October 28, 2016 – Snapshot Survey-Do You Know What Value Based Pay Is?

Dr. Reid
Dr. Malcolm Reid
October 28, 2016
Volume 16, Number 38


Dear Colleagues:

Federal and state policymakers are increasingly leaning on public and commercial payers to increase the use of so-called value-based payments in Medicare, Medicaid and commercial health coverage.

MSSNY has created a survey to assess to what extent physicians are already participating in such value-based payment structures.  We also would like to obtain your perspective regarding the sufficiency of health insurer networks to be sure your patients can receive the care they need. The purpose of this survey is to assess to what extent physicians are already participating in such value-based payment structures.

I am hoping it will give us a “snapshot” and some “conversational data” regarding each of these topics that we can use in our advocacy.

Please take a few minutes to help us to help you.

Click here the survey.

Malcolm Reid, MD, MPP
President, Medical Society of the State of New York

Please send your comments to comments@mssny.org

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Physicians Urged to Familiarize Themselves with Medicare Quality Payment Program Rules Effective for 2017
As previously reported, CMS has issued its final rule implementing the Medicare Quality Payment Program that starts in 2017.   The American Medical Association (AMA) has prepared two summaries that you can review from MSSNY’s website to familiarize yourself with the important provisions of this rule.  You can access these documents by clicking HERE and HERE.

Among the positive changes contained in the final rule that provide some flexibility to physicians in complying with new Medicare Merit Based Incentive Payment System (MIPS) include:

  • increasing from $10,000 to $30,000 the annual Medicare revenue threshold requiring participation in the MIPS program;
  • enabling physicians who report on one quality measure or one quality improvement activity for 2017 to avoid a 2019 Medicare payment penalty;
  • enabling physicians who report 90 continuous days (instead of the entire year) of quality data to be eligible for a 2019 Medicare payment bonus;
  • reducing from 90% to 50%  the percentage of patients of which a physician has to report quality measures;
  • Reducing from 11 to 5 the number of measures to be reported in the Advancing Care Information category (which replaces Meaningful Use) and permitting 90-day rather than full year reporting;
  • Enabling physicians practices recognized as a “Patient Centered Medical Home” to receive full credit in the “Clinical Practice Improvement” Category (15% of your MIPS score); and
  • Eliminating the “Cost” component in the 2017 MIPS evaluations.

Weekly Charting Tip: Prescribing Medical Marijuana
In New York, if you are registered, you may provide a prescription for your patient to receive an acceptable form of medical marijuana if they have one of the following diagnoses: Cancer, HIV Infection or AIDS, ALS, Epilepsy, Inflammatory Bowel Disease, Neuropathy, or Huntington’s Disease. Here is the catch: You patient MUST have associated or complicating conditions that ONLY include: cachexia (wasting syndrome), severe or chronic pain, severe nausea, seizures, or severe of persistent muscle spasms.

CAUTION: It is NOT sufficient to have a diagnosis JUST of severe or chronic pain! It must be associated with one of the listed diagnoses. Additionally, the diagnosis MUST be severe, debilitating or life threatening that is also accompanied by one of the acceptable diagnoses. For example, somebody diagnosed with Basal Cell Carcinoma probably would not qualify. A neuropathy MUST have notations in your chart that specifies how and where the neuropathy is causing severe pain or is debilitating. The nature of the pain? What the patient can do, or no longer do must be charted as well. It is not enough just to list a diagnosis and some symptoms. Go into detail. This is another example of how to avoid a problem; have a complete and accurate chart!  If you have any questions, please contact Kern Augustine, P.C. at 1-800-445-0954 or via email at info@DrLaw.com. 

“When Is the Flu Not the Flu?” Nov. 16 CME Webinar Registration Open
MSSNY will begin its 2017 Medical Matters continuing medical education (CME) webinar series with “When Is the Flu Not the Flu?” on Wednesday, November 16, 2016 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.

A copy of the flyer can be accessed here. Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are: 1). Recognize the distinction between influenza virus infections and other similarly presenting illnesses.  2). Describe strategies for prevention, diagnosis and management of patients presenting with flu-like symptoms. 

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. 

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. Additional programs are will be conducted in January-May 2017, and topics include: Triage in a Disaster Event; The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team; and Mosquito Borne Diseases.  Program dates for Medical Matters will be announced shortly.

Webinar: Learn More about the New Medicare Quality Payment Program
CMS invites you to join webinar on November 15 on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule with comment period. The webinars will provide an overview of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program.

