March 24, 2017 – GOP Cancels Healthcare Vote

PRESIDENT’S MESSAGE Dr. Malcolm Reid

March 24, 2017 Volume 17 Number 12

Breaking News: House Republican leaders abruptly pulled a rewrite of the nation’s health-care system from consideration on Friday

Dear Colleagues:

This week, as Congress was feverishly debating whether to take up legislation that would change much of the Affordable Care Act (ACA), the MSSNY Executive Committee issued a statement highlighting both the positive and negative aspects of the proposed American Health Care Act (AHCA).

As a diverse group, our MSSNY members have a wide array of perspectives regarding whether they believe the ACA has been a success or a failure.  As a society that represents physicians of every region, of every specialty, and of every type of practice setting, extensive debate is to be expected.  The ACA was the most significant health care law enacted in our generation.  Regardless of our personal viewpoints on the ACA, most physicians would likely agree, that it is important that our policymakers address problems such as the narrow networks and use of high deductible plans that have clearly accelerated since the ACA went into effect.

In this regard, our statement acknowledged some of the positive aspects of the legislation before Congress, including ideas adopted at the MSSNY House of Delegates such as:

• expanded use of Health Savings Accounts to provide health insurance coverage; and
• preventing implementation of a tax on comprehensive health insurance coverage, also known as the “Cadillac Tax”, which would disincentivize employers from offering plans that limit patient cost-sharing.

At the same time, our statement expresses significant concerns regarding the impact that this bill may have for many of our patients who currently receive coverage through the “Essential Plan,” or expanded Medicaid.  The provisions of the AHCA under consideration  may cause patients to face  far greater out of pocket costs for plans that may not be as generous as what they are currently receiving under the ACA.  In fact, many patients may choose simply not to buy health insurance coverage at all.

That is a serious problem with this proposed legislation, which we hope can be addressed as Congress continues to debate how best to fix the ACA.  We also hope it is an opportunity to look at other issues that we believe impact upon health insurance costs, such as the excessive liability exposure faced by physicians, as well as the extraordinary market power held by the health insurance industry, not only in New York but also throughout much of our country.

For too long, debate over the ACA has been dominated by those who either want to completely eliminate it, or those who have been reluctant to change any aspect of it. In my opinion, neither side is correct.

It is my hope that the debate currently before Congress is the first step, not the last step, towards making necessary changes to improve the availability of affordable and comprehensive coverage options for our patients. For the benefit of our patients, let’s continue this conversation.

Please send your comments to comments@mssny.org

Final Stretch of NY Budget Negotiations
It comes down to just a few days.

Budget negotiations have entered their final stages as Governor Cuomo and legislative leaders iron out the details of a final State budget agreement. It is expected that “round the clock” talks will continue through the weekend and into early next week.  The final budget is due by April 1^st. While the NYS Senate and NYS Assembly’s “one-House” budgets rejected several Executive Budget provisions that had been opposed by MSSNY, these provisions could still end up in the final enacted budget.

It is critical that you contact your legislators to ensure that they hold strong and to urge that they:

• REJECT burdensome “tax clearance” requirements for physicians to obtain Excess Medical liability insurance coverage.

• REJECT inappropriate scope of practice expansions such as the proposal that would permit pharmacists to enter into medication management protocols with nurse practitioners;

• REJECT changes to increase burdensome physician prior authorization requirements contained in the proposed State Budget;

Critical items also under discussion in the final days of Budget negotiations include Workers Compensation reform, as well as proposals advanced by the Governor (and supported by MSSNY) that would directly regulate Pharmaceutical Benefit Managers, and regulate e-cigarettes under the “Clean Indoor Air” Act. To View a chart listing all of the Budget proposals in which MSSNY is engaging, please click here.   (Belmont)

Lacking Votes to Pass, ACA Repeal Bill Pulled From Consideration on House Floor
After a substantial floor debate on Friday afternoon, leaders of the US House of Representatives pulled from consideration the American  Health Care Act (AHCA), legislation to repeal and revise many aspects of the Affordable Care Act (ACA).  The bill was pulled from consideration when it appeared that there would not be enough votes for the bill to pass the House.

