February 5, 2016 – Come on March 8th or Retire

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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February 5, 2016
Volume 16, Number 5

Dear Colleagues:

Reschedule Your Schedule for March 8 or Go Ahead and Take Early Retirement

It is IMPERATIVE that Doctors across New York who are not providing critically necessary medical services to patients be in ALBANY on March 8, 2016.  The medical malpractice crisis with the almost certain lengthening of the Statute of Limitations will adversely affect every physician in the state.  The failure to address the Health Republic debacle will cost millions of dollars to doctors across the state.  Unfunded mandates and radical changes in how we are reimbursed will change the practice of medicine like nothing in the past century.  IF YOU ARE NOT IN ALBANY on MARCH 8th, 2016 you may as well retire from medicine.  Most of us in this society will find the looming threats too onerous to remain in solo or small independent practices.  MSSNY CAN NOT BRING ABOUT THE NECESSARY CHANGES WITH A FEW DOCTORS.  New York’s PHYSICIANS MUST RISE UP AND COME TO ALBANY AND CONVEY OUR POSITION TO THE LEGISLATOR AND THE GOVERNOR.  Contact your county society to make plans to be present that date.  RESCHEDULE your patients.  Be in Albany on March 8, 2016.

Follow-up on last week’s column

Last week’s President’s column evoked the greatest response to date for my column.  Before elaborating further on the response, I want to thank you all for reading my column, and especially to those who took time from their busy schedules to share their views.  For all readers, it should be clear that the column reflects my personal views on issues I believe to be relevant to New York physicians.  On occasion, they may reflect MSSNY policy and in those instances, I state it.

While most applauded the idea of reframing the discussion to de-politicize the issue in the context in which it is currently debated, a few felt the reframe raised other concerns.  These included most importantly, those raised by colleagues in the mental health community who are concerned that I have advanced the notion that individuals with mental illness perpetrate violent crimes.  I do not believe nor do I in anyway support the notion that individuals with mental illness are more prone than members of the general population to commit violent crimes.  However, I do hold the belief that many individuals who commit violent crimes have untreated mental illness which may have in addition to other factors, contributed to their perpetration of acts of violence.  The nuances of this complex discussion can be better understood by carefully reading the Position Statement of the American Psychiatry Association   the press release by the American Psychological Association at:

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


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MSSNY Lobby Day Scheduled for March 8th – Physicians Urged to Attend And Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on March 8th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.  If you plan to attend, please register here.

A full slate of legislators and top Administration officials have been invited to dialogue with Advocacy Day participants including:

  • Donna Frescatore, Executive Director, NYS Health Benefit Exchange;
  • Troy Oechsner, Executive Deputy Superintendent, Department of Financial Services;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

 

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief informal luncheon to which members of each House are invited to dine and speak with their constituents will follow the morning program.   County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Given the wide range of threats physicians face including legislation that would expand the statute of limitations with a broad date of discovery exception potentially increasing physician premiums by 14.5%; legislation to repeal the Trial Lawyers contingency fee limits, potentially increasing premiums by over 10%; significant reductions in eligibility of the Excess Program; legislation that will mandate physicians to take a 4-hour Pain Management CME course every two years; and a move to effectuate statutory and regulatory changes to implement a value-based payment structure under Medicaid and potentially to Medicare and commercial products as well. 

PHYSICIANS ARE ENCOURAGED TO IMMEDIATELY REGISTER THROUGH THE LINK BELOW TO ATTEND THE MARCH 8TH LOBBY DAY IN ALBANY.   

http://goo.gl/forms/Mw7CX8JfzL                                                                            (GOVERNMENTAL AFFAIRS STAFF)


Contact Your Legislators to Support a Health Republic Guarantee Fund; Senator Valesky Introduces Legislation

With the failure of the Executive Budget to include a Guarantee or other fund to cover the likely   hundreds of millions in payments due to Health Republic contracted providers, all physicians are urged to continue to contact their legislators and demand that the State Legislature take action to create such Guarantee or other fund to cover these costs.

This week Senator David Valesky (D-Onondaga County) and fellow Independent Democratic Conference member David Carlucci (D-Rockland County) introduced legislation (S.6667) to create such a Guarantee Fund.  Senator Valesky’s press release announcing the introduction of this legislation

(http://www.nysenate.gov/newsroom/press-releases/david-j-valesky/senator-valesky-proposes-guaranty-fund-rx-consumer-and) included a statement from MSSNY President Dr. Joseph Maldonado that “Physicians thank Senator Valesky for introducing legislation to assure that Physicians can receive payment for services rendered to their patients who had health insurance coverage through the now defunct Health Republic. Physicians and other healthcare stakeholders should not bear the losses associated with the demise of this company. The failure to address this problem will have a de-stabilizing effect on our already fragile health care system at a time changes are being demanded of by policymakers on physicians to accept far greater insurance risk”.  The press release also included statements in support by the Healthcare Association of New York State and the Greater New York Hospital Association, groups MSSNY has been working with to support such a fund.

Urging the Legislature to enact a Guarantee fund as part of the State Budget process was a major component of the testimony that MSSNY recently to a joint hearing of the Assembly Ways & Means and Senate Finance Committees.  For more information, see here.

Remind your legislators that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs, insurance companies dropping physicians from their networks and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for patient care and employment in your community.                                                                                                (AUSTER, DEARS)


Physicians Urged to Oppose Huge Cuts to Excess Medical Liability Insurance Program
Physicians are urged to continue to contact their legislators  to object to the huge cuts contained in the Executive Budget to the Excess Medical Malpractice Insurance program.      MSSNY’s strong opposition to these cuts was a major component of MSSNY’s recent testimony to the Assembly Ways & Means and Senate Finance Committees, as well as in meetings with legislators and key legislative staff.  For more information, click here.

Specifically, the proposal would cut funding by $25 million, with the effect that 55% of physicians who currently receive this essential coverage being dropped from the program.  Across much of upstate New York, only neurosurgeons, bariatric surgeons and OB-GYNs would keep this coverage. That means that in the Capital District, in Northern New York, in Central New York, in western New York and in the Southern Tier every family physician, internist, pediatrician, ophthalmologist, emergency room physician, vascular surgeon, cardiologist, radiologist, pathologist, otolaryngologist, dermatologist and allergist would be automatically dropped.  And downstate, many primary care physicians, ophthalmologists, otolaryngologists, pathologists, dermatologists and allergists would be dropped.

The Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level.  The program was created over 30 years ago as a result of the liability insurance crisis of the mid-1980’s to address concerns among physicians that their liability exposure far exceeded available coverage limitations.  Absent meaningful liability reform, with verdicts and physician liability premiums continuing to be far out of proportion compared to the rest of the country, full funding for the Excess program is absolutely essential in today’s very challenging practice environment.

At a time when the state is seeking to attract and retain physicians, this proposal deters physicians from wanting to practice in New York State for fear of putting themselves and their families in financial jeopardy for judgements and settlements exceeding the limits of their primary coverage.  Please urge your legislators to reject these cuts and restore full funding for the program!
(AUSTER, DEARS)


Disastrous Liability Expansion Bill Back on Assembly Calendar and Now Re-Introduced in Senate; Physicians Must Contact Their Legislators to Oppose Now!
All physicians must continue to contact their Senators and Assembly members to urge that they oppose legislation (A.285, Weinstein, S. 6596, DeFrancisco) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

With the bill having passed the Assembly in 2015, but not the Senate, it resumed a place on the Assembly Calendar, where it could be voted on by the full Assembly at any time.   The bill was brought up for initial consideration on Monday 1/11, but was “laid aside” by the Assembly Republican Conference.

At the conclusion of the 2015 Legislative Session, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that they would be working with representatives on both sides of this issue.  Since that time, MSSNY working together with MLMIC and hospital associations have met with top Senate staff to discuss comprehensive medical liability proposals to work towards legislation that would reduce the outrageous cost of physician medical liability premiums.

As these discussions ensue, you need to let your legislators know that no liability increases can be tolerated!  MLMIC’s estimate is that A.285/S.6596 could increase physician liability premiums by an untenable 15%!   New York physicians continue to pay liability premiums that are among the very highest in the country.  They also face rapidly increasing overhead costs to remain in practice such as the huge costs associated with implementing expensive and cumbersome electronic medical record systems.  At the same time, they face reduced payments from Medicare and commercial insurers, and many practices face losses of tens of thousands, hundreds of thousands and in some cases millions of dollars in losses due to the collapse of Health Republic.

And to make matters even worse, trial lawyers are aggressively pushing the Legislature to consider additional liability expansion bills such as legislation that would eliminate the statutory limitation on contingency fees in medical liability actions, legislation that MLMIC has estimated could have the effect of raising your premiums by over 10%.   Physicians need liability reform to bring down these costs, not legislation that increases them!                                                                                                                                                                                 (AUSTER, DEARS)

Physicians Urged to Continue to Oppose One-Sided Workers Compensation Reform Proposals
All physicians should continue to contact their State Senators and Assemblymembers here to express their strong opposition to sweeping Workers’ Compensation reform proposals contained in the Executive Budget.

MSSNY recently gave testimony to the Senate Finance and Assembly Ways & Means Committees raising significant concerns with Budget proposals that would:

  • Enable treatment of injured workers and direct payment for care by various non-physicians without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery when specialized care is needed; whether new funds will be allocated or whether existing fees will need to be cut to cover this expanded list of care providers; and whether a non-physician can perform an IME of an injured worker to review the care provided by a physician to an injured worker;
  • Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose significant fines on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule;
  • Remove the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation, which is currently an important peer review function provided by county medical societies to assure physician applications are complete and physician applicants are appropriately qualified to deliver this needed care to injured workers;
  • Reduce choice for injured workers by prohibiting an injured worker not subject to a collective bargaining agreement from seeking medical treatment from outside a Workers Compensation PPO before 120 days after his or her first visit to a PPO provider; and
  • Remove the requirement for a referral by a physician for an injured worker as a pre-condition to receive psychological care;

Exacerbating these concerns is that the proposal also does not meaningfully address the many excessive administrative hassles and payment delays that have caused many physicians to be unable to participate in the Workers Compensation program.   While there have been some modestly positive actions taken by the WCB in recent years to encourage physician participation in the WC program through removal of arbitration fees and development of an electronic portal for facilitating authorizations from carriers, these one-sided Budget proposals, if enacted, could further chase physicians away from the program.

MSSNY has reached out to labor organizations and attorneys for injured workers to coordinate its advocacy in opposition to these adverse proposals.  MSSNY has also been working closely with county medical society leadership from across the State to encourage their outreach to their local Senators and Assemblymembers to request that these proposals be jettisoned from the Budget.
(AUSTER, DEARS)


MSSNY Testifies Before Joint Senate Finance and Assembly Ways & Means Committee
Last week, MSSNY submitted its testimony of the proposed budget for fiscal year 2016-17.  Noting the fact that many physician practices are struggling to remain viable with the significantly decreasing compensation and increasing overhead costs, including medical liability premium costs, they must bear, MSSNY representatives advocated that the Legislature take action to assure that we create and preserve an economically sensible health care delivery system.

