March 11, 2016 – Opting Out of What Is Being Sold to Us

 Dr. Joseph R.  Maldonado

March 11,  2016
Volume 16, Number 9

Dear Colleagues: 

Opting Out of the Pipe Dream Floated to Most Doctors

The latest mantra being floated by the purveyors of the next iteration to transform healthcare in America is Value Based Payments.  Doctors are told that they will have to adjust to a new reimbursement methodology that changes from fee for service to value based payments.  Those preaching the virtues of this new gospel aim to convince physicians that this new reimbursement methodology rewards them for what they do best.  They extol the virtues of it and label those aspects of the payment methodologies that carry the greatest financial risk, “premium” level engagement.  Surely, those touting such “premium” level methodologies cannot possibly be serious given the just published CMS outcomes for the Value Modifier Program for quality and cost effectiveness measures.  One has to ask whether the failure to attain meaningful positive improvements in physician compensation for value based services is a reflection of Bent Flyvbjerg’s notions of “optimism bias” or simply “strategic misrepresentation.”

Abysmal Misrepresentation

This year’s results indicate that only 1.5% of entities which participated in the CMS’ Value Modifier Program were able to attain a positive adjustment to their reimbursements for 2016.  The prior year’s review indicated that only 0.86% of entities were able to gain a positive adjustment for 2015.  I await the spin that there has been a 50% improvement in physician capability to garner upward adjustment in reimbursement for their stellar quality and cost effectiveness performance.  These numbers clearly show the abysmal misrepresentation that participation in these quality programs offer a real opportunity for physicians to improve their reimbursements.  Consider the investments in time, energy and monies of the 8,395 practices representing 98.5% of those eligible for the touted, but missed, upward adjustments.

The “Game” Is rigged

These dreadful results make it clear to me that participation in these value base payment schemes is a pipe dream for most physician practices.  It is the promise held out by the claw machines for prizes in game arcades.  The prizes are real.  The likelihood of grabbing the prize is low.  The game is rigged.  With no firm guaranty of physicians being made whole in the Health Republic debacle, it is perplexing to me why anyone would believe the promise of a value based payment scheme that offers anything better than the abysmal outcomes reported by the CMS Value Modifier Program in the past two years or the chances with the claw machines in the gaming arcade.

I’ve opted out of this game.  Stop the optimism bias.  Stop the strategic misrepresentation.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to



By All Accounts MSSNY’s Lobby Day A Success – MSSNY Thanks All Who Participated
MSSNY’s “Physician Advocacy Day” was held in Albany earlier this week on March 8th. More than 300 physicians, medical students, residents, alliance members and friends of medicine participated in the event. By all accounts, the Lobby Day was a real success! 

The March 8th program has been archived and is available for viewing here.

A full slate of legislators and top Administration officials participated including Donna Frescatore, Executive Director, NYS Health Benefit Exchange; Jason Helgerson, Medicaid Director, NYS Department of Health; Troy Oechsner, Executive Deputy Superintendent, Department of Financial Services; Senate Health Chair Kemp Hannon; Assembly Health Chair Richard Gottfried; Senate Insurance Chair James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan also addressed the physician advocates in  the morning proceedings. A brief informal luncheon in which members of each House also attended and spoke with their constituents followed the morning program.  In the afternoon participants met with their elected representatives and/or their staff to discuss the organized medicine’s priority issues.

MSSNY’s leadership including its President, Joseph Maldonado, MD, President-Elect, Malcolm Reid, MD, Vice-President, Charlie Rothberg, Immediate Past Presient, Andrew Kleinman, MD, HOD Speaker Kira Geraci-Ciardullo, MD and Legislative Committee Chair Paul Pipia, MD led discussion which ensued with the speakers on important issues including restoration of funding to the Excess program, a Guaranty Fund for failed health insurers like Health Republic, identification of funding to reimburse physicians for care provided to the now defunct Health Republic, and defeat of the retail clinic and workers compensation proposal.

MSSNY would like to thank all county medical society executive directors, the leadership of the NYS Osteopathic Medical Society, the leadership of several specialty medical societies including, in particular, ACOG and David Welch, MD for bringing more than 100 medical students, residents and aspiring High School students to participate in this event.

