MSSNYeNews: Medical Marijuana & You

Thomas J. Madejski, MD MSSNY President

Thomas J. Madejski, MD
MSSNY President

June 22, 2018
Number 23


Dear Colleagues:

This week, the New York State Department of Health Commissioner Howard Zucker, MD, announced that the department will develop a regulatory amendment to add opioid use as a qualifying condition for medical marijuana.  The proposed regulations would join 12 other qualifying conditions under the state’s Medical Marijuana Program, which also were recently updated to include chronic pain and post-traumatic stress disorder.

At the same time, the New York State Legislature passed Senate Bill 8987/A.11011, sponsored by Senator George Amedore and Assemblyman Richard Gottfried, that would allow physicians to certify patients to obtain medical marijuana for “pain that degrades health and functional capability where the use of medical marijuana is an alternative to opioid use, substance use disorder.” The Medical Society of the State of New York has opposed this measure because there is limited evidence to support the recommendation of marijuana as an alternative to opioid pain medications for pain and no data on opioid use or opioid use disorder.

On a personal basis, I practice palliative medicine and deal with a number of patients with chronic pain issues, and comorbidities including substance use disorders and mental health issues.  I have had many discussions with my patients regarding marijuana as an alternative to opioid and other non-narcotic pain medicines.   We have explored their use in reducing or obviating their need for opioids.  My anecdotal, uncontrolled experience is that marijuana may be helpful in a subset of patients.  While I am open to further exploration of marijuana as an additional tool in my armamentarium for easing my patients’ suffering, I am troubled by the promotion of this complicated medication with many variations in dosage form, composition and other poorly studied parameters as a panacea without more robust study and data on the long term consequences of use.

Marijuana for 12 Indications Should Be Measured

This DOH proposal seems to be an attempt to reduce risk or harms when engaging in dangerous behavior, and while this may be an argument to be made for using medical marijuana as a harm reduction strategy, the state should be clear that this is the case.   At this time, there are no established guidelines for treatment of acute pain.  In addition, there is insufficient evidence to support the recommendation of marijuana as an alternative to opioid pain medications for pain.  Furthermore, there is insufficient evidence to support marijuana as an alternative to other treatments for acute pain, including in patients with opioid use disorder. Instead of medical marijuana, MSSNY believes that placing a patient on Medication Assisted Treatment (MAT) for opioid use disorder may be a more appropriate option for treating pain when an alternative opioid pain medication may not be appropriate for those patients that suffer from opioid use disorder.  Any action by New York State to use marijuana for the treatment of any of the 12 indications must be measured, including this one.

MSSNY has always expressed concerns about federal prosecution against a physician who certified a patient for the use of marijuana.  Action by US Attorney General Jeffrey Sessions may allow federal prosecutors to more aggressively enforce marijuana laws—a nuance that we are concerned is not being sufficiently considered.

In addition to medical marijuana, this week, Commissioner Zucker, MD said that a state-commissioned study will recommend allowing recreational use of marijuana.  The report is not yet public, but the commissioner indicated that the report’s authors reached their conclusion after a review of the legal, medical and social implication of legalization.  MSSNY looks forward to further information and will comment when we have had an opportunity to review the data and conclusions.

“Not Yes or No, But How?”

When questioned about Dr. Zucker’s comments, Gov. Andrew Cuomo said the state will at some point legalize recreational use of marijuana, but not this year. What’s more, he said, there are still many details to work out. “It’s not a yes or no, it’s the how,” Cuomo told reporters during an unrelated conference call. “The devil is in the details. What ages, what amounts, what tax rate, where do you sell it, how do you police it?”

George Santayana opined,” those who cannot remember the past are condemned to repeat it.”  Twenty years ago there were many entities which promoted opioids for more widespread usage based on limited data, which subsequently were noted to be flawed, contributing to our current desperate situation with prescription and non-prescription drug abuse.

