal action on any drugs that it concludes pose a larger risk than benefit. The FDA did that last month when it concluded that the painkiller Opana ER was linked to injection drug abuse. Its maker, Endo Pharmaceutical, Inc. pulled the drug from the market last week at the FDA’s request. (Wall Street Journal (7/10)

CMS Proposes Medicare Physician Payment Rule for 2018
On July 13, CMS issued a proposed rule to update the Medicare physician fee schedule for 2018.

To read the CMS press release announcing some of the key policy changes proposed in the rule, click here.

To read the entire rule, click here.

A chart listing the specialty by specialty impact of the proposed rule changes is on pp.727-728.   Specifically, the chart notes that, as a result of these proposed changes, the following specialties will see an overall +1% in allowed charges: geriatrics, hand surgery, infectious disease, physical medicine, psychiatry and radiation oncology.

The chart notes that the following specialties could see an overall -1% in permitted charges: colon and rectal surgery, emergency medicine, gastroenterology, general surgery, interventional radiology, neurosurgery, OB-GYN, pathology, radiology, thoracic surgery, and urology.

The chart also notes that the following specialties could see an overall -2% in permitted charges: cardiac surgery, cardiology, otolaryngology and vascular surgery, with a -3% projected for allergy/immunology.

MSSNY, working together with the AMA and the federation of medicine, will be reviewing the rule and will follow up with further analysis.

CMS Proposed Rule for Implementation of Diabetes Prevention Program (MDPP)
On July 13, 2017, CMS issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) proposed rule that would make additional proposals to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018.

The MDPP expanded model was announced in early 2016, when it was determined that the Diabetes Prevention Program (DPP) model test through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards met the statutory criteria for expansion. Through expansion of this model test, more Medicare beneficiaries will be able to access evidence-based diabetes prevention services, potentially resulting in a lowered rate of progression to type 2 diabetes, improved health, and reduced costs.

The Medicare Diabetes Prevention Program expanded model is a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes. The clinical intervention, the result of National Institutes of Health-funded research, consists of a minimum of 16 intensive “core” sessions of a Centers for Disease Control and Prevention (CDC) approved curriculum furnished over six months in a group-based, classroom-style setting that provides practical training in long-term dietary change, increased physical activity, and behavior change strategies for weight control.

After completing the core sessions, less intensive follow-up meetings furnished monthly will help ensure that the participants maintain healthy behaviors. The primary goal of the expanded model is at least 5 percent weight loss by participants. 

Long-Term Dietary Improvements Associated with Decreased Risk of Death
The New England Journal of Medicine reports that “long-term improvements in diet were associated with a significantly decreased risk of death,” researchers found. The study revealed that “making mostly healthier choices for 12 years could decrease someone’s risk of death during the next 12 years by 20 percent.”

NGS Claim Submission Changes
Healthcare continues to keep up with technology with the new claim submission changes issued by National Government Services (NGS). Beginning July 10, 2017 NGS will no longer be accepting claim submissions with handwriting on the CMS 1500 form (except in the specified signature boxes). As per the new alert issued on June 29th, handwritten claims received will be returned to the provider with a notice to submit a new claim in the acceptable format.

The CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 26, Section 30 notes the CMS 1500 form specifications are “required to facilitate the use of image processing technology such as Optical Character Recognition (OCR), facsimile transmission, and image storing.”

NGS currently allows for claims to be submitted online via NGSConnex. If you are currently submitting handwritten claims it is recommended to open a dialogue with your billers and consider alternatives, as many private insurance carriers look towards Medicare and Medicaid for guidance. 

Lorna Simons CPC, Medco Consultants Inc.

Former Suffolk County President Dr. Bernard Lane Dies
MSSNY member Bernard P. Lane, MD, passed away on July 5, 2017 at the age of 79 after a long battle with cancer.  The Brooklyn native—known to friends and colleagues as Bernie—graduated from Brown University and NYU Medical School.

A founding faculty member of Stony Brook University School of Medicine, Dr. Lane contributed over 45 years of service to medical science and education including his faculty years at NYU and Stony Brook medical schools.  In addition to his duties as Professor of Pathology, Dr. Lane also served as Deputy Chairman, Interim Chair, and Director of the Electron Microscopy Laboratory.  He was the Pathology residency program director for 25 years, mentoring scores of pathologists who have gone on to positions in hospitals and academic medical centers both locally and nationally.

Dr. Lane served as President of the Stony Brook University Faculty Senate, and was the Founding Chairman of the Board of Directors of the Clinical Practice Management Plan at the University Hospital, serving in that capacity for nearly 20 years.

An active member of organized medicine, Dr. Lane was a member of MSSNY since 1986 and served as President of the Suffolk County Medical Society in 1990 and 1991.  He was Chair of the National Group on Faculty Practice of the Association of American Medical Colleges, and president of the Suffolk County Pathology Society.