Dr. Robert Goldberg with Touro medical students at MSSNY’s Lobby Day
(left to right) Senator Kemp Hannon, Chair, Senate Health Committee; Assemblyman Kevin Cahill , Chair, Assembly Insurance Committee; Senator James Seward, Chair, Senate Insurance Committee
Senate Majority Leader John Flanagan addresses physicians at MSSNY’s Lobby Day


Physicians Urged to Oppose Huge Cuts To Excess Medical Liability Insurance Program
While many leaders and staff in the Assembly and Senate have indicated strong concerns with the proposal in the Executive Budget to cut funding for the Excess Medical Malpractice Insurance Program by $25 million, physicians must continue to contact their legislators to urge that they continue to fight to assure this funding is restored in the final State Budget.

The proposal would result in 55% of physicians who currently receive this additional coverage being dropped from the program.  Across much of upstate New York, only neurosurgeons, bariatric surgeons and OB-GYNs would keep this coverage.   And downstate, many primary care physicians, ophthalmologists, otolaryngologists, pathologists, dermatologists and allergists would be dropped.

The Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level.  The program was created over 30 years ago as a result of the liability insurance crisis of the mid-1980’s to address concerns among physicians that their liability exposure far exceeded available coverage limitations.  Absent meaningful liability reform, with verdicts and physician liability premiums continuing to be far out of proportion compared to the rest of the country, full funding for the Excess program is absolutely essential in today’s very challenging practice environment.

At a time when the state is seeking to attract and retain physicians, this proposal deters physicians from wanting to practice in New York State for fear of putting themselves and their families in financial jeopardy for judgements and settlements exceeding the limits of their primary coverage.  Please urge your legislators to restore full funding for the program!                                                                 (AUSTER, DEARS)

Urge Your Legislators to Reduce Liability Insurance Costs, Not Raise Them!
This week, physicians and students from across New York State came to Albany to remind their legislators that, in light of the huge financial pressures threatening the viability of physician practices and our health care delivery system, no further liability increases can be tolerated.  Please join your colleagues by contacting your legislators ( to urge that they oppose legislation (A.285-A, Weinstein/S.6596, DeFrancisco) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   

MLMIC’s estimate is that this bill could increase physician liability premiums by nearly 15%!   New York physicians continue to pay liability premiums that are among the very highest in the country.  By way of example, a neurosurgeon practicing on Long Island must pay an astounding $338,252 for just one year of insurance coverage and an OB/GYN practicing in the Bronx or Staten Island must pay $186,639.   New York far surpasses all other states in terms of total medical liability payouts, per capita payments, and medical liability awards above $1 million.

MSSNY has joined the Greater New York Hospital Association (GNYHA) and Healthcare Association of New York State (HANYS) in an ad in the Albany Times-Union and City & State calling for reduction in these exorbitant costs.

To make matters even worse, trial lawyers are aggressively pushing the Legislature to consider additional liability expansion bills such as legislation that would eliminate the statutory limitation on contingency fees in medical liability actions, legislation that MLMIC has estimated could have the effect of raising your premiums by over 10%.   Please tell your legislators to enact comprehensive liability reform to bring down these costs, not legislation that increases them!

Physicians Urged to Contact Their Representatives to Urge Defeat of the Retail Clinic Proposal
Physicians are urged to contact their elected representatives to urge rejection of the retail clinic proposal included in the Governor’s budget which would  permit public corporations to own and operate retail clinics, or “limited service clinics”, throughout New York State. Go to the following link to send a letter to your legislators.

While various versions of this legislation exist, each seeks to allow publicly traded corporations to establish health clinics without need for certificate of need for review—for the first time in New York State. By permitting this practice, NYS will infringe upon the independence of medical decision-making and the integrity of the doctor-patient relationship. Furthermore, corporately owned and operated retail clinics will open the floodgates to conflicts of interest posed to exist as retail clinics directly profit from the very prescriptions they write, and treatments they recommend—all under the very same roof.

At a time when we in NYS are working hard to ensure and expand primary care and medical home capacity, retail clinics threaten the very viability of primary care physician’s practices. Contact your legislator today, and urge them to oppose the expansion of Retail Clinics in New York State.