First and foremost, in the testimony MSSNY focused on the financial hardship that has been created as a result of the collapse of Health Republic and the need for the creation of a Guarantee Fund or other pool of monies to assure that physicians and other stakeholders will be made whole. MSSNY also encouraged the Legislature to reject the programmatic changes to the Excess program proposed in the budget which would result in the dropping of 55% of physicians who currently have the extra $1M layer of coverage from the program. MSSNY urged the restoration of the $25M funding cut to the historic $127.4M level. MSSNY continues to oppose the establishment by publicly traded corporations of limited-services clinics in pharmacies and other retail establishments, particularly at a time when MACRA and other transformational payment structures reward physicians only if they provide same day access to care, provide for care collaboration and enhanced quality of care. MSSNY expressed its opposition to the sweeping Workers’ Compensation reform proposal contained in the Executive Budget including provisions which would removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation and enable treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery with physicians and no new funds to cover this expanded list of care providers. MSSNY also opposed proposed language that would eliminate existing “prescriber prevails” protection for prescriptions for Medicaid patients.

Most importantly, MSSNY urged comprehensive reform of our flawed medical liability adjudication system including reforms which would: place reasonable limits on non-economic damages, which 30 other states have enacted; identifying and assuring qualified expert witnesses; eliminating joint and several liability; strengthening our weak Certificate of Merit requirement; and assuring statements of apology are immunized from discovery.  Other important measures we support include alternative systems for resolving Medical Liability claims such as Medical Courts or a Neurologically Impaired Infants Fund that applies to physicians.   A copy of the Testimony can be accessed through the following link.
(DEARS, AUSTER) 


To Physicians in Long Island, NYC, Hudson Valley, and Capital District: Please Complete Survey Regarding Impact of Proposed Cigna-Anthem Merger
As many physicians know, Anthem, the parent of Empire Blue Cross/Blue Shield, has filed paperwork to acquire CIGNA.   MSSNY has written to the New York State Department of Financial Services and Attorney General’s office to express its concerns about the impact to patient care as a result of further health insurer consolidation.

State and federal regulators are very interested in knowing the prospective effects of these possible mergers on your practice and patient care.  In this regard, MSSNY working together with the American Medical Association Advocacy Resource Center have developed a survey seeking physician input on the potential impact on these proposed mergers.

Last fall, the AMA released a report articulating the significant potential anticompetitive effects that would occur in numerous regions all across the country as a result of this merger.  Among the identified regions of concern in New York State were Long Island, New York City, the Hudson Valley, the Capital District and the Glens Falls area.  Therefore, physicians practicing in these regions are asked to complete the Survey!

This survey, and any information collected in response, will be used by the Medical Society solely for the purpose of petitioning state and federal government concerning the antitrust issues raised by Anthem’s proposed acquisition of Cigna. The antitrust laws prohibit the state medical association from using any information collected pursuant to this survey for any anticompetitive purposes, including, but not limited to, using that information in discussions with health insurers and other payers in an effort to raise physician payment or otherwise increase physician compensation. The state medical society will also not disclose any information received in response to this survey to its physician members without first consulting experienced antitrust Counsel.                                                                         (AUSTER)


Rescheduled Webinar on Opioid Prescribing to be Held Feb. 9th; Second Webinar in Series to be Held Feb 10
The first webinar in the opioid series will be held Tuesday, February 9th at 7:30 a.m. followed on February 10, 2016 with the second webinar at 7:30 a.m.   Physicians and other prescribers are encouraged to register for the entire webinar series at the following link. Click on the upcoming tab and select the programs.

Physicians will need to register for each webinar; each webinar has different topics described below. Physicians and other prescribers are allowed to register up to ½ hour before the webinar.

The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are jointly providing this free,  four part webinar series on opioid prescribing.  

Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, February 9, 2016 at 7:30 a.m.,  and will be conducted by Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN and the educational objectives are:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

The second webinar will be held on Wednesday, February 10, 2016, 7:30 a.m. Faculty:  Charles E. Argoff, MD.  The educational objective is to:  Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation. 

The remaining webinars in the series are scheduled for:

Tuesday, February 23, 2016, 7:30 a.m.  Faculty:  Jeffrey Selzer, MD and the educational objective:  Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.

Thursday, March 10, 2016, 7:30 a.m. Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM and the educational objectives:  Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed; discuss strategies to reduce risk of treating pain in patients with substance use disorders.

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.
(CLANCY)


Please Complete the New Health Republic Survey!
As MSSNY continues its advocacy in support of a special fund to pay for the unpaid claims as a result of the Health Republic demise, we need you to take the time to complete a MSSNY survey to provide us with updated information regarding the amounts you are due from Health Republic.  To complete the survey, click here: https://www.surveymonkey.com/r/HRepublic2This data is critical to our advocacy efforts!  We thank the many of you who provided data in November detailing the amounts you are owed, but we need to obtain updated and more precise numbers since many legislators have asked us for this data.
(AUSTER, DEARS)

NYS Department of Health Issues Protocals for Zika Virus
The New York State Department of Health has issued new protocols for Zika virus which now include the collection of a urine sample in addition to blood samples.   The health advisory and guidelines for pregnant women may be found at the department website.

The World Health Organization has declared a global emergency due to the Zika virus and NY state officials have indicated that guidelines may change.   DOH Commissioner Howard Zucker indicated that the state will be monitoring mosquitoes closely as the weather gets warmer.  The Department of Health conducted a webinar on Zika and the webinar is now available at the department’s website.
(CLANCY)

 


MSSNY to Sponsor Free CME Webinar on Public Health Preparedness on Feb. 17th
Public Health Preparedness 101 will be the topic of MSSNY’s Medical Matters webinar on Wednesday, February 17, 2016 with. Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS serving as faculty.  This program is designed to help physicians and staff on how to prepare professionally and personally for a public health emergency.  The program will begin at 7:30 a.m.   Registration is now open to physicians and other public health officials.  Go to training session and click on the upcoming sessions tab.

Further information on these programs can be found here.

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.

Further information or assistance in registering for any of these programs,  may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.                                                                                                     (CLANCY, HOFFMAN) 


Assembly Gottfried Seeks to Double the Number of In-State Med. Marijuana Dispensaries
With only several hundred physicians currently registered to certify the use of medical marijuana for their patients, Assemblyman Gottfried introduced legislation (A.9151) last Friday to double to number of marijuana manufacturers and dispensaries in the state. Under the current program, 49 counties with an aggregate population of 7.5 million lack access to a medical marijuana dispensary in their county. With counties underserved and “978,500 New Yorkers for every medical marijuana dispensary”, Assemblyman Gottfried’s legislation would allow for five additional manufacturers, each permitted to operate up to four dispensaries. Currently, the legislation is a one-house bill, without a Senate same-as.
(MCPARTLON) 


NYU Arthur Caplan – It’s Time to Cancel the Summer Olympics
In Wednesday’s Forbes Sport Money section, Arthur Caplan, PhD, of NYU Langone Medical Center, presents the case for evaluating whether the 2016 Summer Olympic Games in Rio de Janiero should to be cancelled. Caplan argues that it is irresponsible to allow the games to take place in an area under a wide-spread outbreak of the Zika virus, which the WHO recently declared an “explosively spreading” “public health emergency of international concern”.            (MCPARTLON)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:          

pschuh@mssny.org ldears@mssny.org            mauster@mssny.org  
pclancy@mssny.org jMcPartlon@mssny.org    

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Physicians and Zika Virus
Commissioner of Health Howard Zucker, MD, JD NYS has placed on the DOH website, “Zika Virus What New York State Clinicians Need to Know” dated February 1, 2016.


Resolutions for the 2016 House of Delegates
The deadline for resolutions is 5:00pm on February 19; or for resolutions resulting from our Lobby Day, 5:00 on March 11 is the deadline. Send all resolutions to lmayer@mssny.org
 


New York State Earns Mixed Reviews in New Tobacco Report
In a report from the American Lung Association (ALA) titled “State of Tobacco Control 2016,” reports, New York earned an “A” in 2015 “on policies that promote smoke-free air.” However, the ALA “called on New York officials to increase funding for the state’s tobacco control programs by $10 million to $52 million per year and expand New York’s Clean Indoor Air Act to restrict the use of electronic cigarettes.”

The smoking rate among the state’s high school students has dropped to 7.3 percent, while the adult smoking rate has dropped to 14.5 percent, below the national average of 17.8 percent, according to figures released by the state last year.

The lung association raised concerns, however, about an increase in the use of products like e-cigarettes and hookahs. And it gave the state failing grades for funding and providing access to programs that help people quit smoking.

The advocacy group called on New York officials to increase funding for the state’s tobacco control programs by $10 million to $52 million per year and expand New York’s Clean Indoor Air Act to restrict the use of electronic cigarettes.


From Socio-Med VP Regina McNally: Go with Dr. First for
E-Prescribing
I have been receiving many calls from physicians regarding the upcoming NYS e-prescribing mandate of March 27, 2016 and you might be getting calls, too. We endorse DrFirst as a “stand-alone” e-prescribing product.  I believe software would be added to the physician’s existing computer.  This stand-alone product will help those physicians who have an EMR or EHR that might not be ready by the 3/27/16 deadline.  Please see the following:  http://www.drfirst.com/mssny/mssny-lp/

MSSNY members get a discount!  DrFirst’s MSSNY hotline number is (866)980-0553.

If a physician member can document either financial or technical limits, s/he can apply for a waiver from electronic prescribing.  The application for the waiver would apply for both controlled and non-controlled prescription drugs.  Note, there’s no guarantee that the waiver will be granted.  Please see the attached for waiver information.

As a point of physician protection, a medical record for the patient (spouse, family, friends, etc.) must be maintained (even if it is on an index card) for every prescription written in either paper or electronic mode. 

E-prescribing of both controlled and non-controlled substances is currently permissible in New York. Practitioners must ensure compliance with the requirement, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances, and registering their certified software applications with the Bureau of Narcotic Enforcement

Below are highlights/key points that may be of particular interest to prescribers and pharmacists:

  • A prescription generated on an electronic system that is printed out to the Official New York State Prescription form or faxed is NOT an electronic prescription.
  • After March 27, 2016, a pharmacist is NOT required to verify that a practitioner properly falls under one of the exceptions from the requirement to electronically prescribe. Pharmacists may continue to dispense medications from valid written, oral, or fax prescriptions that are consistent with current laws, regulations, and Medicaid policies.

A comprehensive list of FAQs can be found here.

The FAQs provide an explanation of the laws and regulations, pharmacy registration forms, registration for official prescriptions and e-prescribing systems (ROPES), software and data requirements, waivers and exceptions, and resource information and contacts.

Questions? Please contact the Bureau of Narcotic Enforcement at

1-866-811-7957 or via e-mail to narcotic@health.ny.gov


Poster Symposium Seeks Judges on April 15 in Tarrytown
If you’re coming to the House of Delegates in Tarrytown – or just live in the neighborhood – and are free on Friday afternoon, April 15, from 2 – 4 pm, please consider participating as a judge at the MSSNY Resident and Fellow Section Poster Symposium. It’s always an exciting, lively event! Please contact sbennett@mssny.org or 516-488-6100 extension 383 if you’re interested. Thank you.


AMA: All Physicians Subject to 2015 Medicare MU Program Should Apply for Hardship
Prior to adjourning for the holidays, Congress passed the Patient Access and Medicare Protection Act (PAMPA), which directed CMS)to make AMA-supported changes to the Medicare EHR Incentive Program hardship exception process that allows physicians to avoid a Meaningful Use (MU) penalty in 2017.

CMS has stated that it will broadly accept hardship exemptions because of the delayed publication of the program regulations. Applying for the hardship will NOT prevent a physician from earning an incentive. It simply protects a physician from receiving an MU penalty. Therefore, physicians who believe that they met the MU requirements for the 2015 reporting period should still apply for the hardship protection. Note that the program operates on a two-year look-back period, meaning that physicians who are granted an exception for the 2015 program will avoid a financial penalty for 2017.

Step-by-step instructions for completing the hardship exception application are attached.

The new applications and instructions for a hardship exception from the Medicare Electronic Health Records Incentive Program 2017 payment adjustment are available here.

This new, streamlined application process is the result of PAMPA, which established that the Secretary may consider hardship exceptions for “categories” of EPs, eligible hospitals, and CAHs that were identified on CMS’ website as of December 15, 2015. Prior to this law, CMS was required to review all applications on a “case-by-case” basis.

Importantly, EPs, eligible hospitals, and CAHs that wish to use the streamlined application must submit their application according to the timeline established in PAMPA:

  • Eligible Professionals: March 15, 2016
  • Eligible Hospitals & CAHs: April 1, 2016

Please note:

Following Congress’ efforts in PAMPA, we have reviewed our administrative authorities and determined that groups of providers may apply for a hardship exception on a single application. Under the group application, multiple providers and provider types may apply together using a single submission. The hardship exception categories are the same as those applicable for the individual provider application. 


NEJM: Surgical Residents’ Long Shifts May Have No Impact on Patient Outcomes
Research published online in the New England Journal of Medicine indicated that “allowing surgeons in training to work extremely long shifts without breaks had no effect on patient outcomes and created only minor dissatisfaction among the young” physicians. http://bit.ly/1P9tCnV Investigators “looked at how many patients died or had serious complications in the month after surgery and found the same low rate – about 9 percent – in both groups.” Meanwhile, “residents’ self-rated dissatisfaction with their education and with their well-being were similarly low – 11 percent and roughly 13 percent respectively in each group.” In an accompanying editorial at http://bit.ly/1VRjodv, Dr. John Birkmeyer “wrote the experiment’s results ‘effectively debunks concerns that patients will suffer as a result of increased handoffs and breaks in continuity of care.’”


Nat’l Center on Addiction/Substance Abuse Releases Report on Food Addiction
The National Center on Addiction and Substance Abuse announced the release of a report that lays out the characterizing symptoms, risk factors and underlying neurobiological characteristics of food addiction, and how these features overlap with those of obesity, eating disorders and substance addiction. This report, Understanding and Addressing Food Addiction: A Science-Based Approach to Policy, Practice and Research, highlights how the knowledge and experience gained from years of substance use research and work in substance prevention, intervention and policy might be applied to controlling unhealthy eating and the food environment that contributes to it. It offers evidence-based recommendations for policy, prevention, health care practice and research to help reduce the deadly and costly health consequences of unhealthy eating.
Highlights of the report include:

  • Evidence regarding the prevalence of food addiction and its co-occurrence with obesity, binge eating disorder and other health conditions
  • The risk factors, characterizing symptoms and biological mechanisms of food addiction and related disorders and how these overlap with other eating disorders and with substance addiction
  • Recommendations for policy, prevention, health care practice and research, and resources for additional information

The report is available for download at no cost and can be found here.

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Jerome I. Sager – Attorney at Law
The health care law experts representing medical professionals for more than 25 years.  See us for Professional Medical Conduct Defense, Medicaid and Medicare Fraud Cases, DEA and Controlled Substance Issues, Third party insurance issues. 212-685-2333 / 917-312-6631, jeromesager@cs.com.

 

 



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OFFICE SPACE – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org

Office Rental 30 Central Park South
Two fully equipped exam rooms, two certified operating rooms, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468drdese@gmail.com.


Jerome I. Sager – Attorney at Law
The health care law experts representing medical professionals for more than 25 years.  See us for Professional Medical Conduct Defense, Medicaid and Medicare Fraud Cases, DEA and Controlled Substance Issues, Third party insurance issues. 212-685-2333 / 917-312-6631, jeromesager@cs.com.



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

January 29, 2016 – Violence, Not Weapons, Is the Issue!

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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January 29, 2016
Volume 16, Number 4

Dear Colleagues:

This past week, a family friend was hacked to death in New York by a machete-wielding neighbor.

Mrs. Carmen Torres-Gonzalez was born in my mother’s home town.  She had been a caregiver for my mother’s sister several years back during her unsuccessful fight against metastatic Adrenal Cancer.  My mother was also the elementary school teacher of one of Mrs. Torres-Gonzalez’s daughters.  As I googled the news story of her gruesome death, I found many more stories of other Americans who were victims of machete wielding criminals this month.  I was surprised to find so many incidents of fatal assaults with the use of a machete.  It made me pause to wonder why I had not previously been aware of the frequent use of machetes in violent deaths.

It seems to me that most of the attention paid to violent death has focused on gun violence.  Indeed, guns rank highest as the weapon used in violent deaths.  However, the benign neglect of violent deaths due to other weapons seem to me to highlight the political agenda of those who focus on gun violence rather than on the more important issue of deadly violence regardless of the weapon of choice as the more critical issue for the public and our society at large.  When we focus attention on gun violence, rather than on the mental illness or drug use which often lies at the core of why perpetrators resort to deadly violence towards others and themselves, we aid and abet political agendas and fail to focus on relevant solutions.

The tragic death of  family friend Mrs. Torres-Gonzalez and that of Jessica Parker, an American Physician Assistant brutally murdered in Grenada this past week, highlight the fact that gun violence is not the real problem on which we must focus as a society.  While most violent deaths in our country are due to guns, the violent deaths with other instruments of harm highlight the fact that the true area of focus needs to be addressing the mental health needs of the mentally ill.  If we fail in this endeavor, we will see that the focus on making guns less accessible will be met with a mounting number of deaths due to the use of other weapons.

We can lead our state and nation in getting the discussion on the right track by refusing to make our public health discussions center on gun violence.  Rather we should take the discussion to activism that focuses on addressing the problems of mental illness and drug abuse which underpin behaviors that express themselves in violence and death, be it with a gun or with a machete.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

In a separate note, last week, we lost a great friend of our Society, Dr. Rufus Nichols, a former longstanding delegate to the House and active committee member from Brooklyn.  A scholarship fund has been established in his memory . It is a scholarship established through the National Medical Association that when awarded will pay for the registration fees and section dues of an Ob/Gyn resident or medical student planning to attend the NMA’s Annual Convention and Scientific Assembly. Checks should be made out to: The National Medical Association, Ob/Gyn Section. The mailing address is: Carole West,OB/Gyn Section Administrator, National Medical Association, 80 Jesse Hill Jr. Dr., SE PO Box 26076, Atlanta, Georgia 30303. Please reference the “Rufus A. Nichols Scholarship Fund” in the memo area of your check.

Please send your comments to comments@mssny.org


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MSSNY Lobby Day Scheduled for March 8th – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on March 8th in the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany, New York.  If you plan to attend, please register.

A full slate of legislators have been invited to dialogue with Advocacy Day participants including:

  • Donna Frescatore, Executive Director, NYS Health Benefit Exchange;
  • Troy Oechsner, Executive Deputy Superintendent, Department of Financial Services;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief informal luncheon to which members of each House are invited to dine and speak with their constituents will follow the morning program.   County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Given the wide range of threats physicians face including legislation that would expand the statute of limitations with a broad date of discovery exception potentially increasing physician premiums by 14.5%; legislation to repeal the Trial Lawyers contingency fee limits, potentially increasing premiums by over 10%; significant reductions in eligibility of the Excess Program; legislation that will mandate physicians to take a 4-hour Pain Management CME course every two years; and a move to effectuate statutory and regulatory changes to implement a value-based payment structure under Medicaid and potentially to Medicare and commercial products as well. 

PHYSICIANS ARE ENCOURAGED TO IMMEDIATELY REGISTER THROUGH THE LINK BELOW TO ATTEND THE MARCH 8TH LOBBY DAY IN ALBANY.
More Information
http://goo.gl/forms/Mw7CX8JfzL              (GOVERNMENTAL AFFAIRS STAFF) 


MSSNY Testifies Before Joint Senate Finance and Assembly Ways & Means Committee
Earlier this week, MSSNY submitted its testimony of the proposed budget for fiscal year 2016-17.  Noting the fact that many physician practices are struggling to remain viable with the significantly decreasing compensation and increasing overhead costs, including medical liability premium costs, they must bear, MSSNY representatives advocated that the Legislature take action to assure that we create and preserve an economically sensible health care delivery system.

First and foremost, in the testimony MSSNY focused on the financial hardship that has been created as a result of the collapse of Health Republic and the need for the creation of a Guarantee Fund or other pool of monies to assure that physicians and other stakeholders will be made whole. MSSNY also encouraged the Legislature to reject the programmatic changes to the Excess program proposed in the budget which would result in the  dropping of 55% of physicians who currently have the extra $1M layer of coverage from the program. MSSNY urged the restoration of the $25M funding cut to the historic $127.4M level. MSSNY continues to oppose the establishment by publicly traded corporations of limited-services clinics in pharmacies and other retail establishments, particularly at a time when MACRA and other transformational payment structures reward physicians only if they provide same day access to care, provide for care collaboration and enhanced quality of care. MSSNY expressed its opposition to the sweeping Workers’ Compensation reform proposal contained in the Executive Budget including provisions which would removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation and enable treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery with physicians and no new funds to cover this expanded list of care providers. MSSNY also opposed proposed language that would eliminate existing “prescriber prevails” protection for prescriptions for Medicaid patients.

Most importantly, MSSNY urged comprehensive reform of our flawed medical liability adjudication system including reforms which would: place reasonable limits on non-economic damages, which 30 other states have enacted; identifying and assuring qualified expert witnesses; eliminating joint and several liability; strengthening our weak Certificate of Merit requirement; and assuring statements of apology are immunized from discovery.  Other important measures we support include alternative systems for resolving Medical Liability claims such as Medical Courts or a Neurologically Impaired Infants Fund that applies to physicians.   A copy of the Testimony can be accessed here.                                                                                                    (DEARS, AUSTER) 


Physicians Urged to Oppose Huge Cuts to Excess Medical Liability Insurance Program
Physicians are urged to continue to contact their legislators to object to the huge cuts contained in the Executive Budget to the Excess Medical Malpractice Insurance program.      MSSNY’s strong opposition to these cuts was a major component of MSSNY’s testimony to the joint meeting of the Assembly Ways & Means and Senate Finance Committees this week, as well as in meetings with legislators and key legislative staff.  For more information, click here and here.

Specifically, the proposal would cut funding by $25 million, with the effect that 55% of physicians who currently receive this essential coverage being dropped from the program.  Across much of upstate New York, only neurosurgeons, bariatric surgeons and OB-GYNs would keep this coverage. That means that in the Capital District, in Northern New York, in Central New York, in western New York and in the Southern Tier every family physician, internist, pediatrician, ophthalmologist, emergency room physician, vascular surgeon, cardiologist, radiologist, pathologist, otolaryngologist, dermatologist and allergist would be automatically dropped.  And downstate, many primary care physicians, ophthalmologists, otolaryngologists, pathologists, dermatologists and allergists would be dropped.

The Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level.  The program was created over 30 years ago as a result of the liability insurance crisis of the mid-1980’s to address concerns among physicians that their liability exposure far exceeded available coverage limitations.  They legitimately feared that everything they had worked for all of their professional lives could be lost as a result of one wildly aberrant jury verdict. This fear continues today since New York State has failed to enact meaningful tort reform to ameliorate this risk. The size of verdicts in New York State has continued to grow significantly and physician liability premiums remain far out of proportion compared to the rest of the country.  Absent meaningful liability reform, full funding for the Excess program is absolutely essential in today’s very challenging practice environment.

At a time when the state is seeking to attract and retain physicians, this proposal deters physicians from wanting to practice in New York State for fear of putting themselves and their families in financial jeopardy for judgements and settlements exceeding the limits of their primary coverage.

Please urge your legislators to reject these cuts and restore full funding for the program!
(AUSTER, DEARS) 


Contact Your Legislators to Support a Health Republic Guarantee Fund
With the failure of the Executive Budget to include a Guarantee or other fund to cover the likely hundreds of millions in payments due to Health Republic contracted providers, all physicians are urged to continue to contact their legislators and demand that the State Legislature take action to create such Guarantee or other fund.  Urging the Legislature to enact a Guarantee fund as part of the State Budget process was a major component of the testimony that MSSNY gave this past week at a joint meeting of the Assembly Ways & Means and Senate Finance Committees.  For more information, see here and here.

Moreover, please take the time to complete an updated MSSNY survey (sent out earlier this week) to provide us with updated information regarding the amounts you are due from Health Republic.  To complete the survey, click here.  This data is critical to our advocacy efforts!

MSSNY has worked with hospital associations to press key State Legislative leaders that it is absolutely imperative for the stability of our health care system that this be addressed soon.  We have shared with public officials the results of MSSNY’s earlier survey that concluded that physicians are owed at least tens of millions of dollars in outstanding claims, of which:

  • 11% are owed $100,000 or more;
  • 20% are owed $25,000 or more; and
  • 49% are owed $5,000 or more.

Moreover, we have shared data from 5 large medical practices in the Lower Hudson Valley that together are owed over $12 million.

Remind your legislators that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs, insurance companies dropping physicians from their networks and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for patient care and employment in your community.
(AUSTER, DEARS) 


CME Mandate Bill Reported by Senate Health Committee; Now Before Full Senate
Senate Bill 4348A (Hannon), which would create a continuing medical education mandate for practitioners with prescribing privileges was approved by the Senate Health Committee and is now before the full Senate for a vote.     Physician action is vitally important.

Physicians are urged to contact their elected representatives to urge that they vote against this mandate!  Send an email through MSSNY’s Grassroots Action Center.

4348A, sponsored by Senator Kemp Hannon, authorizes the Commissioner of Health to establish standards and to review requirements for CME on pain management, palliative care and addiction, would require health care professionals authorized to prescribe controlled substances to complete three hours of continuing medical education, prior to renewal of registration to practice, that involves pain management. The curricula must include but is not limited to, I-STOP and drug enforcement administration requirements for prescribing control substances; pain management; appropriate prescribing; managing acute pain; pain; palliative medicine; prevention, screening and signs of addiction; responses to abuse and addiction; and end of life care. The Commissioner may allow for exemptions if the health care professionals meet requirements to the Commissioner’s satisfaction.

The Commissioner must report on the impact of this legislation and any recommendations no later than three years after its enactment. A similar measure, A. 355, sponsored by Assembly Linda Rosenthal, is in the Assembly Health Committee.                                         
(CLANCY, DEARS)
 


Bill to Limit Opioid Prescriptions to Three-Ten Day Supply Poised for Full Senate Vote
Senate Bill 6091A, which would limit the initial prescription of Schedule II or III Controlled Substance to a three to ten day supply,  has passed the Senate Health Committee and is now before the NY Senate for a full vote.    Sponsored by Senator Kemp Hannon, the bill is intended to encourage patients whose acute pain lasts longer than initially expected to follow up with a physician and it lessens the number of the pills left in medicine cabinets and available for diversion.

The bill does limit the number of co-pays for patients should they need additional prescriptions.   The Medical Society of the State of New York is opposed to this measure and believes that having the New York State Legislature place an arbitrary limit on any type of prescriptions interferes with the practice of medicine.   Its companion measure, A. 8601, sponsored by Assemblymember John T. MacDonald III, is in the Assembly Health Committee.   Physicians are urged to contact senators and urge defeat of this measure.  Senators can be reached here.
(CLANCY, DEARS)


Disastrous Liability Expansion Bill on Assembly Calendar; Physicians Must Contact Their Legislators to Oppose Now!
All physicians must continue to contact their legislators to urge that they oppose legislation (A.285-A, Weinstein) before the full Assembly that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

While the bill currently does not have a Senate sponsor, it is possible that similar legislation could be introduced shortly.   At the conclusion of the 2015 Legislative Session, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that they would be working with representatives on both sides of this issue.  Since that time, MSSNY working together with MLMIC and hospital associations have met with top Senate staff to discuss comprehensive medical liability proposals to work towards legislation that would reduce the outrageous cost of physician medical liability premiums.

As these discussions ensue, you need to let your legislators know that no liability increases can be tolerated!  MLMIC’s estimate is that this bill could increase physician liability premiums by an untenable 15%!   New York physicians continue to pay liability premiums that are among the very highest in the country.  By way of example, a neurosurgeon practicing on Long Island must pay an astounding $338,252 for just one year of insurance coverage and an OB/GYN practicing in the Bronx or Staten Island must pay $186,639.   New York far surpasses all other states in terms of total medical liability payouts, per capita payments, and medical liability awards above $1 million.

They also face rapidly increasing overhead costs to remain in practice such as the huge costs associated with implementing expensive and cumbersome electronic medical record systems.  At the same time, they face reduced payments from Medicare and commercial insurers, and many practices face losses of tens of thousands, hundreds of thousands and in some cases millions of dollars in losses due to the collapse of Health Republic.

And to make matters even worse, trial lawyers are aggressively pushing the Legislature to consider additional liability expansion bills such as legislation that would eliminate the statutory limitation on contingency fees in medical liability actions, legislation that MLMIC has estimated could have the effect of raising your premiums by over 10%.   Physicians need liability reform to bring down these costs, not legislation that increases them!
(AUSTER, DEARS)


Physicians Urged to Shared Concerns with Legislators Regarding Workers Compensation Reform Proposals in Executive Budget
MSSNY’s testimony to the Senate Finance and Assembly Ways & Means Committees this week raised significant concerns with the sweeping Workers’ Compensation reform proposal contained in the Executive Budget.   Physicians are urged to contact their State Senators and Assemblymembers to express their opposition to these proposals.

Among the proposals of greatest concern to physicians and their injured worker patients:

  • Enables treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery when specialized care is needed; whether new funds will be allocated or whether existing fees will need to be cut to cover this expanded list of care providers; and whether a non-physician can perform an IME of an injured worker to review the care provided by a physician to an injured worker;
  • Removes the requirement for a referral by a physician for an injured worker as a pre-condition to receive psychological care;
  • Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose a $5,000 fine on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule;
  • Prohibits an injured worker not subject to a collective bargaining agreement from seeking medical treatment from outside a Workers Compensation PPO before 120 days after his or her first visit to a preferred provider organization provider; and
  • Removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation, which is currently an important peer review function provided by county medical societies to assure physician applications are complete and physician applicants are appropriately qualified to deliver this needed care to injured workers.

Exacerbating these concerns is that the proposal also does not meaningfully address the many excessive administrative hassles identified by physicians that have caused many physicians to withdraw from participation in the Workers Compensation program.   While there have been some modestly positive actions taken by the WCB in recent years to encourage physician participation in the WC program through removal of arbitration fees and development of an electronic portal for facilitating authorizations from carrier, the Budget proposals if enacted could further chase physicians away from the program.

MSSNY has reached out to labor organizations and attorneys for injured workers to coordinate its advocacy in opposition to these adverse proposals.  MSSNY has also been working closely with county medical society leadership from across the State to encourage their outreach to their local Senators and Assemblymembers to request that these proposals be jettisoned from the Budget.
(AUSTER, DEARS)


Contact Your Legislators to Oppose the Expansion of Retail Clinics
With the inclusion of language to permit public corporations to own and operate retail clinics, or “”limited service clinics”, throughout NYS in the Governor’s Proposed Budget and with introductions of one house bills in both the Assembly & Senate all physicians are urged to contact their legislators and demand that the State Legislature prevent the proliferation of publicly-traded corporations practice of medicine. 

While various versions of legislation exist, each seeks to allow publicly traded corporations to establish health clinics without need for certificate of need for review—for the first time in New York State. By permitting this practice, NYS will infringe upon the independence of medical decision-making and the integrity of the doctor-patient relationship. Furthermore, corporately owned and operated retail clinics will open the floodgates to conflicts of interest posed to exist as retail clinics directly profit from the very prescriptions they write, and treatments they recommend—all under the very same roof.

At a time when we in NYS are working hard to ensure and expand primary care and medical home capacity, retail clinics threaten the very viability of primary care physician’s practices. Contact your legislator today, and urge them to oppose the expansion of Retail Clinics in New York State.
(McPARTLON, DEARS)


DOH Files HCA-Proposed Flexibility in Signed M.D. Order Rules, Billing Deadlines for Home Care
The Home Care Association of New York State (“HCA”), working together with MSSNY’S Long-Term Care Subcommittee, has succeeded in urging the NYSDOH to examine its proposal to provide flexibility in signed physicians-order and Medicaid billing deadlines for home care services under Medicaid, allowing a full year to obtain physician orders and then bill. When implemented, the proposed regulations will positively impact collaboration between home care agencies and physicians.

DOH officials reported that the proposed regulations were filed on January 22nd, and they expect the regulations to be published in the February 10th State Register for a 45-day comment period.

Several months ago, HCA obtained an initial agreement from the state to consider HCA-drafted regulatory language to align state deadlines for signed physician orders with the broader time constraints allowed by Medicare, replacing the current 30-day limit for signed orders (and 90-day deadline to bill Medicaid) with a one-year outside window for signed orders and billing.

Of important note is that this does not change the requirements for having physician orders for start of care or revisions in care plans. The rule change applies specifically to the signed order requirements, which form the basis for the state’s current 30-day and 90-day billing compliance standards.

MSSNY will notify Long-Term Care Subcommittee members once the proposed regulations are published.
(McPARTLON)

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:          

pschuh@mssny.org ldears@mssny.org            mauster@mssny.org  
pclancy@mssny.org bellman@mssny.org    

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REMINDER:  All Prescriptions Must Be Sent Electronically Beginning March 27th

Tell your patients NOW that you will NOT be issuing papers scripts as of March 27. With the e-prescribing mandate quickly approaching, we at MSSNY are concerned about the lack of preparedness expressed by New York doctors.  Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate. 

We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are compliant with the law. 


Do Not Wait until March; Buy E-Prescribing Software NOWAs a MSSNY member benefit, you qualify for a substantial discount on DrFirst’s industry-leading Rcopia® with EPCS GoldSM.  The cost is $500 for a one-year license (a $299 discount) and includes e-prescribing for both legend drugs and controlled substances, as well as the DEA-required identity proofing and two-factor authentication soft token.

If you buy now, you’ll be ready when the deadline arrives, and DrFirst will extend your software license from now until March 27, 2017 at no additional charge. To purchase online, visit www.drfirst.com/MSSNY and use coupon code MSSNY, or call the MSSNY E-prescribing Hotline at 866-980-0553. 


Shortcut to Apply for Medicare EHR Incentive Program Hardship Exception
Prior to adjourning for the holidays, MSSNY worked with the AMA and other state medical associations in support of a measure passed by Congress to direct CMS to make changes to the Medicare EHR Incentive Program hardship exception process that allows physicians to avoid a Meaningful Use (MU) penalty in 2017. The AMA has developed a short document that details the steps physicians should take to apply for this hardship. The AMA is encouraging ALL physicians subject to the 2015 Medicare MU program to apply for the hardship.   According to the AMA, applying for the hardship will not prevent a physician from earning an incentive. It simply protects a physician from receiving an MU penalty. Therefore, physicians who believe that they met the MU requirements for the 2015 reporting period should still apply for the hardship protection. Note that the program operates on a two-year look-back period, meaning that physicians who are granted an exception for the 2015 program will avoid a financial penalty for 2017.


Young Physicians Section Annual Meeting
Saturday, February 27, 2016
8:00 am – 1:00 pm
865 Merrick Avenue, Westbury (MSSNY HQ) and Hilton Garden Inn (across street)Don’t miss this essential leadership presentation by Richard Popovic, a highly experienced consultant in the fields of physician leadership, strategy, management and patient safety. CME available, no charge:

  • Learn tips on how to take an active role in shaping public policy on healthcare
  • Increase your ability to make decisions in the best interest of quality care and patient safety
  • Find the right balance between clinical and administrative duties
  • Identify barriers to physician leadership and advocacy
  • Define goals and assess needs of your organization – and achieve results!

MSSNY’s three sections, YPS, RFS, and MSS will gather for the presentation at the Hilton. If you wish to stay overnight, the Hilton is offering a corporate room rate (contact sbennett@mssny.org).

YPS will start at MSSNY HQ with business and breakfast, then proceed to the Hilton for the presentation. Lunch will follow back at MSSNY.

This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of MSSNY and the Medical Educational & Scientific Foundation of New York, Inc. (MESF). MSSNY 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 1.5 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


Want to Join MSSNY’S Task Force for Independent Physicians?
At the 2015 House of Delegates of the Medical Society of the State of New York, Resolution 210 was passed calling for the creation of a Task Force on Independent Practice. The purpose of the taskforce is two-fold. First, the Taskforce would explore viable options for independent physicians to collaborate and create practice models to achieve the goals of “diversity of service, economy of scale and collective negotiations.” Second, consult experts and examine successful independent practice models in NY and elsewhere that will facilitate the preservation of independent practice in the State of New York. We need your help!

I am looking to assemble the MSSNY team to tackle this work. This calls for physicians who have developed innovative business models of private practice as well as those who have working knowledge of practice models that can accomplish the goals of the committee. This is NOT a committee for those who want to learn on the job. Rather, it is a team of individuals who have working experience both at the individual practice level establishing new medical business ventures as well as those who have expertise through academic, business and health policy endeavors.

Is your practice unique in what it offers? Have you created an IPA? Have you written a master’s thesis on collective negotiations and messenger model negotiations? Are you a physician offering concierge services or a telemedicine based practice? Are you a physician with a law degree or an MBA that has innovated healthcare delivery for your practice in a non-traditional manner or in an innovatively thriving traditional practice? This taskforce can use your skills.

Please contact Eunice Skelly at MSSNY (eskelly@mssny.org) with a short bio and letter expressing your interest, expertise and what you intend to bring to the taskforce to advance the mission of the project. I will be looking for diversity of practice location as well as types of innovations that may contribute to a robust and comprehensive report and plan of action for preserving independent practice in New York. 


USPSTF Calls for Routine Depression Screening of All Adults
The guidelines from the USPTF were published online Jan. 26 in JAMA that recommended that general physicians screen all adults for depression and treat those affected by the mood disorder with antidepressant medication, refer them to psychotherapy or do both. In a previous recommendation made in 2009, the USPSTF “had recommended screening adults for depression only when mental health services were available.” An accompanying editorial  
observed that primary care professionals “should screen people with a history of depression at every visit.”


NEJM: One Percent of Physicians Account for 32% of Paid Claims
A study published Thursday in the New England Journal of Medicine that found “the more often a doctor is sued, the more likely he or she will be sued again,” based on the past ten years of claims listed in the National Practitioner Data Bank.

The study found “one percent of all doctors account for 32 percent of all paid malpractice claims.” Neurosurgeons and orthopedic surgeons were more likely to have a paid claims, while “pediatricians were 30 percent less likely to have one.”

“Approximately 1% of all physicians accounted for 32% of paid claims. Among physicians with paid claims, 84% incurred only one during the study period (accounting for 68% of all paid claims), 16% had at least two paid claims (accounting for 32% of the claims), and 4% had at least three paid claims (accounting for 12% of the claims). In adjusted analyses, the risk of recurrence increased with the number of previous paid claims. For example, as compared with physicians who had one previous paid claim, the 2160 physicians who had three paid claims had three times the risk of incurring another (hazard ratio, 3.11; 95% confidence interval [CI], 2.84 to 3.41); this corresponded in absolute terms to a 24% chance (95% CI, 22 to 26) of another paid claim within 2 years. Risks of recurrence also varied widely according to specialty — for example, the risk among neurosurgeons was four times as great as the risk among psychiatrists.” 


MSSNY/NYS Psychiatric Assn. Present Veterans Mental Health Primary Care Training Initiative

When: Friday, February 5, 2016, 8:00 a.m. to 9:00 a.m.

Where: Niagara Falls Conference Center, 101 Old Falls Street, Niagara Falls, New York

Topic  : PTSD and TBI In Returning Veterans: Identification and Treatment

Presented By Frank Dowling, M.D.

Program Summary:  The Medical Society of the State (MSSNY) and NYSPA (NYSPA) welcome primary care physicians and providers, including those in internal medicine, family practice, emergency medicine, and OB/GYN, to attend this one hour training. The objectives:

(1) Explain the two most common disorders facing returning veterans today, their prevalence, risks, costs, and comorbidities.

(2) Identify common symptoms and causes of PTSD and Traumatic Brain Injury (TBI), especially those that affect returning veterans the most.

(3) Outline proven treatment options in psychotherapy and pharmacotherapy, from concept to implementation.

(4) Outline the process of recovery and post-traumatic growth.

(5) Discuss barriers to treatment, including those unique to military culture, and how to overcome them.

Following the training physicians are welcome to attend a panel discussion hosted by MSSNY, NYSPA, and the National Association of Social Workers – New York State Chapter, starting at approximately 9:15 a.m. regarding the post deployment experiences and challenges veterans have faced, specifically focusing on treatment.

REGISTRATION REQUIRED:  Click Here

For more information, contact Greg Elperin at MSSNY via gelperin@mssny.org or (518) 465-8085; or Donna Gajda at NYSPA via centraloffice@nyspsych.org or at (516) 542-0077.

Accreditation Statement: 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.

Disclosure Statement: The Medical Society of The State of New York relies upon planners and faculty participants in its CME activities to provide educational information that is objective and free of bias. In this spirit and in accordance with the guidelines of MSSNY and the ACCME, all speakers and planners for CME activities must disclose any relevant financial relationships with commercial interests whose products, devices or services may be discussed in the content of a CME activity, that might be perceived as a real or apparent conflict of interest. None of the planners and presenters has any relevant financial relationships to disclose. 

The Veterans Mental Health – Primary Care Training Initiative is supported by a grant provided by the New York State Legislature and administered through the New York State Office of Mental Health. 


Seven New York Residents Diagnosed with Zika Virus
Dr. Mary T. Bassett, the city’s health commissioner, and Dr. Herminia Palacio, New York City’s deputy mayor for health and human services, held a news conference at City Hall on Thursday, saying that at least seven people in the state of New York have been diagnosed with Zika virus. The officials announced plans to build on the “robust infrastructure” created in response to West Nile virus and other mosquito-borne illnesses as a way to prevent Zika from entrenching itself in the city

The NYS-DOH reported that two Zika patients have been confirmed in New York City, one in Orange County, one in Nassau County, and one in upstate Monroe County. All of them contracted the virus abroad.

The U.S. Centers for Disease Control and Prevention has said pregnant women or those who may become pregnant, should try to avoid travel to 24 countries and territories, mostly in Latin America and the Caribbean, where Zika virus has been spreading.

The CDC travel alert names the following countries and territories where pregnant women in any trimester should consider staying away, and all visitors should take care to protect against mosquitoes, CBS News reported:

  • In Latin America: Bolivia, Brazil, Colombia, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Panama, Paraguay, Suriname and Venezuela.
    • In the Caribbean: Barbados, the Dominican Republic, Guadeloupe, Haiti, Martinique, St. Martin, Puerto Rico, the U.S. Virgin Islands.
    • Cape Verde, off the coast of western Africa.
    • Samoa in the South Pacific.

https://www.health.ny.gov/press/releases/2016/2016-01-22_three_cases_of_zika_virus.htm

Dear Physicians:

TELL YOUR PATIENTS NOW THAT YOU WILL NOT BE GIVING PAPER SCRIPTS AS OF MARCH 27.


CMS-1500 Claim Form ICD Indicators
The National Government Services Mail and Distribution department has noticed an increase of claims returned as unprocessable due to an invalid diagnosis code indicator. The CMS-1500 Claim Form ICD Indicators news article explains the details of reporting the ICD indicator and shows exactly where the indicator should be added.


Check Out Doctors Without Borders’ LIVE Recruitment Webinar
All interested MEDICAL AND NON-MEDICAL aid workers are invited to join us for a live teleconference and webinar to learn how you can be a part of Doctors Without Borders’ field work.
Thursday, February 25, 2016 @ 7:00PM EST Register here.

Human Resources Officers will discuss requirements and the recruitment process, a Doctors Without Borders aid worker will talk about life in the field, and participants will be able to ask questions.
SPACE IS LIMITED.  PLEASE REGISTER.
Click here for more information.


Classifieds


OFFICE SPACE – Sutton Place
Newly renovated medical office. Windows in every room looks out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower. Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or e-mail: advocate@medicalpassport.org

Office Rental 30 Central Park South
Two fully equipped exam rooms, two certified operating rooms, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468drdese@gmail.com.


Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49th Street, this ground level office is handicapped accessible. Private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581



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

January 22, 2016 – Yes to Corporate Partnerships?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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January 22, 2016
Volume 16, Number 3

Dear Colleagues:

Yesterday’s Council meeting included a lengthy discussion concerning changes related to the corporate practice of medicine statutes being considered by the New York State Departments of Health and Financial Services. The architects of healthcare reform in the state of New York are seeking to improve how healthcare services are delivered to the residents of the state. There is a prevailing view that in order to improve health outcomes, adjustments need to be made that change how relevant services are delivered.

The current view is that services that are critical to improving outcomes for many costly chronic conditions is delivered in an incomplete and/or fragmented fashion.  In order to improve outcomes, we must improve the coordination of services as well as the modalities and organizations that provide the relevant services. This is where things get wickedly complex and where we, as the highest order licensed healthcare professionals, have the duty to weigh in to insure safe delivery of high quality, evidence-based medical care.

