May 12, 2017 – In It or Can’t Win It!


PRESIDENT’S MESSAGE
Charles Rothberg. MD
May 12, 2017
Volume 17
Number 18

MLMIC Insurance

Dear Colleagues:

As you know, MSSNY has, in the past, issued a statement that expressed significant concerns about the impact to New York practices, patients and the State Budget regarding the American Health Care Act (AHCA) legislation. At the same time, MSSNY’s statement noted the need for substantial revisions to the ACA.

In order to craft a clear physician message, we must come to understand where it is that we stand on health legislation and then come to an agreement on the merits or lack of them.

Last week, we sent out a five-question survey to our MSSNY’s Legislation and Advocacy Committee regarding their opinion of the AHCA legislation. I did not cherry-pick physicians for the survey because I figured that these physicians constitute a group that is interested, engaged and well informed on physician issues in New York.

On the recent AHCA bill, exactly 50% were opposed, 20% supported it and an amazing 30% neither supported nor opposed. On the matter of the 2010 Affordable Care Act (ACA) now in place, the outcome was evenly balanced—50% answered that the ACA (not the AHCA) should be repealed and 50% opposed repeal.

Last week MSSNY joined over 20 patient advocacy organizations in a letter to New York’s Congressional delegation stating that “…the AHCA would have significant adverse consequences to millions of New Yorkers.”  The letter urged that New York’s Congressional Delegation fight to:

  • ensure uninterrupted healthcare coverage for the 850,000 New Yorkers who gained coverage under the ACA;
  • not harm New York State’s budget and not shortchange New York’s Medicaid program; and
  • protect the more than 600,000 New Yorkers who gained coverage under the essential plan.

I have been traveling all over the state since my inauguration to speak with county society members. They want to talk about this issue. The ACA certainly caused animus among us but not division. One of our physician survey-responders commented that “we should never be in the position of opposing proposed legislation. It is far better to at least remain neutral and help craft it to our liking.”

Who better to shape this than physicians?

I attended a hospital Medical Staff meeting this week, too. Hospitals are very worried about the AHCA bill. HANYS opposes the AHCA for the following reasons:

  • It would increase by 24 million the number of uninsured nationwide, placing 2.7 million New Yorkers at risk;
  • It would upend the Medicaid program, stripping hospitals and health systems of needed resources while they care for more uninsured and underinsured patients; and
  • It would weaken federal protections for New Yorkers with pre-existing conditions.

Is the ACA working? For some yes. The patients that seem to be most negatively affected by this law are those who are “too rich for Medicaid” but too poor to afford insurance.

We all must get active and come up with better ideas.  We want to engage you on this matter—Please follow us on Twitter @MSSNYRothberg.

If you need help setting up an account, call Roseann Raia at 516-488-6100 ext. 302 to assist you.

Your comments are welcome. The elected officials’ ideas are not up to snuff.

When physicians ask me what I think, I offer them my mantra. All decisions should be made after they consider how it will affect their practice, their patients, their community and their profession.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


Please Urge Your Legislators to Enact Legislation to Address Prior Authorization Hassles and Expand Patient Choice of Physicians
With just 6 weeks left in the Legislative Session, MSSNY is strongly advocating for a number of bills to address prior authorization hassles imposed by health insurance companies, increase coverage for patients, and to limit the ability of health insurers to narrow their networks.  These bills include:

  • 3943 (Hannon)/A.2704 (Lavine) – would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract.  The bill has passed the Assembly and was recently reported to the Senate floor. Please send a letter in support, click here.
  • 3663 (Hannon)/A.4472 (Gottfried) – would permit independently practicing physicians to collectively negotiate patient care terms with market dominant health insurers under close state supervision. In addition to the ability to push back against exorbitant administrative hassles imposed by insurers, it would also help to protect physicians to have a stronger option to remain in independent practice. The bills have advanced to the Senate Finance Committee, and the Assembly Ways and Means Committee.  Please send a letter to your legislators in support, click here.
  • 5675 (Hannon)/A.7671 (Rosenthal) – would require health insurers to make out of network coverage options available to consumers through the New York Health Insurance Exchange. Currently, there are no out of network coverage options in the Exchange in downstate New York, despite Exchange officials strongly encouraging the offering of these options by insurers.  The bills are in the Senate Health and Assembly Insurance Committee. Please send a letter to your legislators in support, click here.
     (DIVISION OF GOVERNMENTAL AFFAIRS) 


