MSSNY eNews – End of Life Care Task Force Named
Thomas J. Madejski, MD
June 8, 2018
On June 6, 2018, two announcements were published in the NYS Register concerning the Workers’ Compensation Program. The first notice states that the WC Board has increased the fee for providing testimony at a WC hearing from $400 to $450. The second notice announced the proposed update in the Official Workers’ Compensation Medical Fee Schedule which will now use the 2017 AMA-CPT coding and provide a 5% increase in the WC Conversion Factors for payment of medical care to injured workers. In addition, physicians or their staff should explore this website for information about the DRAFT fee schedules for Workers’ Compensation.
Please note, DFS Superintendent Maria T. Vullo stated that the WC fee increase could not have been anticipated by auto insurance carriers when rates were established for policyholders. So, to mitigate the effect of unforeseen rate increases, the Superintendent deems it necessary to delay implementation of the WC fee increase for No Fault for 18 months. If you have any questions, please contact email@example.com
On the Road Again
One of the best parts of being MSSNY President is traveling throughout the Great State of New York to meet our members at their County Medical Society meetings. So far I’ve been to Buffalo and Rochester, as well as back and forth to the Greater New York region, and out to Suffolk County. Hearing the concerns of our members one-on-one and in small groups is instructive to me personally, and I believe helps your MSSNY executive team to hone our MSSNY’s message and deliver value to our members. This past weekend I traveled to Northern New York to meet some of our members in St. Lawrence and Franklin County. We had a wide-ranging discussion on issues affecting public health, the current practice environment, as well as physician health and wellness. The various issues discussed reflect the diversity of our members, as well as different practice environments. One of the challenges for our smaller counties is maintaining administrative services in the face of consolidation of practices and healthcare systems in rural environments. Our strategic planning committee continues to look at how best to support our County Medical Societies and ensure their viability.
My thanks and congratulations to the new President of St. Lawrence county Dr. Magendra Thakur and Past President Dr. Cynthia Baltazar for their hospitality. I was also able to relax a little bit with my good friend, our Vice Speaker, Dr. Bill Latreille on the Salmon River. A splendid time was had by all on a beautiful spring Saturday, although I would have liked to catch a few more fish.
Editor’s note: Today’s Buffalo News published a profile of Dr. Madejski.
Thomas J. Madejski, MD
MSSNY Testifies at Assembly Hearing Examining CVS-Aetna Merger
Following the conclusion of the hearing, in a statement Assembly Insurance Committee Chair Kevin Cahill summarized, “Our hearing today helped shine light on the impact the proposed merger will have on health care delivery in New York State. New York has a long tradition of professional and non-profit healthcare and it is critical that regulators, both at the Federal and State level, ensure that any major changes, such as this one, have unimpeded objectives of improving access and quality of care…” He also noted that “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: “An acquisition like this would reshape health care delivery. Pharmacy benefit managers, like CVS’s CareMark, and health plans have leverage over pharmacies in ways that could favor CVS’s own stores at the expense of independents and other chains. 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. Today’s hearing, including feedback from CVS, Aetna, other health care providers, and consumer advocates, was an important step in that process.”
To view the entire 4 hour hearing, Click Here: Dr. Rothberg’s comments begin at about the 2:20 mark.
Please Click Here to view a Capital Tonight interview with Assemblyman Cahill as he discusses his concerns with the merger proposal including the physician, pharmacy, and consumer concerns. (AUSTER)
5% Overall Increase to Workers Compensation Medical Fee Schedule Proposed
To review how such increase is proposed to be implemented, Click Here: As comments are due to the WCB by August 5, MSSNY is reviewing the entire proposal, and has sought feedback from the members of its Workers Compensation and No-Fault committee. MSSNY has also sought input from societies representing affected medical specialties such as Orthopedics, Anesthesiology and Osteopathy.
The proposed regulation also notes that the cost of ordering a hard copy of the fee schedule will be $100, and an electronic copy will cost $400.
By separate regulation, the WCB also proposed to increase the WC testimony fee for physicians from $400 to $450.
These proposals are part of a multi-pronged effort by the WCB to increase care availability for injured workers. As reported last week, the WCB has also advanced legislation (S.8812 and A.8387-B) in the Assembly and Senate that would expand the list of eligible providers allowed to treat injured workers. The bill expands eligibility to include acupuncturists, chiropractors, nurse practitioners, physical therapists, physician’s assistants, podiatrists, psychologists and social workers.