Quality Payment Program Final Rule MLN Connects® Call — November 15

  • Date: Tuesday, November 15, 2016
  • Time: 1:30 to 3:00 PM ET
  • Register MLN Connects Event Registration.
  • Target Audience: Medicare Part B Fee-For-Service clinicians, office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders.

During these calls, participants will learn about the provisions in the recently released final rule; participants should review the rule prior to the call. A question and answer session will follow the presentation.

Space for these webinars is limited. Register now to secure your spot. After you register, you will receive an email message with a dial-in number and webinar link. Please note, you will not be able to share your participant information because it will be unique to you.

For More Information

To learn more about the final rule and the Quality Payment Program, view the following resources:

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

AMA Webinar on How Final Rule Affects Your Practice
On November 21 and December 6, the AMA will host educational webinar sessions to help physicians prepare and understand what the final rule means for their practice.

Register for November 21
Register for December 6

Review of all the provisions of the final rule is ongoing.  Medical societies across the country including the AMA and MSSNY had advocated for additional flexibility, particularly for smaller practices that may not have the infrastructure necessary to be successful in these value-based payment programs.

LI Pharmacist Gets Up To 24 Years for Selling Black-Market HIV Meds
Attorney General Eric T. Schneiderman announced that pharmacist Ira Gross, 63, of Babylon, was sentenced to 8 to 24 years in state prison for his role in selling over $274M dollars of diverted, medically worthless HIV medication. Gross was also ordered to pay back the amount he pocketed as a result of the scheme, which totaled $25.2M.

The evidence at trial revealed that from 2008 to 2012, Gross and others sold the diverted medications, mostly expensive HIV antiretroviral medications purchased off the street, to MOMS Pharmacy in Melville. MOMS Pharmacy then dispensed the diverted medications to thousands of its unsuspecting patients, many of whom were Medicaid recipients, throughout New York and other states.  Ultimately, the New York Medicaid program paid $124M for those tainted medications distributed to New York Medicaid patients.

Gross organized the scheme and coordinated the sale of the diverted street medication to MOMS Pharmacy. Evidence at trial showed that Gross paid Glenn Schabel, the supervising pharmacist and compliance officer for MOMS Pharmacy, over $5 million to buy medication that he knew or should have known were diverted. Schabel, 55, of Melville, was also arrested and pleaded guilty in September 2016 to Criminal Diversion of Prescription Medications and Prescriptions in the First Degree and Commercial Bribe Receiving in the First Degree.  Schabel was sentenced to two to six years in state prison and has paid $5.45M in restitution.

Free DOH Posters Educate Patients re Appropriate Antibiotic Prescribing
The NYS Department of Health and the NY “Get Smart Campaign” are pleased to share brand new “Get Smart Guaranteeposters to demonstrate healthcare professionals’ commitment to appropriate antibiotic prescribing. 

The posters can be personalized with a provider’s photo and signed. When displayed, they not only enhance provider “buy-in” to appropriate antibiotic prescribing but are also a way to educate patients about appropriate antibiotic prescribing and use.  CDC-sponsored “Get Smart Week” is November 14-20 (but the DOH would appreciate displaying these posters year-round!) The posters may be downloaded via this link.

Simpler yet, the NY Get Smart Campaign can mail you limited copies of 11”  X 17” Get Smart Guarantee posters. The poster is available at no cost to you and may be ordered by contacting the NYSDOH Get Smart Program Coordinator, Mary Beth Wenger, at marybeth.wenger@health.ny.gov Additionally, there are patient Palm Cards carrying the same message, which can be handed out to patients, explaining why antibiotics aren’t always the answer.

Healthcare providers may be pressured by patients to prescribe antibiotics even when they have a viral infection. Displaying this poster in waiting or examination rooms sends a message to patients that antibiotics aren’t always appropriate. We hope the posters will help facilitate conversations with patients on the appropriate use of antibiotics.

New Diabetes Guidelines Recommend that Patients Move Every 30 Minutes
The American Diabetes Association now recommends that patients with diabetes take a break from prolonged sitting every 30 minutes, citing blood glucose benefits. This could mean 3 or more minutes of standing, walking, or doing light-intensity activities like office chair swivels. Previously, the group recommended movement breaks every 90 minutes.

The group’s first comprehensive physical activity guidelines, published in Diabetes Care, also make the following recommendations:

  • Physical activity should be prescribed to all patients with diabetes.
  • Patients should aim to get at least 150 minutes of physical activity every week. Both resistance and aerobic training are encouraged. Patients should go no more than 2 consecutive days without activity.
  • Older adults with diabetes should aim for 2–3 days a week of flexibility or balance training, such as tai chi or yoga.

