May 19, 2017 – Speak Now or Forever Hold…

Charles Rothberg, MD
May 19, 2017
Volume 17
Number 19

MLMIC Insurance

Dear Colleagues:

There are some extremely important issues that affect every physician. You might want to take a minute to go to our Grassroots Action Center —it really only takes a minute—to let your opinion be known to YOUR legislator. With the legislative session expected to end June 21, MSSNY is currently advocating for various pieces of legislation so that you can assure your patients they will continue to receive timely and quality care.

  • Collective Negotiation
    In my opinion, a primary goal of having collective negotiation (under states’ rights doctrine) is to level the currently one-sided contracting playing field, which would minimize the need to actually engage in bargaining. And we have precedent in the effectiveness of this concept in surprise bill legislation whereby physicians and payers seem to come to terms, mostly without resorting to the dispute resolution process. One of MSSNY’s priority bills recently moved through the Senate Health Committee to the Finance Committee. The bill (S.3663, Hannon / A.4472, Gottfried) would allow independently practicing physicians to collectively negotiate patient care terms with market dominant health insurers under close state supervision. Its Assembly counterpart has advanced to the Assembly Ways & Means Committee. It is very important that you send a letter to your legislators so that we can inform them how important the bill is for physicians. Physicians can send a letter here.
  • Expanding Medical Liability Lawsuits (3339/S.4080)
    If we do not continue to talk about this, our adversaries will win. The Assembly bill has advanced to the Assembly floor and can be voted on at any time. It is very important that you send a letter to your legislators so that we can inform them how important the bill is for physicians. This bill would substantially lengthen the statute of limitations for medical malpractice actions and lead to enormous increases in the cost of liability insurance for physicians and hospitals. If enacted this bill could increase your liability premiums by 15%.  Please send a letter in opposition click here.
  • Conversion Therapy
    Legislation (A.3977/S.263) would bar mental health providers from trying to change the sexual orientation of anyone under the age of 18, something 5 states have already done.Gov. Cuomo signed an executive order in February precluding insurance companies in the state from covering conversion therapy. The DFS is issuing regulations barring New York insurers from providing coverage for conversion therapy given to an individual under the age of 18.The NYS DOH is prohibiting coverage of conversion therapy under New York’s Medicaid program.

You can call your legislator’s directly in their legislative offices in Albany to speak about the issues impacting your ability to treat patients. The bill
Senate: 518-455-2800
Assembly: 518-455-4100.

Finally, I attended the Queens County Annual Dinner this week where Dr. Carlos Zapata was inaugurated as President. I congratulate Carlos and am thrilled how quickly he has zipped up the ranks as I “mentored” him back in his medical school days.

Charles Rothberg, MD
MSSNY President

Please send your comments to

Please Contact Your Legislator to Oppose One Sided Liability Expansion Bills
All physicians should contact their legislators to urge them to oppose a package of bills that moved through the Assembly Codes and Judiciary Committees this past week. Physicians can send a letter please here. These bills would drastically increase New York’s already exorbitantly high medical liability premiums when no premium increases can be tolerated.  The timing of these bills could not be worse.  We now have multiple malpractice insurance companies operating in New York State that appear to be in serious financial jeopardy which can ill-afford to absorb the substantial costs of a brand new cause of action. Moreover there is a great uncertainty in the NY healthcare delivery system as a result of legislation before Congress that could profoundly restructure Medicaid spending.

Among the bills that MSSNY is opposing include:

  • Expanding the Medical Statute of Limitations Lawsuits (A.3339/S.4080) – would substantially lengthen the statute of limitations for medical malpractice actions and lead to enormous increases in the cost of liability insurance for physicians and hospitals.  If enacted this bill could increase your liability premiums by 15.
  • Expansion of Medical Liability Damages (A.1386/ S.411) – would greatly expand the categories of damages which a plaintiff may recover in a wrongful death action.  Actuarial studies have predicted that this bill could increase liability premiums by over 50%.
  • Third Party Defendant (A.1500 / S. 412) – would permit a plaintiff to bypass the defendant he or she sued to collect a judgment from a third party defendant who or which had been sued by the defendant for contribution or indemnification as a result of the underlying action.
  • Prohibiting Ex-Parte Interviews of Plaintiff’s Treating Physician (S.243/A.1404) – would prohibit a physician’s defense counsel in a medical liability action from conducting an interview with the plaintiff’s treating physician. This bill would present significant issues for physicians in a medical liability action by limiting the opportunity to fully examine the plaintiff’s health condition to evaluate the merit of the plaintiff’s claim.     

