September 9, 2016 – Reject Anthem-Cigna Merger
Dr. Malcolm Reid
September 9, 2016
The following is a summary of my testimony at the Department of Financial Services hearing yesterday strongly opposing the proposed Anthem-Cigna merger:
On behalf of our over 20,000 members, I thank you for the opportunity to present our concerns regarding the impact to patient care if Anthem, the parent of Empire Blue Cross/Blue Shield, is permitted to acquire Cigna. The recent litigation initiated by the US Department of Justice to block this proposed merger as well the proposed Aetna-Humana merger validated the very serious concerns held by many physician and patient advocacy groups in New York State and across the country. Specifically, the DOJ noted that the proposed mergers of four of the five largest health insurance companies in the country were “unprecedented in their scale and in their scope.”
Greatest Impact on Smaller Practices
We agree that this proposed merger could have serious adverse implications for care delivery, with the greatest adverse impact upon smaller physician practices, which are already reeling from the profound changes arising from policy advanced from both the federal and state governments. Indeed, these concerns regarding insurer market concentration have been made by physicians and physician advocacy groups for years as many insurers have merged or have been purchased, or converted to for-profit status. More specifically, this concern was expressed by many of our physician members when we sought their feedback on this proposed merger of these two insurance giants. Many physicians already feel powerless to negotiate for fairer treatment by existing insurance behemoths, and believe that this merger will exacerbate an already extremely difficult practice environment. Many feel they have no choice but to become employees of large systems, which can cause disruptions to existing physician-patient relationships.
Based upon information reported by the American Medical Association within its 2015 Competition in Health Insurance report, this proposed merger would substantially increase the market share of the combined entity in several New York State regions. We believe this would have a serious detrimental impact on patient access to care, as Empire has a mixed record in assuring patients can receive the care they need based upon DFS’ own 2015 Guide to Health Insurers.
Based upon data contained in the AMA’s 2015 Competition report, if Anthem were to purchase Cigna, the market share for Empire could:
- increase from 17% to 27% in the Lower Hudson Valley and New York City;
- increase from 21% to 27% in Long Island; and
- increase from 20% to 26% in the mid-Hudson Valley.
Another AMA report, written specifically to assess the market impact of this proposed merger across the country, notes that the resulting Anthem-Cigna entity “would be presumed to likely enhance the market power” of the combined entity in Long Island, and “raises significant competitive concerns” and “warrants scrutiny” for the combined entity in New York City and the Hudson Valley. The report makes these determinations using the Horizontal Merger Guidelines developed by the U.S. Department of Justice and Federal Trade Commission.
Merger Would Increase Anthem’s Market Share Considerably
Additionally, the DFS Superintendent’s letter highlighted the impact of this takeover on the large employer health insurance market. She noted that it would increase Anthem’s market share across commercial products to 31.2% statewide, of which Anthem would command nearly 10% of New York’s fully insured market and nearly 50% of the self-insured market. The biggest impact would be felt in the New York City metro area, where Anthem would control nearly 70% percent of the commercial self-insured market in the Bronx and Staten Island, 63% in Queens and Brooklyn, and 55% in Putnam County. United, which purchased Oxford, and Emblem, which formed from the merger of HIP and GHI, have been publicly reported in the last few years to have drastically reduced their physician networks, reducing patient access for many.
Moreover, it is important to note that, according to DFS’ public data, Empire has at best a mixed record with regard to addressing the care needs of their insureds. Specifically, the 2015 Consumer Guide to Health Insurance prepared found that in 2014:
- Empire had the worst overall consumer complaint ratio among HMO products offered in New York State;
- Empire had the worst overall prompt payment complaint ratio among HMO products offered in New York State; and
- Empire had the highest number of external appeals taken against it (705) among any health insurer operating in New York State.
It stands to reason that with less competition, there will be less incentive for Empire and the remaining health insurers to have comprehensive physician networks and to fix prior authorization abuses identified by physicians and patients.
In summary, we are very concerned that these problems will only get worse as insurers’ market shares increase. We appreciate that the DOJ, the DFS and the NY AG have recognized these concerns and urge that this proposed merger be rejected on the grounds that it would harm patient access to needed care.
Malcolm Reid, MD, MPP
President, Medical Society of the State of New York
Please send your comments to firstname.lastname@example.org
CMS Announces Flexibility Options for MACRA Participation for 2017
This week CMS Acting Administrator Andrew Slavitt announced in a blog posting its plans to provide some flexibility to physicians complying with the MACRA Medicare value-based payment programs scheduled to begin January 1, 2017. While the final rule will not be released until later this fall, CMS announced that the final MACRA regulation will exempt physicians from any risk of Medicare payment penalties for 2019 within the Merit Based Incentive Payment System (MIPS) program if they choose one of three distinct reporting options in 2017, in addition to the option of participating in an advanced APM:
- Full-year reporting that begins on January 1;
- Partial year reporting for a reduced number of days; and
- A “test” option under which physicians can report minimal amounts of data.
