Sept. 14, 2018 – MSSNYeNews: Do No Harm: The Movie

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
September 14, 2018
Volume 20  Number 34

MSSNYPAC


Do No Harm Movie

MSSNY President Thomas Madejski, MD (far right) speaks to panel (L-R) Michael Myers, MD; Pamela Wible, MD; Michele and John Dietl; Hawkins M., MD

Colleagues:

This week’s travels brought me back to New York City to attend the MSSNY Board of Trustees meeting and to preside (that’s what Presidents do best) at the MSSNY Council meeting. Physician wellness is one of the key components of MSSNY’s agenda.  Fortuitous timing allowed me to attend the World Premiere of Do No Harm, a heartrending film documentary focused primarily on the negative transformation of some students during medical school leading too often to depression and, in some cases—to suicide.

The filmmaker, Robyn Symon is the daughter of a physician. Ms. Symon’s film is a sensitive depiction of some of the factors that may lead to despondency, and lethality, and is especially powerful due to the narrative provided by Michele and John Dietl who lost their son, Kevin, to a self-inflicted gunshot wound; and Hawkins M., a 1st year resident, who attempted to end his life, and fortunately has recovered and is doing well.  I was honored to represent MSSNY at a post-screening   panel discussion along with these three courageous individuals, MSSNY member Dr. Michael Myers, professor of Psychiatry at SUNY Downstate, an expert on physician mental health and suicide and a member of the CPH Advisory Committee and Dr. Pam Wible, a family physician and advocate.

Fear of Stigma

Versions of the Hippocratic Oath and the Declaration of Geneva require a commitment to personal wellness and an obligation to care for our brothers and sisters within our profession, yet too often stigma and fear of negative impact on our work prevents physicians from seeking assistance for stress, depression or substance use disorders.  The film starts out by suggesting there is hypocrisy towards the oath due to a potentially toxic combination of factors that physicians encounter along their career path.  We had a robust discussion about the complex issues involved and potential solutions. I explained MSSNY’s commitment to physician wellness and the resources we have available currently. The discussion session was wide ranging and the audience, a mix of physicians and interested non-physicians, came away with a better sense of the adverse environmental stressors and other factors.

Dr. Frank Dowling, MSSNY secretary and member of the Committee on Wellness and Resilience explained our efforts to develop a statewide confidential Peer-to-Peer Support Program.

The most moving part of the evening was the courage of the Dietl family and Hawkins who in sharing their pain, hopefully, will help us come together to improve the care of our caregivers.  Do No Harm is a powerful, encouraging start to expand the conversation about medical student and physician suicide outside of our profession that includes our entire community.

Watch the film trailer here.

Non nobus solum nati sumus

Please share your thoughts and comments with me at comments@mssny.org.


Thomas J. Madejski, MD 
MSSNY President


eNews

Please Plan to Participate in NYS “Listening Sessions” on Legalizing Recreational Marijuana Use
As reported last week, New York Governor Andrew Cuomo has called for a series of “listening sessions” across New York State to receive public comment regarding a proposal to legalize and regulate the recreational use of marijuana in New York State.  As noted below, there are forums coming up next week on Monday (9/17) in the Bronx and Thursday (9/20) in Manhattan.

Last week, MSSNY Treasurer Dr. Joseph Sellers testified at an Albany forum to raise public health concerns with this proposal.  Dr. Sellers’ testimony noted MSSNY’s support for de-criminalizing marijuana possession, but also significant concerns with outright permitting recreational use noting that “data from jurisdictions that legalized cannabis demonstrated concerns particularly around unintentional pediatric exposures resulting in increased calls to poison control centers and ED visits as well as an increase in traffic deaths due to cannabis-related impaired driving.

Physicians are urged to register to participate and testify at these upcoming forums from the links below:

  • Bronx – Monday, September 17, 2018 – Register
  • Manhattan – Thursday, September 20, 2018 – Register
  • Queens – Monday, September 24, 2018 – Register
  • Brooklyn – Tuesday, September 25, 2018 – Register
  • Staten Island – Wednesday, September 26 – Register
  • Long Island – Thursday, September 27, 2018 – Register
  • Newburgh – Monday, October 1, 2018 – Register
  • Binghamton – Tuesday, October 2, 2018 – Register
  • Buffalo – Wednesday, October 3, 2018 – Register
  • Rochester – Thursday, October 4, 2018 – Register
  • Syracuse – Tuesday, October 9, 2018 – Register
  • Utica – Wednesday, October 10, 2018 – Register
  • Watertown – Thursday, October 11, 2018 – Register


Council Notes-September 13, 2018

  • MLMIC Vice President and Assistant Secretary Donald Fager reported to Council that the Berkshire Hathaway transaction is very close to completion and thanked MSSNY for its support. Department of Financial Services Superintendent Maria Vullo has approved the Demutualization Application, the Acquisition Application and the application for approval of the amendments to MLMIC’s Charter and By-laws. Mr. Fager noted that the final step is policyholder approval.
  • Council approved the MSSNYPAC Endorsement recommendations for candidates running for re-election to the New York State Legislature and to the US Congress. Click here to view the list.
  • Physicians’ Day at the Races, which took place at the Saratoga Race Track in July, was a great success and raised $13,000 for MSSNYPAC. Plan to join the fun next summer for another Physicians’ Day at the Races!
  • MSSNY President Dr. Tom Madejski and New York County Medical Society president Dr. Naheed Van de Walle reported on a September 5 meeting in which MSSNY and New York County Medical Society leaders met with NYS Assembly Health Committee Chair Richard Gottfried to discuss and raise questions about various aspects of his legislation (A.4738) that would create a single payor system in New York State.
  • Elizabeth Amato, Vice President, SHIN-NY Programs at New York eHealth Collaborative (NYeC) provided an update on the Data Exchange Incentive Program (DEIP), which provides physicians with up to $13,000 to help connect to the SHIN-NY. Overview documents are available online at nyehealth.org/deip. Or contact NYeC with any questions at deip@nyehealth.org.

Primaries: Strong Wins for Cuomo and Hochul; Defeat Many Senate IDC Members
While New York Governor Andrew Cuomo and Lt. Governor Kathy Hochul each won decisive victories this week, several incumbent state legislators lost in their respective primary elections to represent their parties for the upcoming November 6 general election.

Governor Cuomo defeated challenger Cynthia Nixon for the Democrat nod for Governor by a 64%-34% margin.     Lt. Governor Hochul defeated challenger Jumaane Williams by a 53%-47% margin.  They will face Republican gubernatorial candidate Marc Molinaro and Lt. Governor candidate Julie Killian in the general election.

New York City Public Advocate Leticia James won a four-way primary battle to get the Democratic line for New York State Attorney General.    She will face Republican Keith Wofford in the general election.

Six of the 8 members of the former New York State Senate Independent Democratic Conference (IDC) lost their Democratic primaries:

  • In the 11th Senate District (Queens), John Liu defeated Senator Tony Avella
  • In the 13th Senate District (Queens), Jessica Ramos defeated Senator Jose Peralta
  • In the 20th Senate District (Brooklyn), Zellnor Myrie defeated Senator Jesse Hamilton
  • In the 31st Senate District (Manhattan/Bronx), Robert Jackson defeated Senator Marisol Alcantara
  • In the 34th Senate District (Bronx/Westchester), Alessandra Biaggi defeated Senator Jeff Klein
  • In the 53rd Senate District (Onondaga/Madison), Rachel May defeated Senator David Valesky.

The only former IDC members to win their primaries were Senator Diane Savino (Staten Island) and Senator David Carlucci (Rockland/Westchester).

In addition, Democratic Senator Martin Dilan lost his primary to challenger Julia Salazar.

Currently, the NYS Senate is divided between 31 elected Republicans and 32 elected Democrats, with one of the Democrats Simcha Felder aligning with the Republicans to create GOP Majority. As a result, there is an intense campaign battle as to which party will have majority control after the upcoming November elections.


Advocacy Organizations Express Concern re Proposed E&M Payment Changes
Several news articles (such as here and here) have highlighted the strong concern of physician advocacy organizations, including MSSNY, with the CMS proposal to contract Medicare payment rates different levels of E&M services. 

As previously reported, MSSNY sent a letter to CMS, as well as joining on to multiple group letters, to raise serious concern with CMS’ proposal to collapse evaluation and management (E/M) payments as part of its Medicare payment rule for 2019.  These letters express appreciation for the CMS “Patients Over Paperwork” initiative to reduce the extraordinary documentation burden facing physicians, but also note that any benefit to be gained would be sizably outweighed by the likely significant reductions in payments.  Under the proposal, payments for E&M codes 99202-99205 would be $134 (instead of ranging from $76 to $211) and payments for E&M codes 99212-99215 would be $92 ($45 to $148).

MSSNY signed on to a letter initiated by the AMA and 170 other medical associations.  That letter that noted medicine’s support for CMS’ “goal of reducing administrative burdens for physicians and other health care professionals so that they can devote more time to patient care”, but also that there are “unanswered questions and potential unintended consequences that would result from the coding policies in the proposed rule.”  Moreover, it expressed concerns that the policy change “could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care.”

MSSNY also signed on to a letter initiated by the Coalition of State Medical Societies (consisting of the medical societies of AZ, CA, FLA, LA, NC, NJ, OK, SC and TX together with MSSNY), which articulated the following concerns:

  • Eliminating incentives for physicians to care for complex or complicated patients including those with disabilities and those with serious or terminal illnesses;
  • Making treating patients covered by Medicare even more financially challenging for physicians, leading more physicians to limit the number of Medicare patients they see or to opt out of the program entirely; and
  • Similar changes being imposed by commercial insurance companies that tend to follow CMS’ lead on payment matters.

Abentity


Heart Group Updates Guidelines on Resistant Hypertension
The American Heart Association has updated its 2008 guidelines on detecting and managing resistant hypertension — defined as above-goal blood pressure (≥130/80 mm Hg) despite use of three antihypertensive drugs, or controlled BP on a four-drug regimen.The guidelines, published in Hypertension, contain numerous practical diagnostic and clinical management tips. Among the most notable:

  • Healthcare providers should regularly ask patients with resistant hypertension about their sleep patterns. Poor sleep duration and quality trigger the sympathetic and renin-angiotensin systems and, thus, can interfere with BP control.
  • The role of lifestyle is emphasized as part of first-line management of resistant hypertension. Clinicians should advise patients to follow a low-sodium diet (
  • If BP is above goal despite an optimal lifestyle and adherence to a three-drug regimen, providers should consider switching from hydrochlorothiazide to chlorthalidone or indapamide. If BP is still high after that, spironolactone may be considered as a fourth drug.

AHA guideline in Hypertension https://www.ahajournals.org/doi/10.1161/HYP.0000000000000084


NY Sepsis Deaths May Have Declined In Since State Mandate Implemented
Medscape (9/7) reported researchers found that “deaths from sepsis declined during the [two] years following implementation of a [New York] state mandate requiring hospitals to follow sepsis care bundles and report on patient outcomes.” The findings were published in the American Journal of Respiratory and Critical Care Medicine.


Study: More Documentation Should be Required to Show Need of Opioids
Research published Monday in the Annals of Internal Medicine state that a review of medical records from 2006 to 2015 “showed that a physician gave no explanation at all for writing an opioid prescription in 29 percent of the cases.” The findings by researchers at Harvard Medical School and the Rand Corp. “help support criticism by the Centers for Disease Control and Prevention, the Food and Drug Administration and others that say inappropriate prescribing practices have helped drive the opioid crisis.”

Researchers examined 32,000 clinician visits in which an opioid was prescribed to adults. Of these visits, 5% were documented as related to cancer-associated pain, 66% were coded for non-cancer pain, and 29% had no recorded pain diagnosis. Lack of a recorded pain diagnosis was more common among continuing rather than new opioid prescriptions (31% vs. 23%).The Boston Globe (9/10) reports “inappropriate prescribing, bad recordkeeping, or a combination of both were possible reasons for the missing data, according to the researchers.” Study author Tisamarie Sherry said, “Whatever the reasons, lack of robust documentation undermines our efforts to understand physician prescribing patterns and curtails our ability to stem overprescribing.”



Medical Society of NY Classifieds


Three Hospitals Earn Through Captive Insurers Despite Settlement with State
Modern Healthcare (9/8) reported that Maimonides Medical Center, Montefiore Medical Center, and Mount Sinai Hospital “continue to make money – about $64 million this year – off a revamped version of an insurance maneuver that New York regulators last year characterized as a hidden scheme to funnel hundreds of millions of dollars back to the hospitals.”

Last year, New York’s Department of Financial Services “found that the professional liability insurer Hospitals Insurance Co. illegally kept secret the fact that its offshore captive insurance company soaked up more than $160 million in premium payments that yielded more than $200 million in investment income over a two-decade period, all while avoiding domestic regulation.” Despite a settlement with the state, however, “the latest financial filings from” the three hospitals “indicate” they “have kept a version of the operation running.”

CME Webinar

 “Influenza 2018-19” CME Webinar on October 17; Registration Now Open
The first of MSSNY’s 2019 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2018-19” on Wednesday, October 17, 2018 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:

  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
  • Describe clinical and laboratory diagnostic features and treatment specific to each flu season
  • Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated

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. 


CMS Updates 2017 MIPS Performance Feedback
Recently, CMS released performance feedback for clinicians included in the Merit-based Incentive Payment System (MIPS) during the 2017 performance year. As we’ve previously announced, we saw a very high 91 percent participation rate for the first performance year (2017) of MIPS. Over the last several weeks, individual clinicians, groups, and eligible clinicians in certain Alternative Payment Models (APMs) have had access to this feedback on the Quality Payment Program website, which provides a comprehensive overview of their MIPS final score, performance category details, and 2019 MIPS payment adjustment.

Along with releasing performance feedback, we launched a process known as targeted review. A targeted review provides the opportunity for clinicians, groups, or those participating in certain APMs to request that we review their MIPS payment adjustment factor(s), if they believe there is an error with the 2019 MIPS payment adjustment calculation.

The requests that we received through targeted review caused us to take a closer look at a few prevailing concerns. Those concerns included the application of the 2017 Advancing Care Information (ACI) and Extreme and Uncontrollable Circumstances hardship exceptions, the awarding of Improvement Activity credit for successful participation in the Improvement Activities (IA) Burden Reduction Study, and the addition of the All-Cause Readmission (ACR) measure to the MIPS final score. Based on these requests, we reviewed the concerns, identified a few errors in the scoring logic, and implemented solutions. The targeted review process worked exactly as intended, as the incoming requests quickly alerted us to these issues and allowed us to take immediate action.

Addressing and correcting for the above elements resulted in changes to the 2017 MIPS final score and associated 2019 MIPS payment adjustment for the clinicians who were impacted by the identified issues. Additionally, in order to ensure that we maintain the budget neutrality that is required by law under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), some clinicians will see slight changes in their payment adjustment as a result of the reapplication of budget neutrality.  These revisions were made to the performance feedback on the Quality Payment Program website on September 13, 2018. We encourage you to sign-in to the Quality Payment Program website as soon as possible to review your performance feedback. If you believe an error still exists with your 2019 MIPS payment adjustment calculation, the targeted review process is available for you.

To offer additional time for clinicians, groups, and APM entities and their participants to access and review their performance feedback, we are extending the targeted review deadline to October 15, 2018 at 8:00pm (EDT). We also have a number of resources available on our Quality Payment Program Resource Library to help you understand your performance feedback and the targeted review process. If you are in-need of additional assistance, please reach out to the Quality Payment Program Service Center by phone at 1-866-288-8292, (TTY) 1-877-715-6222 or by email at QPP@cms.hhs.gov, or contact your local technical assistance organization for no-cost support.

From the onset of the Quality Payment Program, goals have included creating a program that is fully transparent and provides accurate information. We believe that the above steps are essential to achieving that goal for the first performance year (2017), also referred to as the “transition” year. We will continue to work closely with the clinician community to learn from one another and ensure operational excellence in implementation.


4th Columbia Psychosomatics Conference – Oct 20-21, 2018 NYC

If you can’t see this image please go to 4th Columbia Psychosomatics Conference website HERE.