On Thursday, MSSNY President Dr. Malcolm Reid issued a statement developed by MSSNY’s Executive Committee shared with the New York Congressional delegation noting the need to fix the flaws of the ACA, and that the legislation had some beneficial provisions.  However, the statement also highlighted the concerns with provisions in the AHCA “that may cause New Yorkers who currently have low cost, ‘first dollar’ coverage to instead purchase coverage with high deductibles and other high cost sharing responsibilities.  Moreover, the statement noted our concerns regarding the “long-term impact of the AHCA on New York State’s Budget finances”.

As has been previously reported, several health care and patient advocacy organizations, including the AMA, AARP, the American Cancer Society, the Greater New York Hospital Association and the Healthcare Association of New York State (HANYS) had expressed strong concerns with the proposal.  Governor Cuomo also has issued several statements opposing the AHCA by highlighting the district by district financial impact on hospitals and nursing homes if the bill were to be enacted.

The proposal would have kept some of the popular provisions from the ACA, including required coverage for pre-existing conditions, prohibiting annual and lifetime limits, and requiring dependent coverage up to age 26.   It would also significantly expand the amount of funds that a person could direct to their Health Savings Account.

At the same time, the bill would have substantially revised ACA rules that facilitated various subsidized coverage programs for those who make up to 400% FPL ($94,000 for a family of 4).  While the expanded eligibility for Medicaid (up to 138% FPL) would be available through the end of 2019, starting in 2020 such expanded coverage would only be continued for those who had such coverage prior to the end of 2019.  The AHCA would also repeal the tax credits currently provided to help cover cost-sharing amounts for coverage for individuals who earn too much to qualify for Medicaid.

Instead, tax credits of $2,000-$4,500 (depending upon age) would be provided to enable the purchase of health insurance coverage.   Tax credits will be available in full to individuals earning less than $75,000 and households earning less than $150,000, but they will be capped for higher earners.  It appears as if the AHCA would have also completely eliminated funding for New York’s Essential Plan, which provides low-cost health insurance coverage with little cost-sharing responsibilities for over 600,000 New Yorkers who make between 138% and 200% of the FPL.

The bill would have repealed several other notable ACA provisions, including the requirement for all individuals to have health insurance coverage, the large employer coverage mandate, the provision to impose a “tanning” tax and a provision that limits the tax deductible treatment for health insurers of executive income that exceeds $500,000.

As of this writing, it is unclear how the legislation will be revised to garner majority support.  Please remain alert for further updates.        (AUSTER)

Increase in Cases of Hepatitis A among Men Who Have Sex with Men Reported in NYC
The New York City Health Department has noted an increase in hepatitis A cases among men who have sex with men (MSM) who did not report international travel.  There have been five cases of hepatitis A among unvaccinated MSM since January 1, 2017 and three of the five patients were hospitalized and all patients have recovered.   Since 1996, the Advisory Committee on Immunization Practices (ACIP) has recommended that all MSM receive two doses of hepatitis A vaccine; the second dose should be administered 6-12 months after the first dose.   The New York City Department of Health has issued Alert #6 and has sent a letter to all providers in the New York City region.   A copy of the letter can be found here.         (CLANCY)

Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!

SAVE THE DATE for Veterans’ Mental Health Training Initiative: CME Programs and Panel Discussions
The Medical Society of the State of New York, along with the New York State Psychiatric Association and the National Association of Social Workers will hold a two-day Veterans’ Mental Health Training Initiative: Addressing the Unspoken Needs of Veterans.

This two-day event will be held on Friday, May 5 (1-4:30 p.m.) and Saturday May 6 (8:30 a.m.-3 p.m.) at the Clarion Hotel and Conference Center, 3845 E Veterans Memorial Hwy, Ronkonkoma, NY.  Physicians are urged to reserve the dates for participation in this weekend.  Reservation links will be forthcoming for the entire conference.

The program will include three continuing medical education (CME) seminars on PTSD and TBI, Substance Use Disorders, and Suicide as well as panel discussions on the Dwyer Peer to Peer Program, Diversity among Veterans, and veteran-driven case studies.

Faculty for the CME programs includes Frank Dowling, MD, Thomas Madjeski, MD, and Adolph Meyer, MD. Physicians can register for all or part of the three CME programs. Just click on the program name listed below.

PTSD and TBI
Friday, May 5, 1:15 p.m.
Faculty Presenter: Thomas Madjeski, MD
The educational Objectives for the PTSD program are:

1)  Describe the symptoms of PTSD and TBI.

2)  Describe the treatment modalities of PTSD and TBI.