Earlier this year, I applauded Governor Cuomo for his cautious approach to the complicated question of medicinal and recreational use of cannabinoids. History sometimes does repeat itself.  Unfortunately, it is often cunningly disguised and not recognized until the damage is done.  Truly, the devil is in the details, not only for the recreational use of marijuana but for clinical use as well.  MSSNY is concerned with additional uses for medical marijuana being legislated without adequate clinical evidence to support its use, and little knowledge of the consequences of chronic use on our patients and throughout society.


Please send your thoughts to

Thomas J. Madejski, MD 
MSSNY President

MLMIC Insurance

Capital Update

Legislature Completes Session with Public Health Victories
With the New York State Senate gaveling out at 2 AM early Thursday morning, the scheduled portion of the 2018 Legislative Session came to a close.  Despite the political deadlock in the NYS Senate, working together with the many specialty societies, patient advocacy groups and other allies, the Session produced a number of public health victories for physicians and their patients, and the defeat of hundreds upon hundreds of adverse pieces of legislation that would have added new mandates, new costs, and harmed patient access to needed care.

Among the measures adopted by the Legislature supported by MSSNY:

  • Creating a statewide drug “take back” program for the safe disposal of medications,
  • Requiring health insurers to provide data to the DFS for public reporting purposes regarding how insurers are complying with the mental health parity/substance abuse coverage requirements
  • Expanded insurance coverage for prostate cancer screening without cost-sharing
  • Prohibiting use of tanning facilities for those under 18
  • Provisions to extend MSSNY’s Committee for Physicians’ Health confidentiality and liability  until 2023

Moreover, numerous adverse proposals that had been under serious consideration in the final weeks of Session were defeated or had objectionable provisions removed.  Though there are far too many to list off here, some of the more notable proposals would have:

  • Required physicians to report certain patients to the Department of Motor Vehicles
  • Required physicians to inquire and document the school attended by their school age patients
  • Required physicians to co-prescribe naloxone for patients for whom an opioid medication is prescribed
  • Reduced to 3 days the time frame for a physician to write an initial prescription for an opioid medication for a patient with acute pain
  • Expanded religious exemptions for otherwise required child immunizations
  • Expanded the scope of practice for naturopaths, podiatrists, dieticians, estheticians, psychologists and many other non-physicians
  • Reduced the role of county medical societies in approving physicians to become authorized under Workers Compensation
  • Expanded liability against physicians through expansion of wrongful death awards, removal of contingency fee limits and prohibiting ex-parte interviews.

We thank all the physicians who took the time to communicate and/or visit with their legislators.   With a few unfinished items (not related to health care) it is still possible for the Legislature to return to Albany later in the year where various bills effecting health care delivery could be brought up again. 

Legislation Passes to Require Public Reporting of Health Insurers’ Compliance with Mental Health & Substance Use Disorder Parity Laws;
The Senate and Assembly completed passage of legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the Superintendent of the Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.   MSSNY working together with the New York State Psychiatric Association and other specialty societies had strongly supported this legislation, and many physicians weighed in with their legislators in support. 

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS.  Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws.  (DIVISION OF GOVERNMENTAL AFFAIRS)

Bill to Establish a Statewide Drug Takeback Program Passes the NYS Legislature
Senate Bill 9100/ A9576-B, which would establish a drug takeback program, passed the New York State Legislature this week and will now go before the governor.   This measure, sponsored by Senator Kemp Hannon and Assemblymember Aileen Gunther, would require manufacturers of a covered drug to either submit, individually or jointly, a drug take back program for approval to the New York State Department or to enter into an agreement with the Department to operate a drug take back program on its behalf.  Under the bill’s provisions, manufacturers are responsible for all administrative and operational fees associated with their take back program, including the cost of collecting, transporting and disposing of covered drugs from pharmacies and other authorized collectors and the recycling or disposal, or both, of packing collected with the covered drug. This bill further requires chain pharmacies and mail-order pharmacies to provide for the collection of covered drugs by providing consumers with on-site collection, prepaid mail-back envelopes or other Drug Enforcement Agency (DEA) approved methods.  The program would accept all types of any medication in any form including prescription and nonprescription drugs, drugs in medical devices and combination products, brand and generic drugs and drugs for veterinary use.