Medicaid

DOH Hosts Medicaid Drug Cap
The Department of Health will be hosting a webinar on the SFY 18-19 Medicaid Drug Cap on September 17, 2018 at 2:00 pm. There will be an email address provided at the end of the webinar for questions and answers. Materials will be made available after the webinar at: https://www.health.ny.gov/health_care/medicaid/regulations/global_cap/. To register please follow the instructions below. This event requires registration.

Topic: SFY 18-19 Medicaid Drug
Host:  Office of Health Insurance Programs
Date:  Monday, September 17, 2018 2:00 pm
To register for the online event:
  1. https://meetny.webex.com/meetny/onstage/g.php?MTID=ee02c8551d0ed9d5a9948b31aef96c3cb
    2. Click “Register”.
    3. On the registration form, enter your information and then click “Submit”. 

Meaningful Use Attestations Due Oct. 15 for NY Medicaid EHR Incentive
Don’t delay! The deadline to attest 2017 Meaningful Use is October 15, 2018. All attestations for the NY Medicaid EHR Incentive Program must be submitted through MEIPASS at https://meipass.emedny.org/ehr/login.xhtml. Eligible professionals (EPs) no longer have to mail hard copies of their attestations – Everything is submitted online!

Note: Extensions will be automatically granted to EPs whose 2016 attestations are still pending state review. Those EPs will be notified via email about their extended deadlines, so they have sufficient time to attest 2017 Meaningful Use in MEIPASS.

Need assistance with MEIPASS? Check out our video tutorials and walkthrough to help you with the attestation process. For additional assistance, please contact program support at 1-877-646-5410 or hit@health.ny.gov.


 

Join MSSNY

Classified

RENTAL/LEASING SPACE


Magnificent Medical Suites for Lease 184 East 70th St. New York, NY
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital, Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A: one consultation room plus 2 exam rooms. $6000 per month
Space B: One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500. other combination may work as well. Available for sharing For full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com 


West 57 St. – Shared Office Space to Rent
Lovely Garden view office with natural light. Located near Columbus Circle in a beautiful Art Deco building. Recently renovated office with additional exam room/ room with a sink. Wi-Fi, medical waste pickup and cleaning included.  Ideal location in desirable neighborhood. Contact Jason Faller 914-393-6583 goutmd@aol.com


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day (about $180) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.



 


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES

Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to resume@health.state.ny.us with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.


Physicians Wanted to Help Shape the Future of Primary Care
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Interested? Learn more and apply today at www.98point6.com/pcc

 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews: Talking Marijuana/Single Payor

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
September 7, 2018
Volume 20  Number 33

MSSNYPAC

Dear Colleagues:

Being MSSNY President is a new adventure every day.  Your leadership and staff have been active this week on many fronts.  Many of you are aware that the Governor and Health Department are considering legalization of marijuana for recreational use.  MSSNY and the AMA have extensive policy on a scientific approach to evaluating marijuana as a therapeutic agent, as well as for recreational use.  Just before the Labor Day Holiday, Governor Cuomo announced a series of public comment opportunities throughout the state.

Pundits often joke about public policy— “you can lead the train, be on the train, or be under the train.”  I’m concerned that further expansion of non-medicinal marijuana usage in New York State may lead to a train wreck.  We have some data with regards to increased use of marijuana that is troubling.  The AMA Council on Science and Public Health recently reviewed Clinical Implications and Policy Considerations of Cannabis Use (read here, beginning on page 25) in response to the request of AMA and MSSNY members last fall.  I encourage you to read it.  After discussion with our leadership team, MSSNY in conjunction with some of our specialty and County Society leaders will provide comment to hopefully keep the train on track.  We want our patients to arrive safely at their destination, prevent the inappropriate expansion of drug use, misuse, and abuse, and avoid the development of a ‘new tobacco’ industry that exploits our most vulnerable citizens. 

Medical Marijuana

Thanks to Dr. Joe Sellers, our MSSNY Treasurer who was able to pinch hit for me in Albany on Wednesday, where he represented MSSNY at the Governor’s listening session on medical marijuana.  Read the full statement here.

While Dr. Sellers was covering for me in Albany, I was in New York at the MLMIC Executive Committee meeting.  MSSNY provided testimony at the recent public hearing with regards to the proposed sale of MLMIC to Berkshire Hathaway.

Single Payor

Later in the day, President Elect Dr. Arthur Fougner and I along with colleagues from New York County, spent a couple of hours with Assemblyman Richard Gottfried—who has been a great advocate for patients and physicians. He provided insight into his proposed single payer legislation.  We came away with a better understanding of the general workings of the plan and how it could affect your practice.  We agreed to continue dialogue on the evolution of the plan.  You can find our policy with regards to single payer here. I will keep you updated periodically on those discussions.

Your membership and personal contributions allow us to be effective advocates on behalf of our patients and our profession. Click here to join or contribute to MSSNYPAC.

Excelsior!

Please share your thoughts and comments with me at comments@mssny.org.


Thomas J. Madejski, MD 
MSSNY President


eNews

DOH HIV Prevention and Partner Service to Aid “End the Epidemic”
The NYS Department of Health’s HIV Prevention and Partner Service programming is highlighted in the attached document. NYS and County health department staff can assist in locating and re-engaging individuals with diagnosed HIV infection into HIV-related medical care. Staff also actively refer HIV status unknown or negative persons with syphilis or other STDs to clinicians offering PrEP and facilitate access to these services.

A new HIV/STI prevention approach works with individuals in rapidly growing transmission clusters to ensure their partners are linked to HIV and STI testing, medical care, PrEP and other prevention services. Finally, electronic clinician reporting is included in the document to improve efforts for expedited partner services to aid in the efforts to End the Epidemic.

MIPS, NO MIPS, HATE MIPS? TELL US!
Please take the three-question survey on your use/non-use of MIPS! https://www.surveymonkey.com/r/MIPS_Survey

Governor Announces Series of Listening Tour for Regulated Marijuana
Governor Andrew Cuomo has announced a series of listening sessions on regulated marijuana slated for September and October.  The purpose of these sessions is to garner input from community members and key stakeholders on the implementation of a regulated marijuana program in New York State. This input will assist the regulated marijuana workgroup in drafting legislation for an adult-use marijuana program for the legislature to consider in the upcoming session.  A copy of the governor’s press announcement is available here.

MSSNY will have representation at each listening session. NOTE: Although the dates are finalized, several of the venues have not been finalized.

The listening dates and registration is required for the sessions:

– Monday, September 17 –    Bronx

– Thursday, September 20 – Manhattan

– Monday, September 24 –    Queens

– Tuesday, September 25 –    Brooklyn

– Wednesday, Sept. 26 –       Staten Island

– Thursday, September 27    Long Island

– Monday, October 1 –          Newburgh

– Tuesday, October 2 –         Binghamton

– Wednesday, October 3 –     Buffalo

– Thursday, October 4 –        Rochester

– Tuesday, October 9 –         Syracuse

– Wednesday, Oct.  10 –       Utica

– Thursday, October 11 –     Watertown

Registration for individual listening sessions: https://tinyurl.com/y9sh5j9k

DFS’ Report Ranking Health Insurers Based Upon Complaints and Care Access
This week, the NY Department of Financial Services released it 2018 Consumer’s Guide to Health Insurers, which provide consumers information regarding the complaints, appeals and grievances filed against insurance companies during 2017, as well as out of network independent dispute resolution (IDR) statistics for 2017.

For 2017, the insurers with the highest overall ranking based on the lowest number of complaints were:

  • MVP Health Services Corp.
  • Independent Health
  • Genworth Life Insurance Company
  • Community Blue (Health Now)

Some of the most noteworthy findings of the report:

  • For Prompt Payment complaints, CDPHP had the best ranking among HMO plans and MVP the best among EPO/PPO plans. Empire had the worst ranking among HMO plans, and GHI the worst among EPO/PPO plans.
  • For Overall complaints, Independent Health had the best ranking among HMO plans and MVP the best among EPO/PPO plans. Empire had the worst ranking among HMO plans, and GHI had the worst among EPO/PPO plans.
  • There were 1,512 external appeals of health insurer denials of care, of which approximately 38% where reversed entirely or in part.
  • For “Access and Service”, CDPHP had the highest ranking among HMOs and Empire had the highest among PPOs. However, Empire had the lowest ranking among HMOs and MVP had the lowest among PPOs.
  • Regarding IDR for “surprise” medical bills, of the 332 resolutions reached, the provider’s charge was found more reasonable in 141 claims, the plan’s payment more reasonable in 49 claims, a “split decision” in 75 claims, and a settlement in 67 claims.
  • Regarding IDR for out of network emergency care bill, of the 475 resolutions reached, the provider’s charge was found more reasonable in 61 claims, the plan’s payment more reasonable in 2013 claims, a “split decision” in 102 claims, and a settlement in 109 claims.

MSSNY Joins Patient Advocacy Organizations to Protest CMS Authorization of Step Therapy for Part B Medications
MSSNY this week joined nearly 200 patient and physician advocacy association in a letter to US House and Senate leaders expressing strong concerns about the Center for Medicare and Medicaid Services’ (CMS) recent notification to Medicare Advantage plans that they will no longer be prohibited from utilizing step therapy protocols for physician administered drugs covered under Medicare Part B beginning in 2019.   It would in effect overturn a 2012 CMS policy that had prohibited the use of step therapy for Part B covered medications.

Last week, MSSNY also joined many other national specialty and state medical societies in a similar letter initiated by the American Medical Association to CMS.

Numerous states across the country, including New York, fought for the enactment of strong patient protection laws that put strict guardrails around the insurer/PBM use of “step therapy” for needed medications.  However, this policy would go in the opposite direction.  In particular, the group letter expressed concerns that “CMS’ sudden and disruptive decision to allow the inappropriate use of step therapy policies is inconsistent with the requirement that MA plans provide coverage consistent with Original Medicare and threatens to restrict access and decrease therapy choices for patients. This could put patients’ health at risk and potentially creates long-term health care issues in the process.”

The measure was advanced <by CMS as part of its “Blueprint” to lower prescription costs.

4th Columbia Psychosomatics Conference – Oct 20-21, 2018 NYC
Healing “Unexplainable” Pain: Advances in Multidisciplinary Integrated Psychosomatic Care”
Columbia University Medical Center & Office of Mental Health of the State of New York present: 4th Columbia Psychosomatics Conference.

Healing “Unexplainable” Pain: Advances in Multidisciplinary Integrated Psychosomatic Care Lectures and workshops by multidisciplinary world experts in research and treatment of psychosomatic disordersConference Chairs: Alla Landa, PhD, Harald Gündel, MD, Brian A. Fallon, MD, Philip R. Muskin, MD

When: Sat-Sun, October 20 – October 21, 2018
Where: New York State Psychiatric Institute at Columbia University Medical Center,
 1051 Riverside Drive, NY, NY
Advanced registration is encouraged at the number of seats is limited!
For information on CME, complete program, and to register please visit conference website here.

CME Programs

FREE BUPRENORPHINE WAIVER TRAINING: Sept. 22, 2018 in White Plains
Saturday, September 22nd, 2018 9:00AM – 2:00PM

The NYSDOH AIDS Institute in partnership with Westchester Medical Center (WMC) Health Network Performing Provider System (PPS), Westchester County Department of Health and Hudson Valley Community Services is sponsoring a free Buprenorphine Waiver Eligibility Training for Clinical Providers at Westchester County Center, 198 Central Ave, 2nd Floor, Room E, White Plains, NY 10606. Parking: available on the street and in a paid parking lot across the street. Light refreshments will be provided. Directions.  Online Registration.

Under current regulations, authorized practitioners (MDs, DOs, NPs, and PAs) are required to obtain a ‘waiver’ to prescribe buprenorphine. To acquire this waiver, physicians are required to complete a standardized buprenorphine waiver 8-hour training. Nurse Practitioners (NPs) and Physician Assistants (PAs) are required to complete the standardized buprenorphine waiver 8-hour training as well as an additional 16 hours of online training as established by the Comprehensive Addiction and Recovery Act (CARA). Residents may also take the course and apply for their waiver once they receive their DEA license. The buprenorphine waiver 8-hour training is offered in a ‘half and-half’ format [4.5 hours of in-person training followed up by 3.5 hours of online training]. Upon completion of the required training, providers will meet the requirement of the DATA 2000 to apply for a waiver to prescribe buprenorphine for opioid-dependent patients. Please contact us for further information.

Questions: NYSDOH, AIDS Institute, Office of Drug User Health

Stephen Crowe, 212-417-4558, stephen.crowe@health.ny.gov Belinda Duncan, 212-417-4553, buprenorphine@health.ny.gov

ACCREDITATION: This activity has been planned and implemented by NYSDOH, AIDS Institute in accordance with the accreditation requirements and policies of the American Academy of Addiction Psychiatry (AAAP) and in partnership with Westchester Medical Center (WMC) Health Network Performing Provider System (PPS), Westchester County Department of Health and Hudson Valley Community Services.

“Influenza 2018-19” CME Webinar on October 17; Registration Now Open
The first of MSSNY’s 2019 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2018-19” on Wednesday, October 17, 2018 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:

  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms
  • Describe clinical and laboratory diagnostic features and treatment specific to each flu season
  • Identify recommended immunizations and antiviral medications for treatment and how best to effectively encourage patients to get vaccinated

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. 

2018 MSSNY Continuing Medical Education Provider Conference
To meet the challenges facing planners, providers, and participants of CME, MSSNY recognizes the need for ongoing education and training of its Accredited Providers as well as physicians and other healthcare professionals in NYS. This conference will inspire participants to explore new developments in continuing medical education, including compliance with the changing accreditation criteria that clearly address practice gaps and practice-based needs while creating opportunities for measurable change in physicians and reinforcing the undeniable link between a successful CME activity and quality improvement for physicians and patients alike.

Conference will take place on Friday, September 21, 2018, at the Courtyard Westbury Long Island (adjacent to the MSSNY Westbury Office).  Registration links and more information are available here.  Graham McMahon, MD, President and CEO of the Accreditation Council for Continuing Medical Education (ACCME) will deliver the keynote speech, as well as leading an educational session on “Better Methods” for planning and implementing CME activities.  MSSNY President Thomas Madejski, MD will deliver the welcome and opening remarks.  For more information, please contact Miriam Hardin at mhardin@mssny.org.

Two Studies Doubt Benefits of Commercialized Probiotic Products
Two studies published Thursday in the journal Cell “cast further doubt on the benefits of the highly-commercialized probiotic products.” Because they are “marketed as dietary supplements, not drugs,” probiotics do not need to be approved by the FDA for claims that they prevent or treat any health conditions, such as “preventing the common cold to treating allergic disorders.”

In the first study, “25 healthy volunteers ate a generic probiotic with 11 strains of ‘good’ bacteria,” and while each had “probiotic bacteria in their stool,” when physicians “did the endoscopy to evaluate their intestines, they found that probiotics had only actually ‘stuck’ and grown in a few people.” In the second study, the researchers tested what happens when a patient takes probiotics after a course of antibiotics and discovered the probiotics colonized their gastrointestinal tracts “at the expense of the normal gut microbiome, delaying the return to its normal, pre-antibiotic state by several months.”

CMS Medicare

MSSNY Joins House of Medicine to Urge CMS to Reject Proposal to Collapse E&M Payments
MSSNY has joined on to multiple letters to the Center for Medicare & Medicaid Services (CMS) to raise serious concern with CMS’ proposal to collapse evaluation and management (E/M) payments as part of its Medicare payment rule for 2019.  Both letters express appreciation for the CMS “Patients Over Paperwork” initiative to reduce the extraordinary documentation burden facing physicians, but also note that any benefit to be gained would be sizably outweighed by the likely significant reductions in payments.  Under the proposal, payments for E&M codes 99202-99205 would be $134 (instead of ranging from $76 to $211) and payments for E&M codes 99212-99215 would be $92 ($45 to $148).

Register for September 12 All-Payer Combination Option Overview Webinar
Join CMS for 9/12 Webinar on All-Payer Combination Option Overview on Wednesday, September 12, 2018 at 2:00 PM ET to provide an overview of the All-Payer Combination Option, which allows clinicians to become a Qualifying APM Participant (QP), and therefore eligible for the 5% APM Incentive payment, through participation in a combination of Medicare Advanced Alternative Payment Models (APMs) and Other-Payer Advanced APMs, including Medicaid, Medicare Advantage and commercial payers.

