October 13, 2017 – Executive Order Concerns

Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE
Charles Rothberg, MD
October 13, 2017
Volume 17
Number 39

Dear Colleagues:

Yesterday, when we received news regarding President Trump’s Executive Order, we responded quickly about how this may impact our patients. My statements were picked up by today’s Newsday and Politico. My full press statement is as follows: 

“The Medical Society of the State of New York is still assessing the full impact of the President’s Executive Order, and we have many questions regarding how this will be implemented.  We are generally very supportive of efforts to increase the availability of affordable insurance options for our patients. At the same time, we are also very concerned about the possibility that the expanded use of Association Health Plans (AHPs) could remove oversight of health insurance plans away from state governments. Specifically, we are concerned that it could result in more consumers purchasing plans with even more exorbitant out of pocket costs, fewer choices of physicians and a reduction in the ability of patients and physicians to enforce provisions of a health insurance contract.  Of greatest concern, it very well could result in increased costs for those consumers who remain in New York’s health insurance market due to potential adverse selection by these AHPs.”

Opportunity to Donate Your Time and Skill to Hurricane-Ravaged Puerto Rico

MSSNY is continuing to look for ways for physicians to participate in efforts to help repair the hurricane-ravaged medical system in Puerto Rico. We have information to share regarding an opportunity for physicians to donate their time, talent and medical supplies to the relief effort.

Dr. Jodie G. Roure, JD, PhD, a tenured Associate Professor of human rights at John Jay College of Criminal Justice-City University of New York, is coordinating a hurricane relief effort to Puerto Rico.  Dr. Roure is recruiting physicians and nurses to volunteer in Puerto Rico. She is also collecting donations of medications and medical supplies (including oral and topical antibiotics, insulin and GI medications).

Dr. Roure is working with Dr. Jose Joaquin Vargas, who is charged by the Puerto Rican government with heading and coordinating the medical relief efforts, and Attorney Fernando Alarcon, Special Assistant to the President of the Puerto Rican Senate of Puerto Rico for Public Health and Governmental Issues.

Dr. Vargas and Special Assistant Alarcon have developed a protocol regarding medical malpractice and liability and the ability to practice medicine in Puerto Rico without a Puerto Rico license.  Medical malpractice will be covered by the state insurance accreditation after proper registration of each doctor.

Dr. Vargas estimates he will be needing volunteers for the next three to four months. The first trip will depart on JetBlue from JFK NYC airport tomorrow. We will keep you posted as to when the next missions are departing. The government will provide ground transportation and accommodations when the medical personnel arrive in Puerto Rico.

For more information, please contact Prof. Jodie Roure, Latin American Studies Department, John Jay College, NY, NY 10019 (787) 400-2337.

There are other ways to join in the recovery. I encourage you to join me in supporting the work of the MESF with a generous contribution to assist the physicians affected by the storm.

All donations are tax deductible.

Thank you for helping us to help others.

Sincerely,

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large

Urge Congress to Extend CHIP Funding: Contact your Federal Legislators Today
Over 350,000 New York Children are covered through its Child Insurance Program, which receives a substantial portion of its funding from Congress. However, the authorization to provide funding to the states for this essential program expired on September 30. While the Senate and House have each advanced separate bills to continue this program, an agreement remains elusive.

Governor Cuomo on Wednesday warned that inaction by Congress has jeopardized health care for the 350,000 New York children covered under the program and urged an extension of Child Health Funding. Last week, MSSNY and other Health Provider groups sent a letter to Congress urging them to not allow CHIP funding and insurance subsidies to expire.   This week, MSSNY joined the medical societies of Arizona, California, Florida, Louisiana, New Jersey, North Carolina, Oklahoma, South Carolina, Texas in a letter to Congressional leaders urging that legislation be enacted to extend CHIP funding for 5 years.

Please urge our Representatives and Senators to put aside partisan differences and reach an agreement to continue this important funding.  You can contact your federal legislators here.

MedPAC Recommends MIPS Repeal and Replacement with Different VBP Program
Noting that the newly implemented Medicare Merit-Based Incentive Payment System (MIPS) is “extremely complex” and imposes a “$1 billion reporting burden” on physicians and other health care providers, the Medicare Payment Advisory Commission (MedPAC) has recommended that Congress repeal the program.