Disastrous Liability Expansion Bill on Assembly Codes Committee Next Week; Contact Your Legislators to Oppose
All physicians are urged to contact their legislators to oppose legislation (A.3339) before the Assembly Codes Committee next week that would substantially lengthen New York’s medical liability statute of limitations.  Physicians can send a letter in opposition here: click here.  An actuarial analysis of substantially similar legislation indicated that enactment of this legislation could produce a medical liability premium increase of 15%, perhaps even greater, at a time when no increases can be tolerated and at a time when there is tremendous instability in our health care system.    Similar, but not identical legislation (S.4080) has been introduced in the Senate and is in the Senate Judiciary Committee.  Please let your legislators know that we need comprehensive medical liability reform, not one-sided proposals that will harm access to care!                                        (AUSTER)

US Senate Begins Review of AHCA
The United State Senate has begun its review of legislation that narrowly passed the US House of Representatives that enacts a partial repeal and significant revision of the ACA.  The Senate announced a 13-Senator working group to look at changes to the American Health Care Act (AHCA) legislation that was objected to by many patient and health care provider associations across the country and here in New York State.

MSSNY had previously issued statements that expressed significant concerns about the impact of the AHCA legislation to New York patients and the State Budget.   MSSNY recently joined with nearly two dozen patient advocacy organizations in a letter to New York’s Congressional delegation that noted that “while the Affordable Care Act (ACA) can be improved, replacing it with the AHCA would have significant adverse consequences to millions of New Yorkers”.   Instead, the letter urged that New York’s Congressional Delegation fight to: “Ensure uninterrupted healthcare coverage for the 24 million Americans, including the 850,000 New Yorkers who gained coverage under the ACA; Do not harm New York State’s budget and do not shortchange New York’s Medicaid program; and Protect the more than 600,000 New Yorkers who gained coverage under the Essential plan.”

These concerns were reiterated at a meeting this week of the Albany County Medical Society where physicians heard a presentation from Representative John Faso (R-Upper Hudson Valley), one of the key “swing” votes that led to the AHCA being passed by the House.  Rep. Faso’s detailed comments regarding his support for the legislation led to a spirited debate among physician attendees regarding the potential consequences to our health care delivery if this or similar legislation were to be enacted, as well as the potential consequences if this or similar legislation were not enacted.

As has been previously reported, the AHCA would maintain some provisions from the ACA, such as required coverage for pre-existing conditions, and requiring dependent coverage up to age 26.   It also contains components supported by MSSNY, such as significantly expanding the amount of funds that a person could direct to their Health Savings Account and delaying for several years implementation of the “Cadillac Tax” on comprehensive health insurance coverage.

However, the bill would jeopardize the availability of affordable health insurance coverage options for many in New York.   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.   It should be noted that these tax credits would not be available for any health insurance policy that covers abortions (which is required in New York.)

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.  The AHCA would also completely eliminate funding for New York’s Essential Plan, which provides low-cost insurance coverage with little cost-sharing responsibilities for over 600,000 New Yorkers who make between 138% -200% FPL.  As the US Senate continues its review and revisions over the next weeks and months, please remain alert for further updates.    (AUSTER)

Anthem Calls Off Proposed Takeover of Cigna
Several media sources were reporting this afternoon that Anthem (the parent of Empire Blue Cross) is terminating its proposed merger with Cigna. The decision comes after a Delaware judge ruled Thursday that Cigna could walk away from the deal, which Anthem had tried to stop.  Two weeks ago, a federal appeals court upheld a lower-court ruling that blocked this proposed mega-merger from moving forward.

MSSNY worked together with the AMA and several other state medical associations to oppose this proposed merger.  Last fall, then-MSSNY President Dr. Malcolm Reid as well as AMA representatives testified at a public hearing hosted by the New York Department of Financial Services examining this proposed merger.  Dr. Reid’s testimony emphasized the already very difficult practice environment for physicians in New York State that has become worse in recent years, as a result of the narrowing of health insurer participating provider networks and increasing pre-authorization burdens, problems which undoubtedly would be made worse had this merger been permitted to move forward.

