July 7, 2017 – PRI Oust & Urge Gov Veto
 PRESIDENT’S MESSAGE Charles Rothberg, MD |
July 7, 2017 Volume 17 Number 26 |
Dear Colleagues:
Today’s press has reported the Department of Financial Services (DFS) findings following a yearlong audit of PRI, the second largest malpractice carrier in the state. As a result of their findings the CEO of PRI has been ousted. The superintendent of the DFS, Maria Vullo, stated, “…, the examination determined that AFP (PRI’s management company) and its top executives, including its CEO and owner, Anthony J. Bonomo, disregarded sound actuarial principles when setting PRI’s loss reserves, and then tried to cover it up by seeking to silence outside auditors and employees who objected to this misconduct.”
The board of PRI voted yesterday to void the company’s management contract with Administrators for the Professions, a subsidiary of AJB Ventures, which Mr. Bonomo owns. The new management contract will be given to PRIMMA, LLC, and a wholly-owned subsidiary of PRI. PRIMMA will be run on an interim basis by The Princeton Partnership, a firm that specializes in turnaround and runoff management. Read more here.
More importantly, this information comes at a volatile time for New York’s malpractice industry, especially in view of the Expansion of Liability bill that will be delivered to the Governor. He needs to make a decision whether or not this is the appropriate time to sign such legislation into law. This does not appear to be the optimal time to further destabilize the climate of the malpractice industry in New York.
Expansion of Liability Bill
New York has a reputation of being a difficult place to be a doctor. Yet the legislature in Albany has potentially made this problem far worse. It passed a “one-sided” bill that, if enacted, will drastically increase health care costs by radically increasing the number of lawsuits that could be brought against our doctors and hospitals. But the law ignores much of the problem illustrated by the story of Lavern.
Voice your opposition here!
The bill is a hastily conceived legislative response to the sad case of Lavern Wilkinson. Ms. Wilkinson, treated at a public hospital, was not informed of a cancerous lesion present on an x-ray. Sometime later, when Ms. Wilkinson ‘discovered’ the cancer, it had already spread. She was unable to sue for medical negligence owing to the short 15-month statute of limitations that applies to public hospitals like the one that treated her. Had she been treated elsewhere in New York, with the standard 30-month statute, Lavern would have been able to sue. Sadly, she succumbed to this cancer.
The legislature could have solved Lavern’s medical liability ‘problem’ by simply extending the shortened statute against public hospitals to 30 months (like in non-public hospitals). Instead, they unreasonably extended the statute to date of discovery (as long as 7 years from treatment) to all venues. If this law is enacted, despite the unnecessary burden on all physicians and hospitals, patients presenting to public hospitals might still find themselves unable to sue. For example, a patient presenting to a public hospital for evaluation following a motor vehicle accident, not informed of an aneurysm on x-ray, would still be unable to sue after 15 months’ time. This bill, that would increase liability costs for physician practices by 15%, would not provide a remedy for many patients like Lavern!
We are not alone in this fight. HANYS and the Greater New York Hospital Association are equally opposed. Ken Raske, in a letter to the Governor, stated that they are “deeply disappointed with the Senate leadership—whom we have repeatedly supported—for putting this onerous, extremely damaging bill forward… At the very least, it will lead to more litigation, as parties seek to take advantage of the bill’s drafting ambiguities.” Specialty societies were against it, too.
But if there is a need to expand the time to bring lawsuits; it must be balanced with legislation to address the numerous flaws of our medical liability system that drive our excessive costs – “comprehensive” reform. Unfortunately, the Legislature, with its hasty one-sided remedy, ignored the risk of harm to our already fragile care delivery infrastructure.
Governor Cuomo must veto this bill and instead work for comprehensive medical malpractice reform effort that address deficiencies raised by all sides – patients, lawyers and doctors. New York is already the worst state to be a doctor largely because our medical liability costs and premiums far exceed any other state. Many other states such as California, Texas and Florida, along with the majority of others, have put reasonable controls on liability awards to preserve some stability in their health care systems.