Contact your legislature today!

A Collective Voice Matters
MSSNY will continue to push for comprehensive liability reform to preserve access to care for patients, not one-sided proposals that would further reduce access.  With the trial lawyers having their Lobby Day in Albany this week, it is important that we counteract their message.  With only a few weeks left in session, we must be active in every way.  Please call and write your legislators.  MSSNY continues to oppose legislation that would have drastic consequences on York’s health care system.  It is imperative that legislators hear directly from their physicians, family and friends.   Decisions on these issues will be based on the feedback from each and every legislator.

Here are some facts to help you with your contacts:

  • A recent analysis from the website WalletHub listed New York as the worst state in the country in which to practice medicine, in large part due to its overwhelming liability exposure as compared to other states in the country.
  • New York physicians have reached the breaking point and already face extraordinary overhead costs, declining payments from insurers, and increasing mandates from government, such as required participation in unproven value based payment systems.
  • Many New York physicians already pay extraordinary medical liability premiums to remain in practice, premiums which are among the highest in the country.   Shockingly, many New York physicians pay premiums that far exceed $100,000 and in some cases even exceed $300,000.
  • New York has by far and away the highest total of medical liability payouts and per capita payouts than any other state in the country, according to a recent study Dietrich Healthcare.  (BELMONT)

Legislation Placing E-cigarette Under the Clean Indoor Air Act Passes NYS Assembly
Assembly Bill 516, which would place electronic cigarettes under the Clean Indoor Air Act (CIAA) passed the New York State Assembly this week.  The measure, sponsored by Assemblywoman Linda Rosenthal, would prohibit the use of electronic cigarettes in public places and certain outdoor areas.

Its companion measure, S. 2543, sponsored by Senator Kemp Hannon, is on the calendar in the NYS Senate and can be voted on as early as next week.   Additionally, S.3978/A.273, which would increase the purchasing age for tobacco products from eighteen to 21 years of age is in the Assembly Health Committee and the Senate Finance Committee.   Physicians are urged to send a letter in support of both these measures from MSSNY Grassroots Action Center (GAC) or can call their senator at 518-488-2800. To send a letter, please click here.

Please Urge Your Legislators to Enact Legislation to Address Prior Authorization Hassles and Expand Patient Choice of Physicians
With just a few weeks left in the legislative session, physicians are urged to contact their legislators to ask them to support legislation strongly supported by MSSNY 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:

  • S.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 please: click here.
  • S.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 by clicking here.
  • S.5675 (Hannon)/A.7671 (Rosenthal) – would require health insurers to make out of network coverage options available 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.

Moreover, legislation is likely to be introduced shortly that would help to reduce insurer-imposed administrative hassles consistent with the recently released document entitled Prior Authorization and Utilization Management Reform Principles please click here.  These principles were developed by the American Medical Association, American Hospital Association, Medical Group Management Association, American Pharmacists Association, and Arthritis Foundation along with other health and patient advocacy associations including MSSNY.

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

Support Legislation to Repeal Arbitrary Limits on Compensation Arrangements with Billing Vendors
At the April MSSNY House of Delegates meeting, a resolution was adopted calling on MSSNY to “work for repeal of the New York State law barring percentage-based payment arrangements between physicians and their billing agents” and, to “oppose efforts by state government officials to demand refunds from physicians based upon allegations that claims were submitted to Medicaid using percentage-based arrangements between physicians and their billing agents”.

Legislation (A.193, Buchwald/S.2247, Hannon) has been introduced that would accomplish one of the goals of the resolution by eliminating the “one of a kind” New York law that prohibits health care practitioners from entering into contracts with practice management companies that use percentage-based billing arrangements.  Physicians are urged to send a letter to their legislators in support of this legislation please click here.

Bill to Prohibit Mid-Year Formulary Changes Advances to Assembly Floor
After receiving unanimous support from the Assembly’s Insurance Committee, legislation (A.2317, Peoples-Stokes) has advanced to the Assembly Floor that would protect patients from unforeseen changes in prescription drug formularies during a policy year that could in turn seriously interfere with their drug therapy.  This bill would protect thousands of insured New Yorkers by preventing the imposition of higher out of pocket costs. The Medical Society of the State of New York supports enactment of this measure. Similar legislation has been introduced by Senator Sue Serino (S.5022), and has referred to the Senate Insurance Committee.