The Medical Society of the State of New York House of Delegates had adopted policy calling for a program to allow daily access to safe, convenient, and environmentally sound medication return for sites unwanted prescription medications.  The HOD policy also calls for MSSNY to support a medication disposal program that’s fully funded by the pharmaceutical manufacturers, including costs for collection, transport and disposal of these materials as hazardous waste.                       (CLANCY)

Legislature Passes Measure to Eliminate Patient Cost-Sharing for Prostate Cancer Screening
The Senate and Assembly passed legislation this week (S.6882-A, Tedisco/A.8683-A, Gottfried) to ensure that health insurers provide coverage for diagnostic testing for prostate cancer for men 40 and over with a family history, and men 50 and over who are asymptomatic, without such care being subject to annual deductibles or coinsurance.  The bill would also require the inclusion of information regarding the availability of insurance coverage for prostate cancer screening without cost sharing in the standardized written summary prepared by the Commissioner of Health.  New York has for many years required insurance coverage for these tests, but were subject to cost-sharing.  If signed into law, this legislation would provide coverage without patient cost-sharing to a greater cohort of men for necessary prostate cancer screening than what has been recommended by the US Preventative Services Task Force.                                                                            (AUSTER, CLANCY)

Tanning Bill Prohibition For Children Under 18 Passes NYS Legislature
Legislation that would prohibit the use of tanning booths for children under 18, has passed in the NYS Legislature.  The measure, Assembly Bill 7218A/Senate Bill 8858A, is sponsored by Assemblywoman Ellen Jaffe and Senator Phil Boyle.  The Medical Society of the State of New York and several public health organizations, such as the American Cancer Society, were unanimous in their support of this measure and worked together to obtain passage of this important public health measure.   Currently, the law allows children between the ages of 17-18 years of age to use tanning booths with parental permission.  According to the American Cancer Society, skin cancer is the most diagnosed cancer in the United States. About 95,400 invasive skin cancers will be diagnosed in the US, and more than 87,000 of these will be of melanoma, the most serious form.  The bill now goes to the Governor for his consideration.                                                                              (CLANCY)

Legislation to Expand Non-Physician Care in Workers’ Compensation Does Not Pass
The Legislature left Albany without taking action on legislation (S.8812-A/A.8387-C) that would have expanded the list of eligible health care professionals allowed to treat injured workers, including acupuncturists, nurse practitioners, social workers, and physician’s assistants.  While each of these professionals can play an important role in the delivery of care to patients, MSSNY raised concerns with the possibility of care being provided to injured workers without the coordination of a physician including assessing the injured worker’s level of disability and determining causation of a patient’s injury.

MSSNY had also expressed concern over another component of the legislation that would have modified the process of how county medical societies recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation.  While the provision had been improved over earlier versions, MSSNY was concerned that the phrasing of the proposal could be interpreted to enable the WCB to bypass the county medical society in approving physicians to be authorized to treat or provide IMEs under Workers’ Compensation.

Discussion on this proposal will likely continue over the year and into next year.  The legislative proposal was part of a series of WCB initiatives to expand care access to injured workers, which also included a separate WCB regulatory proposal to provide a 5% increase to the Workers Compensation medical fee schedule effective October 1.                          (AUSTER, BELMONT)

Raising the Tobacco Purchase Age Not Acted On By NYS Legislature
Legislation to increase the purchase age for tobacco products from 18 to 21, failed to be acted upon this year in the New York State Legislature.  The bill made it to the Assembly Calendar, but was not voted upon.   It had not moved from the Senate Finance Committee.  Assembly Bill 273/ Senate Bill 3978, sponsored by Assemblywoman Linda Rosenthal and Senator Diane Savino, would have allowed New York State to increase the purchase age for tobacco products from 18 to 21 years of age—there are currently 22 municipalities and counties that have increased the purchase age.  The Medical Society of the State of New York worked with  other public health associations to try to enact this legislation into law.                                                                                                        (CLANCY)