In lieu of MIPS, MedPAC recommended a different program by which a portion of payments (such as 2%) would be withheld. Clinicians not in an advanced payment model (APM) could join a group of physicians whose claims data is reviewed on certain population-based health measures to see if they qualify to have the withheld funds returned. Clinicians who do not participate in an APM or the new model would forfeit the withheld portion.

MedPAC’s recommendations are not binding on Congress, but sometimes help shape the debate around a particular issue.

Among the concerns articulated by MedPAC is that the program is designed primarily to measure how doctors perform, such as whether they ordered appropriate tests or followed general clinical guidelines, rather than if patient care was ultimately improved by that provider’s actions.

The MIPS program became effective at the start of 2017 and will impact Medicare payments starting in 2019.  Last year, CMS adopted provisions that provided that physicians could avoid Medicare penalties in 2019 if they reported one quality measure or one clinical improvement activity during 2017.

Based upon 2018 performance, however, those not exempted from MIPS participation (if they see 200 or more Medicare patients or have more than $90,000 in Medicare charges) could see their Medicare payments shifted up or down 5% in 2020 based upon how their performance in reporting quality measures, use of EHR and clinical improvement activities compares with other physicians.

Earlier this year, the MSSNY House of Delegates passed a resolution calling upon MSSNY to work with the AMA to advocate to repeal the law that conditions a portion of payment on compliance with the MIPS and APM program, while simultaneously advocating to significantly reduce the administration burdens and penalties with the program.

For more information for how physicians can comply with the MIPS program, please visit the Physicians Advocacy Institute’s MACRA Resource Center.  MSSNY is a board member of the Physicians Advocacy Institute.

Legislation To Require E-cigarettes Be Included in Clean Indoor Air Act Before Governor for Signature
Legislation which would include that e-cigarettes is now before Governor Andrew Cuomo for his consideration and physicians are urged to send a letter to him in support of this measure.  S.2543A/A/516A, sponsored by Senator Kemp Hannon and Assemblywoman Linda Rosenthal, includes vaping in the definition of smoking, along with the use of electronic cigarettes or e-cigarettes.  It would place the same restrictions on e-cigarettes that already exist on tobacco products under the Clean Indoor Air Act.  The Medical Society of the State of New York supports this legislation and urges that it be signed into law.  Physicians are urged to send a letter by clicking here.

Electronic cigarettes, commonly known as e-cigarettes, are electronic devices that deliver nicotine to the user.  People are being placed at risk because of the lack of information regarding the chemical makeup of liquid nicotine or the risk to individuals from inhaling the water vapor either directly or through secondhand exposure.

Testing done by the FDA shows that electronic cigarettes can be dangerous because users inhale carcinogens and toxic chemicals, such as diethylene glycol, an ingredient found in antifreeze.  Recent studies have suggested that e-cigarettes may contain more carcinogens than traditional cigarettes, in some instances ten times the carcinogens of traditional cigarettes.



Promo Code: MSSNY


Medicaid Fee- for- Service Providers Dispense Brand Name Drug when Less Expensive than Generic Program
The latest update for Medicaid FFS providers dispensing brand name drugs when less expensive generic is available. Changes are effective October 19, 2017.

Please visit our website for additional, up-to-date information.

Drug Ads: Too Many Risks Dilutes Larger Risks to the Public
A Study http://go.nature.com/2xDr1Tt published in the journal Nature Human Behaviour found “that when a drug advertisement throws too many risks at you…the less risky a drug is perceived to be by a potential consumer” based on “a psychological phenomenon called ‘the dilution effect.’” The article says advertisements for medications “are required by the Food and Drug Administration to list their risks along with the drug’s benefits,” although “savvy marketers” may have found “that the more risks the commercial or print ad lists, the better for their brand because the smaller side effects dilute the larger risks.”

Make the Voices of Recovery Count in New York State
Friends of Recovery – New York (FOR-NY) needs your help in distributing the FOR-NY Life in Recovery Survey. The survey will help FOR-NY identify current needs, strengths and gaps in addiction and recovery services and supports for individuals and families in recovery.