During the webinar, CMS will discuss:

  • Overview of APMs and Advanced APMs
  • All-Payer Combination Option Basics
  • Determinations of Other Payer Advanced APMs (Payer and Eligible Clinician Initiated Processes)
  • Determinations for QPs under the All-Payer Combination Option
  • Frequently Asked Questions
  • Additional Resources

CMS will address questions from participants at the end of the webinar, as time allows.

Webinar Details

The audio portion of this webinar will be broadcast through the web. You can listen to the presentation through your computer speakers. CMS will open the phone line for the Q&A portion. If you cannot hear audio through your computer speakers, please contact CMSQualityTeam@ketchum.com.

More on Medicare Revalidation
Previously, MSSNY has reminded physicians of the requirement to revalidate their enrollment with the Medicare program. Once a timeframe is established for the physician or group, revalidation will occur every 5 years.  Physicians need to know that CMS/NGS Medicare reserves the right to perform off cycle revalidations in addition to the regular 5–year revalidations and may request that a provider or supplier recertify the accuracy of the enrollment information when warranted to assess and confirm the validity of the enrollment information maintained by CMS. Off cycle revalidations may be triggered as a result of random checks, information indicating local health care fraud problems, national initiatives, complaints, or other reasons that cause CMS to question the compliance of the provider or supplier with Medicare enrollment requirements. Off cycle revalidations may be accompanied by site visits.

In addition, physicians, non-physician practitioners, and physician and non-physician practitioner organizations must report the following reportable events to their Medicare contractor within the specified timeframes:

(1) Within 30 days—

(i) A change of ownership;

(ii) Any adverse legal action; or

(iii) A change in practice location.

(2) All other changes in enrollment must be reported within 90 days.

The law further provides that no payment will be made (by the program or the Medicare beneficiary) for an otherwise Medicare covered item or service during the period of deactivation of billing privileges.

Physician Fee Schedule Year 3 Proposed Rule: Comments Due September 10
On July 12, CMS released proposed changes to the Physician Fee Schedule and Quality Payment Program. CMS seeks comment on various proposals by 5 pm ET on September 10. See the proposed rule for information on how to submit your comments. If you haven’t yet done so but would like to, you can submit your comments on the CMS Proposed Rule electronically here – look for the green box, see below: This document has a comment period that ends (09/10/2018) SUBMIT A FORMAL COMMENT

NOTE: Personalized comments have the highest impact on CMS’ decision making process, so the public is encouraged to submit separate comments and add information about how this rule will uniquely impact the medical practice and patients. 

Classified

RENTAL/LEASING SPACE


Magnificent Medical Suites for Lease 184 East 70th St . New York, NY
The space has just undergone a complete STATE OF THE ART renovation.
Located in a luxury building with a separate elevator entrance on the prestigious upper east side of Manhattan, this recently renovated space is conveniently situated steps from Lenox Hill Hospital , Cornell /Columbia Presbyterian, HSS and Memorial Sloan Kettering. Includes exam rooms, new custom cabinetry, new exam beds, scale, waiting area – new furniture, new TV, water cooler etc. Space A: one consultation room plus 2 exam rooms. $6000 per month
Space B: One consultation room plus one exam room. $4500 per month
Space C: one consultation plus one exam $4500. other combination may work as well. Available for sharingFor full details and photos see listing at http://bit.ly/2E3Zvh0 or contact Karen Tamir at 917-865-1006 or KarenTamir@Yahoo.com

 


West 57 St. – Shared Office Space to Rent
Lovely Garden view office with natural light. Located near Columbus Circle in a beautiful Art Deco building. Recently renovated office with additional exam room/ room with a sink. Wi-Fi, medical waste pickup and cleaning included.  Ideal location in desirable neighborhood. Contact Jason Faller 914-393-6583 goutmd@aol.com


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. . Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day (about $180) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


 


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES

Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to resume@health.state.ny.us with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.


Physicians Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology startup committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are compensated for their participation, which requires only a few hours annually.

Interested? Learn more and apply today at www.98point6.com/pcc

 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Council – September 13, 2018

AGENDA
MSSNY Council Meeting
Thursday, September 13, 2018, 9:00 a.m.
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590


A. Call to Order and Roll Call
B. APPROVAL of Council Minutes of May 10, 2018
C. New Business (All Action & Informational Items)

1. President’s Report
a. Minutes of the MSSNY Executive Committee Teleconference, August 20, 2018
b. Talking Points on the Membership Agreement with Northwell Hospitals
c. DRAFT Summary – Meeting with Assemblyman Gottfried

d. Long Range Planning Committee Grid

2. Board of Trustees Report –   Dr. Robert Hughes will present the report (handout)

3. Secretary’s Report – Dr. Frank Dowling will present the report for Nominations for   Life Membership, Dues Remissions & Special Life Membership request

4. MLMIC Update  –  Donald Fager will present a verbal report

5. AMA Report – Dr. John Kennedy will present the report

6. MSSNYPAC Report – Dr. Joseph Sellers will present the report (handout) 
       MSSNYPAC Executive Committee Action Item
    Approval of the MSSNYPAC Endorsement recommendations for candidates
    running for  re-election to the New York State Legislature and to the US Congress
    (FOR COUNCIL APPROVAL)

7. MESF Report – Dr. Charles Rothberg will present the report

8. CME Report – On behalf of Dr. Mark Adams, Dr. Paul Pipia will present the report

9. Presentation – Elizabeth Amato, Vice President, SHIN-NY Programs New York     eHealth Collaborative (NYeC)
Update on the Data Exchange Incentive Program (DEIP). The program which provides   physicians with up to $13,000 to help connect to the SHIN-NY).

10.    Councilors’ Action Reports (No written reports submitted)

D. Reports of Officers (Verbal Reports)    

  1. Office of the President – Thomas J. Madejski, MD
  2. Office of the President-Elect – Arthur C. Fougner, MD
  3. Office of the Vice President – Bonnie L. Litvack, MD
  4. Office of the Treasurer – Joseph R. Sellers, MD Financial Statement for the period 1/1/18 to 7/31/18
  5. Office of the Speaker – Kira A. Geraci-Ciradullo, MD

E. Reports of Councilors (Informational)

  1.          Kings & Richmond Report – Parag H. Mehta, MD
  2.          Manhattan & Bronx Report – Joshua M. Cohen, MD
  3.          Nassau County Report – Paul A. Pipia, MD
  4.          Queens County Report – Saulius J. Skeivys, MD
  5.          Suffolk County Report – Maria A. Basile, MD 
  6.          Third District Branch Report – Brian P. Murray, MD
  7.          Fourth District Branch Report – Gregory Pinto, MD
                 (no written report submitted)
  8.          Fifth District Branch Report –Howard H. Huang, MD
  9.          Sixth District Branch Report – Robert A. Hesson, MD
  10.        Seventh District Branch Report – Janine L. Fogarty, MD
  11.        Eighth District Branch Report – Edward Kelly Bartels, MD
  12.        Ninth District Branch Report  –  Thomas T. Lee, MD
  13.        Medical Student Section Report –  Breyen Coffin
  14.        Organized Medical Staff Section – Stephen F. Coccaro, MD
                  (no written report submitted)
  15.        Resident & Fellow Section Report – Justin Fuehrer, DO
                  (no written report submitted)
  16.        Young Physician Section Report – L. Carlos Zapata, MD
                  (no written report submitted)

F.  Commissioners (Committee Informational Items)

    1. Commissioner of Communications, Maria A. Basile, MD, MBA
           Report from the Division of Communications

    2. Commissioner of Governmental Relations, Gregory Pinto, MD

        1. MSSNY’s 2018 Legislative Summary (handout)
2. HIT Committee Minutes, June 1, 2018

    3. Commissioner of Membership, Parag H. Mehta, MD
       (No written report submitted)

    4. Commissioner of Science & Public Health, Joshua M. Cohen, MD
     1. Bio Ethics Committee Minutes, May 11, 2018
     2. Eliminate Health Disparities Committee Minutes, April 27, 2018
     3. Preventive Medicine & Family Health Minutes, May 3, 2018
     4. Division of Public Health & Education Report

5.Commissioner of Socio Medical Economics, Howard H. Huang, MD 
      1. Interspecialty Committee Minutes, June 28, 2018
      2. Workers’ Compensation & No Fault Minutes, June 6, 2018

G. Report of the Executive Vice President, Philip Schuh, CPA, MS
        1. Membership Dues Revenue Schedule
        2. Group Institutional Dues Comparison Report

H. Report of the General Counsel, Garfunkel Wild, P.C.

1.   Amendment to the Bylaws of the Nassau County Medical Society
An amendment to the bylaws of the Nassau County Medical Society was reviewed. A review confirms that the amendment relates to the internal governance of the Nassau County Medical Society, and does not conflict with the bylaws of  MSSNY.  Accordingly, it is recommended that the Council approve the amendment to the bylaws of the Nassau County Medical Society. (FOR COUNCIL APPROVAL)

2.    Amendments to the Bylaws of the New York County Medical Society

       The amendments to the bylaws of the New York County Medical Society were presented for review.  A review shows that the amendments relate solely to internal matters of the county medical society, which do not conflict with the bylaws of MSSNY. Accordingly, it is recommended that the amendments be approved.
(FOR COUNCIL APPROVAL)

3.     Amendments to the Bylaws of the Richmond County Medical Society
The amendments to the bylaws of the Richmond County Medical Society were
presented for review. A review shows that the bylaws are not in conflict with the bylaws of MSSNY.  Accordingly, it is recommended that Council approve the amendments.
(FOR COUNCIL APPROVAL)

I. Report of the Alliance, Valerie Semeran, Co-President
    Alliance Report

J. Other Information/Announcements  (all attached

1. Continuing Board Certification: Vision for the Future Commission Summary of Testimony July, 2018

    2. Department of Health & Human Services Letter to the AMA regarding changes in reimbursement rates for laboratory services on the Medicare Clinical Laboratory Fee Schedule and CMS Clinical Laboratory Fee Schedule Sign-On Letter.

3. Dr. Madejski’s Letter to Department of Health & Human Services – E&M Services & Coalition of State Medical Societies Sign-On E&M Letter

4. Dr. Madejski’s Letter to Workers’ Comp Board – Increase in the Workers’ Comp Medical Fee Schedule

5.  National Council of State Boards of Nursing Sign-On Letter – A request to reconsider certain provisions of the Advanced Practice Registered Nurse(APRN) Compact that alter state laws related to the scope of practice of APRNs

6. AMA Letter to the CEO of Walmart – Walmart Opioid Policy

7. Physician Advocacy Institute Letter to CMS & PAI Statement – Physician Self-Referral Law 

K. Adjournment

 

 

 

 

MSSNY eNews: Together-Yes! We Are Stronger!

 

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
August 31, 2018
Volume 20  Number 32

MSSNYPAC

Dear Colleagues:

I want to wish you a peaceful Labor Day weekend, and thank you for the care you provide to your patients individually, and through your membership in your County Medical Society and MSSNY for your efforts on behalf of patients collectively.  MSSNY and your County Society allow us to come together to advocate on behalf of our patients and our profession to improve the health and productivity of our country.

Some of you know that I am a member of the Council on Medical Service at the American Medical Association. I am writing this in the airport Tuesday afternoon, awaiting my flight to return to Buffalo from our summer Council on Medical Service meeting. The Council creates policy proposals for consideration by the AMA House of delegates. We reviewed a number of different topics, and had wide ranging discussions on how to improve care for our patients, improve physician satisfaction, and provide value to society.  We often have discussions about cost effectiveness and continue to look for data to support the AMA policies on healthcare. Some of the value we bring to patients and society is difficult to quantitate due to measuring effectiveness of a particular policy or intervention and the perspective of different entities—patients, physicians, insurers, economists and others.  During the creation of an upcoming report on the patient centered medical home, we had mixed data on the cost effectiveness of the PCMH concept.  Part of the discussion again looked at value to different stakeholders. From the patient standpoint, improved coordination of care and better preventive care seems like a no-brainer, but patients who live longer might ultimately be paradoxically more expensive in the long run.  Most of the tools used do not adequately capture the value to society from— hopefully—a reduction in the disabled population and a longer more productive life.

MSSNY and the AMA have a great working relationship. The AMA is a great source for health policy and assists MSSNY in our advocacy efforts at the New York State level.  MSSNY brings grassroots issues to the AMA on behalf of New York’s physician community, and through our MSSNY AMA delegation has led the country on issues relating to Out of Network billing, medical education, and many public health issues.

Local Medical Societies, MSSNY, and the AMA continue to work on behalf of our patients, our members, and the betterment of our societies.

Working together, we ARE stronger.  Thanks for your membership and labor on behalf of your patients.

Excelsior!

Please share your thoughts and comments with me at comments@mssny.org.


Thomas J. Madejski, MD 
MSSNY President


eNews

MIPS, NO MIPS, HATE MIPS? TELL US! 
Please take the three-question survey on your use/non-use of MIPS! https://www.surveymonkey.com/r/MIPS_Survey

MSSNY Joins Numerous Other Organizations to Protest CMS Permission to MA Plans to Use Step Therapy
MSSNY joined several other physician advocacy associations in a letter initiated by the American Medical Association to the Center for Medicare and Medicaid Services (CMS) expressing strong concerns about CMS’s recent notification to Medicare Advantage plans that they will no longer be prohibited from utilizing step therapy protocols for physician administered drugs covered under Medicare Part B beginning in 2019.   It would in effect overturn a 2012 CMS policy that had prohibited the use of step therapy for Part B covered medications.

Numerous states across the country, including New York, fought for the enactment of strong patient protection laws that put strict guardrails around the insurer/PBM use of “step therapy” for needed medications.  However, this policy would go in the opposite direction.  In particular, the AMA letter noted that “Step therapy protocols that require patients to try and fail certain treatments before allowing access to other, potentially more appropriate treatments can both harm patients and undercut the physician-patient decision-making process”.  Moreover, it would result “in delays in getting patients the right treatments at the right time and unnecessary complications in the physician-patient decision-making process”.

The letter also notes that the new policy would have a particularly significant impact on the sickest of Medicare-covered patients. “In many cases, patients receiving drugs covered under Part B are especially vulnerable, many with serious or life-threatening conditions. Many cancer therapies, for example, are covered under Part B. For cancer patients, selecting the proper personalized treatment as quickly as possible can be critical to survival. For others, such as those suffering from conditions like autoimmune disorders and progressive blinding eye diseases, delays in getting appropriate treatments can mean prolonged symptomatic periods and irreversible damage, making a “fail first” approach to treatment inappropriate.” The measure was advanced by CMS as part of its “Blueprint” to lower prescription costs.

MSSNY Joins House of Medicine to Urge CMS to Reject Proposal to Collapse E&M Payments
MSSNY has joined on to multiple letters to the Center for Medicare & Medicaid Services (CMS) to raise serious concern with CMS’ proposal to collapse evaluation and management (E/M) payments as part of its Medicare payment rule for 2019.  Both letters express appreciation for the CMS “Patients Over Paperwork” initiative to reduce the extraordinary documentation burden facing physicians, but also note that any benefit to be gained would be sizably outweighed by the likely significant reductions in payments.  Under the proposal, payments for E&M codes 99202-99205 would be $134 (instead of ranging from $76 to $211) and payments for E&M codes 99212-99215 would be $92 ($45 to $148).

MSSNY signed on to a letter initiated by the AMA and 170 other medical associations.  That letter that noted medicine’s support for CMS’ “goal of reducing administrative burdens for physicians and other health care professionals so that they can devote more time to patient care”, but also that there are “unanswered questions and potential unintended consequences that would result from the coding policies in the proposed rule.”  Moreover, it expressed concerns that the policy change “could hurt physicians and other health care professionals in specialties that treat the sickest patients, as well as those who provide comprehensive primary care, ultimately jeopardizing patients’ access to care.”