Legislation To Allow Enhanced Religious Exemptions for School Based Immunizations Defeated
Senate Bill 6141D and A. 8123B, sponsored by Senator Martin Golden and Assemblymember Richard Gottfried, which would have allowed the admission of certain unvaccinated students to public schools, did not pass the Legislature.   MSSNY opposed this measure and it worked with other public health associations and medical groups to urge that this measure not be acted upon.  There were many physicians that also sent letters to their legislators and/or made calls.   The bill did move from the NYS Senate’s Education Committee and this was the first time that this bill has been voted on by members of any Senate committee.

The bill amends the Education Law to provide the procedure for religious exemptions from vaccination requirements.  Under the bill, a parent or guardian would complete a religious beliefs vaccination exemption form to ensure a public school district does not deny admission to their unvaccinated child.  A religious exemption is currently allowable under NY State law, but the exemption allows the school institution to make a decision on whether the student should be exempt from vaccination.   This bill, if it had been passed by the Legislature, would have forced schools to accept the form and allow unvaccinated students to enter the school.                                                     (CLANCY)

Legislature Passes Bill to Call for DMV to Require Examination of Certain Patients; Does Not Contain Physician Reporting Mandate
As a result of advocacy by several patient advocacy groups along with MSSNY, the Legislature did not pass legislation (S. 3569, Young / A.10094, Carroll) that would have required a licensed physician, physician assistant or nurse practitioner to report patients that have a chronic condition which cause or may cause unconsciousness or unawareness to the Department of Motor Vehicles.  The legislation had advanced to the Senate floor, but moved no further.  In addition to MSSNY, that bill had been opposed by the Epilepsy Foundation and American Diabetes Association. 

Instead, the Legislature passed a different bill (S.8990, Young/A.11121, Carroll) which would authorize the Department of Motor Vehicles (DMV) to require driver’s license holders to submit to a DMV re-examination of their fitness to drive if the licensee experienced a loss of consciousness and was involved in a reportable accident while driving and DMV receives evidence that the loss of consciousness caused or contributed to the accident.  The bill also directs the DMV, in consultation with the Department of Health and the Division of State Police, to review its notification process by physicians to DMV including identifying the impediments of physicians, police officers and others to reporting certain patients to DMV, and report back to the Legislature within one year of enactment of this bill.                                                                                                                        (BELMONT, AUSTER)

Legislation To Mandate Collection of School Information Does Not Pass
The Senate and Assembly left Albany without taking action on legislation (S. 2113-A, Felder/A.352-A, Perry) which would have required physicians and hospitals to inquire and document the name of the school attended by school-aged patients and to include this information in their admission registration forms.    In addition to MSSNY, the bill had also been opposed by the Healthcare Association of New York State and the NYC Health and Hospitals Corporation.

The bill was on the “Debate List” on the floor of the Assembly the last 2 weeks of Session, as well as on the floor of the Senate.     However, considerable grassroots activism from physicians, as well as significant advocacy in Albany by various groups, resulted in several Senators and Assemblymembers objecting to the legislation.  MSSNY had raised concerns that New York Public Health Law Section 2101 already requires physicians to report immediately to the local health officer regarding the presence of any communicable disease. The health officer is then charged with the responsibility to investigate cases of communicable disease, to ascertain sources of infection, to seek out contacts, and to take other steps to reduce the spread of the disease.  MSSNY also raised concerns that increasing mandates take more and more time away from the ability to deliver the timely care patients expect to receive.                                                                                (AUSTER, BELMONT)

NYS Assembly Passes Single Payor Legislation; Bill Not Taken Up in the Senate
Last week, the New York State Assembly passed by a 94-46 vote legislation that would have created a single payor health care system in New York State.   The bill, which has passed the Assembly each year since 2015, was not taken up by the NYS Senate prior to leaving Albany.  While there are many physicians who support a single payor system, MSSNY has repeatedly advised legislators that it has a long-standing policy position opposing the creation of a single payor system, a policy position which was re-affirmed in the fall of 2017.