Urge the Inclusion of Monies to Pay Health Republic Claims in the State Budget
This week numerous key legislative leaders articulated their awareness that failure to pay outstanding Health Republic claims will have a seriously destabilizing impact on regional health care delivery systems across the State.  Therefore, as the Assembly, Senate and Governor’s office begin in-depth negotiations on the State Budget, it is imperative that physicians continue to contact their legislators to urge that a Guarantee Fund or other allocation of monies be included in the State Budget to assure these claims are paid.  To send a letter, click here.

So far, 35 Assemblymembers have joined Assembly Health Committee Chair Richard Gottfried and Assemblyman Charles Lavine (D-Nassau County) in co-sponsoring legislation (A.9311) to establish a Guarantee Fund to help to assure the payment of the hundreds of millions that Health Republic owes physicians and hospitals across New York State, as well as to protect consumers and health care providers from future health plan insolvencies.  To view the list of co-sponsors, click here.

Identical legislation (S.6667, Valesky, also with several co-sponsors – see here) has been introduced in the State Senate.

You must remind your legislators that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs, insurance companies dropping physicians from their networks and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for patient care and employment in your community.

Payment of Health Republic Claims, Restoring Excess Insurance Cuts, Listed as Priorties of Senate Democratic Conference
The New York State Senate Democratic Conference this week released a 17-page letter outlining its Budget priorities as the Assembly and Senate Majority conferences were planning to advance its own suggested modifications to the Governor’s proposed Budget.  Of note, Senate Democratic Leader Andrea Stewart-Cousins’ letter to Senate Majority Leader Flanagan included the following items consistent with MSSNY’s Budget advocacy:

  • Restoring the $25 million cut to the Excess Medical Malpractice Insurance Program, and extending the program for 3 years;
  • Establish a Health Care Guarantee Fund “to reimburse providers for uncompensated care as a result of the collapse of health insurance companies such as Health Republic”;
  • Rejecting the proposed Workers Compensation reforms;
  • Rejecting the proposal to permit the establishment of limited service (retail) clinics;
  • Rejecting the proposal to eliminate “prescriber prevails” in fee for service Medicaid and Medicaid managed care.

Physicians Must Continue to Let Their Legislators Know of Concerns With Adverse Workers’ Compensation Budget Proposal
While leaders and staff in both the Assembly and Senate have articulated significant concerns with the sweeping Workers Compensation reform proposals contained in the Executive Budget, all physicians must continue to contact their local legislators to urge that these proposals be rejected as in-depth negotiations towards a final Budget commence.

MSSNY staff continues to meet with key legislative leaders and staff to voice its very serious concerns with Budget proposals that would:

  • Expands the list of non-physicians who can treat and be paid directly for care to injured workers without any clarity as to how these non-physicians will coordinate care delivery when specialized care is needed;
  • Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose significant fines on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule;
  • Remove the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation.
  • Reduce choice for injured workers by expanding the circumstances when an injured worker must seek care within a PPO network;
  • Remove the requirement for a referral by a physician for an injured worker as a pre-condition to receive psychological care; and
  • Remove the ability of professional associations, such as MSSNY, to recommend arbitrators to resolve medical fee disputes between health care providers and carriers.

Working closely with MSSNY, county medical society leaders from across the State have been writing to, and meeting with, their local Senators and Assemblymembers to request that these proposals be jettisoned from the Budget. Moreover, many of these proposals are being opposed by other stakeholders, including the NYS AFL-CIO, the NYS Trial Lawyers Association, the Injured Workers Bar Association and the New York Insurance Association.
(AUSTER, DEARS)                                                                             

Legislation to Make Changes to the ERx Law to Exempt Low Volume Prescribers Passes NYS Senate; Amendments Introduced in The Assembly
Legislation (S.6779, Hannon) which would completely exempt low volume prescribers from the e-prescribing mandate passed the Senate this week. Amendments were made to the Assembly counterpart (A.9335, Gottfried) to clarify that when a low volume prescriber terminates his/her low volume status because they intend to issue more than twenty five prescriptions in a year the validity of the first twenty five prescriptions remain intact.  The amendments also make clear that a provider who certifies to the Department that he/she is a low volume prescriber must make a notation in the patient’s medical record that the reason a paper script was issued is that the prescriber is certified as low volume. This will obviate the need to contact the Department each time he/she issues a paper script.