This week MSSNY also signed on to a letter initiated by the Coalition of State Medical Societies (consisting of the medical societies of AZ, CA, FLA, LA, NC, NJ, OK, SC and TX together with MSSNY).  In that letter, it was noted that the adverse outcomes of this change include:

  • Eliminating incentives for physicians to care for complex or complicated patients including those with disabilities and those with serious or terminal illnesses;
  • Making treating patients covered by Medicare even more financially challenging for physicians, leading more physicians to limit the number of Medicare patients they see or to opt out of the program entirely; and
  • Similar changes being imposed by commercial insurance companies that tend to follow CMS’ lead on payment matters.

NY Assembly Insurance Committee Chair Urges US DOJ to Block CVS-Aetna
Expressing great concern that the proposed acquisition of Aetna by CVS “creates a conglomerate that will be too difficult to regulate and will likely harm patient care,” this week Assembly Insurance Committee Chair Kevin Cahill urged the US Department of Justice to block this merger.  As noted in his press release, the letter to DOJ summarized several significant concerns that came to light during a June 4 hearing held by the New York Assembly Committees on Health and Insurance.  He asserted “that the loss of competition will result in increased prescription drug prices, harm independent pharmacies and diminish provider choice – all of which significantly hurts New York consumers.”

MSSNY President Dr. Thomas Madejski issued a statement thanking Assemblyman Cahill for sending this letter, and noting MSSNY’s testimony during the June 4 hearing that raising numerous concerns about the adverse impact to patient access to needed care. These concerns include: reduced community pharmacy access; reduced health insurer competition; increased prior authorization hassles; and marginalization of physician-owned medical homes.

Dr. Madejski’s statement also noted that several other entities, including the California Insurance Commissioner, the American Medical Association and the American Antitrust Institute also urged the DOJ to reject the proposed merger.   “Several diverse perspectives have resulted in the same conclusion – that this merger would have an adverse impact on patient access to care. We are hopeful that the US DOJ reviews these submissions very carefully, and reaches a similar decision” stated Dr. Madejski.

The Pharmacists Society of the State of New York also issued a statement to thank Assemblyman Cahill for taking this action, noting that “nothing good can come out of this merger”, and that “the only improved health outcome from this merger will be the dividends returned to CVS and Aetna shareholders”.

Governor Announces Series of Listening Tour for Regulated Marijuana
Governor Andrew Cuomo has announced a series of listening sessions on regulated marijuana slated for September and October.  The purpose of these sessions is to garner input from community members and key stakeholders on the implementation of a regulated marijuana program in New York State.  This input will assist the regulated marijuana workgroup in drafting legislation for an adult-use marijuana program for the legislature to consider in the upcoming session.  A copy of the governor’s press announcement is available at:

The listening dates and registration is required for the sessions:

– Wednesday, September 5 – Albany

– Thursday, September 6 – Glens Falls

– Monday, September 17 – Bronx

– Thursday, September 20 – Manhattan

– Monday, September 24 – Queens

– Tuesday, September 25 – Brooklyn

– Wednesday, September 26 – Staten Island

– Thursday, September 27 – Long Island

– Monday, October 1 – Newburgh

– Tuesday, October 2 – Binghamton

– Wednesday, October 3 – Buffalo

– Thursday, October 4 – Rochester

– Tuesday, October 9 – Syracuse

– Wednesday, October 10 – Utica

– Thursday, October 11 – Watertown

Registration for individual listening sessions: https://tinyurl.com/y9sh5j9k

USPSTF: Women at Risk for Perinatal Depression Should Get Counseling
The US Preventive Services Task Force is advising clinicians to refer women at risk for perinatal depression to counseling in a draft recommendation statement.

The grade B recommendation applies to both pregnant women and those who have given birth in the past year. The group suggested providing counseling to women with a history of depression, current depressive symptoms that are below the diagnostic threshold, or socioeconomic risk factors like low income or being young or single.

Effective counseling interventions include cognitive behavioral therapy and interpersonal therapy.

USPSTF draft recommendation

USPSTF draft evidence review

Background: NEJM Journal Watch Women’s Health coverage of averting postpartum depression in women at risk  

Free Tuition at NYU Medical School Could Create Pressure for Other Med Schools
Few medical schools could pull off NYU School of Medicine’s policy of offering free tuition and it could create a gap between well-financed institutions and other schools, two medical students at the Icahn School of Medicine at Mount Sinai wrote in STAT.

Classified

 

RENTAL/LEASING SPACE

 


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. . Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day (about $180) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.


Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES

Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to resume@health.state.ny.us with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.


Physicians Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology startup committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are compensated for their participation, which requires only a few hours annually.

Interested? Learn more and apply today at www.98point6.com/pcc 


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews: NYU’s Bold Step

 

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
August 24, 2018
Volume 20  Number 31

MSSNYPAC

Dear Colleagues:

When NYU School of Medicine announced last week that it will offer full tuition scholarships to all new, current and future students, it signaled a potential game-changer for the future of medical education in this country.

NYU Medical School students will graduate and move into residency with the ability to choose a path based on their passion—which might include research, family medicine or pediatrics—rather than choosing a more lucrative specialty in order to pay back loans. NYU will also benefit from an increasingly competitive applicant pool.  Hopefully, this will translate into new research initiatives and improved access and health outcomes for patients in the years ahead.

Presently, some residents may choose a specialty based on future income potential because of their massive loan debt. I don’t think that is a consideration for most students when they enter school, but has to be part of the equation for choosing a specialty as the bills pile up. According to the Association of American Medical Colleges, three out of four medical school graduates in 2017 graduated in debt—with the median amount at $192,000.

MSSNY and the American Medical Association both have concerns about the indebtedness of medical school graduates affecting their choice of specialty, as well as practice location.  While it is reasonable to postulate that reduced or no tuition will free medical students to follow their passion, the impact of loan forgiveness programs to date is less than compelling.

I practice in a rural, underserved area in upstate New York.  While New York State and the Federal government have a number of programs to entice physicians to practice in underserved areas, it is unusual to have a participant in those programs stay long term.

Studies that look at the long term effects of loan forgiveness are challenged to demonstrate any long term positive effect.  Having some of these gifted clinicians practicing in underserved areas is good for the community but, as demonstrated  by the decline in practitioners and small hospitals in rural areas in upstate New York, has not had a long lasting impact.  Nonetheless, every one of these physicians who stays long term is critical to maintain access and improve the health of their community.

The NYU initiative is a bold step in the right direction towards solving the long-standing issue of onerous and out-of-control medical school debt. Personally, I am skeptical that it will have a major effect on specialty choice as debt is just one of many factors in choice of specialty.  Will it help to improve access to care and health of our communities?  Is the $600 million cost of the program money well spent?  How will other medical schools respond to the NYU initiative?

Please share your thoughts and comments with me at comments@mssny.org.


Thomas J. Madejski, MD 
MSSNY President


eNews

MSSNY Testifies in Support of Transaction to Bolster Financial Stability of MLMIC
MSSNY Executive Vice-President Phil Schuh testified in support of MLMIC’s acquisition by Berkshire Hathaway, during a New York Department of Financial Services hearing this week examining the proposed transaction.  Mr. Schuh noted that “MLMIC’s alliance with Berkshire Hathaway will fortify its finances and enable MLMIC to continue its mission to assure physicians, dentists and hospitals have access to quality medical malpractice insurance coverage and risk management services long into the future”.

If the proposed transaction were to be approved, MLMIC policyholders between July 15, 2013 and July 14, 2016 would be eligible to receive approximately 1.9 times the amount paid in premiums over that time period.

Mr. Schuh’s testimony also urged that DFS assure that there is a strict deadline for release of the funds following the closure of the transaction after approval. Specifically, he urged that there be a prompt resolution to situations where a Policy Administrator (such as a health system or physician group) believes it has a legal right to payments otherwise due to the physician policyholder because it had paid premiums on behalf of that physician policyholder.  He noted that “some physicians have expressed concerns that entities with enormous resources at their disposal could coerce a physician to give up their statutory right to these proceeds because of the fear of excessive litigation costs.   He suggested that DFS impose a condition on the conversion approval “to assure a strict deadline for release of the funds from escrow following the closure of the transaction, whereby the funds will be awarded to the policyholder at the conclusion of such period if the process for resolving the dispute has not yet been completed.”


Governor Urged to Sign Legislation to Require Greater Transparency of Insurer Compliance with Mental Health & SUD Parity Laws
Physicians are urged to send a letter to the Governor requesting that he sign into law legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the NY Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws. A letter can be sent from here.

MSSNY, working together with the New York State Psychiatric Association and other specialty societies, had strongly supported this legislation as it passed the Legislature nearly unanimously.  While many physicians weighed in with their legislators in support earlier this year, advocacy should now be directed to the Governor’s office in support of this important measure.

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS. Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws.


Photos from the MSSNY Booth at the Great New York State Fair
The Great New York State Fair is now underway in Syracuse (August 22-September 3). Come Visit the MSSNY booth in the Hall of Health outside gate #2!

 

Karen Jonas from Central New York Care Collaborative (left)
and Dr. Joseph Maldonado (right) 

Dr. David Page checks blood pressure at the MSSNY Booth


Attention: Guide to Timely Filing is Now Available
The “Guide to Timely Billing” presentation being used by the Department of Health for its August webinar series has been posted to emedny.org. Click here to view the PDF. For more information, contact 1-800-343-9000 or emednyalert@csra.com

Emblem Notified Its Network of A New Policy on July 19 re Modifier 25
The “Guide to Timely Billing” presentation being used by the Department of Health for its August webinar series has been posted to emedny.org. Click here to view the PDF. For more information, contact 1-800-343-9000 or emednyalert@csra.com.

Modifier 25 with Evaluation and Management Services Reported with Procedures

Date Issued: 7/19/2018

Modifier 25 is used to describe a significant, separately identifiable evaluation and management (E/M) service that was performed at the same time as a procedure.

Beginning October 30, 2018, our current coding policy will apply to GHI plans regarding E/M services billed with modifier 25 within 28 days of a previous face-to-face service. The E/M service will be denied when both of the following apply:

  • The E/M service (92002-92004, 92012-92014, 99201-99380, 99441-99499) is billed with modifier 25 on the same day as a procedure with a 0-day, 10-day, or 90-day postoperative period.
  • The patient has had a face-to-face service with the same provider for the same condition as the E/M service, and the 0-day, 10-day or 90-day procedure within the previous 28 days.


Face-to-face service codes included in this medical policy: 10021-36410, 36420-44680, 44800-69990, 90935-90993, 92002-92371, 92502-92504, 92511, 95831-95852, 96365-96379, 96405-96406, 96440, 96450, 96542-96999, 97597-97755, 97802-98943, 99100-99170, 99201-99285, 99291-99337, 99341-99357

After members questioned MSSNY about the veracity of this policy change, MSSNY questioned the plan.  Their Medical Director responded, as follows:

“As per the definition of Modifier 25, if there is a significant separate and distinct problem, not associated with a procedure performed or during the global period for a prior procedure, then the physician should appeal the determination by providing the appropriate documentation that substantiates the additional billing.”

                                                                    Regina McNally, MSSNY VP Socio-Med


New York Ranks Second Among States in Healthcare Spending

The Poughkeepsie (NY) Journal (8/22, Robinson) reports New York spent $57.6 billion, or about $3,000 per person, on healthcare in 2015, the second-highest total in the nation, behind New Mexico, according to a new study. The biggest driver of healthcare costs is Medicaid, accounting for about 80 percent of annual state health costs. More than six million New Yorkers are enrolled in the program, approximately one third of the state’s population. The state’s healthcare spending, however, “doesn’t appear to be translating into better quality,” as it “recently was ranked the 17th best health care system in the country based on cost, accessibility and medical outcomes.”

 

NEW MEMBER BENEFIT

Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!
MSSNY is pleased to announce our newest member benefit!  Our new Abenity App provides members with exclusive perks and over $4,500 in savings on everything from restaurants, City Pass, AMC movie tickets, theme parks, hotels, car rentals, mortgage savings, auto care and much more!

Popular Features Include:

  • Nearby Offers: Use our show and save mobile coupons to quickly access savings on the go.
  • eTickets On Demand: Save up to 40% with no hidden fees.
  • Showtimes: Find movies, watch trailers, and save up to 40% at a theater near you.
  • Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!

REGISTER & LOG IN:

    • Click on the following link: http://mssny.abenity.com
    • Create a unique user name and password
    • Visit the App Store and download the Abenity App
    • Begin Saving!

 

Classified

 

RENTAL/LEASING SPACE

 


Rare Find — Great Office Share
Wonderful office share in terrific location at great price. Choice of smaller windowed consultation room with adjoining exam room or big windowed consultation room with one or two exam rooms. . Beautiful bright rooms, lovely reception area and front . First-rate building on 58th Street between Park and Lexington.  Rent by day (about $180) or by month ($5500). Front desk and office management available, along with many other amenities, including internet, ultrasound, EMG Kitchen, optional C Arm. Willing to make changes for new tenant. Call 646-642-0700.


Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.


Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES

Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to resume@health.state.ny.us with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.


Physicians Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology startup committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are compensated for their participation, which requires only a few hours annually.

Interested? Learn more and apply today at www.98point6.com/pcc 


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews: Visits from the DEA!

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
August 17, 2018
Volume 20  Number 30

MSSNYPAC

Dear Colleagues:

On Monday, August 13, I attended a meeting at the Medical Society of the County of Erie in order to better understand the DEA’s role in audits and investigations of buprenorphine providers.

Representing the medical community at this meeting were: Gale Burstein, MD, Chair, Public Health Committee (MSCE) and Commissioner-Erie County Department of Health; Nancy Nielsen, MD, PhD, Senior Associate Dean for Health Policy, Medicine, SUNY at Buffalo; and Christine Nadolny, Executive Director-MSCE.  Representing the DEA were: Edward Orgon, Resident Agent in Charge-US DEA, Joseph Cowell, Group Supervisor – US DEA Diversion Squad and Michael Cereo, Group Supervisor, US DEA Tactical Diversion Squad. 

There are two types of visits that a prescriber might receive from the DEA:  Compliance Inspections and Audits: 

  • Compliance Inspection is a minimally-invasive visit to an office wherein the DEA representative interviews the provider and may check buprenorphine stock on hand. This is done unannounced, but we received assurances that the DEA does not “shut down the office” while this is taking place, is done in a very respectful manner and in a way that does not alert patients that the DEA is on the premises.
  • Audits, which are normally only done after a compliance inspection and only if the DEA feels that a more thorough audit of the practice may be necessary.

According to Mr. Cowell (US DEA Diversion Squad), the only reason the audits are conducted is to ensure that buprenorphine is not being diverted onto the streets and prescribing physicians are employing all the prescribing protocols put forth by SAMHSA and state and federal regulations, which include:

  1. Verifying the prescriber’s credentials
  2. Checking on the number of patients under the prescriber’s care
  3. Ensuring that patients are monitored regularly during their treatment
  4. Verifying the ages of patients being treated
  5. Verifying the number of prescriptions being written v. number of patients
  6. Effectiveness and outcomes of treatment with buprenorphine
  7. Verifying that patients being referred to counseling are required to undergo urine testing for substances being administered (and results of testing).
  8. Verifying whether the prescriber is dispensing or administering buprenorphine on site or prescribing buprenorphine.

A physician practicing medicine in a lawful way has nothing to fear from either type of visit from the DEA.

Mr. Cowell provided some stats that prove that these types of aforementioned actions by the DEA are rare:

  • Of the 16,000 prescribers in the jurisdiction of the Division of the DEA that Mr. Orgon oversees, there have been only 20 cases of physicians being prosecuted criminally in the last 5 years. There is always a thorough investigation and evidence in hand before the DEA will “shut the office down” and bring an indictment against a provider.
  • The number of visits to provider’s offices (within the 17 counties overseen by this particular DEA office’s jurisdiction) have steadily decreased from 40 visits in 2013 to 9 visits in 2017 indicating that providers are prescribing within the confines of the law.  The DEA has not conducted one inspection or audit of a buprenorphine provider in the 17 counties to date in 2018.

It was clear during our discussion that all parties involved have the same goal in mind—the safe prescribing of buprenorphine to stop diversion of buprenorphine on the streets and to keep the health and safety of the public as the main priority.

Please send your thoughts to comments@mssny.org.