To view how each Assemblymember voted on this bill, click here.  The view the 2½ hour Assembly debate on this legislation from June 14, click here (starting at about the 1:00 mark).   (AUSTER) 

Bill to Allow Newborn Standing Orders Passes New York State Legislature
Legislation, which would authorize hospital standing orders for the care of newborns, has passed the New York State Legislature.   S. 8774B/A. 9950B, sponsored by Senator Kemp Hannon and Assemblyman Richard Gottfried, will allow a hospital to establish standing orders for the care of newborns.  The bill also allows the ability of a nurse to depart from the standing order and does require that the attending nurse shall advise the attending practitioner if the nurse becomes aware of circumstances that reasonably indicate a need to depart from the standing order.  MSSNY expressed concern that the legislation then goes on give the nurse discretion to deviate from the protocol without authorization from the attending practitioner, provided that they act within their scope of practice.

The order must also provide that the attending practitioner shall review and acknowledge in writing the care provided under the standing order.   MSSNY indicated that the tests and getting a newborn ready for admittance into a nursery pertains to a “healthy” newborn and that there is no need to deviate from the standing order.   MSSNY also indicated that if there is a medical issue that arises between the delivery room to the nursery with a “healthy” newborn then emergency protocols would be in effect and consults with a physician would be required.  However, the NYS AAP (American Academy of Pediatrics) supported this measure and the NYS Chapter, American College of Obstetricians and Gynecologists, (ACOG), District II, took no position on the measure.  The bill will now go to the Governor for his consideration.                                                                            (CLANCY)

AMA Announces Formal Opposition to CVS Takeover of Aetna
The American Medical Association (AMA) announced this week that, after conducting an exhaustive analysis on the proposed acquisition of Aetna by CVS Health, it would urge federal and state regulators to block the merger. The announcement was made by AMA President Dr. Barbara McAneny, in testimony on the proposed CVS-Aetna deal at a hearing held by the California Department of Insurance.  Earlier in the year, the AMA had presented strong concerns about the merger during a hearing of the US House of Representatives Judiciary Committee, but had stopped short of calling for an outright rejection.

According to the press release, the AMA position in opposition is based on evidence indicating the merger’s likely anticompetitive effects on Medicare Part D, pharmacy benefit management services, health insurance, retail pharmacy, and specialty pharmacy, including:

  • An expected increase in premiums due to a substantial increase in market concentration in 30 of 34 Medicare Part D regional markets.
  • An anticipated increase in drug spending and out-of-pocket costs for patients as Aetna and CVS fortify their dominant positions in the health insurance, pharmaceutical benefit management, retail and specialty pharmacy markets that already lack competition.
  • A reduction in competition in health insurance markets that will ultimately adversely affect patients with higher premiums and a reduction in the quality of insurance.
  • A foreseeable failure to realize proposed efficiencies and benefits because the merger faces enormous implementation challenges, and those efficiencies have a questionable evidence base.

Earlier this month, Immediate MSSNY Past President Dr. Charles Rothberg expressed MSSNY’s opposition to this proposed acquisition during a New York State Assembly Insurance-Health Committee hearing on this topic. Strong concerns were also expressed by consumer and pharmacy groups.

Following the conclusion of the NY Assembly hearing, Assembly Insurance Committee Chair Kevin Cahill noted, “Our State must be proactive in responding to such drastic potential changes in our health care delivery systems. The past has taught us that reactive approaches to challenges in health care could have devastating effects on consumers and our health care system. This acquisition poses serious questions for the long-term stability of the State’s insurance markets and access to health care products”.

Assembly Health Committee Chair Richard Gottfried added: “It should be of great concern to have what economists call ‘vertical integration’ – in this case a major health care provider and a major health insurer sharing the same bottom line – with dramatic effect on consumers and others in the market. It’s critical that State and Federal regulators assess and understand the potential impact on patients, insurance networks, and drug purchasing and dispensing processes.”