DFS Superintendent Maria Vullo issued a letter last August that highlighted concerns with the significant market impact the merger would have had if approved.  New York Attorney General Eric Schneiderman, joined several AGs across the country in litigation to oppose the proposed merger.

Following Anthem’s announcement, the AMA released a statement noting that:

“Today’s action marks the end of a proposed merger that the American Medical Association, courts and regulators widely condemned as a bad deal for patients and harmful to the nation’s health system. The termination of the Anthem-Cigna merger is a clear victory to preserve competition in the health insurance industry. To the detriment of patients, there is already far too little competition among insurers. Networks are already too narrow, and premiums are already too high…Today’s action concludes a successful campaign by the AMA and 17 state medical societies to stop the Anthem-Cigna merger. The AMA and its coalition of state medical societies worked tirelessly to protect patients and block both this merger and the Aetna-Humana merger.”
(AUSTER) 

Bills That Would Raise The Purchasing Age For Tobacco And Restrict E-Cigarettes Moving In The NYS Legislature
Two tobacco related pieces of legislation are advancing in the NYS Legislature and physicians are urged to contact their legislators to support both measures.  S.2543/A.516, which would include the use of electronic cigarettes or e-cigarettes under the Clean Indoor Air Act, is now on the calendar in both houses and can be voted on at any time.   S.3978/A.273, which would increase the purchasing age for tobacco products from eighteen to 21 years of age, is on the Senate Finance Committee for its consideration.   The Medical Society of the State of New York strongly supports both these measures and urges physicians to contact their legislators to vote in support for both bills.  Physicians can send a letter to their legislators by clicking on the link here                                                                  (HARRING, CLANCY) 

Please Contact Your Legislators to Reject Bill that Would Potentially Expand CRNA Scope
Physicians should continue to contact their legislators to urge defeat of legislation (A.442/S.1385), which purports to statutorily recognize the title of a nurse anesthetist, but is written in such a way that it could potentially empower CRNAs to work beyond the scope of their training and work independently of physician supervision.  The legislation was recently advanced from the Assembly Higher Education Committee to the Assembly Ways & Means Committee.  MSSNY and the New York State Society of Anesthesiologists oppose this legislation.  Physicians can send a letter here, click here.                                                                                             (AUSTER)            

Please Review DFS Q&A Regarding New Law to Give Physicians Power to Challenge Improper Step Therapy Protocols
The New York Department of Financial Services has released a detailed Q&A regarding the legislation enacted last year that provides physicians with a stronger ability to override health insurer step therapy medication protocols to better ensure that their patients will have coverage for the most appropriate medications.  To read the DFS Q&A, click here.

The new law requires health insurers to grant a physician’s override request of an insurer step therapy medication protocol if the drug required by the insurer is contraindicated for the patient, likely to be ineffective for the patient, or if the patient is stable on the medication requested by the physician.  If the physician’s request for an override of the step therapy protocol is denied, it would enable a physician to formally appeal the decision both within the plan’s existing appeal mechanism as well as taking an independent external appeal to assure the patient receives coverage for the medication needed by the patient.  MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations and physician specialty societies to achieve enactment of this legislation.

The DFS Q&A notes that these new protections apply to any health insurance policy that was delivered, issued for delivery or renewed after January 1, 2017 (this would typically be group plans, which are approved by DFS on a “rolling” basis throughout the calendar year).   For example, if a policy is issued or renewed on March 1, 2017, it must comply with the new step therapy law.  However, for plans obtained through the individual market, which began this past January 1, the effective date for the step therapy protections will not be until January 1, 2018.  Please let us know if you have questions regarding this important new law.                                                          (AUSTER)  

New York Among Several States to Resolve Allegations Against CareCore for Alleged Improper Review of Imaging Requests
New York Attorney General Eric Schneiderman announced this week that New York was one of 20 states to reach an agreement with CareCore National LLC, an entity that reviews the medical necessity of imaging services.   According to the press release, the agreement settles allegations that CareCore instituted a scheme to “auto-approve” hundreds of radiology service requests on a daily basis, deeming those diagnostic services as reasonable and medically necessary, even though there had been no evaluation of those cases by the appropriate medical personnel. CareCore will pay the federal government $54 million, of which $18 million will go to the state Medicaid programs, including over $7.6 million to be returned to New York.    To read the AG’s press release, click here.