The document also provides guidance for youth, pregnant patients, physical activity considerations with various diabetes complications, and suggested carbohydrate intake before exercise.

American Diabetes Association news release

CMS: New Ops for Clinicians to Join Advanced Alternative Pay Models
CMS announced new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) developed by the CMS Innovation Center to improve care and potentially earn an incentive payment under the Quality Payment Program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program rewards clinicians with sufficient participation in Advanced APMs that align incentives for high-quality, patient-centered care. By giving more clinicians the opportunity to participate in these models, today’s announcement will extend the benefits of high-quality, coordinated care to more Medicare beneficiaries.

CMS is announcing that it expects to re-open applications for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and new participants in the Next Generation Accountable Care Organization (ACO) model for the 2018 performance year. In addition, CMS is announcing that the Innovation Center’s Oncology Care Model with two-sided risk will now be available in 2017, which will qualify the model as an Advanced APM beginning in the 2017 performance year.

In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through sufficient participation in the following Advanced APMs:

  • Comprehensive ESRD Care Model (Large Dialysis Organization (LDO) arrangement)
  • Comprehensive ESRD Care Model (non-LDO arrangement)
  • CPC+
  • Medicare Shared Savings Program ACOs – Track 2
  • Medicare Shared Savings Program ACOs – Track 3
  • Next Generation ACO Model
  • Oncology Care Model (two-sided risk arrangement)

In 2018, we anticipate that clinicians may also earn the incentive payment through sufficient participation in the following models:

  • ACO Track 1+
  • New voluntary bundled payment model
  • Comprehensive Care for Joint Replacement Payment Model (Certified Electronic Health Record Technology (CEHRT) track)
  • Advancing Care Coordination through Episode Payment Models Track 1 (CEHRT track)

These lists will continue to change and grow as more models are proposed and developed in partnership with the clinician community and the Physician-Focused Payment Model Technical Advisory Committee.

For more information, please click here.

Insurers Must Be Up to Date on Physician Participation Info for MA Plans
Starting next year, the federal government will require health insurers to give patients enrolled in  Medicare Advantage plans or in policies sold in the federally run health exchange up-to-date details about which doctors are in their plans and taking new patients.

Under a rule published last month by CMS, Medicare Advantage plans must contact doctors and other providers every three months and update their online directories in “real time.” Online directories for policies sold through healthcare.gov, the health law exchange run by the federal government in 37 states, must be updated monthly, CMS announced in a separate rule.

Inaccuracies in the Medicare Advantage directories may trigger penalties of up to $25,000 a day per beneficiary or bans on new enrollment and marketing. CMS will also use the directories to help determine whether insurers have enough doctors to meet beneficiaries’ needs.

The administration last year announced rules designed to make sure those networks have adequate numbers of providers. The newest rules will help guarantee that consumers get good information on those networks.

Nearly 9 million people have enrolled in plans on the federal marketplace for 2015, according to officials.

Incorrect information was found for almost half of the 5,832 doctors listed in directories for 54 Medicare Advantage plans checked last fall, they said. Only online directories were examined.

CDPHP and Capital Care Create Acuitas Health for Value-Based Pay Success
For nearly a decade, CDPHP and CapitalCare have partnered to achieve a shared mission of improving the quality and affordability of health care for residents in and around the Capital Region. The organizations – which are philosophically aligned around the goals of value-based care – have taken that partnership to the next level, creating an organization which will allow physicians to remain independent, while offering patients access to better health, better care, and lower costs.

Acuitas Health provides practices with a turn-key solution needed to succeed in a value-based payment environment. This includes a comprehensive readiness assessment, realignment of staff and workflows, and oftentimes, a total transformation in the way the practice delivers care.

Acuitas Health will embed care managers within physician practices and use sophisticated population health management tools to identify patients with gaps in care or are at high-risk, or rising risk, clinically. Care managers will work with the practice to engage with patients, ensuring that individuals receive the right care, at the right time.  For more information on Acuitas Health, please visit www.acuitashealth.com.

Established in 1984, CDPHP is a physician-founded, member-focused and community-based not-for-profit health plan that offers high-quality affordable health insurance plans to members in 24 counties throughout New York.

CapitalCare Medical Group is a physician-owned medical practice with over 650 employees including more than 230 healthcare professionals.  The group offers primary care services in Family Practice, Pediatrics and Internal Medicine throughout the Capital Region. CapitalCare also provides services in Endocrinology, Pulmonary and Sleep Medicine, Developmental-Behavioral Pediatrics, Nephrology, adult and pediatric Neurology, medical nutrition therapy, comprehensive diabetes education and operates a state-of-the-art clinical laboratory.