MSSNY is aware that physicians who are low volume prescribers (those who write less than 25 prescriptions a year) are receiving waivers from the mandate; but those waivers are only good for one year requiring low volume physicians to reapply each year. This measure would eliminate the need for them to re-apply for a waiver each year.

The bill would also amend the eRx law by eliminating existing provisions which require prescribers who invoke one or more of the exemptions to the eRx mandate to contact the department when they exercise an exemption. Instead, the bill would require a prescriber to make a notation in the patient’s record that the exercise of the exemption was utilized.

It is anticipated that the Senate will recall and amend S.6779 to incorporate the amendments thereby making it the same as the Assembly version and will re-pass it as soon as possible.                       (DEARS, AUSTER) 

Legislation to Enable Nurses in LTC Facilities to Act as Agent for the Physician Passes NYS Senate
Legislation (A.9334, Gottfried/S.6778, Hannon), supported by MSSNY, passed the Senate this week and was advanced to the floor of the Assembly. Specifically this proposal would allow prescriptions for non-controlled substances for nursing home residents to be made orally rather than electronically.  For decades, nurses, acting as the agent to the physician, have been authorized to take oral orders from the physician for non-controlled medications through the nursing home medication administration system to deliver medications to residents safely and without delay. In this long-standing system, the physician then routinely signs the oral orders within 48 hours.

Physicians are not physically present in nursing homes 24 hours a day. Nurses serve a vital role ensuring proper medication administration in nursing homes. This bill is necessary to assure that physicians’ orders are timely filled to protect the health and well-being for each resident in a safe and secure method.

CMS Proposes Huge Changes to Payment for Medicare Part B Drugs; Prompts Negative Reaction From Physician Groups and Pharma
This week CMS proposed testing a new model for covering drugs under Medicare Part B, such as chemotherapy medications, which immediately prompted concerns from several groups and members of Congress, as was noted in the New York Times.  CMS is proposing to change the reimbursement methodology of Part B drugs from the current 6% add-on to the “Average Sales Price (ASP)” to 2.5% plus a flat fee.  CMS also proposed a second phase that would implement value-based purchasing tools similar to those employed by commercial health plans, pharmacy benefit managers, hospitals, and other entities that manage health benefits and drug utilization.

The American Society of Clinical Oncology released a statement condemning the proposal noting that “it is inappropriate for CMS to manipulate choice of treatment for cancer patients using heavy-handed reimbursement techniques…..Physicians did not create the problem of drug pricing and its solution should not be on their backs.”

To read the CMS press release and other materials describing CMS’ proposal, click here.                                                                                                             (AUSTER)

Clinical Update for Primary Care Providers on Pre-Exposure Prophylaxis (Prep)
The New York State (NYS) Department of Health AIDS Institute Clinical Education Initiative (CEI) and Mount Sinai Institute for Advanced Medicine will be offering an educational program on the Treatment for Hepatitis C: New Tests, New Drugs & New Recommendations on Thursday, March 31, 2016, 9:00am – 12:00pm at St. Mary’s Healthcare, Amsterdam – Carondelet Pavilion Auditorium, 380 Guy Park Ave, Amsterdam, New York 12010. 

RegistrationOn-line registration is required as space will be limited.

This free event will focus on the current epidemiological trends, updates on prevention and care best practices, and NYSDOH guidance on HIV & HCV, as well as therapeutic regimens and monitoring plans.

This event is open to New York State clinical providers, such as physicians, physician assistants, nurses, nurse practitioners, and pharmacists.  The New York State (NYS) Department of Health AIDS Institute Clinical Education Initiative (CEI) is designed to enhance the capacity of New York’s diverse health care workforce to deliver clinical services to improve health outcomes related to HIV, sexually transmitted diseases (STDs) and hepatitis C (HCV). The aims of the CEI are fourfold:

  • provide progressive HIV, HCV and STD education to clinicians;
  • disseminate AIDS Institute clinical practice guidelines;
  • expand the base of providers able to diagnose and care for HIV, HCV and STD patients; and
  • foster partnerships between community-based providers and HIV, HCV and STD specialists.