3)  Describe military culture & how to overcome unique barriers                 to treatment intrinsic to military culture

Suicide
Friday, May 5, 2:30 p.m.
Faculty Presenter: Frank Dowling, MD
The educational Objectives for the Suicide program are:

1)   Address the causes and warning signs of suicide and suicidal                  behavior among veterans.

2) Explore the best evidence-based diagnostic and treatment                       options available including psychotherapy and
pharmacotherapy.

3)  Identify barriers in military culture to identification and                             treatment and how to overcome them.

Substance Use Disorders
Saturday, 10:45 a.m.
Faculty Presenter: Adolph Meyer, MD
The educational objectives for the Substance Use Disorders program are:

1)  Explain substance use disorders (SUDs), symptoms, warning                   signs, comorbidities

2)  Explore treatment options for veterans including evidence-                      based practices in psychotherapy and pharmacotherapy

3)  Identify barriers to identification and treatment, including                        those unique to military culture, and how to overcome them

Veterans Matters is a CME series made possible through a grant from the New York State Office of Mental Health.

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 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.  (ELPERIN)

MSSNY to Hold CME Webinar on Concussion in Pediatric and Adult Population on April 19^th; Registration Now Open
The Medical Society of the State of New York will hold a Continuing Medical Education (CME) webinar on the “Current Concepts in Concussion for Pediatric & Adult Patients” on Wednesday, April 19, 2017 at 1 p.m. for all physicians and other health care providers.  Registration for the webinar is now open HERE.

Faculty for the course will be John Anthony Pugh, MD, PhD, assistant professor of Neurology at Albany Medical Center (AMC), and Deborah Ilana Light, MD, primary care sports medicine and associate program director for the Sports Medicine Fellowship at Albany Medical Center.  Educational objectives are: 1) Identify signs and symptoms indicative of concussion as well as red flags that indicate alternate or more severe pathology; 2) Outline an appropriate management plan for a patient presenting with concussion including a return to “normal life” protocol; 3) Describe methods for the primary and secondary prevention of concussion; 4) Identify patients who would benefit from referral to a concussion specialist.

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.  (CLANCY)

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

AG: Three Heart Monitor-Related Apps Are Not Medical Devices nor FDA Approved
Today, Attorney General Eric T. Schneiderman announced settlements with three popular health-related applications sold in Apple’s App Store and Google Play regarding misleading claims and irresponsible privacy practices. The settlement follows a year-long investigation of mobile health applications and requires the implicated companies and developers to amend deceptive statements about their apps and modify their privacy policies to better protect consumers, while also making clear that their apps are not medical devices and are not approved by the U.S Food and Drug Administration. The Attorney General today announces settlements with the following app developers:

• Cardiio, an American company that sells Cardiio, an app downloaded hundreds of thousands of times that claims to measure heart rate. The developer had not tested its accuracy with users who had engaged in vigorous exercise, despite marketing the app for that purpose. The developer also misleadingly implied that the app was endorsed by MIT.
• Runtastic, an Austria-based company that sells Runtastic, an app that purports to measure heart rate and cardiovascular performance under stress. Yet the developer failed to test its accuracy with users who had engaged in vigorous exercise, despite marketing the app for that purpose to the 1 million people who downloaded it.
• Matis, an Israel-based company that sells My Baby’s Beat, an app downloaded hundreds of thousands of times, which Matis previously claimed could turn any smartphone into a fetal heart monitor, despite the fact that it has never been approved by the FDA. Although Matis exhorted consumers to use My Baby’s Beat rather than a fetal heart monitor or Doppler, it never conducted, for example, a comparison to a fetal heart monitor, Doppler, or any other device that had been scientifically proven to amplify the sound of a fetal heartbeat.

Additionally, the developers now post clear and prominent disclaimers informing consumers that the apps are not medical devices and are not approved by the FDA.

 MLMIC’s Risk Management Conference for Physicians on April 20 at HOD
In partnership with MSSNY and the 2017 MSSNY House of Delegates, Medical Liability Mutual Insurance Company (MLMIC) will be hosting its first House of Delegates Risk Management Conference on Thursday, April 20, 2017 at 9:30 a.m. at the Westchester Marriott in Tarrytown, NY.  Attendance at this complimentary educational event will enable physicians to earn AMA PRA Category 1 Credits™.

In this program, a renowned attorney from Fager Amsler Keller & Schoppmann, LLP, specializing in healthcare law will address recent legislative, regulatory and malpractice case law developments that impact the provision of healthcare.

The program will also feature risk management advice on electronic health records (EHRs) and their associated liability risks.  A highly regarded malpractice defense attorney and a physician expert and MLMIC Risk Management Consultant will discuss a number of topics, including the legal pitfalls of EHRs and the proper use of EHR features such as templates, the copy and paste function, and auto-population.  Recommendations will be provided to help improve medical and legal documentation and reduce potential liability exposures.

All NYS physicians are welcome to attend.  Pre-registration is required and space is limited. Register Today 

Multiple Physician Positions with DOHMH Office of School Health
Office of School Health is the largest program of the New York City Department of Health and Mental Hygiene (DOHMH). This bureau is responsible for managing the health issues and promoting the well-being of the over 1.3 million children and adolescents enrolled in New York City’s 1700 school buildings.

Positions with the Office of School Health (OSH) combine clinical skills and public health training. OSH focuses on child health, asthma prevention, obesity and nutrition, vision screening, dental care, mental health, reproductive health, and childhood disability. We collaborate with various city and community based agencies to provide social and academic services to address the needs of all New York City school children, especially those facing the most significant social, economic, and health challenges.

The Office of School Health is currently undergoing expansion. There is an immediate need for physicians with an expertise in pediatric, adolescent, or family medicine, with the capacity to utilize primary care skills set through a public health lens. OSH is also  interested in public health and preventive medicine graduates with programmatic, analytic, and social medicine skills.

The NYC DOHMH is reaching out to identify candidates for this recruitment. We are enlisting your help to nominate medical professionals who are committed to contributing their talents to improve health and academic outcomes in our schools. Please consider applying for these positions or passing these opportunities on to talented physicians among your own personal networks.

Attached are the American Academy of Pediatrics position statements on the role of the School Physician as well as the job description and recruitment flyers:

• Adolescent School Health Physician, Family and Child Health/SH Reproductive/City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 277208
• Field Doctor, Bureau of School Health/SH Medical (pre-K-8 Programs or High School) City Medical Specialist, Level: 01/Part-time/Flexible Work Schedule (20-35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ In the Job ID search bar enter: Job ID: 265869
• Supervising Medical Doctor, Bureau of School Health/SH Reproductive Health, City Medical Specialist, Level: 02/Part-time (35 hrs/week) To learn more about this position & apply, please submit your resume & cover letter to: https://a127-jobs.nyc.gov/ Job ID:  277026

Please list in your cover letter how you heard about this position (including name of the professional association, website, or individual who referred you). If you have questions, please contact Caroline Volel, MD, MPH at OSH@health.nyc.gov.

Weekly Charting Tip: Fair Market Value v. Commercial Reasonableness
In order to comply with three different federal laws, it is very important that you document the fair market value (FMV) and commercial reasonableness of the “arrangement” at issue. Fair Market Value is “the value in arm’s length transactions, consistent with the general market value”. In other words, if I were a stranger, and I wanted a similarly situated arrangement, what would it be worth? There are professional people who actually will prepare a FMV report for you. This is the safest way of doing it. What do rents go for in the same area for a similar amount of space? You can factor in closeness to public transportation, parking lots and the like. Commercial reasonableness encompasses both the series and payment for them. Is it reasonable to pay a neurologist say $300,000 for the 40 hours a week you are offering? That depends on the location and what is expected of the neurologist. Areas with many neurologists tend to offer less. Rural areas may offer more. Think supply and demand. If a deal is too good to be true, it probably is!

–Larry Kobak, Esq., LKobak@DrLaw.com

If you have any questions, please contact Kern Augustine, P.C. at 1-800-445-0954 or via email at info@DrLaw.com.

BECOME A LEADER IN HEALTH PROFESSION EDUCATION. ATTEND AN EVENT TO GET MORE INFORMATION ABOUT THIS DYNAMIC PROGRAM AT HOFSTRA UNIVERSITY
Hofstra University’s Master of Science in Health Professions Pedagogy and Leadership is a program designed to prepare clinicians who provide care to patients with an expanded role as an educator for students, residents, externs and fellows and to advance in leadership roles in their field. The focus of the program is on advancing teaching, leadership and research skills applicable to established healthcare educational environments. All health professionals and administrators interested in teaching in their clinical fields of expertise, overseeing educational programs, or preparing for leadership roles can benefit from this program, which is offered in a hybrid, executive format.

Attend one of the following to learn more information about this dynamic MS program:

ONLINE WEBINAR
Tuesday, April 18, 2017 @ 5:30pm
Register

IN PERSON
Monday, April 24, 2017 @ 5:30pm
Center for Learning and Innovation (CLI)
1979 Marcus Avenue Suite #101
Lake Success, NY 11042
Register

In addition, you may contact Dr. Alice Fornari, Program Director, at Alice.Fornari@hofstra.edu for more information.

Pediatrics: Calls to Poison Control-60% re Kids Under Five; 30% Are Teenagers
A study published in Pediatrics  indicates that “from January 2000 until December 2015, about 188,000 calls were placed to poison control centers regarding pediatric and teenage exposure to opioids.” The data indicated “sixty percent of the children exposed to opioids were younger than 5, while teenagers accounted for 30 percent.”

A companion paper in Pediatrics  reports a strong link between prescribed opioids and their recreational use.” The study indicated that “teens who abused opioids were often prescribed the drugs at some point by a physician.”

Match Day Madness!
The Upstate Medical University Class of 2017 presents 2017 Matchin’, a parody of 24k Magic, in celebration of their Match Day! https://www.youtube.com/watch?v=sk6AyP4u2f0

CDC: Four Countries Added to Interim Travel Guidance
The CDC is working with other public health officials to monitor for ongoing spread of Zika virus‎. On March 10, 2017 CDC posted a Zika virus travel notice for Angola, Guinea-Bissau, Maldives and Solomon Islands. CDC has issued travel notices (level 2, “practice enhanced precautions”) for people traveling to destinations with Zika. For a full list of affected countries/regions, visit http://wwwnc.cdc.gov/travel/page/zika-travel-information.

To help pregnant women and others identify areas of Zika risk, CDC published a new interactive World Map of Areas with Zika Risk that allows people to search for location-specific Zika information and travel recommendations. CDC also published an interactive “Know Your Zika Risk” tool that offers tailored risk and prevention messages based on information provided by travelers.  In addition, CDC’s Zika testing recommendations for pregnant women have been aligned with these three risk categories, as depicted in a new map for healthcare providers to use for evaluating and caring for pregnant women possibly exposed to an area with Zika risk.

CDC update
From January 1, 2015 to March 15, 2017, there have been 5,139 Zika virus disease cases reported in the US. Of these cases:

• 4,842 cases were in travelers returning from affected areas
• 222 cases acquired through presumed local mosquito-borne transmission in Florida (N=216) and Texas (N=6)
• 75 cases acquired through other routes, including sexual transmission (N=45), congenital infection (N=28), laboratory transmission (N=1), and person-to-person through an unknown route (N=1).

Meanwhile there were 1,534 pregnant women with any laboratory evidence of possible Zika virus infection in the US as of February 21, 2017.

Join Nassau County for Dinner and CME Program on “Frontiers in Cellular Therapy”
The Nassau Academy of Medicine and the Nassau County Medical Society Joint Membership Meeting will be held on TUESDAY, MARCH 28, 2017 at the WESTBURY MANOR, 1100 Jericho Turnpike, Westbury. Complimentary Dinner Meeting for NCMS / NAM Members. Non-members and their staff may attend at $25 per person. Seating is limited. REGISTRATION is at 6:30PM; dinner and meeting at 7:00PM.  PRE-REGISTER NOW – Send E-Mail Response To: NASSAUMED@GMAIL.COM The CME Program, “NEW FRONTIERS in CELLULAR THERAPY” will be presented by Patricia Shi, MD, MS, Medical Director, Therapeutic Apheresis and Cellular Therapy Collection Service, New York Blood Center

Educational Objective:  At the end of this CME activity, participants should be able to; distinguish between the various types of cellular therapies being investigated; understand the potential risks, benefits, and unknowns of such therapies and become familiarized with ethical concerns and questions raised by the advance of cellular therapy. 

Accreditation Statement: This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of the Suffolk Academy of Medicine and the Nassau Academy of Medicine. The Suffolk Academy of Medicine is accredited by MSSNY to provide Continuing Medical Education for physicians. The Suffolk Academy of Medicine designates this live educational activity for a maximum of 1 AMA PRA Category 1 Credit. Physicians should claim

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Physician Opportunities

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