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
Registration is now 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  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)

MSSNY & NYSDOH Presents Current Concepts in Concussion for Pediatric and Adult Patients
MSSNY’s Continuing Medical Education webinar on Current Concepts in Concussion for Pediatric and Adult Patients is available on the MSSNY CME website Dr. John Pugh, assistant professor of Neurology at Albany Medical Center, and Dr. Deborah Light, Director of the Sports Medicine Fellowship at Albany Medical Center, discuss topics including identifying symptoms indicative of concussion, outlining appropriate management plans, and methods for primary and secondary prevention of concussion.

Click here  to view the webinar and fulfill the requirements to receive a certificate awarding one hour of CME. COMING SOON – Dr. John Pugh and Dr. Deborah Light discuss the topic of concussion in MSSNY’s podcast on Current Concepts in Concussion for Pediatric and Adult Patients. The podcast will soon be posted to MSSNY’s CME webpage.

NYS DOH Expands HIV Testing Website
The New York State Department of Health announced the release of its newly designed New York State Expanded HIV Testing website:  DOH has streamlined its site to better serve hospital and clinic administrators and New York State clinical providers.  Physicians are encouraged to visit the site and refer to it for all routine HIV testing questions and needs.  Additionally, physicians are invited to partake in a research study entitled “Usability and evaluation of the NYS Expanded HIV Testing Website” conducted by the University of Rochester and the New York State Department of Health.  The purpose of the study is to help DOH understand practicing providers’ current HIV testing practices.

DOH will use this information to address potential gaps in routine HIV testing.  This study involves an on-line survey that should take no more than three minutes to complete. To learn more about the study or complete the survey, click here If there are additional questions or need assistance to complete the survey, please email the study coordinator at:  Physicians will receive up to two follow-up emails about participating in this study.  If you would like to stop receiving these emails please let us know at:                                                            (CLANCY)

NYS DOH Conducts Buprenorphine Waiver Trainings throughout New York State
The NYS Department of Health, AIDS Institute, Office of Drug User Health, is sponsoring free buprenorphine waiver trainings for all clinical providers at various locations throughout the state.  Training will take place on Saturday, May 20th, from 8:00 a.m. to 1:00 p.m. at Champlain Valley Physicians Hospital, 75 Beekman Street, Plattsburgh, NY 12901.   Online registration please  click here   Additional information, registration, and locations please   click here.      (CLANCY)   

Join MSSNY and Support MSSNYPAC Today
MSSNY and MSSNYPAC enables physicians to pool their resources to fight the multitude of misguided proposals being pushed by many groups whose agendas are diametrically opposed to physicians and the patients they treat.   It also provides resources to help fight for needed changes in our health care system so physicians can continue to deliver the quality and timely care expected by their patients.

We thank you for your support and urge you to make sure your colleagues also join us in these efforts.  If all physicians were to join MSSNY and MSSNYPAC there is little we could not accomplish.  Please do not let your colleagues ignore the need for a strongly supported MSSNY and MSSNYPAC.

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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HHS notification: International Cyber Threat to Healthcare Organizations
Dear HPH Sector Colleagues,
HHS is aware of a significant cyber security issue in the UK and other international locations affecting hospitals and healthcare information systems. We are also aware that there is evidence of this attack occurring inside the United States. We are working with our partners across government and in the private sector to develop a better understanding of the threat and to provide additional information on measures to protect your systems. We advise that you continue to exercise cyber security best practices – particularly with respect to email.

Laura Wolf,
Critical Infrastructure Protection Lead

May 12, 2017
Additional information on ransomware provided by HHS Office for Civil Rights can be found at:

Cyber Newsletters:

Ransomware Guidance: 

Doctors Do Dismiss Patients for Difficult or Inappropriate Behaviors
Nine out of 10 health care provider practices have “fired” a patient because of poor patient behaviors, according to research published this week in JAMA Internal Medicine. According to the researchers, the findings show that physicians are not dismissing patients because of particularly difficult or complex medical issues as insurers shift from fee-for-service reimbursement toward value-based payments. “The reasons practices are dismissing patients aren’t so much related to the things people were worrying about — that if [insurers reimburse more for] quality of care, doctors might start cherry-picking patients,” said Dr. Ann O’Malley, Mathematica Policy Research senior fellow and lead author.