MSSNY has expressed concern that the proposal would enable a nurse practitioner to assess an injured worker’s level of disability and determine causation of a patient’s injury without the involvement of a physician. MSSNY has also expressed concern over another component of the legislation that would modify the process of how county medical societies recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation. While the provision has been improved over earlier versions, MSSNY remains very concerned that the phrasing of the proposal could enable the WCB to bypass the county medical society in approving physicians to be authorized to treat or provide IMEs under Workers’ Compensation. (AUSTER, BELMONT)
MSSNY Opposes Requiring New Physician Mandates
Increasing mandates take more and more time away from the ability to deliver the timely care patients expect to receive. This trend is well documented. A recent 2016 study reported in the Annals of Internal Medicine concluded, remarkably, that for every one hour of patient care delivered by a physician, two more must be spent on paperwork. (BELMONT)
Bill to Prohibit Flavored E-liquid in E-Cigarettes Moves in the NY Assembly; On Senate Calendar for Vote
E-cigarette use poses a significant health risk to young people in by increasing the possibility of addiction and long-term harm to brain development and respiratory health. E-cigarettes liquid is nicotine and most now have flavoring in them. E-cigarettes are considered tobacco products. According to a 2016 report by the U.S. Surgeon General, young adult users of e-cigarettes (ages 18 through 24) are much more likely to use flavored e-cigarettes than are users over the age of 25.
The Surgeon General also reported that the majority of youth who have tried e-cigarettes first used a flavored product. Youth are attracted to e-cigarettes due to the flavoring and a perceived lower risk than using traditional tobacco products. Electronic cigarette companies use colorful packaging and enticing flavors to lure young people when they are at the most common age to begin smoking. The Medical Society of the State of New York supports this measure. (CLANCY)
Bill to Include Lyme Long Term Therapy Prohibition in OPMC on Assembly Floor
Under this measure, no health care professional shall be subject to professional discipline for prescribing long-term antibiotic therapy for a patient diagnosed with or treated for Lyme disease or other tick borne illness. In 2015, the New York State Legislature amended the statute by putting into place existing principles that were being followed by OPMC regarding the investigation of physicians, physician assistants and specialist assistants who use treatment modalities that are not universally accepted by the medical profession, such as the varying modalities used in the treatment of Lyme disease and other tick-borne diseases.
These principles had existed since 2005. When this law was enacted in 2015, according to officials from OPMC, there have only been one physician who has ever lost his or her license for misconduct related to the use of antibiotics, and that occurred in the mid- 1990s. To MSSNY’s knowledge, there has not been any other professional who has been reviewed on antibiotic use. The Medical Society of the State of New York has, for over last 20 years, worked with the Department of Health and the New York State Legislature to enhance due process protections for physicians under the OPMC statute. MSSNY believes that those protections already preserve the freedom of physicians to exercise their clinical judgment in the treatment of their patients. MSSNY is opposed to this measure. There is no companion measure, at this time, in the New York State Senate. (CLANCY)
MSSNY Joins Patient Groups to Advocate to Prevent Mid-Year Formulary Changes
Earlier in the year MSSNY participated in a press conference in support of the legislation, together with the sponsors of the bill, as well as many of its supporters, including the Global Healthy Living Foundation, Lupus and Allied Diseases Association, NAACP, AARP, New Yorkers for Accessible Health Coverage, the Epilepsy Foundation, the Arthritis Foundation, the American Cancer Society, the National Association on Mental Illness-NY, the NY Chapter of the American College of Physicians, the NYS Osteopathic Medical Society, and the American College of Rheumatology.
MSSNY President Dr. Thomas Madejski stated the following for the press release: “Continuation of a medication regimen prescribed by a patient’s treating physician is critical to assuring a patient’s recovery from illness, maintaining their health, or preventing worsening of their condition. Unexpected changes to a medication formulary could result in significantly higher out-of-pocket costs for patients. This could seriously interfere with their continued ability to obtain these needed medications. Insurance company formulary changes are not made with the intimate knowledge of the patient’s personal physician. Additionally, this legislation would help to protect consumers from unforeseen higher cost-sharing requirements. (AUSTER)
Bill To Allow Superintendent of DFS to Evaluate Insurers & Health Plans Compliance with Mental Health & Substance Use Disorder Parity Laws; Physicians Urged to Contact Legislators
Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, there still exists within the health insurance and health plan industry patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services, which is further evidence by the settlements/agreements the office of attorney general in New York State reached over the last several years with several major insurers, health plans and managers of behavioral health benefits regarding acts of non-compliance. This further demonstrates the need for an industry wide approach and annual evaluation of compliance. MSSNY along with NYSPA firmly believe this legislation is the next step for New York to take to assure compliance and full implementation of the federal and state MH/SUD parity laws, thereby for enhancing access to care for MH/SUD care and treatment. Physicians are urged to send a letter to please Click Here. (CLANCY)
MSSNY Committee for Physicians Health Bill Passes Senate
The CPH is a program designed to confront and assist physicians thought to be suffering from alcoholism, substance abuse or mental illness. Since the inception of this program, CPH has assisted thousands of physicians in returning healthy to medical practice. The work of the CPH program is an important public service both to our health care system as well as the general public. As a result, the State Budget annually includes an appropriation of $990,000 for the program, which is generated from a $30 assessment on all physicians’ biennial registration fees.