Thomas J. Madejski, MD 
MSSNY President


MLMIC Insurance

eNews

How to Obtain a Waiver to Treat Opioid Dependency
According to the Substance Abuse and Mental Health Services Administration (SAMHSA) there are 751 physicians in New York State that have a waiver to treat opioid dependency with approved buprenorphine products.  The 751 physicians are certified to treat 30 patients and there are 146 physicians who are certified to treat 100 patients.

Under the Drug Addiction Treatment Act of 2000 (DATA 2000)  qualified physicians may apply for waivers to treat opioid dependency with approved buprenorphine products in any settings in which they are qualified to practice, including an office, community hospital, health department, or correctional facility.

To Obtain a Waiver, please click here.

GOVERNMENT AFFAIRS

Governor Urged to Sign Legislation to Require Greater Transparency of Insurer Compliance with Mental Health & SUD Parity Laws
Physicians are urged to send a letter to the Governor requesting that he sign into law legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the NY Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.   A letter can be sent from here.

MSSNY working together with the New York State Psychiatric Association and other specialty societies had strongly supported this legislation as it passed the Legislature.  While many physicians weighed in with their legislators in support earlier this year, advocacy should now be directed to the Governor’s office in support of this important measure. 

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS. Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws. 

Tanning Bill Prohibition for Children under 18 Passes NYS Legislature
Governor Cuomo this week signed into law legislation strongly supported by MSSNY that would prohibit the use of tanning booths for children under 18.  The measure, Assembly Bill 7218A/Senate Bill 8858A, was sponsored by Assemblywoman Ellen Jaffe and Senator Phil Boyle.  MSSNY worked together with several public health advocacy organizations, including the American Cancer Society, to urge this measure be passed and signed into law.

“We have long known the dangers of indoor tanning and the devastating health risks that go along with prolonged exposure to ultraviolet rays,” Governor Cuomo said in signing this measure. “By further limiting our children from exposing themselves to this health risk, we can stop the spread of preventable disease and help save lives.”

Currently, the law allows children between the ages of 17-18 years of age to use tanning booths with parental permission.  According to the American Cancer Society, skin cancer is the most diagnosed cancer in the United States. About 95,400 invasive skin cancers will be diagnosed in the US, and more than 87,000 of these will be of melanoma, the most serious form.    The law takes effect immediately.


NYU: Free Tuition for Medical Students!
On August 15, New York University issued a statement that it will cover tuition for all its medical students regardless of their financial situation, a first among the nation’s major medical schools and an attempt to expand career options for graduates who won’t be saddled with six-figure debt. (Wall Street Journal Aug16)

NYU raised more than $450 million of the roughly $600 million it estimates it will need to fund the tuition package in perpetuity. The school will provide full-tuition scholarships for 92 first-year students—another 10 are already covered through MD/PhD programs—as well as 350 students already partway through the MD-only degree program. The full tuition program does not cover room and board. The school will refund out-of-pocket tuition payments already made for the current year, and return loans students may have taken out.

Nationally, 72% of graduates from the class of 2018 had debt from medical school, with a median of $195,000 in loans, according to student surveys by the Association of American Medical Colleges. More than one-third of medical students also have student loans from prior academic programs.

Sixty-two percent of NYU medical school’s most recent graduating class had student loans, averaging $171,908 for medical school and $184,000 overall. Most medical students will still need to pay for about $29,000 in annual room, board and other living expenses; tuition had been set at $55,018 for the coming year. (Wall Street Journal)

LEGAL

NYS Sues Purdue Pharma for Misleading Physicians about Opioids
New York State filed a lawsuit against Purdue Pharma on Tuesday, alleging that the opioid maker misled doctors and patients about the dangers of its drugs. The state joins a growing list of states and local governments that have turned to the courts in their effort to go after drug companies to link them to tens of thousands of fatal overdoses across the country.

Governor Andrew Cuomo said in a statement: “The opioid epidemic was manufactured by unscrupulous distributors who developed a $400 billion industry pumping human misery into our communities.” (Reuters 8/14) The suit says that more than 75 percent of New York’s opioid deaths were a result of painkillers and asserts that a statewide investigation found that the company’s marketing scheme contributed to the excessive use and prescription of opioids.

CASE DISMISSED: ACA Does Not Pre-Empt NY’s Risk Adjustment Rules
A federal judge has ruled that the Affordable Care Act does not pre-empt New York’s new risk adjustment rules, dismissing a lawsuit from UnitedHealthcare of New York. The decision could potentially cost the insurer tens of millions of dollars. U.S. District Court Judge John Koeltl said the insurer’s claims “are meritless.” “If Congress intended to preempt all state risk adjustment programs, it is unlikely it would have included provisions expressly leaving to the states the power to promulgate any regulations that did not conflict with the ACA,” Koeltl wrote. Maria Vullo, the superintendent of the Department of Financial Services, said in a statement she is pleased with the federal court’s decision. “This decision correctly upholds New York’s regulatory insurance authority and clearly affirms that New York’s continued enforcement of New York insurance law and regulation is not preempted by federal law,” she said. (Politico, Aug. 14)


BILLING

MSSNY Members Only: Unpaid Claims?? We Can Help!
In 2016, MSSNY’s Ombudsman Program was successful in recovering $89,815.79 for physicians who had reached a stalemate regarding unpaid claims. For calendar year 2017, we recovered a total of $308,889.18 for our MSSNY members who availed themselves to the Ombudsman service. So far for January through June of 2018, we recouped $62,639.58 for our members.  If you are a member in good standing, this service is available to you for FREE! For further information, call 516-488-6100 ext. 334 or 332.


NEW MEMBER BENEFIT

Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!
MSSNY is pleased to announce our newest member benefit!  Our new Abenity App provides members with exclusive perks and over $4,500 in savings on everything from restaurants, City Pass, AMC movie tickets, theme parks, hotels, car rentals, mortgage savings, auto care and much more!

Popular Features Include:

  • Nearby Offers: Use our show and save mobile coupons to quickly access savings on the go.
  • eTickets On Demand: Save up to 40% with no hidden fees.
  • Showtimes: Find movies, watch trailers, and save up to 40% at a theater near you.
  • Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!

REGISTER & LOG IN

Click on the following link: http://mssny.abenity.com and then create a unique username and password 

MEDICAID

Reminder: 2018 Meaningful Use Registration for Public Health
In order to meet the 2018 Meaningful Use Public Health Reporting requirements for the NY Medicaid EHR Incentive Program, providers must complete their registration of intent in the Meaningful Use Registration for Public Health (MURPH) System. Registration of intent must be completed before or within 60 days of the start of the provider’s 2018 EHR reporting period.

The last 90-day EHR reporting period available in 2018 is October 3, 2018 – December 31, 2018. Therefore, the final day a registration of intent may be submitted for that period is December 1, 2018.

Note: Only one registration is required. If you previously completed your registration in MURPH, then you do not need to submit a new registration. You may edit an existing registration as necessary.

More information about Meaningful Use Public Health Reporting, including webinars, MURPH registration guides, and FAQs are available at www.health.ny.gov/ehr/publichealth. For additional assistance, please contact program support at 1-877-646-5410 Option 3 or MUPublicHealthHelp@health.ny.gov.

INNOVATOR

SOMOS-IPA: An “Innovator,” New Value Based Payment Contracting Designation
First Physician Group to Achieve Innovator Designation

The New York State DOH, on August 14, announced that Somos Independent Practice Association has been designated as an Innovator under Medicaid’s Value Based Payment (VBP) Roadmap, a key component to the Delivery System Reform Incentive Payment (DSRIP) Program. Somos-IPA is the first physician-led group in the State to reach VBP Innovator status.

VBP Innovators contract at the most advanced payment levels with managed care organizations to improve quality of care for a defined group of patients while sharing in financial gains and risks. By taking on additional management and administrative functions, providers approved as Innovators are eligible for an increased portion of the monthly payment made by Medicaid to the Managed Care Plan. New York’s Roadmap is unique in requiring Innovators to include community-based organizations and address social determinants of health interventions such as housing, food insecurity or transportation.  As part of New York’s $8 billion DSRIP federal waiver, the VBP Roadmap builds on the success of DSRIP’s Performing Provider Systems (PPS) and paves the way for New York’s Medicaid program to shift to paying for value over volume.

The Somos-IPA, which is comprised of three community based Physician IPAs: Corinthian, Excelsior, and Eastern Chinese American Physicians, will cover Bronx, Kings, Queens, and New York Counties. The Innovator network will also partner with Montefiore Health System & St. Barnabas Hospital, MEDISYS Health System, NYU Health System, and Wycoff Heights Hospital. Included in the Somos-IPA Innovator network will be17 community-based organizations to help address social determinants of health such as nutrition, economic stability, and housing. By contracting with seven Medicaid Managed Care Organizations, the SOMOS-IPA will care for an estimated 180,000 Medicaid members in its first year. Somos IPA is the third VBP Innovator designated by the State. Earlier this year, DOH designated Montefiore ACO-IPA and NYU-Langone IPA,

two hospital-led systems, as VBP Innovators.

Classified

 

RENTAL/LEASING SPACE

 


Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.


Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES

Medical Director in the NYS Office of Health Insurance Programs Division of Systems
The Medical Director position will be responsible to review prior approval requests and issue denials as indicated.  The incumbent will review pended claims and recommend whether payment should be made or denied and review requests for enhanced reimbursement for Out-of-State Hospital services.  The incumbent will participate in several external and internal committees including: Provider Enrollment Appeals Committee, Laboratory Policy Committee, Internal Benefit Review Committee, Irregular Billing Committee, Utilization Review Edit Committee, Quality Improvement Committee, Physician Administered Medication Committee, and Medical Coding Review and Coverage Decisions Committee.  The incumbent will also attend the Hearing Aid Dispensing Advisory Committee representing the Commissioner of Health and participate in the Evidence-Based Benefit Review.  The incumbent will a key stakeholder in monitoring the Radiology Utilization Management Contract and interacting with the Medical Director and clinical staff.  The incumbent will also be responsible to participate with other OHIP Medical Directors in meetings on topics about Medicaid Policy including DSRIP and VBP.

Interested candidates may submit a resume to Human Resources Management Group, Room 2276, Corning Tower Building, Empire State Plaza, Albany, New York 12237-0012, 

or by email to resume@health.state.ny.us with a subject line “OHIP Medical Director Position,” or by fax to (518) 474-6771.


Physicians Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology startup committed to delivering more affordable, accessible, high-quality primary care. To support our mission, the insights of forward-thinking physicians like you are invaluable. Members of our exclusive Primary Care Council have no clinical responsibilities and are compensated for their participation, which requires only a few hours annually.

Interested? Learn more and apply today at www.98point6.com/pcc 


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews – MSSNY Partners: “No to CVS-Aetna!”

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
August 10, 2018
Volume 20  Number 29

MSSNYPAC

Dear Colleagues:

I am happy to report that MSSNY now has partners in our opposition to the proposed CVS takeover of Aetna.

Earlier this year Immediate MSSNY Past President Dr. Charles Rothberg wrote to the New York Attorney General’s office and to the NY DFS to express our very serious concerns with this merger of health care behemoths. He also testified at an Assembly hearing in June examining the impact of this merger proposal where he shared our numerous concerns.

These concerns include the possibility of reduced community pharmacy options, increased prior authorization burdens, a reduction in health insurer competition, and the proliferation of corporate owned retail clinics. Our statements about these concerns were reported in several media publications.

AMA and California Insurance Commissioner Agree with MSSNY

Last week, the California Insurance Commissioner submitted a letter urging the US Department of Justice to block the merger because of the potentially “significant anti-competitive impacts on consumers and health care and health insurance markets”.  Commissioner Jones found that the proposed merger poses competitive concerns in the Medicare Part D market, where both companies currently compete, as well as in the highly-concentrated market for PBM services, and in the retail pharmacy market. This followed a June public hearing where the California Medical Association, the AMA and several legal professors raised serious concerns.

And this week the AMA released its own comprehensive analysis that was sent to the DOJ that also urged the DOJ to work to block the merger.  Earlier this year, the AMA had submitted testimony to the US House Judiciary Committee raising similar concerns.

MSSNY has shared these analyses with the NYS DFS. However, it is unknown whether DFS will make a similar request to the DOJ. No hearing has been planned as of yet.  However, a few weeks back, Superintendent Vullo was quoted in Politico-NY about her concerns with this proposed merger.   The Pharmacists Society of the State of NY has also urged action by regulators to reject this merger.

We are hopeful New York will view this merger in the same concerning way that California has. Stay tuned for further updates.

Please send your thoughts to comments@mssny.org.

Thomas J. Madejski, MD 
MSSNY President


Capital Update

NY DFS Announces Increased 2019 Premium Rates for Insurance Plans
Far Less than Requested by Insurers
The New York Department of Financial Services recently announced that the approved premiums for individual and small group health insurance plans for the 2019 policy year will increase by an average of 4.8% for 2019, an amount that was far less than what was proposed by health insurers.  To read the full press release, click here.

For the individual market, DFS noted that it reduced the insurers’ total average requested increase from 24% to 8.6%.  Notably, DFS reduced a 38.6% requested increase by Fidelis to 13.7%; a 23.6% requested increase by United to 1.5%;and rejected entirely a 24% requested increase by Empire.

For the small group market, DFS noted it reduced the insurers’ total average requested increase from 7.5% to 3.8%.  Notably, DFS reduced a16.2% requested increase by Aetna to 7.9%; an 8.3% from Oxford to 3%; and 7.2% requested increase by United to a 1% decrease.


CMS Proposes to Permit “Step Therapy” for Part B Drugs in Medicare
This week the Centers for Medicare & Medicaid Services (CMS) issued a guidance that will permit Medicare Advantage (MA) plans, beginning January 1, 2019, to have the option to implement “step therapy” to manage a patient’s use of medications covered by Medicare Part B.  Step therapy is a form of prior authorization whereby an insurer can make a patient “fail first” on alternative medication before the preferred medication is permitted to be covered by the insurer.

In its press release, CMS notes that MA plans will still be required to cover all medically necessary Part B drugs for beneficiaries. The beneficiary can ask the MA plan for an exception if they believe they need direct access to a drug that would otherwise only be available after trying an alternative drug.  The press release also notes that step therapy can only be applied to new prescriptions or administrations of Part B drugs for patients that are not actively receiving the affected medication, so that MA plans cannot disrupt ongoing Part B drug therapies for patients.

The guidance further provides that a patient subject to step therapy can ask the MA plan for an expedited exception if they believe they need direct access to a drug that would otherwise only be available after trying an alternative drug. Exception requests will be completed as expeditiously as the beneficiary’s health condition requires, generally within 72-hours. Furthermore, the release notes that, if a plan denies a beneficiary’s request, the beneficiary has the right to appeal and CMS will be monitoring appeals activity to ensure beneficiaries’ requests are appropriately evaluated.

MSSNY will be working with the AMA and other state medical societies to assure that there are necessary patient protections for step therapy use that are at least as favorable for patients as the law that passed in New York in 2016 applicable to patients enrolled in commercial and Medicaid managed care plans.  MSSNY advocated forcefully for this law together with other specialty societies and patient advocacy groups.

AMA President Dr. Barbara McEneny issued the following statement:

      “The AMA has serious concerns about the Administration’s guidance to allow Medicare        Advantage plans to use step therapy.  Physicians are concerned with patients getting the most effective treatment, and step therapy requirements frequently get in the way. Patients who already are subject to step therapy requirements must contend with denials for medications from health plans.  Physicians have no easy access to patient benefit and formulary information at the point of prescribing, so they will not be able to readily determine which drugs are preferred by their patients’ MA plans. This results in treatment delays and unnecessary red tape for physicians and patients.”


CMS Proposes Significant Restructuring of Medicare ACO Program to Increase Risk-Bearing
This week the Centers for Medicare & Medicaid Services (CMS) proposed a rule to significantly restructure the existing Medicare Accountable Care Organizations (ACO) program with the goal to “transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses).”   CMS projects the proposed rule would produce $2.24 billion in federal savings over 10 years.

In announcing the proposed rule, CMS Administrator Seema Verma noted that “the time has come to put real ‘accountability’ in Accountable Care Organizations.  Medicare cannot afford to support programs with weak incentives that do not deliver value,” adding that “most Medicare ACOs do not currently face any financial consequences when costs go up, and this has to change.”