The AMA will file a post-hearing memorandum outlining its concerns later this month.  (AUSTER)

Legislature Rejects Scope of Practice Changes
The State Legislature left Albany this week without taking an action on a plethora of bills opposed by MSSNY together with many specialty societies which would have created or expanded the scope of practice of numerous non-physician health care providers.   Some of these bills include: 

  • Certification of Certified Registered Nurse Anesthetists  – A.442 / S.1385
  • Broadening the scope of practice of dentistry -A.4543 / S.3551
  • Expand the ability of podiatrists to provide wound care – A.1880/S.4734
  • Statutory recognition to naturopaths – 5913/S.4297
  • Psychologists Prescribing – 2851 / S.4498                          
  • Expand scope of dieticians to order lab tests – 2231-C/A.8504-B
  • Allow PAs to Operate Fluoroscopy Imaging Technology – 4716/S.8165
  • Permitting estheticians and others to do laser hair removal with limited physician oversight – S.6088-A/A.7977-A

            (DIVISION OF GOVERNMENTAL AFFAIRS)                                                                                                                                       

MSSNY Participates in New York State Lyme and Tick-Borne Disease Summit
Governor Cuomo has called upon the Department of Health, Department of Environmental Conservation, and the Office of Parks, Recreation and Historic Preservation to collaborate in order to target priority counties and public lands with the highest risk of tick exposure and Lyme disease.  On Tuesday, both public and private stakeholders met to discuss the goals of the collaboration at the New York State Lyme and Tick-Borne Disease Summit.

The goal of the working group on Lyme and other tick-borne diseases is to review New York State’s current initiatives and make policy recommendations on actions that New York State can take in the next one to three years to advance prevention, diagnostics, and other best practices. The Statewide Tick-Borne Pathogen Surveillance Initiative has been actively surveying lands across New York State and has recently launched a website displaying their findings. To view their research, click here. Tick season has started in many areas of the state and will continue through November.  To learn more about Lyme disease, prevention, and tick removal, click here.

Medical Society of the State of New York Announces Veterans Matters Programs are Available on CME Website
Did you know that in a recent report, the New York State Health Foundation discovered that nearly HALF of veterans prefer to receive their care OUTSIDE of the VA system, and less than 3% of physicians outside of the VA are fully prepared to help veterans?

The Medical Society has created a free CME program series entitled Veterans Matters to assist New York State physicians in recognizing the unique health problems faced by veterans and the best way to provide care to veterans.  These programs are all available at 

Veterans Matters: PTSD & TBI in Veterans

Faculty: Emerald Lin, MD

Educational Objectives:

  • Identify signs and symptoms of PTSD & TBI
  • Examine evidence-based treatment modalities for PTSD & TBI
  • Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture. 

Veterans Matters: Substance Use Disorders in Veterans

Faculty: Frank Dowling, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention, and treatment options
  • Identify barriers to identification and treatment in military culture and methods to overcome them 

Veterans Matters: Suicide in Veterans

Faculty: Jack McIntyre, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention and treatment options
  • Identify barriers to identification and treatment and methods to overcome them

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 Melissa Hoffman at                                                                        (HOFFMAN)

Medical Society of the State of New York Encourages You to Check out CME Website
The Medical Society of the State of New York has recently added several new emergency preparedness and Medical Matters CME programs to our CME website. You can earn FREE CME credits on a myriad of topics related to Bioterrorism and Disaster/Terrorism response.  Emergency preparedness topics include our 4-part Physician’s Electronic Emergency Preparedness Toolkit, Anthrax, Smallpox as well as Ebola and numerous others.