What do our legislators not see?
Governor Cuomo must insist on fair balance by vetoing this bill and pushing for comprehensive reform instead.
Sincerely,
Charles Rothberg, MD
MSSNY President
Please send your comments to comments@mssny.org
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
Please Contact Gov. to Urge Veto to Prevent More Lawsuits and Increased Costs
All physicians are urged to contact Governor Andrew Cuomo to veto legislation (S.6800/A.8516) that would prompt significant increases in medical malpractice lawsuits and premiums at a time when no further increases can be tolerated. Please call at (518) 474-8390, and send a letter here: Take Action
This week, MSSNY President-elect Dr. Thomas Madejski and Erie County Medical Society President Dr. Willie Underwood authored an op-ed that appeared in the Buffalo News urging the Governor to veto the bill, and press for comprehensive medical liability reform instead. Read the op-ed here.
Introduced in the final days and passed in the final hours of the 2017 Legislative Session over the strong objections of MSSNY, the specialty societies, the hospital industry and medical liability insurers, S6800/A8516 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 from the date of the alleged negligent act.
While it is likely that a more narrowly focused bill will reduce somewhat the premium increase needed from the 15% projected increase for an earlier version of this bill, there is great ambiguity in the legislation as to which cases the 7-year limit would apply. Moreover, the bill does not just apply to treatment that occurs after the proposed effective date of the bill but has a very significant retroactive impact, subject to numerous interpretations, for which insurance companies have not reserved premium dollars (another reason to veto the bill!). These errors and/or ambiguities are likely the result of the bill being “rushed into print” to meet the constitutional “3-day aging” requirement before a bill can be considered by the Legislature.
Of greatest concern, the bill fails to include needed tort reforms to help bring down our already exorbitant medical liability costs.
While it is not known when the bill will be officially delivered to the Governor for his consideration, it could be sent at any time. Please take action and urge your colleagues to do the same.
DOH Announces Additional Four-Hour Medical Marijuana Course
The New York State Department of Health announced the availability of an additional four-hour medical use of marijuana course. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete one of the available approved courses. The Department also streamlined the process for practitioners to register with the program. See the following press release for additional information on these enhancements to the program.
CDC: Opioid Prescribing Down Since 2010, But Varies Widely
The amount of opioids prescribed in the United States decreased each year between 2010 and 2015, according to a Vital Signs report released this week by the CDC. The amount of opioids prescribed per capita fell from a peak of 782 morphine milligram equivalents in 2010 to 640 MME in 2015, but remains about three times higher than in 1999 and varies widely by county, with some counties prescribing six times as much as others.
“This variation highlights the need for health care providers to consider evidence-based guidance when prescribing opioids,” said Deborah Dowell, M.D., chief medical officer for CDC’s Division of Unintentional Injury Prevention. Between 2010 and 2015, MME per capita decreased in half of US counties and increased in 23% of counties.
NAM Collaborative Calls for Research to Address Clinician Burnout
The National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience, whose sponsors include the AHA, yesterday issued a discussion paper calling for research to identify the organizational and health system factors that place physicians, nurses and other health care professionals at increased risk for burnout; the implications for health care outcomes; and effective interventions to improve clinician well-being.
“The U.S. health care system is rapidly changing in an effort to deliver better care, improve health, and lower costs while providing care for an aging population with high rates of chronic disease and co-morbidities,” notes the paper, whose co-authors include AHA Chief Medical Officer Jay Bhatt, D.O. “…Navigating these changes are health care professionals, whose daily work is critical to the success of health care improvement.
Unfortunately, as a result of these changes and resulting added pressures, many HCPs are burned out, a syndrome characterized by a high degree of emotional exhaustion and high depersonalization (i.e., cynicism), and a low sense of personal accomplishment from work.” On July 14, the collaborative will host its first public meeting to solicit feedback and highlight research and examples of promising approaches to promoting clinician well-being. To attend in person or via webcast, register here.