The proposed rule would eliminate the existing Tracks 1 and 2 in the program and instead establish a new “BASIC track” allowing ACOs to “gain experience with more modest levels of performance-based risk on their way to accepting greater levels of performance-based risk over time.”  The current Track 3 would be renamed the “ENHANCED” track which will have higher levels of potential risk and reward.  More experienced ACOs would be limited to “higher-risk participation options,” and CMS would conduct more rigorous screening of certain ACOs.

CMS proposes to provide a 6-month extension for ACOs with agreements expiring in 2018, and a “special one-time July 1, 2019 start date that will have a spring 2019 application period for the new participation options.”

To read the CMS press release and additional information, click here.

To read CMS Administrator Verma’s justification for the program in Health Affairs, click here.

eNews

 

DOH

Effective Immediately: Marijuana Can Be Prescribed for Chronic Pain
On July 12, the New York State Department of Health announced the filing of emergency regulations adding any condition for which an opioid could be prescribed as a qualifying condition for medical marijuana. Effective immediately, registered practitioners may certify patients to use medical marijuana as a replacement for opioids, provided that the precise underlying condition for which an opioid would otherwise be prescribed is stated on the patient’s certification. This allows patients with severe pain that doesn’t meet the definition of chronic pain to use medical marijuana as a replacement for opioids.

In addition, the regulation adds opioid use disorder as an associated condition. This allows patients with opioid use disorder who are enrolled in a certified treatment program to use medical marijuana as an opioid replacement.

Plans to add opioid replacement as a qualifying condition for medical marijuana were first announced last month.

As of June 18, 2018, there are 59,327 certified patients and 1,697 registered practitioners participating in the program.

Opioid replacement joins the following 12 qualifying conditions under the state’s Medical Marijuana Program: cancer; HIV infection or AIDS; amyotrophic lateral sclerosis (ALS); Parkinson’s disease; multiple sclerosis; spinal cord injury with spasticity; epilepsy; inflammatory bowel disease; neuropathy; Huntington’s disease; post-traumatic stress disorder; and chronic pain.

The permanent regulations were published in the New York State Register on August 1, 2018, and will be subject to a 60-day public comment period.

In addition, certified patients and designated caregivers will be able to print temporary registry ID cards. (See notice below). This will allow them to purchase medical marijuana products more quickly after registering for the program. Patients may use the temporary registry ID card in conjunction with a government issued photo identification to purchase medical marijuana products from a registered organization’s dispensing facility. Prior to this enhancement to the Medical Marijuana Data Management System, it could take 7 to 10 days for patients and their caregivers to receive their registry identification cards after their registration was approved.

Other recent enhancements to New York’s Medical Marijuana Program include adopting new regulations to improve the program for patients, practitioners and registered organizations; authorizing five additional registered organizations to manufacture and dispense medical marijuana; adding chronic pain and PTSD as qualifying conditions; permitting home delivery; and empowering nurse practitioners and physician assistants to certify patients.

As of July 10, 2018, there are 62,256 certified patients and 1,735 registered practitioners participating in the program.

For more information on New York’s Medical Marijuana Program, go here.

The following is the public list for physicians registered with the medical marijuana program:
https://www.health.ny.gov/regulations/medical_marijuana/practitioner/public_list.htm


Emergency Medical Marijuana Regulations Effective Immediately
Temporary ID Cards will be available for certified patients to purchase products more quickly. Certified patients and designated prescribers will be able to print temporary registry ID cards.


DOH: Please Answer Survey re Social Determinants of Health Assessment Tool
The New York State Department of Health, Office of Health Insurance Programs, Bureau of Social Determinants of Health, is asking stakeholders to fill out this quick ten question survey regarding the creation and use of social determinants of health (SDH) assessment tool. A SDH assessment tool is defined as a survey or questionnaire that is administered to patients/clients/members to assess their level of vulnerability or accessibility to needed social determinants of health interventions including but not limited to:  food, housing, medication, child care, legal help, domestic violence services, employment, smoking cessation, sobriety services, and education.


New York City Online Pharmacy Plans To Expand Operations across US
The Wall Street Journal (8/8) reports that Capsule Corp., an online pharmacy, is preparing to expand its operations across the US. The company currently offers same-day delivery of prescription drugs in New York City, but plans to expand nationally over the next 18 months.


Hospital-At-Home Care: Potential to Improve Outcomes in Low-Risk Patients
Hospital-at-home (HaH) care offers acute hospital-level care for selected patients at home. In 2014, a New York healthcare system implemented a HaH care bundle with a 30-day postacute care period of home-based transitional care. Patients were admitted to HaH on weekdays from 8 a.m. to 4 p.m. only. HaH care was provided by a daily nurse visit and a daily assessment by a physician or nurse practitioner (in person or by video call). Services included vital sign measurements, administration of intravenous and oral medications, wound care, and patient education. For 30 days after discharge, nurses and social workers provided self-management support and coordination of outpatient care.

Compared with 212 control patients, 295 HaH patients had significantly shorter acute care length of stay (mean difference, 2.5 days); significantly higher patient satisfaction; and significantly lower 30-day hospital readmissions (16% vs. 9%), emergency department revisits (12% vs. 6%), and skilled nursing facility admissions (10% vs. 2%) in adjusted analyses. Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Federman AD et al. JAMA Intern Med 2018 Aug.


Analysis of ADHD Drugs: Use Methylphenidate in Kids, Amphetamines in Adults
A meta-analysis of the drugs used to treat attention-deficit/hyperactivity disorder in the short term finds the best choices to be methylphenidate in children and adolescents, and amphetamines in adults, according to a Lancet Psychiatry report.

Researchers examined efficacy and tolerability data from published and unpublished double-blind, randomized, controlled trials. The 133 trials included some 14,000 children and 10,000 adults. Other drugs evaluated in the “network meta-analysis,” which allows indirect comparisons of drugs not directly tested head-to-head, included atomoxetine, bupropion, clonidine, guanfacine, and modafinil.

Overall, results favored using methylphenidate in children and adolescents, and amphetamines in adults as first-line, short-term (12 weeks or under) treatment.

Asked to comment, Dr. Barbara Geller of NEJM Journal Watch Psychiatry wrote: “The two most effective drugs (methylphenidate for children, amphetamine for adults) should be prescribed first because they have good safety records after decades on the market.”

Lancet Psychiatry article

Background: Physician’s First Watch coverage of methylphenidate and improved ADHD symptoms in kids


Non-Alcohol Fatty Liver Disease Patients Should Still Avoid Alcohol
People who have non-alcoholic fatty liver disease “that wasn’t caused by heavy drinking may still need to avoid alcohol if they want to prevent their liver damage from getting worse,” according to a Korean study published in Hepatology. Researchers examined 58,927 young and middle-aged adults in Korea with the disease and “moderate drinkers were 29 percent more likely to have worse fibrosis” by the end of the eight-year study than those who abstained. Light drinkers “were also 6 percent more likely to have their fibrosis become more advanced than people who avoided alcohol altogether.”


SYMPOSIUMS/CONFERENCES

Garfunkel Wild ASC Symposium on Nov 2; MSSNY Members Receive $65 Discount
November 2, 2018 is Garfunkel Wild’s 5th Annual NY Metro ASC Symposium at the Marriott Marquis (Manhattan). Please find the agenda for the day and additional information by clicking here. 

MSSNY members will be entitled to a $65 discount. 


Nine Reads for Doctors from American Assoc. of Medical Schools

These books, from renowned physicians and other great science writers, will remind you why you went into medicine in the first place.

Classified

RENTAL/LEASING SPACE


Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.


Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews – Thoughts on New Marijuana Regs?

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
August 3, 2018
Volume 20  Number 28

MSSNYPAC

Dear Colleagues:

MSSNYPAC Sarasota Race Track

Day at the Races. Dr. Myrna Sanchez; Dr. Bill Latreille; Dr. John Kennedy; Barbara Ellman; Mrs. Pinto and Dr. Greg Pinto; and MSSNYPAC Chair Dr. Joe Sellers

Our best laid plans don’t always work out as intended. We had a splendid time at Saratoga Springs Race Track Saturday afternoon at MSSNYPAC’s Day at the Races.  We had physician members from all over New York State join us for an afternoon of camaraderie and widely variable statistical analysis.  We picked a couple of winners, but the house won in the end.  We hope to create similar events throughout the State for the enjoyment of our members, and to enhance MSSNYPAC funds.

My travels were not all fun and games.

I have heard from many MSSNY members about the emergency regulations on the use of marijuana for both pain and for opioid use disorder. As a result of these comments, I—along with other MSSNY representatives—met this week with NYS Department of Health officials to discuss these regulations and to gather additional information before submitting MSSNY’s comments on these regulations.

We met with Sally Dreslin, RN, deputy executive director of the New York State Department of Health (DOH); Richard Zahnleuter, Esq., DOH Counsel; Erin Hammond, DOH’s Office of Governmental Affairs; Josh Vinciguerra, Esq., director DOH’s Bureau of Narcotic Enforcement and Nicole K. Quackenbush, Pharm.D, Director, NYS DOH’s Medical Marijuana Program. MSSNY representatives included myself, Dr. Frank Dowling, MSSNY secretary and a member of the American Medical Association’s Task Force on Opioids; Dr. Jeffrey Selzer, Medical Director for the Committee on Physicians’ Health; Phil Schuh, C.P.A , M.S., MSSNY Executive Vice President; and Pat Clancy, MSSNY’s Sr. Vice President for Public Health and Education/Managing Director.

The topics we discussed included the use of marijuana for the purposes of “acute” pain and as an alternative for the treatment of opioid use disorder. Physicians can now certify a patient to use marijuana for both these conditions under the emergency regulations. However, in order to be eligible for a physician to certify them for marijuana, a patient must be in an OASAS approved program.. We discussed both the process for the regulations and the anecdotal evidence and expert opinion that the department used to make its decision to expand the use of marijuana for the treatment of these conditions.

The intent of the DOH’s regulations are laudable: to provide alternatives for treatment that may have less risk for patients with acute pain, and additional treatment options for opioid use disorder. Dr. Selzer, Dr. Dowling, and I expressed concern about the evidence base for expansion of the approved indications. The Health Department participants acknowledged that there are not well controlled long term studies available regarding the use of marijuana for the new indications, but felt that the expansion of treatment options as an alternative to opioids for pain and medication-assisted treatment for opioid use disorder outweighed the risks.  MSSNY expressed concern that with little long term data on efficacy and side effects, patients may be exposed to significant adverse reactions that could divert them from more effective treatments.

I am particularly concerned that promotion of marijuana use for opioid use disorder may worsen psychiatric co-morbidities, and give a false impression to patients that it is as effective as established effective treatments such as methadone and buprenorphine, particularly in the prevention of fatal opioid overdose.

DOH indicated that it is collecting data on medical marijuana usage, but is not involved in studies of efficacy of marijuana for the existing approved conditions at this time.  I will ask our Legislative Committee to consider— as part of our agenda—a request for the State to provide funding for research on the efficacy and long term effects of our experiment with marijuana.

My personal assessment of the available data and anecdotal experience is that marijuana is helpful in a small number of patients and a small number of conditions. One of the good parts of New York’s experiment is development of definable products that can be studied.  The expansion of opioid use two decades ago began with anecdotal experience and expert opinion that turned out to be incorrect, and subsequently promoted by industry to create the societal problem we are dealing with today.

History repeats itself, but sometimes in cunning disguise—so that we never detect the resemblance until the damage is done.

Primum non nocere! 

Please send your thoughts to comments@mssny.org.

Thomas J. Madejski, MD 
MSSNY President


eNews

Share Your Thoughts on New Marijuana Regulations
MSSNY will be formally submitting comments on these regulations in the near future and will involve its Addiction and Psychiatric Medicine Committee in the drafting of the comments.  Please share your thoughts and comments with us at comments@mssny.org.

DOH Adds Pain and Opioid Use Disorder as Conditions for Marijuana Use
The New York State Department of Health (DOH) has added pain and opioid use disorder as conditions that marijuana could be used under the New York State marijuana program.  Under regulations released earlier this month, a physician, nurse practitioner and/or a physician assistant can now certify patients for these conditions. However, a patient who suffers from opioid use disorder must be in an OASAS program in order to qualify for use of marijuana.  A copy of the emergency regulations can be found here.

Additionally, the DOH released its interagency report on recreational marijuana in New York State.   The report, entitled, “Assessment of the Potential Impact of Regulated Marijuana in New York State,” concludes that the “positive effects of a regulated marijuana market in NYS outweigh the potential negative impacts. Areas that may be a cause for concern can be mitigated with regulation and proper use of public education that is tailored to address key populations. Incorporating proper metrics and indicators will ensure rigorous and ongoing evaluation.” The report was issued by the DOH under the direction of Governor Andrew Cuomo, who directed NYS agencies to evaluate the health, public safety and economic impact of legalizing marijuana. The report, to MSSNY knowledge, did not involve any outside medical groups or organizations in making this assessment. A copy of the report can be found here.

Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!
MSSNY is pleased to announce our newest member benefit!  Our new Abenity App provides members with exclusive perks and over $4,500 in savings on everything from restaurants, City Pass, AMC movie tickets, theme parks, hotels, car rentals, mortgage savings, auto care and much more!

Popular Features Include:

  • Nearby Offers: Use our show and save mobile coupons to quickly access savings on the go.
  • eTickets On Demand: Save up to 40% with no hidden fees.
  • Showtimes: Find movies, watch trailers, and save up to 40% at a theater near you.
  • Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!

REGISTER & LOG IN

Click on the following link: http://mssny.abenity.com and then create a unique username and password.

ZocDoc Update
We posted a note in our last newsletter regarding Zocdoc’s plans to change their pricing model.  MSSNY, together with its General Counsel, Garfunkel Wild, P.C., has been engaged in discussions with Zocdoc to better understand and analyze the planned changes and engage in what we anticipate will be productive conversations on behalf of our members.

To enable physicians to provide feedback and to enable Zocdoc and MSSNY time to work collaboratively together in advance of any changes, Zocdoc will not be moving forward with changes to its pricing model in October. Zocdoc has indicated that they are committed to taking the time necessary to better understand the feedback that we have received from members.  We will provide updates as these discussions continue.

Summer is a Great Time to Catch Up on CME
MSSNY now has more than 30 modules on our CME website (note: new users to the site will need to create an account).  You can earn free CME credits on emergency preparedness topics that range from Anthrax to Zika Virus.  We also have modules on Veterans Matters as well as diabetes prevention and concussion in pediatric and adult patients—including a CME accredited podcast on the same topic.

MSSNY also has more than ten informative podcasts that you can listen to here. There are multiple brief podcasts on immunizations and MSSNY’s Physician’s Emergency Preparedness Toolkit.  Each podcast offers insights from medical experts. 

New York’s Single-Payer Bill Would Require 156% Increase in Tax Revenue
Crain’s New York Business (8/1, LaMantia) reports on the New York Health Act, a proposal that would create a statewide single-payer health plan in New York, that has passed the Assembly in each of the past four years, but “it hasn’t advanced in the Republican-controlled Senate.” Research from the Rand Corp. and the New York State Health Foundation into the legislation found that in order “to finance the program, the state would need to raise an extra $139 billion in taxes, a 156% increase compared with the $89 billion expected in 2022.” The study considered a new tax structure which would increase taxes on the wealthy.

Does Your Practice Use Social Media? Learn about Risks and Inappropriate Use
The use of social media by medical practices allows them to better market their services and share important medical information with current and prospective patients. However, there are a number of concerns associated with the use of social media, including advertising risks, breaches of patient confidentiality and inappropriate use. Join the Medical Society of Queens, in collaboration with MLMIC, for a one-hour presentation entitled Social Media in Healthcare. The presentation by William Hassett, Esq., will review the unique benefits and appropriate use of social media in a practice and will address the associated liability issues and offer strategies to minimize the risks.
When
: Wednesday, August 15, 2018, 8:30-9:30 am
Where: Medical Society of the County of Queens, 112-25 Queens Blvd, 4th Fl, Suite 1, Forest Hills 11375. Click here for more information.

Nominations Open for 2017 Albion O. Bernstein, MD, Award
The Medical Society of the State of New York is accepting nominations for the 2017 Albion O. Bernstein, MD Award.  This prestigious award is given to: “…the physician, surgeon or scientist who shall have made the most widely beneficial discovery or developed the most useful method in medicine, surgery or in the prevention of disease in the twelve months prior to December, 2017.”