Additionally, all of our Medical Matters programs from the past several years have been archived at  Topics range from Zika Virus, Influenza and Plague to Nuclear Radiation, Disaster Triage and Mental Health as well as a variety of other timely and relevant subjects.  For assistance, or more information, please contact Melissa Hoffman at or call (518) 465-8085.                                                (Hoffman)

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


Group Health Insurance Survey
Do you have a moment to take a brief survey? MSSNY is exploring the possibility of developing a cost-effective health plan for our members, their dependents, and their employees (not an associated health plan [AHP]).

Our ability to move forward will be based on the number of members that express an interest in participating with this new group.

You can access the survey here.

Thank you for your participation.

Is It OK to Charge Patients $.75 Per Page for Their Records?
Can doctors still charge 75 cents per page? NO, not automatically.

Now, practices need to do some figuring.  Copies can be provided by paper or electronically by CD or USB stick.

Then, the practice needs to do some calculations.

HIPAA requires that the charge for paper or electronic copies must reflect actual cost.  The cost may include:

  • cost of labor to copy—but not labor to review request or search and retrieve;
  • cost of certain supplies such as paper, CD or USB flash drive;
  • postage;
  • cost of labor to prepare a summary or explanation, but only if both parties agree.

Based on the results, the practice will need to ensure that whatever cost is most favorable to the patient is what can be charged.  If all else fails [or, is too cumbersome to figure out] a maximum flat rate of $6.50 can be charged.

Please be sure to see the actual HHS guidance on this link.

Notice from MLMIC to All Endorsed Partners
A public hearing has been scheduled by the New York State Superintendent of Financial Services pursuant to Section 7307 of the New York Insurance Law, to consider the Plan of Conversion adopted by the Board of Directors of Medical Liability Mutual Insurance Company, a New York mutual insurance company (“MLMIC”) on May 31, 2018, and revised on June 15, 2018.

The public hearing will be held at the offices of the New York State Department of Financial Services, One State Street, New York, NY, 10004 (6th floor in the main hearing room), beginning at 10 a.m. EST on August 23, 2018.

To view a digital copy of the entire notice of public hearing, click here.

To view a digital copy of the Plan of Conversion, click here.

For additional information about the transaction, visit  Frequently Asked Questions or call 1-888-998-7871.

Please see MLMIC’s latest news on the Berkshire Hathaway Transaction here. MLMIC policyholders should go to this link for information or to call their BH hotline 1-888-998-7871 to speak with knowledgeable staff regarding their questions.

Nurse Pleads Guilty: $60M Fraud Allegedly Involved Accelerating Patient Deaths
A nursing supervisor for Novus, a shuttered hospice provider in Frisco, Texas, has pleaded guilty to conspiracy to commit healthcare fraud for her role in a $60 million scheme that federal prosecutors say involved fatally overdosing patients for profit, according to The Dallas Morning News. Jessica Love, RN, served as Novus’ nurse case manager and regional director before the company shut down several years ago. She was one of 16 defendants charged in the healthcare fraud scheme in February 2017.

According to court documents, Ms. Love and her co-conspirators, including Novus’ owner and CEO Bradley Harris, allegedly enrolled as many people as possible in hospice care, even patients who were not eligible for the services. Once the patients were enrolled, they were given around-the-clock care, which Medicare reimbursed at a higher rate than routine care. If hospice patients were in continuous care for too long, Novus workers allegedly overmedicated them so they would die.

Ms. Love was allegedly involved in the fatal overmedication of two patients, according to the report. Documents from Ms. Love and another Novus employee, who also pleaded guilty in the case, stated Mr. Harris instructed “nurses to intentionally overmedicate beneficiaries with medications such as hydromorphone and morphine with the intent to hasten their deaths,” according to the report.

Mr. Harris has denied any wrongdoing. “We are not aware of any evidence that shows that Mr. Harris caused, hastened or otherwise contributed to the death of the hospice patients being treated by Novus,” Chris Knox, an attorney representing Mr. Harris, told The Dallas Morning News.

WHO Releases ICD-11: 5 Things to Know
After more than a decade in the making, the 11th edition of the International Classification of Diseases has been released by the World Health Organization.