The critical information we gather will help us pinpoint resources needed by individuals, families, friends and allies to the recovery community so we can make important recommendations to legislators and policy makers to improve the quality of addiction services and recovery supports provided to thousands of New Yorkers.

Survey takers should be at least one of the following:

  • A person in recovery
  • A family member of someone with an addiction
  • A family member who has lost someone to an addiction
  • A professional in the addiction/recovery field

For additional information, please contact Allison Weingarten FOR-NY Director of Policy, by email at aweingarten@for-ny.org or by phone at (518) 487-4395 X22.  

50 Days Left to Submit an Informal Review Request; Review PQRS Feedback Now
Your 2016 Physician Quality Reporting System (PQRS) feedback reports and 2016 Annual Quality and Resource Use Reports (QRURs) were released on September 18, 2017. The PQRS feedback reports show your program year 2016 PQRS reporting results, including if you are subject to the 2018 PQRS downward payment adjustment. The 2016 Annual QRURs show how physicians, physician assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs) in groups and solo practitioners performed in 2016 on the quality and cost measures used to calculate the 2018 Value Modifier as well as their practice’s 2018 Value Modifier payment adjustment.

The payment adjustments shown in the reports are based on proposals that were included in the 2018 Medicare Physician Fee Schedule Proposed Rule (https://federalregister.gov/d/2017-14639). If the policies are not finalized as proposed, CMS will provide an update to report recipients.

Access and review your 2016 PQRS feedback report and 2016 Annual QRUR now to determine whether you are subject to the 2018 PQRS downward payment adjustment and your practice’s 2018 Value Modifier payment adjustment.

If you believe your payment adjustment status was made in error, you may request an informal review of your 2016 PQRS results and/or 2018 Value Modifier calculation during the informal review period from now until December 1, 2017 8:00 pm Eastern Time (ET). 

An Enterprise Identify Management (EIDM) account with the appropriate role is required for participants to obtain their 2016 PQRS Feedback Reports and 2016 Annual QRURs. Both reports can be accessed on the CMS Enterprise Portal using the same EIDM account. Visit the How to Obtain a QRUR webpage for instructions on accessing both reports.

To find out which reports are available for your practice and your current and past PQRS and Value Modifier payment adjustments, you can use the new Payment Adjustments and Reports Lookup feature on the CMS Enterprise Portal. An EIDM account is not needed to use this feature. Instructions for using this feature are located in the “Guide for Accessing the Payment Adjustment and Reports Lookup Feature”.

For more information on your PQRS feedback report:

For more information on your Annual QRUR:

For the 2016 reporting period, the majority of eligible professionals (EPs) successfully reported to PQRS and avoided the downward payment adjustment. CMS anticipates that successful trend to continue under the new Quality Payment Program. The Quality Payment Program began January 2017 and replaces PQRS, the Value Modifier program, as well as the separate payment adjustments under the Medicare Electronic Health Record (EHR) Incentive Program for EPs.

The Quality Payment Program streamlines these legacy programs, reduces quality reporting requirements and offers many flexibilities that allow eligible clinicians to pick their pace for participating in the first year. To prepare for success in the Quality Payment Program, we encourage EPs to review their PQRS feedback report, Annual QRUR, and visit qpp.cms.gov to learn about the Quality Payment Program.

Questions:

  • For assistance with Enterprise Identity Management or PQRS feedback reports, contact the QualityNet Help Desk at 866-288-8912 (TTY 877-715- 6222) or qnetsupport@hcqis.org.
  • For assistance with the QRURs or Value Modifier, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 3).
  • Both Help Desks are available Monday through Friday from 7:00 a.m. to 7:00 p.m., Central Time.


Your membership yields results and will continue to do so. When your 2018 invoice arrives, please renew. KEEP MSSNY STRONG!


MSSNYPAC Physician Family Halloween Party in Staten Island October 29
You’re invited to the home of John Maese, MD & Donna Seminara, MD, for a physician family Halloween party to benefit MSSNYPAC.  Suggested contribution is $175 per family, $10 for medical students and $50 for residents.  Please also consider joining MSSNY’s Councilor’s Club or President’s Circle. Please visit www.mssnypac.org/events to RSVP or learn more. Location is in Staten Island NY and address to be provided prior to event.