Mount Sinai serves as The HIV/HCV Center and provides free education and training for medical providers in NYS. Clinicians are updated on the latest NYS guidelines to enhance the capacity to deliver clinical services to improve health outcomes related to HIV/HCV.  Further information is available by contacting Robert Walsh at 212-636-1315 or at

Learn about MOLST  and eMOLST Dr. Pat Bomba VP and Medical Director, Geriatrics, Excellus BlueCross Blue Shield

When: Tuesday, March 15, 2016 @  12:30-1:30 PM


  • Learn about the MOLST and eMOLST form and how it should be used with patients.
  • Describe how the NYS eMOLST: Improves Quality & Patient Safety and Reduces Harm
  • Learn about the 8 step MOLST protocol and how it can be used effectively
  • Describe how eMOLST aligns with move toward Value Based Payment

Additional information can be found here.

To register for this CME webinar:  Click here and fill out registration form.

For additional information, contact Miriam Hardin at: or (518) 465-8085

Accreditation Statement: 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 this live activity 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.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest.

Any discussion of investigational or unlabeled uses of a product will be identified.

MSSNY to Conduct Medical Matters Webinar on Zika Virus on March 16, April Session on Ebola
The Medical Society, in conjunction with the New York State Department of Health will conduct a Medical Matters webinar on the  “Zika Virus: An Evolving Story” on March 16th at 7:30 a.m.   Registration for this program is now open.  Click on the upcoming tab and select the programs.

The educational objectives for this program are: 1) Describe the epidemiology of Zika Virus infection;

2) Understand the modes of transmission; 3) Understand how to advise patients; and 4) Learn methods for prevention of infection.  William Valenti, MD, chair of MSSNY’s Infectious Disease Committee, and Elizabeth Dufort, MD,  Medical Director, Division of Epidemiology from the New York State Department of Health will conduct this presentation.

The April session of Medical Matters will take place at the MSSNY House of Delegates and is entitled, “Ebola: A Perspective from the Field”.  The program will be conducted by Dario Gonzalez, MD, FACEP. Associate Medical Director,  Fire Department City of New York/Office of Medical Affairs.  Dr. Gonzalez was deployed for nine weeks by Americares to Liberia, West Africa as part of the US response to the Ebola epidemic.  The program will be held on Thursday, April 14, 2016 at 2:00pm. Physicians may attend the session at the Westchester Marriott, 670 White Plains Road, Tarrytown, NY 10591 or by webinar.  Registration is now open. Click on the upcoming tab and select the program.

The educational objective is: Offer perspective and lessons learned from an individual who treated Ebola patients firsthand.

The May session will be “Radiological Emergencies”, this session will be held on May 18, 2016 at 7:30 AM. (Please note that this session was originally scheduled for March 16, 2016) Faculty for this session will be Cham Dallas, PhD.  Dr. Dallas is a professor in the Department of Health Policy and Management at the College of Public Health, University of Georgia.  He is also the Director of the Institute for Disaster Management at the University of Georgia and a Board Member of the National Disaster Life Support Foundation (NDLSF).  Dr. Dallas has a national/international reputation in toxicology and emergency preparedness and response, including over 30 years of experience.

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 this live activity 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.

Further information or assistance in registering for any of these programs may be obtained by contacting Melissa Hoffman at

MSSNY’s Opioid Webinars are Now Available Through Its CME Online Site
The Medical Society has archived its opioid webinar series on its continuing medical education website at   The webinars that are currently on the site are:  Webinar 1 Pain Management at the Crossroads:  A Tale of Two Public Health Problems and Webinar 2   Rational Opioid Prescribing:  Is this Possible for Chronic Pain?  Physicians and other prescribers can earn up to one hour of continuing medical credits by viewing this webinar and completing the test.    The reminder of the webinars will be placed on line in the very near future. 