Children with Persistent Post-Concussion Symptoms May Have Lower Quality of Life Than Youngsters Who Have Recovered
Research Indicates that children “with persistent symptoms months after a concussion have lower quality of life than kids who have recovered, but even kids who recovered quickly may still struggle,” researchers found after assessing “quality of life factors for about 2,000 kids aged five to 18 years who had presented to an emergency department within two days of suffering an acute concussion.” The findings were published online in JAMA Pediatrics.

RFP for Office of Temporary and Disability Assistance


The New York State Office of Temporary and Disability Assistance (OTDA), Division of Disability Determinations is issuing a Request for Proposal (RFP) to solicit proposals from qualified vendors for the establishment of one contract medical provider to establish a site in the upstate area of the Capital District, NY (including the cities of Albany, Schenectady, and Troy and the immediate geographic area) to perform medical examinations and ancillary testing of claimants applying for Social Security disability benefits. If your organization is capable of performing a high volume of medical examinations and diagnostic tests, the Capital District Consultative Examination RFP can be found on the OTDA website at https://otda.ny.gov/contracts/procurement-bid.asp.  If your organization wishes to receive a hard copy of the RFP, please send your request immediately by Certified Mail to:

Mr. Lawrence Rockefeller
NYS Office of Temporary and Disability Assistance
Division of Disability Determinations
One Commerce Plaza, 10th Floor
99 Washington Avenue
Albany, New York 12210

The RFP release date is September 14, 2016 with proposals due no later than November 2, 2016 at 3:00 p.m. EST.  If you have any questions, you may contact Melinda Kuiken at (518) 626-3042.


State of the Art Midtown Medical Office for Rent
Elegant, modern, beautifully designed medical office available, furnished or non-furnished. Full or part time share with thriving Dermatology practice which occupies its own floor. Class A Architects and Designers Building in the best possible Midtown East location near Bloomingdales. Your own private corner, consultation room, two or three large equipped treatment rooms with beautiful cabinetry, sinks, and exam tables. All rooms wired and windowed. Shared oversized waiting room, kitchenette. Your own reception, administrative, front desk and storage space. $8,000-$11,500/month. Contact: (212)–583–2966, email: hefderm@outlook.com for details. No Brokers.

Elegant Plastic Surgery Office (Upper East Side Manhattan)
Very large and classy office to share. Located in the ground floor of a 25′ x 100′ carriage house opposite the 66th Street Armory with large consult room, 2+ treatment/exam rooms, large waiting room, business office, storage. See video of office — you won’t believe it: www.youtube.com/watch?v=Uli8Cck_eRA   $5000/month incl utilities. no brokers. Call Doctor Fischman at (212) 472–3300.Jeffrey R. Fischman, M.D.  110 E 66th Street.

Want to rent your medical office? Need to lease space to expand your practice?
Clineeds is an online platform designed to help physicians find or rent medical office space. Listing is completely FREE! Sign up today at http://clineeds.com/signup We take care of the rest!

Physician Opportunities

County Executive
The Suffolk County Medical Society, a 501C-6 corporation, recognized as the premier professional medical association for the physicians of Suffolk County, is seeking to fill the position of Executive Director.  Successful candidates will possess a Bachelor Degree, (Masters Degree preferred in a healthcare-related field and/or Business/Finance).  Should have minimum of five years experience in healthcare or association management .  Must possess the following abilities: have a thorough working knowledge of the health care industry;  serve as a strong physician and patient advocate; be able to successfully balance multiple demands; possess strong leadership skills with excellent oral and written communications.For more information and a complete job description, visit www.scms-sam.org.  Please forward a resume with a cover letter outlining how you meet the parameters of the position, including salary requirements, to stuscms@optonline.net.  Position scheduled to begin February, 2017.

A Private Multidisciplinary Medical Group is seeking an Internal Medicine/Family Medicine Physician in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire an Internal Medicine/Family Medicine Physician. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.

A Private Multidisciplinary Medical Group is seeking a Podiatrist in Manhattan
A well-established Manhattan based private multidisciplinary medical group is seeking to hire a Podiatrist. This is a great opportunity to start your own practice in a modern office in midtown Manhattan. Attractive base salary plus comprehensive benefits package offered (Malpractice, 3 weeks paid vacation, 1 week CME, CME allowance, paid health insurance, etc).If you are a solo practitioner in private practice looking to join a private group practice, we will work with you to make the transition seamless. Please email your CV to tsrgexpress@gmail.com. No recruiters please.