Physicians who report in 2017 may be eligible for bonus payments in 2019, depending on which option they choose. According to the blog posting, those who opt for full-year reporting will be eligible to receive a “modest positive payment adjustment;” and those who choose partial year reporting will be eligible for a “small positive payment adjustment.” Physicians who choose the “test” option will not be eligible for a bonus, but also not subject to any payment penalties. Qualified participants in advanced APMs will be eligible for 5 percent incentive payments in 2019.
AMA President Dr. Andrew Gurman praised the action taken by the federal government, stating it “strongly applauds Secretary Burwell and Acting Administrator Slavitt – and their teams – for listening to physicians’ concerns about the timeline that was originally proposed for MACRA. By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA. This approach better reflects the diversity of medical practices throughout the country. “The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.”
CMS Offers Session on PQRS Feedback Reports on September 27 at 1PM
The Centers for Medicare & Medicaid Services (CMS) announced a Virtual Office Hours (VOH) session regarding Physician Quality Reporting System (PQRS) feedback reports for program year 2015 results. This VOH session will include information on the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.
The session, titled “2015 PQRS Feedback Reports,” will take place on Tuesday, September 27, 2016 from 1:00 – 2:00 p.m. ET. Topics to be discussed in this session include information about how the 2017 PQRS negative payment adjustment is assessed and how and where to access 2015 PQRS feedback reports depicting payment adjustment results. Additionally, this PQRS VOH session will allow stakeholders an opportunity to ask a CMS representative questions about the 2017 PQRS negative payment adjustment and the 2015 PQRS feedback reports.
You must register to participate in this session, and spots are limited. Registration begins on Tuesday, September 13, 2016 at 12:00 p.m. ET. Click here to access the registration page.
A few notes about this VOH session:
- You will only be able to register on or after 12:00 p.m. ET on September 13, 2016. If you attempt to register before this time you will receive an error message.
- Only a limited number of participants will be allowed to register.
- Only questions related to the 2015 PQRS feedback reports and 2017 negative payment adjustment will be addressed on this call. All other questions, including questions regarding program requirements and policy or reporting specifics, should be directed to the QualityNet Help Desk.
Complete information about PQRS is available on the CMS PQRS website.
For questions about PQRS or the VOH registration process, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. – 7:00 p.m. Central Time.
Your membership yields results and will continue to do so. When your 2017 invoice arrives, please renew. KEEP MSSNY STRONG!
Urge Governor Cuomo To Sign Step Therapy Override Bill
All physicians are urged to send a letter to Governor Cuomo requesting that he sign into law a bill (A.2834-D/S.3419-C) that would establish specific criteria for physicians to request an override of a health insurer step therapy medication protocol when it is in the best interest of their patients’ health.
The bill has not as of yet been delivered to the Governor.
MSSNY strongly supported this bill, and worked with a wide array of patient advocacy organizations, specialty societies, hospitals, and pharmaceutical manufacturers to achieve passage of this legislation. We know the insurers are strongly fighting this bill, so the Governor’s office needs to hear your support.
Over the summer, MSSNY representatives and several other patient advocacy groups met with the Governor’s office to urge that this bill be signed into law. Moreover, in August, dozens of patient advocates rallied at the State Capitol in support of this bill, which received significant media attention, including from WNYT. TWC’s Capital Tonight and Politico-NY.
The bill would require a health insurer to grant a physician’s override request of an insurer step therapy protocol if one of the following factors are present: 1) the drug required by the insurer is contraindicated or could likely cause an adverse reaction; 2) the drug required by the insurer is likely to be ineffective based upon the patient’s clinical history; 3) the patient has already tried the required medication, and it was not effective or caused an adverse reaction; 4) the patient is stable on the medication requested by the physician; 5) the medication is not in the best interests of the patient’s health.
While the legislation would generally require the health insurer to make its decision within 3 days of the override request of the physician, the insurer would be required to grant the override request within 24 hours of the request if the patient has a medical condition that places the health of such patient in serious jeopardy if they do not receive the requested medication. Perhaps most importantly, if the physician’s request for an override 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 external appeal.
Decline In Teenage Pregnancy Due to Use of Contraceptives, Study Suggests.
The New York Times (9/1) reports a new study published in the Journal of Adolescent Health found the “sharp decline in American teenage pregnancy and birthrates in recent years was driven exclusively by the use of contraceptives.” The study of a “nationally representative sample of more than 3,000 women ages 15 to 19” in 2007, 2009 and 2012 concluded “that sexual activity in the last three months of each time period did not vary — about one-third of the young women had had sex during that time.” However, the “percentage of teenagers who reported using contraception increased to 86 percent from 78 percent, and the share using more than one method increased to 37 percent from 26 percent
Zika Virus Commissioner’s Grand Rounds to Be Held on September 29
The 2016-2017 Commissioner’s Medical Grand Rounds series first session will be held Thursday, Sept. 29th from 6-8 p.m. The program, entitled, “From A to Zika: An Update on Zika Virus for Primary Care Providers” will be presented as a live seminar and webinar at Stony Brook Medicine, Health Science Center, Level 2, Lecture Hall 2, 101 Nicolls Road, Stony Brook NY. The presentation will inform clinicians on current evidence about transmission, best practices for laboratory testing and evaluation, potential health effects and prevention of Zika virus infection.