Separation of Physicians and Non-Physicians

We enter into the arena of “wicked problems,” because the healthcare initiatives being considered challenge many of our longstanding beliefs concerning the practice of medicine and the separation of licensed professionals so that non-physicians cannot create professional medical organizations to deliver professional services. These new models do not always seek to create entities that deliver professional physician services. Rather, they seek to allow for the creation of new— perhaps hybrid— entities wherein physicians can deliver professional services that only they can deliver while others—perhaps non-professionals— deliver other services that are critical to the improvement of the physicians’ medical services.

Do we allow room for exploring new delivery models that challenge our views of how we protect the scope of practice of our profession? Do we push the envelope a bit to allow room to explore new models, making sure that physicians have the professional medical and financial control of these new delivery models?  Do we simply draw a line in the ground and raise the standard in the name of protecting our patients while archaic and cumbersome models continue to fail us?  Do we take the risk that our hard stance on the corporate practice of medicine gets railroaded by the political and regulatory machinery to the detriment of our patients because we were unwilling to initiate changes in a manner whereby we could safeguard the health and wellbeing of our patients and our profession?

The challenges facing us are great.  Many of us do not like the changes being proposed. Nonetheless, our Oath, when we entered the profession, requires us to rise above long-held beliefs, and rethink these beliefs in light of changes.

We Must Lead the Way

We must consider these changes and create the mechanisms that improve the delivery of care while we stand firm in the defense that it is the MEDICAL PROFESSION that must lead and control these novel delivery systems in order to insure evidence-based quality and safety outcomes that provide the desired value for our money.

Short of these, the most advanced healthcare system in the world is doomed to collapse or fall into mediocrity.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC_011916_Enews_550x150


MSSNY Lobby Day Scheduled for March 8th – Physicians Urged to Attend and Wear Your White Lab Coats
MSSNY’s “Physician Advocacy Day” will be held on March 8th in the Lewis Swyer Theatre in the Egg located at the

Empire State Plaza in Albany, New York.  Please register here if you plan to attend.

A full slate of legislators have been invited to dialogue with Advocacy Day participants including:

  • Donna Frescatore, Executive Director, NYS Health Benefit Exchange;
  • Troy Oechsner, Special Assistant to the Superintendent, Department of Financial Services;
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair, Richard Gottfried; Senate Insurance Chair, James Seward; Assembly Insurance Chair Kevin Cahill.

In addition, Assembly Speaker Carl Heastie, Assembly Majority Leader Joe Morelle and Senate Majority Leader John Flanagan have been invited.  A brief luncheon to which members of each House are invited to dine and speak with their constituents will follow the morning program.   County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.

Given the wide range of threats physicians face including legislation that would expand the statute of limitations with a broad date of discovery exception potentially increasing physician premiums by 14.5%; legislation to repeal the Trial Lawyers contingency fee limits, potentially increasing premiums by over 10%; significant reductions in eligibility of the Excess Program; legislation that will mandate physicians to take a 4-hour Pain Management CME course every two years; and a move to effectuate statutory and regulatory changes to implement a value-based payment structure under Medicaid and potentially to Medicare and commercial products as well.

PHYSICIANS ARE ENCOURAGED TO IMMEDIATELY REGISTER TO ATTEND THE MARCH 8TH LOBBY DAY IN ALBANY.                                            
(GOVERNMENTAL AFFAIRS STAFF)


Physicians Urged to Oppose Huge Cuts to Excess Medical Liability Insurance Program
Physicians are urged to contact their legislators to object to the huge cuts contained in the Executive Budget to the Excess Medical Malpractice Insurance program.  If permitted to go forwarded, it would unfairly result in more than half of the physicians currently enrolled being dropped.   MSSNY’s strong opposition to these cuts will be a major component of MSSNY’s testimony to the joint meeting of the Assembly Ways & Means and Senate Finance Committees this Monday examining the proposed Health Budget.

Specifically, the proposal would prioritize funding for those physicians who practice in higher risk specialties and in more litigious regions of the State.  However, by cutting the funding by $25 million, it would mean that 55% of physicians who currently receive this essential coverage would be dropped from the program.  In upstate communities north and west of Greene and Columbia counties, coverage would continue only for neurosurgeons, bariatric surgeons and OB-GYNs. That means that in the Capital District, in Northern New York, in Central New York, in western New York and in the Southern Tier every family physician, internist, pediatrician, ophthalmologist, emergency room physician, vascular surgeon, cardiologist, radiologist, pathologist, otolaryngologist, dermatologist and allergist would be automatically dropped.  Even in some downstate communities including in the Bronx, Kings, Queens, Westchester, Sullivan and Orange counties, many primary care physicians, ophthalmologists, otolaryngologists, pathologists, dermatologists and allergists would be dropped.

The Excess Medical Liability Insurance Program provides an additional layer of $1M of coverage to physicians with hospital privileges who maintain primary coverage at the $1.3 million/$3.9 million level.  The program was created over 30 years ago as a result of the liability insurance crisis of the mid-1980’s to address concerns among physicians that their liability exposure far exceeded available coverage limitations.  They legitimately feared that everything they had worked for all of their professional lives could be lost as a result of one wildly aberrant jury verdict. This fear continues today since New York State has failed to enact meaningful tort reform to ameliorate this risk. The size of verdicts in New York State has continued to grow significantly and physician liability premiums remain far out of proportion compared to the rest of the country.  Absent meaningful liability reform, full funding for the Excess program is absolutely essential in today’s very challenging practice environment.

At a time when the state is seeking to attract and retain physicians, this proposal deters physicians from wanting to practice in New York State for fear of putting themselves and their families in financial jeopardy for judgements and settlements exceeding the limits of their primary coverage.

Please urge your legislators to reject these cuts and restore full funding for the program!
(AUSTER, DEARS)


Contact Your Legislators to Support a  Health Republic Guarantee Fund
With the failure of the Executive Budget to include a Guarantee or other fund to cover the likely   hundreds of millions in payments due to Health Republic contracted providers, all physicians are urged to continue to contact their legislators and demand that the State Legislature take action to create such Guarantee or other fund.  Urging the Legislature to enact a Guarantee fund as part of the State Budget process will be a major component of the testimony that MSSNY will give this Monday at a joint meeting of the Assembly Ways & Means and Senate Finance Committees. 

MSSNY has worked with hospital associations to press key State Legislative leaders that it is absolutely imperative for the stability of our health care system that this be addressed soon.  We have shared with public officials the results of MSSNY’s survey that concluded that physicians are owed at least tens of millions of dollars in outstanding claims, of which:

  • 11% are owed $100,000 or more;
  • 20% are owed $25,000 or more; and
  • 49% are owed $5,000 or more.

Moreover, we have shared data from 5 large medical practices in the Lower Hudson Valley that together are owed over $12 million.

Please be on the lookout early next week for a new survey that seeks updated information from you whether this amount has grown since our initial survey was sent in November.  Please take the time to complete this survey, as the data is critical to our advocacy efforts.

And please take the time to send a letter to your legislators at this link.

Remind them that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs, insurance companies dropping physicians from their networks and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for patient care and employment in your community.
(AUSTER, DEARS) 


Disastrous Liability Expansion Bill Back on Assembly Calendar; Physicians Must Contact Their Legislators to Oppose Now!
All physicians must continue to contact their Senators and Assembly members to urge that they oppose legislation (A.285, Weinstein) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

With the bill having passed the Assembly in 2015, but not the Senate, it resumed a place on the Assembly Calendar, where it could be voted on by the full Assembly at any time.   The bill was brought up for initial consideration on Monday 1/11, but was “laid aside” by the Assembly Republican Conference.

While the bill currently does not have a Senate sponsor, it is possible that similar legislation could be introduced shortly.   At the conclusion of the 2015 Legislative Session, Senate Majority Leader Flanagan noted in response to a question from a Daily News reporter that issues like malpractice reform “have never been done in isolation” and that they would be working with representatives on both sides of this issue.  Since that time, MSSNY working together with MLMIC and hospital associations have met with top Senate staff to discuss comprehensive medical liability proposals to work towards legislation that would reduce the outrageous cost of physician medical liability premiums.

As these discussions ensue, you need to let your legislators know that no liability increases can be tolerated!  MLMIC’s estimate is that A.285 could increase physician liability premiums by an untenable 15%!   New York physicians continue to pay liability premiums that are among the very highest in the country.  They also face rapidly increasing overhead costs to remain in practice such as the huge costs associated with implementing expensive and cumbersome electronic medical record systems.  At the same time, they face reduced payments from Medicare and commercial insurers, and many practices face losses of tens of thousands, hundreds of thousands and in some cases millions of dollars in losses due to the collapse of Health Republic.

And to make matters even worse, trial lawyers are aggressively pushing the Legislature to consider additional liability expansion bills such as legislation that would eliminate the statutory limitation on contingency fees in medical liability actions, legislation that MLMIC has estimated could have the effect of raising your premiums by over 10%.   Physicians need liability reform to bring down these costs, not legislation that increases them!
(AUSTER, DEARS)


CME Mandate Bill Taken Off NYS Assembly Health Committee Agenda; Senate Bill Moving in Health Committee
Assembly Bill 355 (Rosenthal) and Senate Bill 4348A (Hannon) which would create a continuing medical education mandate for practitioners with prescribing privileges was taken off the agenda of the Assembly Health Committee on Thursday but a slightly different Senate version of the legislation is on the Senate Health Committee agenda for next week.  Physician action is vitally important.  They are urged to contact their elected representatives to urge that they vote against this mandate!  Send an email through MSSNY’s Grassroots Action Center.

  1. 4348A, sponsored by Senator Kemp Hannon, authorizes the Commissioner of Health to establish standards and to review requirements for CME on pain management, palliative care and addiction, is on the Senate Health Committee agenda for Tuesday, January 26th. It would require health care professionals authorized to prescribe controlled substances to complete three hours of continuing medical education, prior to renewal of registration to practice, that involves pain management. The curricula must include but is not limited to, I-STOP and drug enforcement administration requirements for prescribing control substances; pain management; appropriate prescribing; managing acute pain; pain; palliative medicine; preventative, screening and signs of addiction; responses to abuse and addiction; and end of life care. The Commissioner may allow for exemptions if the health care professionals meet requirements to the Commissioner’s satisfaction. The Commissioner must report on the impact of this legislation and any recommendations no later than three years after its enactment.

MSSNY has strongly opposed this measure in previous legislative sessions. Continuing Medical Education is valuable to physicians in keeping up-to-date on new clinical information, and physicians throughout the state voluntarily take continuing medical education for continued professional development in those areas that pertain to their individualized practice.  However, this bill fails to recognize that the Medical Society of the State of New York, the specialty societies, the American Board of Medical Specialties, and the American Osteopathic Association have all been aggressively promoting voluntary CME on pain management and that there is other course work that addresses many of the above issues. (CLANCY, DEARS)


Concerns with One-Sided Workers Compensation Reform Proposals to be an Important Component of MSSNY’s Budget Testimony
MSSNY’s testimony to the Senate Finance and Assembly Ways & Means Committees to be presented this Monday will raise significant concerns with the sweeping Workers’ Compensation reform proposal contained in the Executive Budget.  Among the proposals of greatest concern to physicians and their injured worker patients:

  • Removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation, which is currently an important peer review function provided by county medical societies to assure physician applications are complete and physician applicants are appropriately qualified to deliver this needed care to injured workers;
  • Enables treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery with physicians; whether new funds will be allocated or whether existing fees will need to be cut to cover this expanded list of care providers; and whether a non-physician can perform an IME of an injured worker to review the care provided by a physician to an injured worker;
  • Removes the requirement for a referral by a physician as a pre-condition for an injured worker to receive psychological care;
  • Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose a $5,000 fine on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule; and
  • Prohibits an injured worker not subject to a collective bargaining agreement from seeking medical treatment from outside a Workers Compensation PPO before 120 days after his or her first visit to a preferred provider organization provider.

