July 28, 2017 – The Skinny on “The Skinny”

Charles Rothberg, MD
July 28, 2017
Volume 17
Number 29

Dear Colleagues:

With the overnight failure of the “skinny bill,” apparently due to the miscalculation of a slender and fractured Senate majority, it’s time to draw parallels to the New York State legislature, our own physician advocacy, and what happens to our initiatives when the divisions overcome what our organizational/professional objectives are (paralysis).

It is worth mentioning that the Congressional Budget Office estimated that 16 million fewer people would have health insurance by the end of the decade. Estimates are here.

Of course, we must now move forward to improve the health and coverage of our patients and the funding of our practices and infrastructure. 

Transgender Issue

Also this week, health insurance for certain members of our Armed Forces became an issue. I thought I’s share relevant MSSNY and AMA policy. MSSNY supported the following resolution:

  • 969 Removing Barriers to Care for Transgender Patients:

MSSNY supports the resolution being presented at the American Medical Association’s

A’08 Meeting by the AMA-Medical Student Section and AMA-Resident and Fellow Section which asks that the AMA (1) support public and private health insurance coverage for treatment of gender identity disorder, and (2) oppose categorical exclusions of coverage for treatment of gender identity disorder when prescribed by a physician. (HOD 2008-171)

Moreover, the President of the AMA, Dr. David Barbie, issued their statement on the issue:

  • AMA policy also supports public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient’s physician. According to the Rand study on the impact of transgender individuals in the military, the financial cost is a rounding error in the defense budget and should not be used as an excuse to deny patriotic Americans an opportunity to serve their country. We should be honoring their service – not trying to end it.

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org

enews large

AMA Summary of What Occurred Last Night and What the Actual Issues Were
Early this morning, the so-called “skinny” or “partial ACA repeal” package was defeated by a vote of 49 to 51 with Senators Collins, Murkowski and McCain joining all 48 Democrats in opposing the proposal.  Elements included in the “skinny” package were:

  • Repeal of the individual mandate by zeroing out the penalty beginning after December 31, 2015.
  • Repeal of the employer mandate by zeroing out the penalties, but only from January 1, 2016 to December 31, 2024.
  • Extend the moratorium on the medical device tax from December 31, 2017 to December 31, 2020.
  • Increase for three years (2018 to 2020) the maximum contribution limit to health care savings accounts (HSA) to the amount of the deductible and out-of-pocket limitations.
  • Defund Planned Parenthood for one year (and expands the one-year defunding to certain other providers that provide abortions if they receive more than $1 million in federal and state funding).
  • Sunset the funding for the Prevention and Public Health Fund after FY 2018.
  • Provide $422 million in additional funding for the Community Health Center Program in 2017.
  • Amend section 1332 of the ACA (Waiver for State Innovation) by: authorizing and appropriating $2 billion for states that submit or implement state innovation waivers; requiring HHS to approve a 1332 waiver if the secretary determine that the application meets the benefit comprehensiveness, cost sharing, enrollment, and budget neutrality guardrail requirements; requiring a waiver determination within 45 days (instead of 180 days); and extending waivers from 5 to 8 years with unlimited renewals for 8-year periods that may not be cancelled by the secretary.

This is not the end of the process.  Hearings and bipartisan discussions about legislation to stabilize the individual market are anticipated when Congress returns from the August recess. We extend thanks and deep appreciation to physician, patient, hospital and other provider groups that joined the AMA in this effort and made this outcome possible.   The ingredients for this success were sound policy guided by clear objectives, effective AMA spokespersons, a broad based coalition and a tremendous grassroots response and engagement with elected officials.

There is much more work to be done on this and other issues to improve the health of the nation.

Tell Gov. to Reject Liability Expansion Bill/Call for Comprehensive Liability Reform
All physicians are urged to continue to call Governor Cuomo at 518-474-8390 and send a letter here  urging that he veto a so-called “cancer only” medical liability statute of limitations expansion bill (S.6800/A.8516) that passed the Legislature over the strong objections of MSSNY, the specialty societies, the hospital industry and MLMIC.  Please urge that legislation be enacted instead that provides for comprehensive medical liability reform.

This ambiguously drafted bill, introduced in the final days and passed in the final hours of the 2017 Legislative Session, would expand the medical liability statute of limitations for cases involving “alleged negligent failure to diagnose a malignant tumor or cancer”.   The bill would permit lawsuits 2.5 years from the “date of discovery” of such alleged negligence, up to an outside limit of 7 years.  Actuaries have estimated that this legislation could increase already exorbitant premiums by 10-15% at a time when no increases can be tolerated.

This week, op-eds appeared in papers across the State from the Presidents of the Albany County , Monroe County and Chautauqua County medical societies urging Governor Cuomo to veto the bill.   The Legislative Gazette also had an article that referenced the opposition of MSSNY and the Lawsuit Reform Alliance.

Again, please urge the Governor to veto this bill and encourage your colleagues to do the same! Please let the Governor know how this bill will harm patient care and exacerbate existing physician shortage issues in your community.

Drinking Alcohol 3 to 4 Days a Week Tied to Lowest Risk for Diabetes
Moderate drinking spread out over several days during the week is associated with the lowest risk for diabetes, according to a study in Diabetologia. Some 70,000 Danish adults without diabetes completed questionnaires about their drinking habits and then were followed for a median of 5 years, during which 2% developed diabetes.