In July: Pilot for Office-Based Surgery Practitioners New Online Practice Report
To assist in the promotion of patient safety and quality of care for patients undergoing procedures in the office-based setting, the NYS Department of Health (NYS DOH) Office-Based Surgery (OBS) Program has developed a new online Practice Report. This Report will assist in providing context for the interpretation of Adverse Event information received by the NYS DOH. Public Health Law provides the NYS DOH with authority to require OBS practices to report additional data for the interpretation of adverse events.[1] Beginning in January 2018, all NYS OBS practice sites will be required to complete an annual Practice Report.
In July of 2017, the NYS DOH will conduct a pilot with OBS practices to ensure practitioners and practices are aware of the report content and are able to complete the Practice Report. They are requesting practices complete the pilot Practice Report using information from January 1 through December 31, 2016. Practices newly accredited in 2017, may provide available 2017 data. The NYS DOH has contacted OBS practices with details regarding the pilot by email.
In late Fall 2017, the NYS DOH will share feedback received from the pilot and any subsequent changes to the report. The NYS DOH is hopeful the pilot Practice Report will assist OBS practices in preparing for the first annual Practice report in January of 2018. If you have any questions, please contact the Office-Based Surgery Program at 518-408-1219 or obs@health.ny.gov.
[1]PHL § 230-d, 4. (b); “the department may also require licensees to report additional data such as procedural information as needed for the interpretation of adverse events”
Athenahealth: The Case for Staying Independent
Join online on Wednesday, July 12, at 2pm ET
Reserve your spot
If you think that merging your independent practice with a larger healthcare system is the only way for it to survive, this webinar is for you. On the heels of Independence Day, this free one-hour presentation takes a close look at topics such as:
- Why it’s so overwhelming for independent practices to operate today
- The measurable advantages independent practices have over larger systems
- 3 case studies of once-struggling independent practices that are thriving today
Know what athenahealth knows about helping you run your practice your way. REGISTER TODAY
Less Expensive Hearing Devices May Work as Well as Traditional Hearing Aids
Some over-the-counter sound amplification devices are nearly as effective as prescription hearing aids, according to a small JAMA study.
Researchers compared five personal sound amplification products with one hearing aid in 40 older adults with mild-to-moderate hearing loss. Speech understanding improved with the hearing aid and four of the amplification products. For three of the products (Sound World Solution sCS50+, Soundhawk, Etymotic BEAN), the improvement in speech understanding was within 5 percentage points of that of the hearing aid.
The authors conclude: “Results lend support to current national initiatives … requesting that the US Food and Drug Administration create a new regulatory classification for hearing devices meeting appropriate specifications to be available over the counter.”
JAMA research letter
New Web Page for Doctors Working in Small, Rural, or Underserved Areas
CMS announced the launch of a new section on the Quality Payment Program on https://qpp.cms.gov/about/small-underserved-rural-practices dedicated to doctors and other clinicians working in small or rural practices as well as those treating patients in underserved areas. This page serves as a single point of reference to help physicians prepare for, and actively participate in, the Quality Payment Program, especially, for those of you participating under the Merit-based Incentive Payment System (MIPS) track.
Physicians can quickly locate contact information for the organizations providing assistance to practices through the Small, Underserved, and Rural Support initiative using a simple interactive map. These local, experienced, community-based organizations provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas.
The training and education resources are available nationwide and will be provided at no cost to eligible clinicians and practices. Physicians can also review the flexibilities to help reduce the participation and reporting burden on small practices for 2017. We anticipate adding more features and information over time and will continue to keep the lines of communication open, as CMS values physician feedback in helping to improve their experience in the Quality Payment Program.
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Physician Opportunities
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.
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.
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
CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355