According to the press release, the agreement would resolve allegations that from January 1, 2005 through June 13, 2013, CareCore developed and implemented a program through which CareCore improperly approved over 200,000 prior authorization requests which CareCore initially determined could not be approved based on the information provided.   The press release also notes that the settlement resolves allegations that CareCore auto-approved the requests in an effort to keep up with the volume of preauthorization requests for diagnostic radiology services and to avoid a contractual monetary penalty per case for untimely reviews, which caused false or fraudulent claims to be submitted to and reimbursed by the State’s Medicaid program.                                                     (AUSTER)

Need to Meet Your Pain Management Requirement?  MSSNY Pain Management, Palliative Care and Addiction Online Program Available
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here. 

These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user.  As a new user, physicians and non-physicians will be required to enter fields that include: position; name (the name should be what you want to appear on the CME certificate); email address; and then create a password.  MSSNY members who encounter a payment page or have difficulty registering, please email cme@mssny.org for technical support.  Directions for creating a new account/or logging in can be found here.  Non-MSSNY physicians will be charged $50 per module. 

The MSSNY CME is a new site and while many MSSNY members have an account with mssny.org a MSSNY member may not necessary have an account with cme.mssny.org   If in doubt, try to create an account and if it tells you that the email address is unavailable or in use,  an account exists.   Passwords can be reset if you don’t know it.  Physicians who have previously had an account at the MSSNY CME site will need to log into the site using their email and password.

The MSSNY CME site provides the ability for physicians and other prescribers to view the archived webinar at their leisure, take the required test, and download their certificate. The online program covers all eight topics required in the New York State statute. MSSNY developed the program with the NYS Office of Alcoholism and Substance Abuse Services (OASAS).  MSSNY is listed as an accrediting organization by the NYS DOH Bureau of Narcotic Enforcement.   Information on the three CME modules is available here.  Additional information or technical support may be obtained by contacting cme@mssny.org .
(CLANCY)

DOH Attestation Process for Pain Management CME Must Be Completed by July 1, 2017
The New York State Department of Health has announced the attestation process for prescribers required to complete Pain Management CME. Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics. A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application.  Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):

  1. Log into the HCS
  2. Under “My Content” click on “All Applications”
  3. Click on “N”
  4. Scroll down to NEAT (Narcotic Education Attestation Tracker) and double click to open the application. You may also click on the “+” sign to add this application under “My Applications” on the left side of the Home screen.

Complete the steps to ATTEST to the completion of the education requirement.   A full set of instructions can be found here.

Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided in the form. The Bureau of Narcotic Enforcement has also released a Frequently Asked Questions (FAQs) on the prescriber mandate.   A copy of the FAQs can be found here.

In certain limited circumstances, the New York State Department of Health may grant an exemption to the required course work or training to an individual prescriber who clearly demonstrates to the department that there is no need to complete such training.  Exemptions will be granted only in very limited circumstances, and not solely on the basis of economic hardship, technological limitations, prescribing volume, practice area, specialty, or board certification.  Prescribers may applied for an exemption through the Health Commerce System.Further information may be obtained by contacting BNE at 1-866-811-7957 or narcotic@health.ny.gov.                                                                                                          (CLANCY)

Register Now For Upcoming Medical Matters 2017 CME Webinar Series
Registration is now open for the next Medical Matters webinar on Wednesday, May 7, 2017 at 7:30 a.m.  “Exercise Response to Novel Influenza Strains” will be conducted by Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.  Registration is now available at this link.

The educational objectives are: 1)  Understand preparedness and response actions of public health and healthcare to a novel pandemic influenza, simulated in full-scale exercise.  2)  Describe two delineated strategies in which public health and office-based physicians would interact in a pandemic influenza.

Registration is also open for “Mosquito Borne Diseases” on Wednesday, June 14, 2017 at 7:30 a.m.  Faculty for this webinar are William Valenti, MD chair of MSSNY’s Infectious Disease Committee and member of the MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee and Elizabeth Dufort, MD medical director, Division of Epidemiology from the New York State Department of Health.  .  Registration is now available at this link.

The educational objectives are: 1) Identify the most prominent mosquito borne diseases, including chikungunya, dengue, West Nile virus, yellow fever and zika.  2)  Describe the epidemiology of mosquito borne diseases.  3)  Review modes of transmission and methods of prevention of infection.  Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.  Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response.  