The lowest diabetes risks were among men who reported consuming 14 drinks per week and women who consumed 9 drinks per week. After multivariable adjustment, men who consumed 7–13 drinks or 14 or more drinks over 3–4 days weekly had 30%–40% lower risks for diabetes than those who consumed less than 1 drink weekly. Women who consumed 1–6 drinks or 7 or more drinks over 3–4 days saw similar risk reductions.

The researchers point to numerous study limitations but conclude, “Our results further indicate that frequent consumption of alcohol is associated with the lowest risk of diabetes.” As one potential mechanism, they note that the polyphenols in red wine “may exert beneficial effects on blood glucose control … thereby lowering the risk of type 2 diabetes.” Diabetologia article

Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!

For Members Only: Brooks Brothers Offers 15% Discount
Enroll for your complimentary Brooks Brothers Corporate Membership Card and Save 15%* on full priced merchandise at all Brooks Brothers U.S. and Canadian stores, by phone and online.


  • You will need to wait 30 minutes after you enroll before you register to shop online.


  • www.BrooksBrothers.com
  • At the top of the page click on My Account & then CREATE AN ACCOUNT.
  • Create new profile and at the bottom click on “I have a Corporate Membership Number”.
  • Enter 12 digit Membership Number.
  • Click on create and you will receive a Welcome Letter.  You are now ready to shop!

CTE in Football Players: Characteristics in Brain Donors Explored
A study of some 200 donated brains from American football players shows a generally increasing prevalence of chronic traumatic encephalopathy (CTE) with higher levels of play.

The deceased donors’ football exposure ranged from two players with only pre-high school experience (neither of whom had CTE) to 111 with National Football League experience (99% of whom had CTE).

All cases of CTE had shown mood, behavioral, or cognitive symptoms, according to interviews with family members, whereas motor symptoms were common mostly in severe cases. Also common in severe cases was the accumulation of neurodegenerative proteins, such as amyloid-beta.

The authors, writing in JAMA, caution against estimating CTE prevalence on the basis of their “convenience” sample, saying their purpose was to characterize CTE’s neuropathological and clinical features. An editorialist agrees, writing that “such a sample is likely to be biased to include more impaired individuals.” JAMA article.

Research: Sperm Count, Concentration Declining Among Men in Western World
Research published in Human Reproduction Update http://bit.ly/2uGlLda found “a 52.4 percent decline in sperm concentration and a 59.3 percent decline in total sperm count among North American, European, Australian and New Zealand men” in 2011 compared with 1973.” The study also indicated that “the quality was worse.” For the study, investigators looked at “data from 185 studies and 42,000 men. The researchers report that while the investigators did not see “a similar decline in non-Western men – those from Africa, Asia and South America,” they “admitted that this absence of a trend may be due to a lack of data.” They added that additional research is required “to determine causation,” investigators “think that our lifestyle choices (smoking, stress and obesity) may be to blame for the drop in sperm count.”

Explanation of Special Status Calculation
The Centers for Medicare and Medicaid Services (CMS) has introduced new information on qpp.cms.gov that indicates whether clinicians have “special status” and can therefore be considered exempt from the Quality Payment Program.

To determine if a clinicians’ participation should be considered as special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data. A series of calculations are run to indicate a circumstance of the clinician’s practice for which special rules under the Quality Payment Program will affect the number of total measures, activities or entire categories that an individual clinician or group must report. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), Rural, Non-patient facing, Hospital Based, and Small Practices.

For more information, please visit the Quality Payment Program website.

Now Available: Accredited Online Course – Quality Payment Program 2017 Merit-Based Incentive Payment System: Improvement Activities Performance Category
A new, online and self-paced overview course on the Quality Payment is now available through the MLN Learning Management System. Learners will receive information on:

  • The Improvement Activities performance category requirements, and how this category fits into the larger Quality Payment Program
  • The steps you need to take to report Improvement Activities data to CMS
  • The basics about scoring of the Improvement Activities performance category

This course is the third course in an evolving curriculum on the Quality Payment Program, where learners will gain knowledge and insight on the program all while earning valuable continuing education credit. Keep checking back with us for updates on new courses. First time learners will need to register for the MLN Learning Management System. Once registered, learners will be able to access additional courses without having to register. For information on how to login or find training, please visit our MLN Learning Management System FAQ sheet.

The Centers for Medicare & Medicaid Services designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Credit for this course expires June 1, 2020. AMA PRA Category 1 Credit™ is a trademark of the American Medical Association.

Accreditation Statements
Please click here for accreditation statements.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

Medical Space Available for Leasing
Currently (last 7 years) occupied by Lab Corp.
2,500 sq. ft. ADA compliant.
25-15 Steinway Street, Astoria, NY 11103
Please contact Landlord: 1-800-283-0602;
e mail: wwwevans@yahoo.com

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

Job Posting – Chief Medical Officer – Cayuga Medical Associates

Cayuga Medical Associates (CMA), a growing multi-specialty group located in the heart of the beautiful Finger Lakes Region in Central New York, is currently seeking a Chief Medical Officer to work within the organization. This newly created 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 Chief Medical Officer 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 President of CMA, with an administrative dyad/partnership to the Chief Operating Officer. In this role, the Chief Medical Officer 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 President and Chief Operating Officer
  •  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
  • Strong 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