This award was endowed by the late Morris J. Bernstein in memory of his son, a physician who died in an accident while answering a hospital call in November, 1940.

The $2,000 award will be presented to the recipient during a MSSNY Council Meeting.  Nominations must be submitted on an official application form and must include the nominator’s narrative description of the significance of the candidate’s achievements as well as the candidate’s curriculum vitae, including a list of publications or other contributions.

To request an application, please contact: Committee on Continuing Medical Education, Miriam Hardin, PhD, Manager, Continuing Medical Education, Medical Society of the State of New York, 99 Washington Avenue, Suite 408, Albany, NY 12210 or call 518-465-8085 or email mhardin@mssny.org.

SYMPOSIUMS/CONFERENCES

Garfunkel Wild ASC Symposium on Nov 2; MSSNY Members Receive $65 Discount
November 2, 2018 is Garfunkel Wild’s 5th Annual NY Metro ASC Symposium at the Marriott Marquis (Manhattan). Please find the agenda for the day and additional information by clicking here: https://www.nymetroasc.com/

MSSNY members will be entitled to a $65 discount. 

Classified

RENTAL/LEASING SPACE


Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.


Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


PHYSICIAN OPPORTUNITIES


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews: Discount Perks for Members

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
July 27, 2018
Volume 20  Number 27

MSSNYPAC

Dear Colleagues:

Hopefully, when you receive this week’s Enews, I’ll be on a golf course in Vermont.  I share that information not to highlight my hopefully improving golf swing, but to remind our MSSNY members and each one of us that in order to take good care of our patients we need to take good care of ourselves.  Some of MSSNY’s most important work over the last few years has been on promoting and maintaining physician health. We’ve developed a number of resources for members individually and for our organizational partners to promote physician health

Our Committee on Physician Wellness and Resilience continues its excellent work to provide new tools and outreach to our members including a Speakers Bureau to help improve the practice environment and reduce factors that can lead to poor health and affect the care of our patients. (See article below.)

Each of us is responsible to our patients, and that implies a responsibility to improve and maintain our health personally. I encourage you to reconnect with your personal physician to reassess, maintain and improve your health.  Find some time (after discussion with your physician) to exercise on a regular basis, improve your diet if necessary, and spend time with your loved ones.  Seek some joy outside of the satisfaction that helping your patients through their challenges provides to you.

Trying to implement your plan can be a challenge. I’m combining my golf with some MSSNY activities, friend and family visits and our first MSSNY Day at the Races at Saratoga Springs tomorrow.  I’m looking forward to a great time with MSSNYPAC members and other friends and expect a splendid time to be had by all!

Memento Vivere!

Please send your thoughts to comments@mssny.org.

Thomas J. Madejski, MD 
MSSNY President


eNews
MEMBER BENEFIT

Join MSSNY’s Member Perks Program and Enjoy $4,500 in Savings!
MSSNY is pleased to announce our newest member benefit!  Our new Abenity App provides members with exclusive perks and over $4,500 in savings on everything from restaurants, City Pass, AMC movie tickets, theme parks, hotels, car rentals, mortgage savings, auto care and much more!

Popular Features Include:

  • Nearby Offers: Use our show and save mobile coupons to quickly access savings on the go.
  • eTickets On Demand: Save up to 40% with no hidden fees.
  • Showtimes: Find movies, watch trailers, and save up to 40% at a theater near you.
  • Monthly Giveaways: Win cash, movie tickets, electronics and more with our monthly contests.

And, with over 302,000 available discounts across 10,000 cities in the United States and Canada, you’ll never be far from savings!

REGISTER & LOG IN

Click on the following link: http://mssny.abenity.com and then create a unique username and password 

New Pricing for Zoc Doc
Several MSSNY physician members have expressed concerns with the new pricing rules announced by Zoc Doc for their marketing and scheduling services.  MSSNY is currently exploring the situation with our General Counsel, Garfunkel Wild and will keep members apprised in the coming weeks.

DOH

NYC Health Department Re-Opening Electronic Death Registry in October
The NYC Health Department will again attempt to roll out an electronic death registration program that was plagued with glitches in October – and critics say the timing is problematic.

The $5.8 million “eVital” system launched in October of 2017 using facial recognition software so funeral directors and doctors could log in using cellphone selfies. But some morticians and doctors could not access the system, forcing the agency to pull it within days of launching.

Because burials and cremations require a signed death certificate, funeral home directors had to scramble to pick up certificates in person at hospitals and doctors’ offices. Then they had to deliver them to the Health Department’s Burial Desk to obtain the burial permit.

Some families waited days to bury loved ones – a disaster for the Jewish and Muslim communities whose customs require burials “as soon as possible,” according to Noor Rabah, president of the Muslim Funeral Services.

When eVital is re-launched on Oct. 1, there will be a 48-hour window between the time the existing “Electronic Vital Events Registration System” is taken down and the eVital system goes up – meaning morticians and doctors will be forced to use the same manual process that delayed burials in the fall. (NY Post July 22)

WORKERS COMP

Workers’ Compensation Changes
We seem to be on a roll.  Last week, we informed you about significant changes being proposed by CMS for the physician fee schedule. This week I am happy to report that the NYS Workers’ Compensation Board has listened to us and is intent on reducing physician burden and enticing more participation in its program.

The New York State Workers’ Compensation Board (Board) will replace the current Board treatment forms: Doctor’s Initial Report (Form C-4), Doctor’s Progress Report (Form C-4.2), Occupational/Physical Therapist’s Report (Form OT/PT-4), Psychologist’s Report (Form PS-4), and Ancillary Medical Report (Form C-AMR) with the CMS-1500 to help reduce paperwork and lower provider administrative burdens. This initiative will leverage providers’ current medical billing software and medical records while promoting a more efficient workers’ compensation system.

Beginning January 1, 2019, physicians may voluntarily transmit CMS-1500 medical bills (and required medical narratives, and/or attachments as applicable) through an approved XML Submission Partner (“clearinghouse”) to workers’ compensation insurers/payers. Guidance on required medical narratives and attachments is available on the Board’s website.  If a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A listing of approved clearinghouses for the CMS-1500 will be posted on the XML Forms Submission section of the Board’s website after each entity successfully completes testing and executes an XML Submission Partner agreement with the Board.

Workers’ compensation insurers/payers will accept CMS-1500 medical billing files from clearinghouses and electronically return acknowledgments of receipt of CMS-1500 files. Such acknowledgements (including receipt date) will be forwarded from the clearinghouses back to providers and the Board.

The Board will receive CMS-1500 files, narrative attachments and acknowledgements of receipt from clearinghouses in a designated XML format. The CMS-1500 forms and narrative attachments will be combined and displayed in the applicable claimants WCB case folders.

MSSNY’s Committee on Worker’s Compensation and No-Fault Insurance has been asking the Board to make these accommodations for several years.  Using the CMS 1500 is anticipated to be less cumbersome than the former C4 Forms and filing electronically should help to alleviate many of the filing difficulties resulting from the limitations and hassles of paper claims.

For more information on this matter, please click here.

560-Member Med Group Expands Risk-Based Contracts– Aetna, Anthem, WellCare
CareMount Medical Group, a 560-physician group in Chappaqua, N.Y., inked risk-based agreements with three Medicare Advantage health insurers: Aetna, Anthem and WellCare.

“By partnering with these top plans, we are focusing on the importance of preventive and value-based care for our senior patients,” said Scott D. Hayworth, MD, president and CEO of CareMount Medical. CareMount, one of the largest independent multispecialty medical groups in New York State, joined CMS’ Next Generation ACO model under its managed care subsidiary, CareMount ACO, in April. CareMount currently serves about 40,000 Medicare Advantage members under advanced-risk based contracts. (Becker’s Hospital Review, July20)

News from MSSNY’s Committee on Physician Wellness and Resilience:

MSSNY Speakers Available to Address Groups Regarding Physician Burnout
The MSSNY Committee on Physician Wellness and Resilience offers resources to help address the increasingly serious challenge posed by stress and burnout in the medical profession. The Committee’s Speakers Bureau is pleased to offer presentations on the causes, effects and treatment of physician burnout.  These were developed for three different audiences to provide insight and effective approaches that can be taken to address the problem.

If interested in scheduling a presentation for your medical staff, group practice, county medical society, residency program, or other meeting, please contact sbennett@mssny.org to make arrangements.

Please specify which kind of presentation you are seeking:

  • One geared for individual physicians, on ways to reduce stress
  • One for health system administrators, on actions that can be taken to reduce institutional stressors
  • One for other stakeholders, such as health insurers, malpractice carriers, etc.

The committee plans to enlist other MSSNY members to add to the ranks of possible presenters on this topic.  We are grateful to have heard from a number of volunteers already.  Plans are now being prepared to familiarize volunteers with our presentations, and committee representatives will be following up with all volunteers soon.

If you would be interested in having one or more of our prepared presentations to your group or institution, and haven’t volunteered already, please contact sbennett@mssny.org, and we’ll include you as part of our Speaker’s Bureau on Physician Wellness and Resilience.

SYMPOSIUMS/CONFERENCES

Garfunkel Wild ASC Symposium on Nov 2; MSSNY Members Receive $65 Discount
November 2, 2018 is Garfunkel Wild’s 5th Annual NY Metro ASC Symposium at the Marriott Marquis (Manhattan). Please find the agenda for the day and additional information by clicking here.

MSSNY members will be entitled to a $65 discount. 

NYSSPA 2018 CME Conference in Albany
The New York State Society of Physicians Assistants are holding their 2018 Conference on Thursday, October 4 through Sunday, October 7 at the Hilton Albany. For more information, go here.

Some Benefits of the Merrill Lynch Bank of America Doctor Loan Program

  1. Put as little as 5% down on mortgages up to $1 million
  2. 10% down on mortgages up to $1.5 million – customized solutions available for amounts over $1.5 million
  3. Exclude your student loan debt from the total debt calculation – gives you a lower debt/income ratio which helps justify a lower mortgage rate (benefit varies for each individual calculation
  4. Close on your new home up to 90 days prior to starting your new position – get a mortgage before you start a new job (need a valid state medical license in state where job is located and real estate is located) Contact Dennis Singh, CRPC®, CFP® at Merrill Lynch 516.498.3356; Dennis.Singh@ML.com
FDA

FDA Approves First Treatment for Smallpox
On June 13, U.S. regulators approved the first treatment for smallpox although it was eradicated worldwide by 1980 after a huge vaccination campaign. People born since then haven’t been vaccinated, and small samples of the smallpox virus were saved for research purposes, leaving the possibility it could be used as a biological weapon.

Maker SIGA Technologies of New York has already delivered 2 million treatments that will be stockpiled by the government, which partially paid for the development of the drug, called TPOXX.

To test the drug’s effectiveness, monkeys and rabbits were infected with a similar virus and then given the drug. More than 90 percent survived, the company said. Vaccination can be used to prevent infection but it must be done within five days of exposure to the virus, well before symptoms appear. The drug is a capsule, taken twice daily for 14 days. “This new treatment affords us an additional option should smallpox ever be used as a bioweapon,” Dr. Scott Gottlieb, head of the Food and Drug Administration, said in a statement.

MEDICARE

In Case You Missed It – Recording of Panel Discussion on E/M Coding Reform
In case you missed it last week, see below for a link to the webcast of the panel discussion on Evaluation & Management Coding:

New Medicare Cards Coming to New York Throughout August
This week and throughout August, the Centers for Medicare & Medicaid Services (CMS) will be automatically mailing new Medicare cards to more than 3.5 million people with Medicare in New York State.

Key features of the new card and rollout process:

  • Social Security Numbers have been replaced with new unique identifying numbers.
  • Social Security numbers are no longer on the new Medicare, helping protect people with Medicare from identity theft and CMS fight fraud.
  • The new Medicare card is free. Avoid scammers by knowing that CMS will not call people with Medicare asking for any personal information, your Social Security Number, bank information, or to pay for the new Medicare card.
  • People with Medicare can sign up for email notifications on when the new cards will be mailed to their area by going to www.medicare.gov/newcard.
  • There are no changes to Medicare benefits. Once you receive your New Medicare card, you should destroy your old Medicare card by shredding or cutting it up with scissors.

New Medicare card fact sheets, graphics, b-roll, images and other resources can be accessed here. 

Classified

RENTAL/LEASING SPACE


Upper East Side Plastic Surgery Office Available for Rent Part Time
Located in posh Carriage House off Park Avenue with fully certified operative suite (AAAASF). OR can be rented separately.  OR Packages available for multiple case use. Please contact 212-628-7600between 11am and 6pm for further information.


Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed built out 4 exam rooms with sinks and wall cabinets
Waiting and reception areas, windows throughout.
Street and private entrances, two bathrooms and storage/lab/staff room.
One block to bus and two blocks to Presbyterian Medical Center and subway.
$1900-$7900/ month for one to 4 exam rooms.
Drdese@gmail.com or 917.8618273



PHYSICIAN OPPORTUNITIES


Practice Monitor Sought
Physician licensed in New York practicing Internal Medicine wanted for position as practice monitor for physician actively engaged in the private practice of Internal Medicine in New York State. Generous salary package offered. A total of eight quarterly very brief reports to be made by the practice monitor over a period of 24 months to The New York State Department of Education,

Office of the Professions, Albany, New York 12234. Contact perlinm@earthlink.net


Paging Primary Care Doctors Who Love Technology
98point6 is a healthcare technology startup that needs your input.  We’re seeking practicing physicians to join our Primary Care Council to help shape the future of primary care.  If the fusion of healthcare and technology inspires you, please join us and apply today. Visit: www.98point6.com/about/pcc/


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSSNY eNews: CMS Chucking 6 Visit Codes

Thomas J. Madejski, MD MSSNY President
PRESIDENT’S MESSAGE

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
July 20, 2018
Volume 20  Number 26

MSSNYPAC

Dear Colleagues:

Your calls to MSSNY demanding that CMS improve patient care are being heard!

CMS heard your stories of physicians looking at computer screens rather than looking at patients. They heard about our resident physicians spending more time on documentation than time spent listening to, examining, and caring for their patients.

CMS is proposing to reduce the hassle of medical record documentation.

Simplifying Documentation

Beginning January 1, 2019, CMS proposes to simplify documentation for the purposes of coding E/M visit levels.

CMS proposes to allow practitioners to choose, as an alternative to the current framework specified under the 1995 or 1997 guidelines, either Medical Decision Making (MDM) or time as a basis to determine the appropriate level of E/M visit. This would allow different practitioners in different specialties to choose to document the factor(s) that matter most given the nature of their clinical practice.

The proposed rule identifies that CMS acknowledges that the coding, payment, and documentation requirements for E/M visits are overly burdensome and no longer aligned with the current practice of medicine. CMS proposes to simplify the office-based and outpatient E/M payment rates and documentation requirements, and create new add-on codes to better capture the differential resources involved in furnishing certain types of E/M visits. CMS is proposing to simplify payment for E/M levels 2 through 5. CMS indicates that eliminating the distinction in payment between visit levels 2 through 5 will eliminate the need to audit against the visit levels, and therefore, will provide immediate relief from the burden of documentation. A single payment rate will also eliminate the increasingly outdated distinction between the kinds of visits that are reflected in the current CPT code levels in both the coding and the associated documentation rules.

The rule also outlines CMS’ proposals on the following and much more:

  • Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services
  • Eliminating Extra Documentation Requirements for Home Visits
  • Eliminating Prohibition on Billing Same-Day Visits by Practitioners of the Same Group and Specialty Physician Self-Referral Law
  • CY 2019 Updates to the Quality Payment Program

For more information about additional changes, please review the CY 2019 Physician Fee Schedule proposed rule (currently 1473 pages!)

MSSNY Will Keep You Posted

I have tasked our MSSNY staff and committees with reviewing the proposal further.  The devil is in the details. What will the effect of the proposed rule change be on physicians’ practice revenue?  Is CMS committed to further payment reform and funding to cover the cost of increasingly complicated patients in an aging society, and reduce other government generated documentation requirements? Will simplified documentation protect our physician members in our increasingly litigious society?  CMS is seeking our input on these proposals.  You may submit electronic comments on this regulation hereFollow the “Submit a comment” instructions.