The ICD serves as a foundation for identifying global health trends and statistics and is used by health insurers whose reimbursements depend on ICD coding.

Five things to know:

  1. The new edition carries about 55,000 codes for injuries, diseases and causes of death. By comparison, the 10thedition had 14,400 codes. And for the first time, the ICD is completely electronic.
  2. The new ICD will be presented at the World Health Assembly in May 2019 for adoption by member states and will go into effect Jan. 1, 2022. “This release is an advance preview that will allow countries to plan how to use the new version, prepare translations and train health professionals all over the country,” the WHO stated.
  3. In an effort to more closely reflect progress in medicine, the codes relating to antimicrobial resistance in the new ICD are more closely aligned with the Global Antimicrobial Resistance Surveillance System.
  4. The new ICD can also better capture data regarding healthcare safety, meaning it will help identify and reduce unnecessary events that may harm health, including unsafe workflows in hospitals.
  5. This ICD has new chapters, including ones on traditional medicine and sexual health. Traditional medicine has not been classified in this system until now. The chapter on sexual health brings together conditions that were previously categorized in other ways. The WHO also added gaming disorder to the section on addictive disorders.

FDA Approves First Generic Versions of Suboxone
On June 14, the U.S. Food and Drug Administration approved the first generic versions of Suboxone (buprenorphine and naloxone) sublingual film (applied under the tongue) for the treatment of opioid dependence.

FDA Commissioner Scott Gottlieb, M.D. said, “The FDA is also taking new steps to address the unfortunate stigma that’s sometimes associated with the use of opioid replacement therapy as a means to successfully treat addiction. Patients addicted to opioids who are eventually treated for that addiction, and successfully transition onto medicines like buprenorphine, aren’t swapping one addiction for another, as is sometimes unfortunately said. They’re able to regain control of their lives and end all of the destructive outcomes that come with being addicted to opioids. When coupled with other social, medical and psychological services, medication-assisted treatments are often the most effective approach for opioid dependence.

New Shingles Vaccine in Short Supply
On Oct. 25, the CDC recommended Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up. The Washington Post (6/20) “To Your Health” blog reports there is a national shortage of the new shingles vaccine Shingrix, “prompting retailers to create waiting lists and the manufacturer to delay additional promotion.” The CDC now recommends Shringrix over Zostavax for people over the age of 50.




For Sale-Outpatient Mental Health Clinic
Started in 1998 and located in the NYC metro area, this multi-location business is a well-established, highly reputable, mental health clinic providing outpatient psychotherapy and counseling services.
Revenues 2017 $1.2 mil.
Profits: 2017 $326k
Asking Price: $970k
Terms are available. The clinic’s market consists of Manhattan, Bronx, Brooklyn and Queens Counties. The 25 clinician practice specializes in group, women’s and psycho-educational therapy as well as parenting groups, court mandated services, domestic violence victims groups, anger management and supervised visitation programs. There are 250+ weekly patients and the business accepts most insurances. Buyer must be a NYS licensed physician, NYS licensed mental health consultant, NYS licensed social worker, psychologist or PhD. The owner is retiring.Direct All Inquiries to:
Steve Epstein, V.P.
Gottesman Company
O: 201-750-9605
C: 201-704-8051

Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up:

Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front. First-rate building on 58th Street between Park and Lexington.  Rent by day (about $180) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for a new tenant. Call 646-642-0700.

For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed built out 4 exam rooms with sinks and wall cabinets
Waiting and reception areas, windows throughout.
Street and private entrances, two bathrooms and storage/lab/staff room.
One block to bus and two blocks to Presbyterian Medical Center and subway.
$1900-$7900/ month for one to 4 exam rooms. or 917.8618273


Paging Primary Care Doctors Who Love Technology
98point6 is a healthcare technology startup that needs your input.  We’re seeking practicing physicians to join our Primary Care Council to help shape the future of primary care.  If the fusion of healthcare and technology inspires you, please join us and apply today. Visit:

Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer.