March 30, 2018 – Happy Doctors’ Day

Thomas J. Madejski, MD MSSNY President

Thomas J. Madejski, MD
MSSNY President
March 30, 2018
Volume 18
Number 12

Dear Colleagues:

Happy Doctor’s Day! The day chosen is March 30th, in honor of the 91st anniversary of the first administration of ether during surgery in 1842 by Dr. Crawford Long of Georgia.  The NY Daily News is honoring our day with a pullout section today that features MSSNY articles. 

Who Am I?

For those who do not know me, I am an Internist who specializes in geriatric medicine and palliative care.  The practice of medicine has changed substantially over the last 25 years.  Many of my geriatric patients are living longer and healthier lives at the same time that a tsunami of obesity, diabetes, and disability arises in our younger population— disproportionately in people with social, economic and other challenges.

There was an article in the New York Post on Tuesday titled, “Beware: Hospitals think ‘do not resuscitate’ means you don’t want to live.  The author was concerned that a patient who chooses to forego some care, may suffer from their physicians and other caregivers not offering other useful interventions that could improve their quality of life.  While I am certain that there are some instances of a bias toward less treatment, the remedy proposed (don’t choose to limit care so that you get the care you should have) will lead to other patients receiving treatment that may cause increased discomfort, iatrogenic complications or actually hasten their demise. There are a number of factual mistakes in the article and much misinterpretation of data.  A couple of links below give some information on prognosis with CPR in patients with chronic disease. 2% or less of patients with advanced COPD, CHF, malignancy or cirrhosis who undergo CPR are discharged to home and live six months.

On the other hand, patients have a better chance of being resuscitated today.  Unfortunately, the survivors have more impairment, lower functional states and are less likely to return home.

The real world solution is listening to patients and adjusting care to their wishes after reviewing treatment options with them. We need to advocate for better implementation of advanced directives and encourage the use of MOLST Forms.

Patients celebrate Doctor’s Day because of the care and compassion you share with them during their time of greatest need.

Thanks to all of you for the difference you make one patient at a time.

I’ll Be Seeing You

We are expecting a busy legislative session this year. I hope to visit all of your districts to foster maintenance and growth in membership this year. We need more troops to enhance our voice both statewide and nationally.

Thomas J. Madejski, MD 
MSSNY President

Please send your comments to

HIT MLMIC Symposium

Northwell Physicians at 2018 House of Delegates

MSSNY - Northwell

(L-R) Dr. Carlos Zapata, Dr. Louis Auguste, Dr. Art Fougner, Dr. Marie Basile, Dr. Paul Hamlin, Dr. Penny Stern, Dr. Cara Kvilekval, Dr. Charles Rothberg, Dr. Ani Bodoutchian, Dr. Robert Schreiber, Dr. Bonnie Litvack, Dr. Michael Ziegelbaum, Dr. David Podwall, Dr. Inderpal Chhabra, Dr. Carol Moodhe

Happy National Doctors’ Day!
Today, in recognition of National Doctors’ Day, we celebrate our physician members who have dedicated their lives to taking care of all New Yorkers.  March 30th was established to recognize physicians, their work and their contributions to society and the community.

Today, we say “thank you” to our physician members for all they do to help their patients every day!

MSSNY has partnered with the NY Daily News to produce a supplement in today’s paper that celebrates the work of New York physicians. Click here to view National Doctors’ Day.

State Budget Still Not Final, But Likely to Reject Several Items Opposed by MSSNY
As of press time, it was uncertain whether the Legislature would be able to complete passage of the State Budget before the April 1 deadline.   However, they were getting close as several of the “agreed-to” Budget bills were being voted upon today.  Importantly, the Health Budget bill has rejected several Budget proposals of great concern that MSSNY together with specialty societies and other allies had been advocating against, including:

  • Independent practice authority for CRNAs
  • Authorization for corporate-owned retail clinics
  • Authorization for patient drug management protocols between Nurse Practitioners and pharmacists.  Moreover, there was a 2-year extension of the current Collaborative Drug Therapy pilot program (between physicians and pharmacists) that MSSNY supports
  • Steep Medicaid cuts to the Patient-Centered Medical Home program
  • Authorizations for EMTs to provide non-emergency care in patient homes without any express coordination requirement with that patient’s treating physician
  • Elimination of “Prescriber prevails” protections for Medicaid prescriptions
  • Provisions which would have reduced from 7 days to 3 days the length of an initial prescription for acute pain.
  • Significant expansion of the DOH’s Commissioner’s power to investigate physician misconduct, including provisions that would have a) greatly reduced the time to respond to document requests and b) expanded the power to search and seize records and equipment.  It should be noted that the final Health Budget bill did include a provision to permit the Commissioner to summarily suspend a physician who is both been charged with a felony crime and believed to be an imminent danger to the public as determined by the Commissioner.

At the same time, the Health Budget bill also included the following important items:

  • Continued funding for the Excess Medical Malpractice Insurance Program at the historical level.
  • A new $150,000 allocation for the MSSNY’s Veterans Mental Health Initiative
  • Reducing some of the insurance barriers to substance abuse treatment
  • Continued historical funding and a 5-year extension of the MSSNY Committee for Physicians Health until 2023.

Please remain alert for further updates.

NY AG, MSSNY AND AMA All Express Strong Concerns with Proposed OCR “Conscience” Rule
New York Attorney General Eric Schneiderman this week led a coalition of 19 state Attorneys General, to oppose a proposed rule of the US Department of Health and Human Services’ Office of Civil Rights (OCR) which would significantly expand the ability of businesses and individuals to refuse to provide necessary health care on the basis of businesses’ or employees’ “religious, moral, ethical, or other beliefs.”

The AG comments to OCR were submitted by the Attorneys General of New York, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Jersey, New Mexico, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and the District of Columbia.

At last weekend’s MSSNY House of Delegates, the physician delegates also expressed strong concern with this HHS “conscience” proposal, passing a resolution that called for MSSNY to a) speak against policies that are discriminatory and create even greater health disparities in medicine; and b) be a voice for New York’s most vulnerable populations, including sexual, gender, racial and ethnic minorities, who will suffer the most under such policies, further widening the gaps that exist in health and wellness in our nation.

The AMA also submitted a detailed letter to OCR expressing its strong concerns, noting that “the Proposed Rule would undermine patients’ access to medical care and information, impose barriers to physicians’ and health care institutions’ ability to provide treatment, impede advances in biomedical research, and create confusion and uncertainty among physicians, other health care professionals, and health care institutions about their legal and ethical obligations to treat patients. We are very concerned that the Proposed Rule would legitimize discrimination against vulnerable patients and in fact create a right to refuse to provide certain treatments or services.” (AUSTER, CLANCY)


Public Health and Education

  • MSSNY will support legislation to prohibit the sale of any device — such as a bump stock — that functionally converts a firearm to fully-automatic operation.
  • MSSNY will support legislation that would ban the sale and/or ownership of high capacity magazines or clips and high speed high destruction rounds.
  • MSSNY will support legislation that requires a waiting period and background checks prior to the purchase of all firearms.
  • As gun violence in the United States is a public health crisis, MSSNY will support legislation that would reverse the ban that prohibits the Center for Disease Control from researching gun related injuries, deaths and suicides related to this violence.
  • MSSNY will create a task force to study and make recommendations regarding how healthcare providers can play a role in safely sequestering a patient’s firearms to reduce the risk of suicide during a vulnerable time.

Governmental Affairs and Legal Matters A

  • MSSNY supports legislation to give discretion to the patient’s attending physician or the emergency physician to have such patient sent for skilled nursing care without having to first meet the current Medicare 3-day hospital stay pre-condition;
  • MSSNY will advocate to reduce the administrative burdens of complying with value-based payment programs and advocate to assure that these programs comply with evidence-based standards of care.
  • MSSNY will work to assure strong enforcement of the NY and federal laws that require health insurance companies to cover emergency room care when a patient reasonably believes they are in need of immediate medical attention, including the imposition of meaningful financial penalties on insurers who do not follow the law.
  • MSSNY will advocate that all pharmacies, prescription programs, and EHR vendors adopt technologies for physicians to easily cancel medications electronically.

Governmental Affairs and Legal Matters B

  • MSSNY will seek to have legislation introduced and signed into law in

New York State stipulating that a patient undergoing any medical treatment requiring anesthesia in a hospital or ambulatory surgical center, regardless of where the hospital or ambulatory surgical center is located and regardless of the type of health insurance coverage, be guaranteed that a physician-anesthesiologist will either personally administer or supervise a nurse anesthetist in the administration of anesthesia or the operative that a designated surgeon, who has agreed to medically supervise the nurse anesthetist.

  • MSSNY will advocate for patients to have a choice to receive maintenance prescriptions from either a mail order pharmacy or a brick-and-mortar pharmacy without any financial penalty, and advocate for legislation that prohibits pharmacies from charging higher prices (from pharmacy benefit managers or insurance plans) than the actual pharmacy price of the medication
  • MSSNY will support legislation to prohibit Medicare plans and HMO plans would not from changing covered drugs during the enrollment year
  • MSSNY will support the use of State funding to establish and to support addiction medicine fellowships in New York State. 

Socio-Medical Economics

  • MSSNY requests that the New York State Department of Financial Services mandate all insurance companies print current copays and deductibles and date of issue on all subscribers’ health insurance cards.
  • MSSNY will adopt the position that it is proper to remove the CLIA certification mandate requirement for physicians who only use CLIA-waived tests and physician-performed microscopy; and bring this proposal to the AMA.
  • MSSNY should call on the AMA to reimburse all AMA members for the fees they pay in relation to CPT coding; and the New York delegation to the AMA bring this resolution to the Annual Meeting of the AMA in 2018.
  • MSSNY will advocate that no providers may remit bills for services until they can document that all resources have been exhausted attaining third party reimbursement; and  when there is a balance for which the patient is responsible, that if paying the total amount due is a hardship for the patient that an installment plan be worked out; and recognizing that installment plans require extra staff time, charging a nominal fee is acceptable for such arrangements; and if it is ascertained that a beneficiary is responsible for a fee, reasonable payment options should be offered. 

Reports of Officers

  • Free county medical society and MSSNY membership for medical students (beginning in 2019)
  • Equity in Dues – HOD adopted policy that the long-term goal of MSSNY is to achieve equity in dues for all members through growth in membership.  The House of Delegates and the Council will monitor all programs created to achieve growth by enrolling members at special dues rates, to ensure that they are conducted in accordance with the MSSNY Bylaws.
  • Life Member Administration Fee – The House approved a pilot project whereby Life Members would be sent an annual statement requesting payment of a recommended voluntary administration fee of $100 to be shared equally by the county medical society and MSSNY.  

Aetna Follows United On Rebates to Customers for Medicines
Aetna announced Tuesday morning it will automatically provide pharmacy rebates to customers when they purchase their medicines. UnitedHealth Group said the same a few weeks ago. Both will provide discounts to people in fully insured commercial plans — which affects around 3 million people for Aetna.  

Antitrust Institute Calls for DOJ to Block CVS-Aetna Merger
Yesterday, the American Antitrust Institute (AAI), an antitrust research and advocacy organization whose mission is to advance the role of competition in the economy and to protect consumers, called upon the DOJ to block the merger of CVS-Aetna.

The AAI request was communicated in a persuasive and well-documented 10 page letter. It opens with a statement that “the letter adds to the concerns raised by other important voices, including the American Medical Association (AMA) and Consumers Union.” The letter concludes with the judgment that the merger would “trigger a fundamental restructuring of the US healthcare system” in ways that would “harm competition and consumers at all levels.” The AAI letter can be found here. 


Register Now For 2018 NY HIT Symposium on Sat. April 28 in Brooklyn

When: Saturday, April 28, 2018 8:30 a.m. – 3:00 p.m.
Where: Brooklyn Borough Hall
209 Joralemon St.
Brooklyn, NY 11201

Please join us as we examine potential risk management issues with EHR technology.

  • Liability pitfalls in EHR documentation
  • Fraud risks in documenting encounters
  • Privacy, security, and confidentiality in EHR technology

The HIT Symposium is designed for physicians in all specialties.

Supported by MLMIC and MSSNY


Plague & Q Fever” CME Webinar on April 18, 2018; Registration Now Open

Upcoming in MSSNY’s Medical Matters continuing medical education (CME) webinar series is: Plague & Q Fever”.  This webinar will take place on Wednesday, April 18, 2018 at 7:30 a.m.   Faculty for this program is Kira Geraci-Ciardullo, MD, MPH.  Register for this webinar here.

Educational objectives are:

  • Describe the epidemiology of Plague and Q Fever
  • Describe the transmission of Plague and Q Fever
  • Describe the diagnosis and treatment of Plague and Q Fever
  • Explain the use of Yersinia pestis and Coxiella burnetii as a biologic weapons(s)
  • Identify infection control procedures
  • Identify resources for reporting

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at

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. 


CMS Extends MIPS 2017 Data Submission Deadline
If you’re an eligible clinician participating in the Quality Payment Program, you now have until Tuesday, April to submit your 2017 MIPS performance data. You can submit your 2017 performance data using the new feature on the Quality Payment Program website.

Note: For groups that missed the March 16 CMS Web Interface data submission deadline, it’s not too late to submit your data through another mechanism.

How to Get Started

Go to and click on “sign in” on the top right side of the web page.

  • You’ll be required to log into the Quality Payment Program data submission feature using your Enterprise Identity Management (EIDM) credentials user name and password. If you don’t have an EIDM account, you’ll need to obtain one. Review this EIDM user guide and get started with the process as soon as possible. Currently, you should allow at least 5 business days for EIDM requests to be processed.
  • After logging in, the feature will connect you to the Taxpayer Identification Number (TIN) associated with your National Provider Identifier (NPI).
  • You’ll be able to report data either as an individual or as a group. Be sure to login and get familiar with the feature before you submit your data.

Real-Time Score Projections

As you enter data into the feature, you’ll see real-time scoring projections for each of the Merit-based Incentive Payment System (MIPS) performance categories. This scoring may change if new data is reported or quality measures that have not yet been benchmarked are used.

Data can be updated at any time during the submission period. Once the submission period ends, CMS will calculate your payment adjustment based on your last submission or submission update.

Please note, your performance category score will not initially take into account your Alternative Payment Model (APM) status, Qualifying APM Participant (QP) status, or other special status—if applicable. To check your QP status, review the updated APM Lookup Tool.

Get Help and Learn More

Contact the Quality Payment Program by email at or toll free at 1-866-288-8292, if you need help or have questions about using the data submission feature.

You can also view the data submission fact sheet and this video to learn more about the Quality Payment Program data submission feature.

Open Payments Program Year 2017 Review and Dispute Period Begins April 1st
Review and dispute for the Program Year 2017 Open Payments data begins on Sunday, April 1, 2018 and will last until May 15, 2018. During the review and dispute period physicians and teaching hospitals may review, affirm, and, if necessary, dispute their attributed records. Physicians and teaching hospitals must initiate their disputes during the 45-day review period in order for the disputes to be addressed before or reflected in the June data publication.

Note: Physicians and teaching hospitals must work directly with the reporting entity to reach a resolution. The Centers for Medicare & Medicaid Services (CMS) does not mediate or moderate disputes.

Physician and teaching hospital review of the data is voluntary, but strongly encouraged.
While the opportunity for physicians and teaching hospitals to dispute any data associated with them expires at the end of the calendar year in which the record is published, the disputes must be initiated during the 45-day review and dispute period, ending on May 15th, in order to be reflected in the June 30th publication.  CMS will publish the Open Payments Program Year 2017 data and updates to previous program year’s data in June 2018.

If You Have Never Registered In Open Payments Before:

Before you begin, make sure you have your National Provider Identifier (NPI) number and State License Number (SLN). Initial registration is a two-step process and should take approximately 30 minutes:

  1. Register in the CMS Enterprise Identity Management System (EIDM);
  2. Register in the Open Payments system

For Users That Registered Last Year and Have Used Their Accounts in the Last 60 Days:

Physicians and teaching hospitals who registered last year do not need to reregister in the EIDM or the Open Payments system. If the account has been accessed within the last 60 days, go to the CMS Enterprise Portal, log in using your user ID and password, and navigate to the Open Payments system home page.

For Users That Registered Last Year but Have Been Inactive for More than 60 Days:

The EIDM locks accounts if there is no activity for 60 days or more. To unlock an account, go to the CMS Enterprise Portal, enter your user ID and correctly answer all challenge questions; you’ll then be prompted to enter a new password.

For Users That Registered Last Year but Have Been Inactive for More than 180 Days:

The EIDM deactivates accounts if there is no activity for 180 days or more. To reinstate an account that has been deactivated, contact the Open Payments Help Desk at



Beautiful NYC Medical Office — Long-term Share
Bright, big consultation room and one or two exam rooms in large,  tastefully furnished office in first-rate building. 58th Street between Park and Lexington. Near transportation.  Smaller, windowed consultation room and exam room also available. Rent by the day or week, beginning June 1 or sooner. $180 per day or $5500 per months. Perfect for internist, rheumatologist, physical medicine, ob-gyn and others. Superb front desk and office management available, along with many amenities including internet, ultrasound, EMG, kitchen, optional C-arm. Call Carol: 917-856-6402.

Medical Office to Sublet – Sheepshead Bay, Brooklyn
Sublet available 2-3 days per week. Features 3 exam rooms, consultation room, x-ray and waiting room. Reasonable rent. Call 917-971-1691

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

For Share – Plastic Surgeon’s Office Facing Central Park Ground Floor Lobby Entrance/Private exit
One to three exam rooms, consult/private office and procedure room for full or part time use.
Elegant, modern and spacious secretarial, waiting and two exam rooms.
Accredited operating rooms and recovery rooms on site.
One block to bus and 20 feet to subways.
$1275-$3750/day monthly for one to three exam rooms. or 917.861.8273

Office Space – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3
bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail:

Magnificent medical suites for lease – 184 East 70th St . New York, NY.
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A : one consultation room plus 2 exam rooms . $6000 per month
Space B:One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500.
other combination may work as well. Available for sharing
For full details and photos see listing at or contact Karen Tamir at 917-865-1006 or  


General or Vascular Surgeon Needed
Busy Vein Center in Brooklyn and Staten Island, NY is looking for a General or Vascular Surgeon,Previous experience in vein procedures is helpful but not necessary. Full-time or part-time  schedules available. For additional information please Call Muhammad Shoaib at 718-435-1777 or send resumes to

Patient Navigation and Patient Advocacy Services for Your Patients
Barbara A. Brody & Associates, LTD., founded in 1992, is a private “Value–Added” resource for practices and patients. Barbara A. Brody, MPA analyses medical insurance policies, long–term care policies, and insurance billing (physicians, healthcare facilities and pharmaceutical plans). We provide an understanding of the details of Medicare, Group and Individual policies to your patients and, in return, to you and your staff.  We can help your patients with long–term claim filing and medical financial management too.  We help your patients figure out their insurance so you don’t have to.  Contact us at (212) 517–5100 or

Family Practice Physician – Schenectady/Amsterdam, NY
Hometown Health Centers is a Federally Qualified Community Health Center in the Upstate, Schenectady and Amsterdam, NY areas. Bi-lingual in English/Spanish is a plus.  Excellent total compensation package.  No hospital rounding. Flexible and part-time schedules available.  Sign-on bonus. For additional information please send inquiries or resumes to