Coding Tip of the Week
By Jacqueline Thelian, CPC, CPC-I, CHCA, Medco Consultants, Inc.

Q: What are the new NCCI edits for orthopedic codes?

A: As you know the National Correct Coding Initiative (NCCI) edits define pairs of CPT/HCPCS codes that should not be reported together for a variety of reasons.

The latest version of NCCI edits V23.3 effective October 1, 2017 targets shoulder procedures. Now CCI will bundle shoulder release code 23020 into arthroplasty 23470-23474 codes. This means it would be inappropriate to report the two codes for the same shoulder. You may however, unbundle and report them on the opposite shoulders.

Additionally, Chapter 4 of the NCCI edits state, “When a fracture or dislocation is repaired, only one fracture/dislocation repair code may be reported. Closed repair codes, percutaneous repair codes, and open repair codes for the same anatomic site are mutually exclusive of one another, and only one of these codes may be reported for the repair of a fracture or dislocation at an anatomic site.”

Once again separate billing would only be appropriate when these services are provided on opposite shoulders.

Source: CMS National Correct Coding Initiative Edits 

If you have a coding or compliance question you would like to have answered please send your question to MSSNY at eskelly@mssny.org, and complete the subject line with Tip of the Week.

The Importance of Herd Immunity” CME Webinar Oct. 18; Registration Still Open

The first of MSSNY’s 2018 Medical Matters continuing medical education (CME) webinar series is: “The Importance of Herd Immunity” on Wednesday, October 18, 2017 at 7:30 a.m.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are:

  • Review the epidemiology of vaccine-preventable infectious disease and role of herd immunity.
  • Describe how herd immunity protects vulnerable populations such as newborns, the elderly and those who are too sick to be vaccinated.
  • Discuss the percentage(s) of a population who need to be vaccinated to allow herd immunity to be effective.

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



CLASSIFIEDS

Medical Family Practice For Sale – Long Beach, NY
Established 14 years. Newly renovated. Fully equipped ground floor premises. 3 exam rooms. Must see! Call Carol – 516-238-3422


Great Neck – Medical Zoned Condo
2690 Sqft – $699,000 – quick easy access to North Shore University Hospital, Long Island Expressway and Long Island Rail Road. 10 Exam rooms plus waiting room & large secretary area http://bit.ly/2wXCbkQ . Call Chris Pappas, LAB 516-659-6508


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery
office available for part-time share and
AAAA-certified (by end of summer).
OR available for rent. Centrally located
on Long Island.Close to expressways.
3 exam rooms, 1 procedure room /OR.
Waiting room, break room and personal office.
Free WIFI. Available for full or half-days.
Suits Plastic/Cosmetic Surgeons/Derm/ENT/
ObGyn/Podiatry or other Medical MDs.
Contact Patricia at info@cosmetichg.com
or 631-318-4008

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 http://www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES


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.

Adolescent School Health Physician
This position offers to the interested physician the opportunity to help address the clinical and public health needs of adolescents in NYC high schools. The physician will work with the innovative Connecting Adolescents to Comprehensive Health Care (CATCH) Program, which provides select reproductive health services to adolescents in select NYC high schools. In addition, the physician will provide medical care and public health services through additional programs offered to adolescents by the Office of School Health.

Under the supervision of the High School Supervising Physician, the Adolescent School Health Physician’s responsibilities will include but are not limited to:

  • Provide CATCH reproductive health services in select high schools.
  • Perform mandated physical examinations (New Admission Exams, Sports Physicals, and Working Paper Physicals).
  • Function as a liaison for students with community health providers to resolve medical issues that affect school performance.
  • Support the development and implementation of initiatives that promote positive health behaviors and reduce high risk behaviors in the adolescent population.
  • Serve as a consultant to the school nurse and administration on school related health concerns.
  • Provide clinical assistance in the event of an environmental or communicable disease occurrence.
  • Function as a liaison for students with community health providers to resolve medical issues that affect school performance.
  • Support all medical initiatives established by the Office of School Health, e.g. programs and protocols in asthma, reproductive health, obesity and diabetes.
  • Maintain good public relations and communicate effectively within the school community and community-based organizations.
  • Keep abreast of health management policy statements and emerging clinical research related to school health.
  • Participate in OSH research activities.
  • Work within the mandates, policies and protocols of the Office of School Health.
  • Attend all mandated DOHMH and OSH trainings.