The MSSNY CME site requires new users to register, but once registered physicians and other health care providers will have a personalized training page to take the webinars and other course work located on the site.   New registrants to the site will create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the tool bar menu located at the top of the page and click on “My training” to view and take the various courses.     MSSNY has over 50 programs at this site and physicians are able to earn continuing medical education credits for each course. 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 online program has various programs with the number of continuing medical education credits, but the majority of the programs are for 1.0 AMA/PRA Category 1 credit™.  Further information on all these programs may be obtained by contacting Pat Clancy at                  (CLANCY) 

PTSD And TBI in Returning Veterans:  March – June Webinars
MSSNY will be holding a series of CME webinars on PTSD and TBI in returning veterans on seven dates listed below from March through June. The faculty presenters will be Frank Dowling, MD and Joshua Cohen, MD.

Course objectives:

  • Explore the two most prevalent mental disorders facing American veterans today, their causes, symptoms, and comorbidities
  • Outline treatment options including evidence-based psychotherapy and pharmacotherapy
  • Discuss barriers to treatment, including those unique to military culture, and how to overcome them
  • Outline the process of recovery and post-traumatic grow

To register for this webinar, click on a date below and fill out the registration form.

Tuesday, March 22, 6-7 PM
Thursday, April 7, 6-7 PM
Tuesday, April 12, 7:30-8:30 AM
Thursday, May 5, 6-7 PM
Thursday, May 19, 7:30-8:30 AM
Thursday, June 2, 6-7 PM
Thursday, June 9, 7:30-8:30 AM

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



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Council Notes

At the March 8 meeting in Albany, Council approved the following items:

  • MSSNY should seek supplemental funding sources other than Medicare funding to increase the number of residency training positions in New York State, and should take the lead in bringing together the various parties to devise a supplemental funding source to meet the medical educational and workforce needs of New York State. This should involve State officials responsible for health and medical education, leaders of academic medical centers, and businesses that are thriving economically and that benefit from the work of the medical profession. Medicare should not bear major responsibility for GME funding. Strong arguments can be made that health insurers, pharmaceutical companies and device manufacturers should also contribute to the cost of graduate medical education.
  • The MSSNY president may decide if a non-MSSNY physician group (such as the Out-of-Network Preservation Work Group) warrants creation of its own special committee within MSSNY. Each President-Elect of MSSNY shall continue to analyze on an annual basis MSSNY’s committee structure with an intention to eliminate any committee not felt to be contributing directly to MSSNY’s mission, and combining committees wherever possible to reduce duplication, confusion and cost.  MSSNY may sign on to letters with non-MSSNY groups when consistent with existing MSSNY policy and at the discretion of the President.

State Awards $112.3 to Long Island Hospitals
The state has awarded $112.3 million to Long Island hospitals and clinics for projects ranging from repairs at Nassau University Medical Center to building an emergency department in East Hampton.

The 16 grants, part of $1.5 billion statewide announced March 4, are intended to help health care providers involved in New York’s Delivery System Reform Incentive Program, or DSRIP.

Under the program, up to $6.42 billion will go to safety-net or public hospitals and their community collaborators statewide if they cut avoidable hospital use among Medicaid recipients by 25 percent by the end of 2019. To do that, hospitals and community organizations must work together to improve access and coordination of patients’ care. These grants — an addition to the $6.42 billion — are meant to assist with that.

REMINDER:  All Prescriptions Must Be Sent Electronically Beginning March 27th
Tell your patients NOW that you will NOT be issuing papers scripts as of March 27. With the e-prescribing mandate quickly approaching, we at MSSNY are concerned about the lack of preparedness expressed by New York doctors.  Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate.
We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are compliant with the law.

From Socio-Med: 38,000 Doctors Will Have to Revalidate with CMS
I have been told that NGS Medicare is required by CMS to initiate the REVALIDATION process for 38,000 NYS practitioners. Please be on the LOOK OUT for a yellow envelope.  The official letter will be mailed from National Government Services in a yellow envelope: J6/JK Provider Enrollment Sample Yellow Envelope

If you rely on Medicare payments, you do not want your cash flow disrupted.  Please be sure that you and your staff are aware of the vital mailing.  In addition, please share this information with your colleagues, especially those who might not use email. The yellow envelope for NGS Medicare should not be overlooked.