The program has traditionally been extended by the Legislature in 3 or 5 year “demonstration programs” with the most recent extension in 2013. The recently enacted State Budget included a provision to create another “demonstration program” until 2023. However, it omitted other provisions historically extended at the same time that are essential to its functioning that could greatly impair its operations unless immediate action is taken.
These includes provisions that set forth the CPH program’s reporting requirements to the Office of Professional Medical Conduct (OPMC), provisions to ensure liability protections for the physician Committee members for work performed in the scope of CPH, and necessary confidentiality protections for the program given the sensitivity of the work they perform. These protections are absolutely essential to the continued functioning of the program to ensure that physicians with the appropriate expertise are willing to serve on the Committee, as well as to assure that the program has the ability to report sensitive information to OPMC when warranted by the circumstances. (DIVISION OF GOVERNMENTAL AFFAIRS)
MSSNY Supports Physician Protection Act
Physicians and other health care employees are exposed on a daily basis to the potential of assault or other violent situations in the course of their duties. Assaults on the job are one of the most frequent causes of serious injuries in health care. While current statute affords protections and increased penalties for assaults on nurses, EMTs, emergency department medical personnel, firefighters, police officers, school crossing guards, sanitation workers and other employees providing direct patient care, physicians are currently not afforded the same safeguards. Please call your legislators and tell them to support S.8055 (Funke) and A.10225 (Joyner). (BELMONT)
Measure to Require Co-prescribing on Naloxone By All Prescribers for All Opioid Prescriptions Held in Committee
The Medical Society of the State of New York is opposed to this measure. The Medical Society, a member of the AMA’s Opioid Task Force, agrees with the task force that physicians be encouraged to consider co-prescribing naloxone when it is clinically appropriate to do so. New York State has enacted a non-patient specific script which allows for ease to do this. The Medical Society of the State also believes that this measure will create greater stigma toward patients with pain. (CLANCY)
Assembly Higher Education Committee Rejects Scope Expansion Bills
DMV Reporting Legislation Update
A new bill, A.11121 Rules (Carroll) was introduced this week. This bill would authorize the Department of Motor Vehicles (DMV) to require driver’s license holders to submit to a DMV reexamination 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 would also direct the DMV, in consultation with the Department of Health and the Division of State Police to review its notification process by physicians and the methodologies by which the DMV receives information.
The bill would review the identification procedures of medical review programs and whether certain drivers should operate motor vehicles due to chronic, ongoing conditions that may cause loss of consciousness, loss of awareness or loss of body control. MSSNY will continue to work with both houses and the various state agencies to continue to advocate that the physician’s duty to report medical conditions that would impair safe driving should be voluntary and under the physician’s discretion. (BELMONT)
Health Insurer Premium Increase Requests Announced by DFS
NYS Program Helps to Subsidize Cost of Connecting to Regional Health Information Exchange
Physicians Urged to Contact Senator On Legislation to Allow Enhanced Religious Exemptions for School Based Immunizations
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 passed by the Legislature, would force schools to accept the form and allow unvaccinated students to enter the school. Its companion measure, A. 8123B, sponsored by Assemblymember Richard Gottfried, chair of the Assembly Health Committee, is also pending before the Assembly’s Education Committee. Physicians are urged to write to the members of the NYS Legislature and urge that this bill not be enacted. To write a letter go to the MSSNY Grassroots Action Center and click on the letter here. (CLANCY)
Medical Society of the State of New York Announces June Medical Matters CME Webinar Schedule
June 20th at 12:30pm – Medical Matters: Children’s Mental Health After Disaster
Register for this webinar here.
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 firstname.lastname@example.org. (HOFFMAN)
MSSNY Announces Members of Task Force for End of Life Care
Dr. Thomas Madejski, MSSNY President, named Jeffrey T. Berger, MD and Dr. John Maese as co-chairs of the task force. Dr. Berger is chair of MSSNY Bioethics Committee and serves as Chief of the Division of Palliative Medicine and Director of Clinical Ethics at NYU Winthrop Hospital. He is board certified in both Internal Medicine and Hospice and Palliative Medicine; Dr. Maese, a member of the MSSNY Committee on Continuing Education, is board certified in Geriatric Medicine and Internal Medicine.