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

MSSNY 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, HOFFMAN) 

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

pschuh@mssny.org mauster@mssny.org pclancy@mssny.org jbelmont@mssny.org

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CMS: 800,000 Clinicians Given a Pass on MACRA Requirements
According to Modern Healthcare (5/11), 806,879 clinicians will not have to comply with Merit-based Incentive Payment System reporting requirements outlined in MACRA. They will not be evaluated under MIPS in 2017. Regina McNally, VP of MSSNY Socio-Economic Division, stated that the 806,879 number includes not only physicians—but also— physician assistants, Nurse practitioners, Clinical nurse specialists, and Certified registered nurse anesthetists. She has asked CMS officials for a breakdown. “Physicians who are excluded should have received a letter from their Medicare Contractor by now. If you have not received, you are probably NOT included. If you want to verify, you can use the QPP Exemption Lookup Tool. Just type in your 10-digit NPI number,” said Ms. McNally.

The majority of physician practices were expected to use the Merit-based Incentive Payment System, known as MIPS, to comply with MACRA as opposed to alternative pay models. Under MIPS, payments would be based on a compilation of quality measures and use of electronic health records.

The exempted physicians include those with less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year. Clinicians new to Medicare this year are also exempt this year. The agency also gave a pass to providers who have implemented a MACRA-compliant Advanced Alternative Payment Model, which is the other value-based reimbursement track doctors complying with the law can choose.

Under MIPS, physician pay will be based on success in four performance categories: quality, resource use, clinical practice improvement and “advancing care information” through use of health information technology. The advancing care criteria is based on the government’s meaningful-use program, which is used to decide whether doctors should be rewarded for using EHRs.

Medicare reimbursement for providers in 2019 will be based on how well doctors perform on these metrics this year. Under MIPS, physicians can earn a bonus or penalty of 4% of their reimbursement in 2019.

Participation Notification Letters

See a sample of the letter (zip) on the Education page of https://qpp.cms.gov/. This tool is another resource for clinicians to use to determine their status.

To get the latest information, visit the Quality Payment Program website. The Quality Payment Program Service Center may be reached at 1-866-288-8292available Monday through Friday, 8:00 AM-8:00 PM ET or via email at QPP@cms.hhs.gov. 

IPRO Supporting CMS Payment Program
IPRO has been awarded a special contract from the Centers for Medicare & Medicaid Services (CMS) to help physician practices in New York, Maryland, Virginia and the District of Columbia prepare for and participate in the new Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This technical assistance, authorized and funded under MACRA, brings direct support to an estimated thousands of Merit-based Incentive Payment System (MIPS) eligible clinicians in small practices with 15 or fewer clinicians, including small practices in rural locations, health professional shortage areas, and medically underserved areas across the country. 

The direct technical assistance is available immediately, free to all MIPS eligible clinicians, and will deliver support for up to a five-year period. “We’re very pleased to be able to support CMS in this effort to offer free technical assistance to thousands of physicians as they implement the new value-based Medicare payment system,” said IPRO Chief Medical Officer Clare Bradley, MD, MPH. IPRO will provide customized technical assistance to MIPS eligible clinicians, which may include, but is not limited to, the following:

  • Conveying the MIPS expectations and timelines,
  • Explaining the MIPS feedback report,
  • Creating a MIPS-score improvement plan,
  • Evaluating practice readiness for joining an Advanced Alternative Payment Model (APM),
  • Assessing and optimizing Health Information Technology,

Supporting change management and strategic planning,

  • Developing and disseminating education and training materials,
  • Enabling peer-to-peer learning and local partnerships.

For more information regarding this support service, go to www.mssny.org for contact information or to seek assistance.

CMP Medica 2017 Staff Salary Results
Looking to see if your staff salaries are in line with national bencharks? Check out our national data on key positions in medical practices broken out by years of experience. http://bit.ly/2qa6H7c

FDA: Doctors Should Get Info re Acupuncture/Chiropractic for Treating Pain
The Food and Drug Administration released proposed changes Wednesday to its blueprint on educating health care providers about treating pain http://bit.ly/2qb5hJk The guidelines now recommend that doctors get information about chiropractic care and acupuncture as therapies that might help patients avoid prescription opioids. “[Health care providers] should be knowledgeable about the range of available therapies, when they may be helpful, and when they should be used as part of a multidisciplinary approach to pain management,” the agency wrote in the proposal.