Expansion to Include Pregnant Women with Sex Partner Who Traveled To a Country with Zika Virus Transmission
On March 9, the NYSDOH was directed by Gov. Cuomo to expand free Zika virus testing to pregnant women who engaged in unprotected sex with a partner who had recently traveled to a country where Zika is present.  Meanwhile, the city is ramping up its efforts in preparation for mosquito season to protect against transmission of the virus in New York. Health Commissioner Mary Bassett said the city is increasing the number of mosquito traps around the city by 20% to 50%.

To date, NYSDOH’s Wadsworth Center has conducted tests on samples from more than 1,400 patients and 40 have been found to be positive. With the exception of the one possible case of sexual transmission, all of the infected patients have been returning travelers from countries where Zika virus is ongoing.

NYSDOH also already offers testing to pregnant women who themselves have traveled to an area with ongoing Zika virus transmission during their pregnancy, as well as to non-pregnant women, men or children who developed symptoms of Zika virus within 4 weeks of travel to an area with active Zika virus transmission.

CDC: NYS has High Rate of Childhood Flu Vaccination
The New York State DOH is being honored, for the second year in a row, by the CDC for having high rates of childhood influenza vaccine coverage. During the 2014-15 flu season, 67 percent of New York children (outside of NYC) 6 months to 17 years of age received the flu vaccine, well above the national average of 59 percent. Childhood influenza vaccination coverage rates in other states ranged from 45.3 percent to 78.6 percent.

CMS Mulling New Payment Models For Some Medicare Part D Prescription Drugs
On March 8, Medicare proposed new models to determine the best “ways to pay for drugs administered in a doctor’s office, including many cancer treatments.” Dr. Patrick Conway, acting principal deputy administrator and chief medical officer of CMS, explained that the Federal government will not decide which drugs physicians can prescribe, but the objective “is to address financial incentives in the current payment system that can encourage the use of a more expensive drug, when a cheaper medication is just as effective.” According to Conway, “‘Perverse incentives’ in the current rules do not benefit patients or Medicare.”

The NY Times reports CMS plans to “test new ways to pay for prescription drugs in an effort to slow the growth of Medicare spending on medicines while encouraging doctors to choose the most effective treatments for their patients.” Dr. Conway said the government was not infringing on the discretion or authority of doctors. “Physicians and clinicians will make the prescribing decisions,” he said. “Nothing limits the ability of physicians to prescribe the most appropriate medications.” Data indicate CMS “spent $20 billion last year under Part B of Medicare for prescription drugs administered in doctors’ offices and hospital outpatient departments.” 

The Age of Compliance and the Impact on Your Healthcare Revenue Cycle
The arrival of the Consumer Financial Protection Bureau (CFPB) and associated increased legislation in the area of Healthcare Debt Collection has made the job of Healthcare Revenue Cycle Professionals more challenging than ever before.

Listen as IC System’s Vice President of Healthcare discusses these issues in detail, and shares tips and tactics to help insure that your Healthcare Business Office stays efficient, effective and compliant.

Please click on this link  to register for the LIVE presentation.

Pediatrics Group Issues New Recommendations to Screen for Poverty
The American Academy of Pediatrics has issued a policy statement at recommending that “with nearly half of American children living in poverty or close to that line, pediatricians need to broach another health-related matter with mom or dad: Are you having trouble making ends meet?”

THE AAP announced the “new recommendations to screen for poverty in a bid to reduce its health effects.” In its policy statement, “the group highlights what it calls the ‘lifelong hardship’ faced by kids who grow up in poverty.”

Ithaca Mayor Wants to Create Heroin Injection Sites to Stop Overdoses
In a more than 1,450-word article, the Washington Post reports Svante Myrick, the mayor of Ithaca, New York, is pushing to create “supervised injection sites where addicts can use” heroin “under the watch of medical professionals” who are available to administer naloxone if overdoses occur. While Myrick will struggle to convince state and Federal officials, the Post states his “proposal nonetheless marks the latest departure from the zero-tolerance orthodoxy that has for years governed the drug war.” The article explains that success stories in Germany, Switzerland, the Netherlands, and Canada “sold Myrick on the idea.”