To Apply: Please email your resume and cover letter to Dr. Caroline Volel: osh@health.nyc.gov OR  Apply online at https://a127-jobs.nyc.gov/.  In the Job ID search bar, enter: job ID number # 277208. 

School Health Field Physician
Under the direction of the Supervising Physician, the School Health Physician’s will:

  • Improve the health of school children through case management of chronic disease, preventive health screening and counseling, health education, and referrals.
  • Perform mandated physical examination (new entrant, sport physical, working paper physicals.
  • Develop relationships with community health providers in order to optimize medical management of students with health issues.
  • Attend to the health needs of your assigned school community.
  • Utilize the Automated Student Health Record (ASHR) to maintain adequate student health records.
  • Serve as a consultant to the school nurse and administration on school related health concerns.
  • Support the development of school educational and prevention programs promoting the health and wellness of all students.
  • Provide clinical assistance in the event of an environmental or communicable disease occurrence.
  • Develop and maintain professional relationships within the school community.
  • Support all medical initiatives put forth by the Office of School Health, e.g. Asthma, Reproductive health, Obesity and Diabetes initiatives.
  • Provide trainings/presentations to school staff, community organizations, or parents.
  • Stay abreast of health management policy statements and emerging research within the health community related to school health.
  • Participate in School Health research and quality improvement activities.
  • Participate in all mandated DOHMH and Office of School Health trainings and professional development sessions.
  • Attend all program meetings and Continuing Medical Education classes provided by the Office of School Health.

To Apply: Please email your resume and cover letter to Dr. Caroline Volel:osh@health.nyc.gov OR Apply online at https://a127-jobs.nyc.gov/.  In the Job ID search bar, enter: job ID number # 279844. 

Supervising School Health Physician 
Job Description
Under the supervision of the Deputy Medical Director, the Supervising Medical Doctor’s responsibilities will include but not be limited to:

  • Supervise School Health Physicians.
  • Work within the mandates, policies and protocols of the Office of School Health (OSH).
  • Attend to the health needs of a designated school community.
  • Utilize the Automated Student Health Record (ASHR) to maintain accurate student health records.
  • Serve as a consultant to the school nurse and school administrative staff regarding school related health concerns.
  • Support the development of school educational and prevention programs promoting the health and wellness of students.
  • Participate in policy development and revisions as indicated.
  • Provide clinical assistance in the event of an environmental or communicable disease occurrence.
  • Function as a liaison for students with community health providers to resolve health issues that affect school functioning.
  • Develop and maintain professional relationships within the school community and the community at large.
  • Support all medical initiatives put forth by the Office of School Health, e.g. Asthma, Reproductive health, Obesity and Diabetes Initiatives.
  • Keep abreast of health management policy statements and emerging research within the health community affecting school health.
  • Assist with or provide trainings/presentations to school health physicians, nurses, school staff, community organizations or parents
  • Participate in School Health research and quality improvement activities
  • Participate in all mandated DOHMH and Office of School Health trainings and professional development sessions
  • Attend all program meetings and Continuing Medical Education classes provided by the Office of School Health.


To Apply: Please email your resume and cover letter to Dr. Caroline Volel: osh@health.nyc.gov OR  Apply online at https://a127-jobs.nyc.gov/.  In the Job ID search bar, enter: job ID number # 277026


Child and Adolescent Psychiatrist – Lockport, New York, Eastern Niagara Hospital
Eastern Niagara Hospital is seeking a Full Time Medical Director for its 12 bed Child and Adolescent Psychiatric Unit.  Responsibilities include inpatient care, shared on-call responsibilities and Medical Director duties.  Competitive compensation package.  For more information, please contact David DiBacco at 716-514-5501 or email to physicians@enhs.org.


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