Dr. Lane and his wife, Dr. Dorothy Lane (nee Spiegel), celebrated their 53rd wedding anniversary in August 2016. In addition to his wife, Dr. Lane is survived by his daughter Erika Neil, his sons Dr. Andrew Lane and Matthew Lane, his daughter-in-law Dr. Wendy Lane, and his grandchildren Zachary Lane, Jacob Lane, Rachel Neil and Justin Neil.

A graveside funeral service was held on Friday, July 7, 2017 at the Washington Memorial Park cemetery in Mount Sinai. In lieu of flowers, the family requests that donations be made in his memory to the Stony Brook Cancer Center or the American Cancer Society.


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Physician Opportunities

Medical Director – Cayuga Medical Associates
Cayuga Medical Associates (CMA), a growing multispecialty group located in the heart of the beautiful Finger Lakes Region in Central New York, is currently seeking a Medical Director to work within the organization. This senior leadership position is designed to ensure that high quality, service-oriented patient care is delivered by Cayuga Medical Associates’ physicians on a consistent basis. The medical director has primary responsibility for clinical issues pertaining to the delivery of patient care services, patient satisfaction, and quality at the practice level. This position will report to the Chief Operating Officer of CMA, and will serve as an ex-officio board member. In this role, the Medical Director will work in an administrative capacity 2 days a week, and will practice as a physician for the remaining 3 days of the workweek.This position will require the physician to:

  • Engage in Physician recruitment, engagement and retention, in collaboration with Executive Director
  • Set and communicate performance, service standards and expectations to all providers
  • Exercise professional clinical leadership regarding specific cases or questions of quality or compliance
  • Assist with compensation model refinements and redesign, with specific focus on quality and productivity metrics
  • Oversee CMA’s Physician Action Council (PAC)
  • Develop and implements physician peer review system, medical policies, and clinical programs

Qualifications for this position include:

  • Graduate from accredited medical school and appropriate residency training
  • Board certified physician in a primary care or related sub-specialty area
  • Active NYS medical license

At least 3-5 years of relevant work experience in a physician practice setting, prior experience in physician leadership role preferred

vStrong leadership skills to develop a close, collaborative working relationship with senior leadership team, physician leaders, and practice management staff

The Finger Lakes region of New York offers endless opportunities for outdoor adventures, as well as rich support of the arts and diverse cultural opportunities, excellent school districts, and charming villages, towns and small cities to call home.  If you are dedicated to excellence and possess a commitment to patient-centered care, please submit your CV and cover letter to cma_hr@cayugamedicalassociates.org or fax to (607) 277-1415, attention Human Resources. CMA offers a competitive pay and benefits package and is an equal opportunity employer.

Position Available for Critical Care Physician to Join Established Practice in Nassau County, Long Island, NY.
The Physician will join our existing team of Board-Eligible/Board-Certified Intensivists. This is a PT/FT position including both nocturnal and daytime responsibilities. The Physician will work with a dedicated group of highly trained mid-level practitioners, respiratory therapists and nurses to provide Critical Care at St. Francis Hospital in Roslyn, NY. St. Francis was ranked one of the top 10 hospitals in the nation for Cardiac Care and is top rated nationally in seven other adult specialties.
We are expanding our Intensivist Program and are expecting to add an Intensivist to our group.
Nassau Chest Physicians, P.C. was established in 1978 to provide state-of-the-art care to patients with pulmonary diseases on Long Island. We have expanded our practice to include 8 Intensivist/Pulmonologists and 5 pure Intensivists. Since 2006, we have assumed management of Critical Care services at St. Francis Hospital-The Heart Center in Roslyn, NY.
St. Francis Hospital is New York State’s only specialty designated cardiac center and is a nationally recognized leader in cardiology and heart surgery, ear-nose-throat, gastroenterology and GI surgery, geriatrics, neurology and neurosurgery. More cardiac procedures are performed at St. Francis than at any other hospital in New York State. The hospital is located on the North Shore of Long Island; approximately 30 minutes from Manhattan. The hospital combines unrivaled expertise in cardiovascular medicine with top-ranged nursing (AACN Magnet Award) to provide the very best in patient care.
In addition, St. Francis offers excellent Thoracic, Vascular, Oncologic, Neurosurgical, and Orthopedic Surgical Programs. We have a very active Emergency Department. The hospital offers the latest in technologies such as Therapeutic Temperature Modification, Impella, ECMO and LVAD. Our excellent and experienced medical staff supports strong medical and surgical subspecialty programs.

Aside from Certified Critical Care Nurses, many who have more than 20 years of experience and are expert at caring for this complex patient population, we have a growing pool of Intensivist mid-level practitioners who work hand in hand with our Intensivist physicians to coordinate the care of the critically ill patient, minister to them and perform procedures.

Of course, a New York License is required. J1 or H1 VISAS accepted.
Additional Salary Information: Salary and benefits are competitive and commensurate with experience. Interested applicants, send resume to: dr.sorett@nassauchest.com