Additionally, Dr. Madejski appointed the following MSSNY members to serve on the task force: Bruce H. Berlin, MD; Patricia A. Bomba, MD; Clare B. Bradley, MD; Erick A. Eiting, MD, MPH; Steven M. Kaner, MD; Shail Maingi, MD; John “Jack” McIntyre, MD; Parah H. Mehta, MD; Nancy H. Nielsen, MD, PH. D. John A. Ostuni, MD; Malcolm D. Reid, MD, MPP; Myrna Sanchez, MD; M. Monica Sweeney, MD, MPH; Rishi Kamlesh Thaker, Medical Student; Joshua Cohen, MD, Commissioner of MSSNY’s Science and Public Health Division; and Janine L. Fogarty, MD, Assistant Commissioner for Science and Public Health.
New York Insurers in Seeking Double-Digit Premium Hikes for ACA Plans
New York’s Department of Financial Services, “Insurers have attributed approximately half of their requested rate increases to the risks they see resulting from its repeal. … Without the federal action, the average requested rate increase would be 12.1 percent.”
AG Settles with Ageless Men’s Health for Misleading PTs with Low Testosterone
New York’s AG, Barbara D. Underwood, announced an agreement with Ageless Men’s Health, P.C. (“Ageless”), requiring Ageless to make complete and accurate disclosures to its patients and prospective patients concerning the diagnosis of low testosterone and the risks associated with testosterone replacement therapy (“TRT”). TRT is an increasingly common treatment for men with low levels of testosterone, sometimes called hypogonadism or “Low T.”
Ageless and its affiliates provide TRT to men at 36 clinics across the United States, including three in New York City. Ageless failed to inform patients that in diagnosing low testosterone and addressing potential side effects of treatment, it was not following evidence-based practices recommended by leading medical organizations. Additionally, Ageless prominently featured a deceptive “Low T quiz” on its website that misled patients regarding the diagnosis of low testosterone.
Medical guidelines, such as the guidelines of the Endocrine Society and the American Urological Association, recommend that two morning blood tests, on different days, should be performed to confirm a diagnosis of low testosterone before starting TRT. Ageless’ practice has been to perform only a single diagnostic blood test, at any time during business hours — more often than not in the afternoon — without informing patients that diagnosing low testosterone in this manner is contrary to these guidelines.
Instead, without informing patients, Ageless relied on different guidelines that do not contain a recommendation one way or the other concerning the time of day of testing or the number of tests that should be performed. In so doing, Ageless led patients to believe that they require treatment when they may not.
Ageless offered TRT to men whose diagnostic testosterone levels are above the thresholds for treatment set out in medical guidelines, including those collected in its own Clinical Operations Manual, without informing patients of that fact. This also led patients to believe that they require treatment when they may not.
Under the agreement, Ageless has committed to (1) remove the misleading “Low T Quiz” from its website; (2) inform patients that according to medical guidelines, blood tests for purposes of diagnosing low testosterone should be performed in the morning, and two morning tests should be performed before starting TRT; (3) inform patients about the thresholds for treatment set out in the relevant medical guidelines; and (4) inform patients in writing about the fertility-related side effects of TRT.
Addressing MSSNY Concerns Regarding eMOLST Registry
New Calculator for Prescribing Meds to Avoid Heart Attack, Stroke
Opioids Responsible for About 20 Percent of Deaths among Young Adults
Researchers Examine Motivating and Deterring Factors for Stool Donors
Important Notice Regarding Handwriting on Face of Claims Submitted to Medicare
Register for Upcoming CMS Webinars
Title: MIPS Promoting Interoperability Performance Category Webinar
CMS is hosting a webinar on Tuesday, June 12 at 1:00 PM ET to provide information about the Promoting Interoperability (PI) performance category (formerly the Advancing Care Information performance category) of the Merit-based Incentive Payment System (MIPS).
Address questions from participants at the end of the webinar, as time allows.
The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion.
Title: CMS Quality Measures: Development, Implementation, and You Webinar (Part 2)
June 14th; 4:00-5:00pm, ET
On June 13, from 12:00-1:00pm, ET, CMS will host the second webinar, of a two-part series, that covers an introduction to quality measures, overview of the measure development process, and how providers, patients, and families can be involved. If you are unable to attend during this time, the same session will be offered again on June 14, from 4:00-5:00 pm, ET. CMS is looking for your feedback and participation in the quality measure community, so please join us during the webinar to hear updates and how you can be a part of the process!
Please note that the two opportunities listed are for the same session; we ask that you only register for one of the sessions.
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Paging Primary Care Doctors Who Love Technology
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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.
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