Expired EpiPens May Still Contain Effective Doses of Epinephrine
In a small study published in the Annals of Internal Medicine, researchers analyzed the contents of 31 EpiPens and 9 EpiPen Jrs that had expired in the prior 1–50 months. None had developed discoloration. Roughly 65% of the EpiPens and 56% of the EpiPen Jrs still had at least 90% of the labeled concentration of epinephrine. An EpiPen that had expired 50 months earlier still had 84% of the stated amount of epinephrine.

The authors conclude: “Although we observed declining concentrations of epinephrine over time, we expect that the dose available 50 months after expiration would still provide a beneficial pharmacologic response. Thus, we conclude that the process for establishing expiration dates for EpiPens should be revised and that, in the setting of outpatient anaphylaxis without other therapeutic alternatives, patients and caregivers should consider the potential benefits of using an expired EpiPen.”

Annals of Internal Medicine letter

Seven Rules of OSHA for Physicians
OSHA, the Occupational Safety and Health Administration is quite alive and well when it comes to enforcing its regulations against physicians. The seven rules that apply to physicians involve:

  1. Having a plan to reduce exposure to bloodborne pathogens.
  2. You must have a safety plan for exiting your office.
  3. You must have a plan for hazard communication; this involves hazardous chemicals of any kind. There must be a written list along with several other requirements.
  4. Electrical safety rules must be observed.
  5. New York does not require reporting occupational injuries and illnesses. There is a federal exemption for medical office reporting.
  6. Every practice must display an approved OSHA poster showing the employee rights to a safe working environment.
  7. For practices that use x-rays and imaging services, there are rules, such as radiation exposure badges.

Do NOT ignore the OSHA requirements as the fines may be substantial.

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

Teens Drinking Less but Binge Drinking More
A report from the CDC that states that “teen drinking appears to have reached a new low.” The report indicates that “the percent of teens who reported drinking at least one drink per month dropped from 50.8 percent in 1991 to just 32.8 percent in 2015.” But, “those who reported drinking tended to also report what is considered binge drinking: 57.8 percent of teens who reported drinking said they have had five drinks in a row.”

The prevalence of binge drinking increased from 31.3% in 1991 to 31.5% in 1999, then declined significantly to 17.7% in 2015. However, in 2015, approximately one in three high school students drank alcohol during the past 30 days and one in six were binge drinkers. Most high school students who drank (57.8%) were also binge drinkers, and more than two in five binge drinkers consumed eight or more drinks in a row.

Open Payments Physician and Dispute Period Ends Next Week
Physicians and teaching hospitals have until May 15, 2017 to review data reported by drug and medical device makers about them and, if necessary, dispute the payments before the data is made public on June 30, 2017.

To review and dispute data, physicians and teaching hospitals must register in the Open Payments system.

If You Have Never Registered In Open Payments Before:

Make sure you have your National Provider Identifier (NPI) number, Drug Enforcement Agency (DEA) number, and State license number (SLN).  Initial registration is a two-step process and should only take about 30 minutes:

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

Please remember to select the role of “Applicable Manufacturer/GPO, Physician, or Teaching Hospital”, when registering in EIDM. If any other role is requested, no access to the Open Payments System will be granted. For any additional information on registering in EIDM, refer to the Open Payments System Quick Reference Guide Enterprise Identity Management System (EIDM) Registration here.

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

Physicians 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, call the Open Payments Help Desk at 1-855-326-8366.

Learn more about the review and dispute process by accessing the educational materials available on the Resources page of the Open Payments website.



CLASSIFIEDS



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Physician Opportunities


Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next generation of primary care. If the fusion of health care and technology inspires you, please apply here.


Ophthalmologist Part Time
Ophthalmologist needed to work at multiple nursing homes in all 5 boros except Staten Island. Part time or full-time position available.  Generous salary and incentives.Ttech provided. Opportunity to perform surgery, but not required. Please email cv to privacyssw@gmail.com


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.


CALL FOR RATES & INFO. CHRISTINA SOUTHARD: 516-488-6100 ext. 355