Presenters will be Samuel Stanley, MD, president, Stony Brook University and Chair, National Science Advisory Board for Biosecurity; Burton Rochelson, MD, Chief of Maternal Fetal Medicine at Northwell Health, Director of Maternal-Fetal Medicine Fellowship Program, Northwell Health; Philip Kurpiel, PhD, MPH; Program Supervisor, MARO Regional Epidemiology Program, NYS Department of Health; Louis Manganas, MD, PhD, Assistant Professor, Department of Neurology, Stony Brook University Medical Center. The program is free of charge for all providers in New York State and advance registration is required. To register, please see the flyer HERE.
The program will be streamed as a live webcast for those unable to attend in-person and will also be archived for future viewing. Participants are eligible for CME credits whether they view in-person, via the live webcast, or the archived webcast. More Info.
Medicine at the Metropolitan Museum: Art in Clinical Practice
Learn how to use art to enhance your observation and communication skills in order to strengthen your clinical practice!
September 16, 2016 from 6 to 8.30pm:
Enhancing Observation and Presence
September 18 from 10.30am to 1pm:
Expanding Point of View and Creative Thinking
Location: The Met Museum in NYC
Space is limited! For more information and to register click here.
From the participants:
“Fantastic course. Therapeutic, informative and reformative.”
“Very interesting and I think it’ll make me a better doctor.”
The Buffalo News – 08/27/16
Opinion – Another Voice: I-STOP changes won’t hurt fight against opioid abuse
(Letter to the Editor from MSSNY president Dr. Malcolm Reid, MD & VP, Dr. Thomas Madejski)
Healthcare Business Daily News – 09/07/16
AMA and MSSNY urge New York State officials to reject Anthem-Cigna merger as anticompetitive
(MSSNY President, Dr. Malcolm Reid quoted)
Becker’s Hospital Review – 09/08/16
AMA, physicians press NY state to reject Anthem-Cigna deal
(MSSNY President, Dr. Malcolm Reid quoted)
The Canadian Business Journal – 09/08/16
AMA and MSSNY: Anthem-Cigna Deal Is Bad Medicine For New York State
(MSSNY President, Dr. Malcolm Reid quoted)
Modern Healthcare – 09/08/16
AMA, consumers urge N.Y. regulators to reject Anthem-Cigna merger
(MSSNY President, Dr. Malcolm Reid quoted)
Ideal for busy medical subspecialty. Exclusive use of consult, exam room. Stress test, echo available. Beautiful décor. Public transportation nearby. Available immediately. Please call 212-996-2900 or e-mail: email@example.com
Medical Co-op Building located on East 60th Street, NYC. Includes one consult room and 2 examination rooms, waiting room, 2 bathrooms, plus 2 medical assistants. Space for one secretary. Available 2.5 days per week. Free internet and Wi-Fi. For more information, contact mamdocs9B@gmail.com or (212) 230-1144.
Luxurious Medical Office Space to Share in Midtown (East) Manhattan! $6,950/monthly
Plastic surgeons desire to share office space (entire office is app. 5,000 square ft., Grade A building) with any medical or surgical specialty (Plastic, Facial plastic, dermatology, surgical subspecialty). Space is located in concierge building on 3rdAvenue (3 blocks to Grand Central Station).2-year sublease starting immediately; includes spacious doctor’s office with wall of windows (15 x 12 ft), and doctor’s staff office (9 x 8 ft). The shared space includes luxurious waiting room (29 x 15 ½ ft) with a grand custom-made mahogany reception desk, three patient exam rooms (one used as procedure room which is 15 x 13 ft), the kitchen (10 x 8 ft), the photo room (8 x 7 ft), and staff bathroom (7 x 6 ft). Price negotiable. Serious inquiries only, may contact us at 201-615-6963 or email us: firstname.lastname@example.org
Crown Medical PC Needs a New Internist and Pediatrician to Join Our Team! Salary $200,000 + plus benefits.
As a part of our continued growth, we are searching for a new Internist and Pediatrician to join our team. Salary is $200,000 + plus benefits.
Examines, diagnoses and treats patients for acute injuries, infections, and illnesses
Counsels and educates patients and families about acute and chronic conditions or concerns
Documents items such as: chief complaint, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment and plan
Formulates diagnostic and treatment plans
Prescribes and administers medications, therapies, and procedures
Orders lab and imaging tests to determine and manage an immediate treatment plan and provides advice on follow up
Responsible for the coordination of care with specialists and appropriate ancillary services
Completes all documentation and paperwork in a timely manner
Maintains quality of care standards as defined by the practice
Active and unrestricted New York medical license
Board certified in Internal Medicine or Pediatrics
Current and unrestricted DEA certificate
Effective communication skills
Outstanding organization skills and ability to multi-task
Takes Initiative, creative, has problem solving ability, is adaptable, and flexible
Ability to work without direct supervision and practice autonomously
Ability to work in fast-paced environment
Crown Medical, PC / ER Medical, PC
Contact: Michael Furman