Among the reasons the nearly 800 practices surveyed gave for cutting ties with a patient:

  • Violent, “disruptive,” or inappropriate behavior toward doctors or staff
  • Violation of policies related to chronic pain and controlled substances
  • Failure to show up to scheduled appointments
  • Repeated disregard of a doctor’s medical recommendations
  • Violation of bill payment policies

Agencies Warn of Faulty Blood Tests for Lead, Recommend Retesting
Some blood tests made by Magellan Diagnostics may falsely report low lead levels in children and adults, the FDA and CDC cautioned on Wednesday. The FDA is warning against using Magellan Diagnostics LeadCare analyzers with venous blood samples. The alert doesn’t apply to blood collected by finger- or heelstick.

Children currently younger than 6 years need to be retested if they had venous blood samples analyzed with any of the following Magellan products — LeadCare, LeadCare II (which is used in provider offices and clinics), LeadCare Plus, or LeadCare Ultra – and their results were 10 µg/dL or less. Pregnant and nursing women should also be retested.

The problem with falsely low readings began as far back as 2014, the FDA said. FDA news releaseCDC health advisory

Join CMS May 22nd to Learn More re Quality Payment Participation Requirements
On Monday, May 22nd at 1:00 PM ET, CMS will host an overview webinar on the participation criteria used to determine inclusion in the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Webinar Details
Title: Quality Payment Program Participation Criteria Webinar
Date: Monday, May 22, 2017
Time: 2:00 PM ET

Description: During this webinar, CMS will provide an overview of:

  • MIPS participation requirements for individual clinicians and groups
  • >Participation requirements for Advanced APMs and MIPS APMs
  • A new tool that allows clinicians to check if they are included in MIPS
  • The recent participation letter sent to clinician offices

Event Registration:

The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. If you cannot hear audio through your computer speakers, please contact Phone lines will be available for the Q&A portion of the webinar.

Have a specific question about the Quality Payment Program? Please e-mail
For More Information<
Visit to learn more about the MIPS participation requirements and other information on MIPS and the Quality Payment Program. To review presentations from previous webinars, visit the Quality Payment Program Events page.

Many Americans Skipping MMR Vaccination before Traveling Abroad
Of US adults who go to travel clinics before traveling internationally, only about half of those eligible for the measles, mumps, and rubella (MMR) vaccine actually receive it, a study in the Annals of Internal Medicine finds.

Researchers studied 40,000 U.S. adults who presented to clinics for pretravel consultation. Of the 6600 who were eligible to receive the MMR vaccine based on self-reported disease and immunization history, 53% did not get vaccinated. Nearly half of the unvaccinated had refused the vaccine; most said they refused because they were not concerned about acquiring measles.

Roughly 28% of eligible patients didn’t receive the vaccine because of the provider’s decision; the vast majority of providers believed that the vaccine was not indicated.

Editorialists conclude: “If persons traveling abroad continue to underestimate the importance of pretravel MMR vaccination, our society is destined to be affected by imported cases of measles, leading to morbidity and mortality from this disease.”
Annals of Internal Medicine article

USPSTF Stance against Using Hormone Therapy to Prevent Chronic Conditions
The U.S. Preventive Services Task Force, in a draft recommendation statement, is again advising against the use of hormone therapy to prevent chronic conditions in postmenopausal women.

In particular, the task force recommends against use of combined estrogen-progestin for this purpose, and against estrogen alone in women who’ve had a hysterectomy. The grade D recommendations are in line with the group’s prior recommendations, issued in 2012 and 2005.

While the USPSTF found evidence that hormone therapy offers some benefits, including reduced risks for fracture and diabetes, it found evidence of more potential harms, including increased risks for invasive breast cancer (with estrogen-progestin only), venous thromboembolism, stroke, dementia, gallbladder disease, and urinary incontinence.

The recommendations do not apply to hormone therapy for the treatment of menopausal symptoms, such as hot flashes and night sweats.
USPSTF draft recommendation statementUSPSTF grade definitions


Medical Practice for Sale in Upscale Westchester Community
Successful well established (1984) and actively growing Internal Medicine/ Primary Care Practice conveniently located only 45 minutes from midtown Manhattan. Great Opportunity for established physician to expand his patient base or for entrepreneurial new graduate.  Lease assignable with option to renew.

Facilities / Business Details

Well known Professional Building with convenient free parking; ground/first floor location, handicap accessible. Contemporary office recently built and painted. Two large exam rooms; one consultation room/doctor’s office, lab, spacious receptionist area and large waiting room. As an independent practice, it provides an extremely appealing option for the patient that does not want to go to a huge impersonal multi-specialty group. Approximately 80% commercial payers; 20% Medicare. Doctor retiring but willing to stay on to introduce new physician to patients and assist in transition.

Asking Price: 


Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at

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

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: 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: 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: 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