Please share your thoughts with me as MSSNY crafts our response to this welcome overture from Seema Varma and CMS at comments@mssny.org

Welcome New Members!

On a lighter note, I would like to welcome our new members from Northwell and the General Physician PC, a large, multi-specialty group practicing in northwest New York.

Caveat Emptor!

Thomas J. Madejski, MD 
MSSNY President


eNews

All Employers Must Act By October 9, 2018 to Comply With the New York State Mandate Requiring Sexual Harassment Training
On April 12, 2018, New York State Governor Andrew Cuomo signed into law new measures aimed at preventing sexual harassment which require prompt action by all New York State employers, regardless of the number of employees they have. Notable highlights include:

  • Required Sexual Harassment Training. By October 9, 2018, all employers must comply with a requirement of conducting annual sexual harassment training. Training must be in-person and interactive, and computer training will no longer be deemed sufficient to meet the requirement.
  • Mandatory Sexual Harassment Policies. By October 9, 2018, employers must adopt a written sexual-harassment prevention policy and distribute it to employees. New York City will be mandating similar requirements that will be effective in April 2019.

We want to be sure you are aware of this requirement and that it applies to medical societies, hospitals, group practices and to every independent physician who has even one employee.

We have asked attorneys from Garfunkel Wild, P.C., MSSNY’s General Counsel, to be available to help members in meeting the requirement.  Garfunkel Wild has a history of providing clients with sexual harassment training, handling internal investigations, litigating sexual harassment cases as well as drafting and reviewing sexual harassment policies.

Call 516-393-2200 to help your practice meet the requirements. 

Med Marijuana: Prescribe for Any Condition Where an Opioid Could Be Used
The NYS Department of Health finalized its emergency regulation, effective immediately, authorizing prescriptions for medical marijuana for any condition for which an opioid could be prescribed. Permanent regulations will be published Aug. 1 and will be subject to a 60-day comment period.

GOLF OPPORTUNITIES – JULY 30 & 31 – CAPITAL REGION
MSSNYPAC has golf opportunities for physicians available on July 30 and July 31 in the Albany area.  If you are interested in representing MSSNYPAC on either date and can travel to Albany, please inquire by calling 518-465-8085 and ask for Jennifer Wilks.  

PHYSICIANS’ DAY AT THE RACES – SAT., JULY 28, 2018 – TICKETS AVAILABLE
We have SIX remaining tickets available for race day in Saratoga Springs.  Please contact Jennifer Wilks at 518-465-8085 to reserve your seat.  Visit www.mssnypac.org/events for details.

Garfunkel Wild: Free Webinar “Right to Try” on Tuesday, August 7

  • Complimentary Webinar “Right to Try” Act: What You Need to Know
  • When: Tuesday, August 7, 2018
  • Time: 12:00 PM – 1:00 PM EST
  • On May 30, 2018, a new Federal “right to try” act became effective which gives patients with life-threatening conditions the right to use experimental medications without the approval of the Food and Drug Administration. This new Federal law can have a dramatic impact on Physicians and Patients confronting physical illness.

Join us as we explore the consequences and questions of this new law. More information here.

This activity has been planned and implemented in accordance with the accreditation requirements and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Medical Society of the State of New York (MSSNY) and Garfunkel Wild, PC.  MSSNY is accredited by 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 Credit™.   Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

New York State Drug Take-Back Bill Becomes Law
Governor Andrew Cuomo signed the Drug Take-Back Act, which requires pharmaceutical manufacturers to finance and manage the safe collection and disposal of unused medications. The law requires pharmacies with ten or more locations to participate as drug collection sites to help ensure convenient access for residents. The law takes effect in 180 days. Program implementation will begin in mid-2019.

Unused medications accumulate in the home, where they are accessible to potential abusers and a danger to seniors, children, and pets. When improperly disposed down the drain or in the trash, unused drugs contaminate New York waterways and harm aquatic organisms. New York is the fourth state to require manufacturers to fund and safely manage drug take-back, preceded by Massachusetts, Vermont, and Washington, along with 22 local governments throughout the U.S.

The new law designates the New York State Department of Health (DOH) to oversee the program. Notably, the legislation gives pharmacies and other collectors the option to use kiosks, mail-back, or “other” approved systems.

4th Columbia Psychosomatics Conference – Oct 20-21, 2018 NYC
“Healing Unexplainable Pain: Advances in Multidisciplinary Integrated Psychosomatic Care”

Conference: Healing Unexplainable Pain at Columbia Medical Center Oct 20-21
Columbia University Medical Center & Office of Mental Health of the State of New York presents:

4th Columbia Psychosomatics Conference – Healing Unexplainable Pain: Advances in Multidisciplinary Integrated Psychosomatic Care

Lectures and workshops by multidisciplinary world experts in research and treatment of psychosomatic disordersConference Chairs: Alla Landa, PhD, Harald Gündel, MD, Brian A. Fallon, MD, Philip R. Muskin, MD

When: October 20 – October 21, 2018
Where: New York State Psychiatric Institute at Columbia University Medical Center, 1051 Riverside Drive, NY, NY

Advanced registration is encouraged at the number of seats is limited!
For information on CME, complete program, and to register please go here.

Emergency Physicians, Georgia Medical Association Sue Anthem
The Medical Association of Georgia and the American College of Emergency Physicians sued Anthem for denying payment for some emergency department services, according to a Bloomberg report.

A few facts about the lawsuit:

  • The medical groups filed their suit July 17 in Atlanta’s U.S. District Court against Anthem subsidiary Blue Cross Blue Shield of Georgia. The physicians requested the court require Anthem to cover any denied ED claims and to stop its policy.
  • Anthem implemented a new ER policy in Georgia in 2017. Under the policy, Anthem reviews diagnoses after members’ emergency room visits. If the condition is determined to be non-emergent, Anthem may not cover the ER visit. The policy is effective in Kentucky, Missouri, Ohio, New Hampshire and Indiana, according to Bloomberg‘s reading of the lawsuit.
  • In their filing, the physicians claimed, “Providers and patients alike are operating in fear of denial of payment by defendants when patients seek emergency department care.”
FDA

FDA: Draft Guidelines That Aim To Make More Drugs Available Without Script
Bloomberg News (7/17) reports the Food and Drug Administration issued a draft guideline that aims to make it easier for patients to access certain common drugs without a prescription. The idea resurfaced in 2012 when the FDA evaluated whether to reclassify treatments for high blood pressure, cholesterol, migraines and asthma as nonprescription. The market for such medicines is vast: Global sales of cholesterol-lowering drugs totaled $7.33 billion last year, according to Bloomberg Intelligence. Slightly more than half of U.S. adults, or about 43 million people, who need cholesterol medication are taking it, according to the CDC. About 75 million Americans, or one out of every three adults, have high blood pressure, though only about half of them have the condition under control, according to the CDC..

WORKERS COMP

Board Announces Technical Specifications for CMS-1500 Initiative
As announced on April 17, 2018, in Subject Number 046-1058 Proposals to Improve Medical Care for   Injured Workers, the New York State Workers’ Compensation Board (Board) will replace the current Board treatment forms: Doctor’s Initial Report (Form C-4), Doctor’s Progress Report (Form C-4.2), Occupational/Physical Therapist’s Report (Form OT/PT-4), Psychologist’s Report (Form PS-4), and Ancillary Medical Report (Form C-AMR) with the CMS-1500 to help reduce paperwork and lower provider administrative burdens. This initiative will leverage providers’ current medical billing software and medical records while promoting a more efficient workers’ compensation system. It is expected that the initiative will roll out in three phases, as follows:

Phase 1: Commencing January 1, 2019:

  • Providers may voluntarily transmit CMS-1500 medical bills (and required medical narratives, and/or attachments as applicable) through an approved XML Submission Partner (“clearinghouse”) to workers’ compensation insurers/payers. Guidance on required medical narratives and attachments is available on the Board’s website. As previously conveyed in Subject Number 046-785, if a CMS-1500 is submitted without the detailed narrative report or office note, it is not a valid bill submission. A listing of approved clearinghouses for the CMS-1500 will be posted on the XML Forms Submission section of the Board’s website after each entity successfully completes testing and executes an XML Submission Partner agreement with the Board.
  • Workers’ compensation insurers/payers will accept CMS-1500 medical billing files from clearinghouses and electronically return acknowledgments of receipt of CMS-1500 files. Such acknowledgements (including receipt date) will be forwarded from the clearinghouses back to providers and the Board.
  • The Board will receive CMS-1500 files, narrative attachments and acknowledgements of receipt from clearinghouses in a designated XML format. The CMS-1500 forms and narrative attachments will be combined and displayed in the applicable claimants WCB case folders

Phase 2: On or about July 1, 2019:

  • Workers’ compensation insurers/payers will electronically transmit Explanations of Benefits (EOB) to their clearinghouses upon adjudication of the associated electronic CMS-1500 medical bills. Such EOB data will be forwarded from the clearinghouses back to providers and the Board.
  • The Board will receive EOB data from clearinghouses in a designated XML format.
  • The Board plans to eliminate the requirement for the insurer/payer to file Form C-8.1B or C-8.4 form (to object to full or partial payment of a medical bill) when an EOB for the medical bill was transmitted through the clearinghouse and the Provider may file Health Provider’s Request for Decision on Unpaid Medical Billing (Form HP-1) (based on receipt of EOB).

Phase 3: On or about January 1, 2020:

  • Providers will be required to submit electronic CMS-1500 medical bills (and required medical narratives, as applicable) through their clearinghouses to workers’ compensation insurers/payers and to receive EOBs back through their clearinghouse.
  • Providers will be required to electronically transmit any disputes for unpaid medical bills to their clearinghouse using the Board-prescribed form. The clearinghouses will electronically transmit medical disputes to the Board in a designated XML format. The Board will eliminate Forms C-4, EC-4, C-4.2, EC-4.2, C-4.1, PS-4, C-4AMR, EC-4AMR, OT/PT-4, EOT/PT4 and EC-4NARR forms. Web submission and XML submission of these forms will no longer be available.
  • The Board will establish a hardship exception process for providers who are unable to meet the mandatory electronic reporting requirements.

Visit the CMS-1500 Initiative section of the website to access technical specifications for the CMS-1500 medical billing and associated acknowledgement data and to find periodic updates.

Please direct questions to CMS1500@wcb.ny.gov.

RESIDENTS

NRMP Publishes New Interactive Data Tools for Main Residency Match Applicants
The National Resident Matching Program (NRMP®) is pleased to announce the availability of two new data tools for applicants participating in the Main Residency Match®. The Interactive Charting Outcomes in the Match allows applicants to compare their personal characteristics with those of prior year applicants who did and did not match to their preferred specialties (the specialty ranked first on the applicant’s rank order list).  The At-A-Glance Program Director Survey includes charts and data tables that capture specialty-specific program director feedback on the criteria used to select applicants to interview and rank.

The Interactive Charting Outcomes in the Match and At-A-Glance Program Director Survey can be accessed from the NRMP website.  Both tools complement the complete Charting Outcomes in the Match and Results of the 2018 Program Director Survey published earlier this month. Copies of the complete PDF reports are housed on the Main Residency Match Data and Reports page.

MEDICIAD

NY Medicaid EHR Incentive Program: Now accepting 2017 Attestations
Effective July 16, 2018, eligible professionals (EPs) may attest 2017 Meaningful Use in MEIPASS at https://meipass.emedny.org/ehr/login.xhtml. EPs have the option to report on either Modified Stage 2 or Stage 3 measures.

2017 attestations shall be submitted completely online via MEIPASS. EPs do not have to mail hard copies of their 2017 Meaningful Use attestations to the NY Medicaid EHR Incentive Program.

The deadline to attest 2017 Meaningful Use is October 15, 2018. Accommodations will be granted to EPs whose 2016 attestations are still pending review.

MEIPASS video tutorials and reference materials are available at https://health.ny.gov/ehr. For additional assistance, please contact program support at 1-877-646-5410 or hit@health.ny.gov.

CMS

The Deadline for Submitting MIPS Targeted Review Request Is Now October 1
If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is now available for review on the Quality Payment Program website. The payment adjustment you will receive in 2019 is based on this final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2019.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including those who are subject to the APM scoring standard may request for CMS to review their performance feedback and final score through a process called targeted review.

When to Request a Targeted Review

If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1, 2018 at 8:00pm (EDT). The following are examples of circumstances in which you may wish to request a targeted review:

  • Errors or data quality issues on the measures and activities you submitted
  • Eligibility issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)
  • Being erroneously excluded from the APM participation list and not being scored under APM scoring standard
  • Not being automatically reweighted even though you qualify for automatic reweighting due to the 2017 extreme and uncontrollable circumstances policy

Note: This is not a comprehensive list of circumstances. CMS encourages you to submit a request form if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by:

  • Going to the Quality Payment Program website
  • Logging in using your Enterprise Identity Management (EIDM) credentials; these are the same EIDM credentials that allowed you to submit your MIPS data. Please refer to the EIDM User Guide for additional details.

When evaluating a targeted review request, we will generally require additional documentation to support the request. If your targeted review request is approved, CMS will update your final score and associated payment adjustment (if applicable), as soon as technically feasible. CMS will determine the amount of the upward payment adjustments after the conclusion of the targeted review submission period. Please note that targeted review decisions are final and not eligible for further review.

For more information about how to request a targeted review, please refer to the Targeted Review of the 2019 Merit-based Incentive Payment System Payment Adjustment Fact Sheet and the Targeted Review of 2019 MIPS Payment Adjustment User Guide.

Classified

RENTAL/LEASING SPACE


Orthopedist to Rent Space
Sports Medicine Multidisciplinary Practice. MIDTOWN MANHATTAN. Exclusive Referrals Available
Turn key operation with full services. Unique opportunity with little to no risk.
Excellent for satellite or primary office. Flexible options available.
Inquire with director@manhattanspine.com www.manhattanmd.com

Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers. With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up


For Rent – Medical Office 715 W 170 Street New York
Ground floor just completed built out 4 exam rooms with sinks and wall cabinets
Waiting and reception areas, windows throughout.
Street and private entrances, two bathrooms and storage/lab/staff room.
One block to bus and two blocks to Presbyterian Medical Center and subway.
$1900-$7900/ month for one to 4 exam rooms.
Drdese@gmail.com or 917.8618273



PHYSICIAN OPPORTUNITIES


Practice Monitor Sought
Physician licensed in New York practicing Internal Medicine wanted for position as practice monitor for physician actively engaged in the private practice of Internal Medicine in New York State. Generous salary package offered. A total of eight quarterly very brief reports to be made by the practice monitor over a period of 24 months to The New York State Department of Education,

Office of the Professions, Albany, New York 12234. Contact norwalkmd@earthlink.net


Paging Primary Care Doctors Who Love Technology
98point6 is a healthcare technology startup that needs your input.  We’re seeking practicing physicians to join our Primary Care Council to help shape the future of primary care.  If the fusion of healthcare and technology inspires you, please join us and apply today. Visit: www.98point6.com/about/pcc/


Chief of Medical Services
MINIMUM QUALIFICATIONS: Possession of a license and current registration to practice medicine in New York State, plus six years of experience in the practice of medicine, two years of which must be in an administrative or supervisory capacity. Appointee must be eligible for and maintain eligibility for full and unconditional participation in Medicaid and Medicare programs. Appropriate certification by an American Medical Specialty Board and one year of post certification experience in that specialty can be substituted for four years of general experience.
PREFERRED QUALIFICATIONS: Board certification in Geriatric Medicine and/or Certification as a Medical Director (AMDA), and experience in a long-term care facility.
RESPONSIBILITIES: Serve as Medical Director of a 242-bed skilled nursing facility for veterans and their dependents. Provide medical leadership and oversight ensuring the delivery of quality health care services while also ensuring compliance with clinical, statutory and regulatory standards.Send resume to:  NYS Veterans Home, Attn: Human Resources, 4207 State Highway 220, Oxford, NY 13830

The New York State Veterans Home at Oxford is a 242-bed skilled nursing facility operated by the NYS Department of Health located in Chenango County. It is an Affirmative Action/Equal Opportunity Employer. 


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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