Physician Opportunities

Family & Internal Medicine Opportunity Just 50 miles North of NYC
Top $$ AND potential partnership with large multi-specialty physicians’ group + the balance of work & personal life you have been seeking. Perfect suburban area just 50 miles north of NYC. This is a growth position with the right person moving into a partnership opportunity within two to three years. You will enjoy a salary of $175K+ as well as:
• A monthly bonus potential
• Health, Dental, Vision and prescription insurance
• 3 weeks’ paid vacation time off annually
• 6 federal Holidays off with pay
• A $2500 CME reimbursement
• A 401K plan with company match
• Company pays 75% of a single premium life insurance policy at twice your annual salary
• Paid malpractice insurance, plus paid DEA and license renewals
The ideal candidate will possess the following:
• BE/C in Family Medicine or Internal Medicine
• Active NYS license
• Current DEA #
• Experienced as well as New Grads welcome to apply
**Relocating physicians are welcome and relocation assistance will be offered to the right candidate!**
For immediate consideration and additional information on position details please contact Laura Rappleyea at 845-344-3434 or and send CV’s for review.

Neurologist & Pain Management Physician Needed
A growing multi-specialty group in Orange County is looking for both a Neurologist and Pain Management Physician to join their group. This position will work with the headache center Neurologist/Pain Management Specialist. All subspecialties are welcome.
The ideal candidate will possess the following:
• BE/C in Family Medicine or Internal Medicine
   • Active NYS license
   • Experienced as well as New Grads welcome to apply
   • Experience in procedures and utilizing an integrated comprehensive approach to pain management.
For immediate consideration and additional information on position details please contact Laura Rappleyea at 845-344-3434 or and send CV’s for review.

OB/GYN Opportunity in the Hudson Valley
Are you looking for a great work/life balance? We are looking for an OB/GYN to join the team. We are looking for a provider to provide comprehensive primary health care to a select population of essentially healthy women, participate in the care of women with complications & responsible for providing a full range of agency approved antepartum, intrapartum, postpartum, gynecological and family planning service.
The ideal candidate will possess the following:
• BE/C in Family Medicine or Internal Medicine
       • Active NYS license
       • Experienced as well as New Grads welcome to apply
For immediate consideration and additional information on position details please contact Laura Rappleyea at 845-344-3434 or and send CV’s for review

Pediatrician Opportunity in Orange County, New York
A prestigious multi-specialty physicians’ group seeks a family driven
Pediatrician to join their group.
The ideal candidate will possess the following:
• BE/C in Family Medicine or Internal Medicine
   • Active NYS license
   • Experienced as well as New Grads welcome to apply
For immediate consideration and additional information on position details please contact Laura Rappleyea at 845-344-3434 or and send CV’s for review. 

Psychiatry Opportunity in New York’s Beautiful Hudson Valley
Our client, a prestigious multi-specialty physicians’ group who has been recognized as a Patient-Centered Medical Home by the National Committee for Quality Assurance, seeks a Psychiatrist to join their group.
The ideal candidate will possess the following:
• BE/C in Psychiatry
   • Active NYS license preferred
   • Experienced as well as New Grads welcome to apply
For immediate consideration and additional information on position details please contact Laura Rappleyea at 845-344-3434 or and send CV’s for review.

Join Well Established Solo Female OB/GYN Physician Practice in New York City
Quality oriented, looking for MD for long term career opportunity. New graduates welcome to apply. Affiliated with Lenox Hill Hospital. The current office has a AAAA certified operating room and an AIUM accredited ultrasound service. Looking to establish another location. Great opportunity to balance personalized practice with quality lifestyle. Please summit CV to

Want to Sublease Your Clinic Space or Rent Space to Expand Your Practice? List with Clineeds 
Clineeds is an online platform designed to help physicians find and sublease clinic space. Listing is completely FREE! Sign up today at We take care of the rest!

Jerome I. Sager – Attorney at Law
The health care law experts representing medical professionals for more than 25 years.  See us for Professional Medical Conduct Defense, Medicaid and Medicare Fraud Cases, DEA and Controlled Substance Issues, Third party insurance issues. We can handle most legal matters. Call us for a free consultation. 212-685-2333 / 917-312-6631,