Exacerbating these concerns is that the proposal also does not meaningfully address the many excessive administrative hassles identified by physicians that have caused many physicians to choose to not participate in the Workers Compensation program.   While there have been some modestly positive actions taken by the WCB in recent years to encourage physician participation in the WC program through removal of arbitration fees and development of an electronic portal for facilitating authorizations from carrier, the Budget proposals if enacted could further chase physicians away from the program.

MSSNY has reached out to labor organizations to coordinate its advocacy in opposition to these adverse proposals.  MSSNY has also been working closely with county medical society leadership from across the State to encourage their outreach to their local Senators and Assemblymembers to request that these proposals be jettisoned from the Budget.
(AUSTER, DEARS)


Physicians Encouraged to Register for Opioid Prescribing Webinar on January 26
Physicians and other prescribers are encouraged to register for the first free webinar on opioid prescribing which will take place on Tuesday, January 26th at 12:30 p.m.  at the following link.

Click on the upcoming tab and select the programs. Physicians will need to register for each webinar.

The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are jointly providing this free,  four part webinar series on opioid prescribing.  Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

The first webinar will be conducted by Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN and the educational objectives are:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

The remaining webinar series will be held on:

Wednesday, February 10, 2016, 7:30 a.m. Faculty:  Charles E. Argoff, MD.  The educational objective:  Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.  Faculty:  Jeffrey Selzer, MD and the educational objective:    Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.

Thursday, March 10, 2016, 7:30 a.m. Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM and the educational objectives:  Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed; discuss strategies to reduce risk of treating pain in patients with substance use disorders.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing.

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.

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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.
(CLANCY, DEARS)


Bill to Limit Opioid Prescriptions to Three-Ten Day Supply on Senate Health Agenda
Senate Bill 6091A, which would limit the initial prescription of Schedule II or III Controlled Substance to a three to ten day supply, is on the Senate Health Committee agenda for Tuesday, January 26th.   Sponsored by Senator Kemp Hannon, the bill is intended to encourage patients whose acute pain lasts longer than initially expected to follow up with a physician and it lessens the number of the pills left in medicine cabinets and available for diversion.  The bill does limit the number of co-pays for patients should they need additional prescriptions.

The Medical Society of the State of New York is opposed to this measure and believes that having the New York State Legislature place an arbitrary limit on any type of prescriptions interferes with the practice of medicine.   Its companion measure, A. 8601, sponsored by Assemblymember John T. MacDonald III, is in the Assembly Health Committee.

Physicians are urged to contact Senators on the Health Committee and urge defeat of this measure.  Senate Health Committee members are:   Senators Kemp Hannon, Hugh Farley, Simcha Felder, Martin Golden, Ruth Hassell-Thompson, Brad Hoylman, William Larkin, Betty Little, Jack Martins, Velmanette Montgomery, Terrence Murphy, Roxane Persaud, Gustavo Rivera, James Seward, Toby Stavisky, David Valesky, and Catharine Young.  
(CLANCY, DEARS)


Governor Nominates Vullo for DFS Superintendent
Governor Andrew Cuomo this week nominated Maria T. Vullo to serve as the Superintendent of the New York State Department of Financial Services. She is currently of counsel at Paul, Weiss, Rifkind, Wharton & Garrison LLP, where she was a partner for 20 years, and previously oversaw the Economic Justice Division in the Office of the New York State Attorney General.   DFS has had multiple Interim Superintendents since the previous Superintendent, Benjamin Lawsky, left the position last spring.  To read more about Ms. Vullo’s background, click here.
(AUSTER)


Centerlight Healthcare Settles for $47 Million in Medicaid Fraud Case
On Thursday, January 21st, Attorney General Eric Schneiderman announced a $47 million settlement with CenterLight Health Care and Centerlight Health System stemming from allegations of fraudulent Medicaid billing for unrendered services to 1,200 Medicaid recipients. As part of the settlement agreement CenterLight admitted that it enrolled ineligible Medicaid beneficiaries in its Managed Long Term Care Plan (“MLTCP”), which was contracted by NYS DOH to provide long-term community based health care; and that it used adult day care centers to provide community-based MLTCP personal care services that did not qualify as personal care services. In addition to its $47 million settlement, CenterLight agreed to additional monitoring for two-years by an independent compliance monitor and the A.G.’s Medicaid Fraud Control unit, and if necessary to revise its compliance policies.
(MCPARTLON) 


Inside Correctional Facilities—Increase in Staff Training on Inmate Mental Health
On January 21st, the New York State Senate passed a one-house bill sponsored by Senator Carlucci (D- Rockland/Westchester) which clarifies the eight-hour annual requirement for training of residential mental health treatment unit staff, as well as security, program services, mental health and medical staff with direct contact of inmates with mental illnesses. The bill was passed unanimously by the Senate, as it contains the language of a previously negotiated chapter amendment to a bill signed into law by Governor Cuomo last month. Current NYS Correction Law similarly requires that new corrections staff receive initial training in mental health treatment upon recruitment. The training topics include: types and symptoms of mental illnesses, the goals of mental health treatment, the prevention of suicide and training in how to effectively and safely manage inmates with mental illness. While a same-as bill has yet to be introduced in the Assembly, it will likely do so shortly.                                                                                            (MCPARTLON)


CMS Posts Information Regarding How Physicians Can Apply for Meaningful Use Hardship
The Center for Medicare and Medicaid Services (CMS) today posted information regarding changes to Medicare EHR Incentive Program hardship exception process.  Medicare is implementing these modifications as a result of the recently passed Patient Access and Medicare Protection Act, which established that the Secretary may consider hardship exceptions for “categories” of EPs, eligible hospitals, and CAHs that were identified on CMS’ website as of December 15, 2015.  Prior to this law, CMS was required to review all applications on a “case-by-case” basis.   The AMA had advised that it will review CMS’ materials and begin to educate physicians about how they can best apply for the exception.  Here is a link to the information CMS posted.

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:          

pschuh@mssny.org ldears@mssny.org            mauster@mssny.org  
pclancy@mssny.org bellman@mssny.org    


Council Meeting Notes: January 21, 2016

  • MLMIC’s Vice President, Don Fager, announced a 20% dividend for policyholders who are insured by May 1, 2016, and maintain continuous coverage through July 1, 2016.
  • Council approved the Board of Trustees report, which included approval of $100/day for delegates at the 2016 House of Delegates and approval for a MSSNY financial audit for 2015.
  • Council discussed MSSNY’s approach regarding the corporate practice of medicine as being proposed within the DSRIP program and agreed to enable leadership to carry on discussions with appropriate parties.
  • Dr. Maldonado stressed the importance of Legislative Day this year, which will be held on March 8 in Albany. He called on physicians to help ensure a large turnout to demonstrate the importance of our issues to legislators.
  • MSSNY will partner with the American Cancer Society and the American Cancer Society Action Network in a new anti-smoking campaign, 2016 New York is Kicking Butts Quit Smoking Campaign. The campaign is currently centered on NYC, but ACS hopes to expand it throughout the state. In New York City, smoking continues to be the number one cause of preventable death.
  • Council approved the following Resolutions:
  • 2015-268: MSSNY will encourage further research into genomic sequencing, including its ethical implications, its clinical implications and its financial implications and will also encourage efforts to increase the number of qualified genetic counselors in anticipation of the increasing clinical need.
  • 2015-253: MSSNY will seek federal legislation to ensure that as the government moves forward to value based payment and reform that the legislature and federal agencies seek direct physician input to ensure that bundled payments result in quality care and best patient outcomes, rather than just concentrating on the cost of care.
  • 2015-263: MSSNY will seek legislation or regulation to ensure that Medicare, Medicaid and insurance plans allow physicians to make dosing adjustments for approved medications to allow the patient to achieve therapeutic levels regardless of BMI and differing metabolic considerations. The dose administered should be within the purview of the treating practitioners based on clinical parameters, documented in the medical record.
  • First District Branch E-Prescribing Motion: MSSNY will press for legislation or regulation that would allow patients’ requests for paper prescription and pharmacy choice to be honored and that this legislation or regulation permit any patient to request opting out of electronic prescribing by requesting the same in writing to a physician who will then be permitted to issue a paper prescription in person or by fax.


MLMIC Policyholders Will Receive 20% Dividend
Our mission is to provide insurance at cost, without a profit motive. To offset premiums, we offer dividends to our policyholders whenever we can. This year, MLMIC policyholders will receive a 20% dividend. To take advantage of this dividend, you simply need to be insured by May 1, 2016, and maintain continuous coverage through July 1, 2016.

MLMIC is a mutual insurer, owned by our policyholders. Over the years, our financial strength has allowed us to pay more than $300 million in dividends to our policyholders, something no other insurer can match.

Learn More  or call (888) 793-0393. 


Medical Schools Seek Dollars for Diversity
The Associated Medical Schools of New York is lobbying the state legislature to boost its funding for fiscal 2017. The organization, which represents 16 public and private medical schools throughout the state, is requesting $2.4 million for scholarships and diversity initiatives, up from $1.6 million last year. The bulk of the money, $2 million, would fund four post-baccalaureate programs that help students from underrepresented backgrounds get into medical school. An additional $400,000 is for launching a new scholarship. African-Americans, Latinos and indigenous peoples make up 35% of New York’s population but only 9% of the physician workforce, according to a 2014 report from the SUNY Albany Center for Health Workforce Studies. Funding for AMSNY’s diversity initiatives was slashed by about 20% after the 2008 financial crisis. The requested funding would help restore the programming that was dropped, said Jo Wiederhorn, the group’s president and chief executive.


Mt. Sinai HCV Intensive Training Preceptorship Program
The Mount Sinai Institute for Advanced Medicine – CEI HIV/HCV Center for Excellence is proud to debut our HCV Intensive Training Preceptorship program! This 2-day clinical education program (March 24-25, 2016) provides an intensive experience for practicing clinicians (e.g. physicians, physician assistants, nurses and nurse practitioners) in New York State. Through a combination of didactic sessions and experiential training, clinicians are able to enhance their HCV prevention, treatment, and care knowledge and competence to better serve their patients.

All clinical experience shadowing will take place at a Mount Sinai affiliated clinic located in Manhattan, NY. Accepted applicants from upstate New York will be provided with an honorarium to assist with transportation and lodging expenses.

The deadline to apply is Friday, January 25 at 5pm. For more information, please visit: https://www.surveymonkey.com/r/HepCPreceptorship or contact sjobe@chpnet.org. 


EHR Incentive Hardship Exception Instructions Available NOW
Today, CMS has posted new, streamlined hardship applications, reducing the amount of information that eligible professionals (EPs), eligible hospitals, and CAHs must submit to apply for an exception. The new applications and instructions for a hardship exception from the Medicare Electronic Health Records Incentive Program 2017 payment adjustment are available here.

This new, streamlined application process is the result of PAMPA, which established that the Secretary may consider hardship exceptions for “categories” of EPs, eligible hospitals, and CAHs that were identified on CMS’ website as of December 15, 2015. Prior to this law, CMS was required to review all applications on a “case-by-case” basis.

Importantly, EPs, eligible hospitals, and CAHs that wish to use the streamlined application must submit their application according to the timeline established in PAMPA:

  • Eligible Professionals: March 15, 2016
  • Eligible Hospitals & CAHs: April 1, 2016

Please note: CAHs should use the form specific for the CAH hardship exceptions related to an EHR reporting period in 2015. CAHs that have already submitted a form for 2015 are not required to resubmit.

In addition, we have heard from stakeholders that they would like a more efficient approach for submitting applications from groups of providers. We have reviewed our administrative authorities and determined that groups of providers may apply for a hardship exception on a single application. Under the group application, multiple providers and provider types may apply together using a single submission. The hardship exception categories are the same as those applicable for the individual provider application.

Providers will have the option to submit an electronic file (in excel or csv formats) with all National Provider Identifiers (NPIs) or CMS Certification Numbers (CCNs) for providers within the group or use a multiple NPI or CCN form to submit their application. In addition, facilities which include both inpatient and outpatient settings may include both the individual NPIs for any eligible professionals and the CCN for the eligible hospitals and CAHs on the same single submission for their organization.


Physicians in Western New York Wary about Medical Marijuana Treatment
The Buffalo (NY) News (1/19, Davis) reports that “of the 226 doctors certified to recommend marijuana in New York State as of last week, 12 of them work” at the Dent Neurologic Institute in Amherst. Dr. Laszlo Mechtler, Dent’s medical director, is a “strong advocate for marijuana’s use where the scientific evidence shows it can help,” but “like many other physicians – remains wary about the drug.”

For physicians, the four-hour NYSDOH approved course is now available online. The online course is provided by TheAnswerPage, an established online medical education site, and includes the following topics: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence. The course will cost $249 to take. Successful completion of the course will provide 4.5 hours of CME credits. The course may be accessed here.


Peconic Bay Joins Northwell Health Group
Newsday (1/19, Ochs) reports that Peconic Bay Medical Center and Northwell Health Group signed a formal agreement on Tuesday, making Peconic Bay the “21st hospital in the health system and anchoring Northwell’s presence on the East End.”  Peconic Bay chief executive Andrew Mitchell “said the agreement signals the beginning of a ‘new era for health care in central and eastern Suffolk’ that will make Peconic Bay, which serves about 200,000 patients and employs 1,300, a regional health care provider.” The agreement also signals the end of “Peconic Bay’s 10-year relationship with Stony Brook University Hospital and the demise of the East End Health Alliance formed in 2008.” 


CDC: Physicians Should Be Aware of Zika Virus in Pregnant Women
The CDC issued a travel warning to pregnant women and women of child-bearing age to avoid traveling to 14 countries in Central America and the Caribbean due to the risk of contracting the Zika virus, which is linked to severe birth defects. CDC is warning physicians to look out for symptoms of the Zika virus in pregnant women returning from trips to South and Central America http://wwwnc.cdc.gov/Travel. Published in

MMWR, the recommendations include:

  • All pregnant women should be asked if they have recently traveled to areas with active Zika virus transmission.
  • Those with recent travel to such areas and with symptoms of fever, rash, muscle aches, or conjunctivitis during or within 2 weeks of travel should be tested for Zika.
  • For pregnant women who test positive for Zika, clinicians should consider conducting ultrasounds every 3 to 4 weeks to monitor the fetus’s growth.

Zika is a mosquito-borne virus suspected of causing thousands of cases of microcephaly in infants born in Brazil over the past year. Last week, the CDC warned pregnant women to consider postponing travel to countries with ongoing Zika transmission.  Click here to read the full MMWR article.


Physicians Should Avoid Overuse of Antibiotics For Respiratory Problems
The CDC and the American College of Physicians have issued guidelines available at http://annals.org/article.aspx?articleid=2481815 intended to help physicians avoid overuse of antibiotics for respiratory problems. The guidelines were published in Annals of Internal Medicine. The guidelines “lay out how doctors begin deciding if antibiotics are warranted for” certain “respiratory complaints, explain that decision to patients and offer guidance on symptom relief.”


Longtime MSSNY Member Rufus Nichols, MD Passes Away
Rufus Nichols, MD passed away on January 20, 2016 after a battling a long illness.  Today would have marked Dr. Nichols’ 46 years as a member of the Society.  Many of you may remember seeing him at the House of Delegates. He served on many important MSSNY Committees: Committee to Eliminate Health Care Disparities; International Medical Graduates Committee; Long Term Care Committee; Organized Medical Staff Section (Officer); and Preventive Medicine and Family Health Committee.

Notes of condolence may be sent to Mrs. Jackie Nichols, 394 Joanne Court, Bartonsville, PA 18321.The funeral will be held at Bethlehem Church, 89-45 Lefferts Blvd., Richmond Hill, NY 11418.  Here is the website – Bethlehem Church NYC.

Services are as follows:


Classifieds

Office Rental 30 Central Park South
Two fully equipped exam rooms, two certified operating rooms, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468drdese@gmail.com.


Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49th Street, this ground level office is handicapped accessible. Private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581



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

Council – January 21, 2016

AGENDA
Council Meeting
Thursday, January 21, 2016
Designated WEBEX locations: Albany Office, Broome County, Monroe County & Westbury Office

A. Call to Order and Roll Call

B. Approval of the Council Minutes of November 5, 2015

C. New Business (All New Action & Informational Items)

1. President’s Report
a. Executive Committee Minutes, December 22, 2015 & November 19, 2015
b. Verbal discussion on Corporate Practice of Medicine in New York
c. ACTION ITEM – MSSNY to join as a partner with the American Cancer Society & the American Cancer Action Network

2. Secretary’s Report – Nominations for Life Membership & Dues Remissions

3. Board of Trustees Report – Dr. Latreille will present the report (handout at Council)

4. MSSNYPAC Report – Dr. Sellers will present the verbal report (handout at Council)

5. MLMIC Update – Mr. Don Fager will present a verbal report (VIA WEBEX)

6. AMA Delegation Update – Dr. Kennedy will present a verbal update

7. MESF Update – No report submitted

8. Commissioners (All Action Items) FOR COUNCIL APPROVAL
1. Commissioner of Science and Public Health, Frank G. Dowling, MD
Committee on Bioethics Resolutions:
Resolution 2015-267, Complete Genomic Sequencing
Resolution 2015-268, Private Insurance Carriers Become Medicare Franchise
     2. Commissioner of Socio Medical Economics, Harold M. Sokol, MD
Interspecialty Committee Resolutions:
Resolution 2015-253, Reimbursement for Non-Bundled Lab Tests
Resolution 2015-260, Monitored Anesthesia Care & Pain Management Injections
Resolution 2015-263, Appeals Process for Medications with Proscribed Dosing
9. Councilors & Presidents (All Action Items from County Medical Societies & District Branches) FOR COUNCIL APPROVAL
1. A MOTION submitted by Zebulon Taintor, MD, President, First District Branch asking the MSSNY Council to ADOPT a Resolution on E-Prescribing and Patient Preference

ADJOURNMENT OF COUNCIL
ACTION ITEM

Empire State Medical, Scientific & Educational Foundation, Inc. Election of Directors

RECONVENE COUNCIL

 

D. Reports of Officers (Informational)
1. Office of the President – Joseph R. Maldonado, MD
2. Office of the President-Elect – Malcolm D. Reid, MD
3. Office of the Vice President – Charles Rothberg, MD
4. Office of the Treasurer – Thomas J. Madejski, MD Financial Statement for the period 1-1-15 to 12-31-15
5. Office of the Speaker – Kira A. Geraci-Ciradullo, MD
E. Reports of Councilors (Informational)
1. Kings and Richmond Report – Parag H. Mehta, MD
2. Manhattan/Bronx Report – Joshua M. Cohen, MD, MPH
3. Nassau County Report – Paul A. Pipia, MD
4. Queens County Report – Saulius J. Skeivys, MD
5. Suffolk County Report – Frank G. Dowling, MD
6. Third District Branch Report – Harold M. Sokol, MD
7. Fourth District Branch Report – John J. Kennedy, MD
8. Fifth District Branch Report –Howard H. Huang, MD
9. Sixth District Branch Report – Robert A. Hesson, MD
10. Seventh District Branch Report – Mark J. Adams, MD
11. Eighth District Branch Report – Edward Kelly Bartels, MD (no written report submitted)
12. Ninth District Branch Report – Thomas T. Lee, MD
13. Medical Student Section Report – Charles A. Kenworthy
14. Resident & Fellow Section Report – Robert A. Viviano, DO (no written report submitted)
15. Young Physician Section Report – L. Carlos Zapata, MD (no written report submitted)
F. Commissioners (All Committee & Sub-Committee Informational Reports/Minutes)
1. Commissioner of Communications, Joshua M. Cohen, MD, MPH
Report of the Division of Communications
2. Commissioner of Science and Public Health, Frank G. Dowling, MD
Public Health & Education Informational Report
3. Commissioner of Socio Medical Economics, Harold M. Sokol, MD
Interspecialty Committee Minutes, Thursday, October 22, 2015
G. Report of the Executive Vice President
1. Membership Dues Revenue Schedule
2. PAI Letter re Proposed Health Insurer Mergers
3. Physician Advisory Council (PAC) Teleconference Minutes
H. Report of the General Counsel
(no written report submitted)
I. Report of the Alliance
Alliance Report
J. Other Information/Announcements
1. Sign-on Letter to CMS re Meaningful Use
2. Sign-on Letter supporting H.R. 2513, Protecting Access, Competition and Equity Act
3. AMA Letter to Dr. Frieden on Proposed 2016 Opioids for Chronic Pain
4. MSSNY Letter to Andy Slavitt, Acting Administrator, CMS re Request for Information(RFI) regarding the implementation on Alternative Payment Models(APMs) and Merit-Based Incentive Programs(MIPS) under the Medicare Access & CHIP Reauthorization Act(MACRA) handout at Council
K. Adjournment

January 15, 2016 – Governor’s Speech Challenges Physicians

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
January 15, 2015
Volume 16, Number 2

Dear Colleagues:

While on the surface the course of healthcare delivery in New York appears to be moving along unfettered, much is happening at levels that have not fully gotten doctors’ full attention.  This week, I would like to highlight several for you.  It is impossible to provide a full review of all the issues in one short column so I ask that you do your homework with others in your group, hospital medical staff or county society.

Senate Roundtable on Health Republic

Last week, Dr. Scott Hayworth (Mt. Kisco Medical Group) and I participated in a Senate roundtable on the Health Republic fiasco.  Other parties included representatives from the DOH, DFS, hospital provider side and other insurers. By far, the largest cohort was that of the insurers. It was an opportunity for the Committee on Health to hear views from stakeholders as to the causes of the debacle and how we should move forward.

Dr. Hayworth and I were clear in our presentations on three points:

1) MSSNY alerted NYS health officials a year earlier to the closing that Health Republic had serious payment problems.

2) Physicians have been harmed significantly, leaving them with financial losses that will impact their abilities to provide necessary services to other patients.

3)  Failure to make physicians whole in the solutions brought forth by the state will likely dissuade doctors from participating in any future DSRIP and SHIP initiatives for fear of another failed healthcare reform project sinking them.  We made it very clear—a guaranteed State Fund is necessary to make physicians whole and ensure future success of physician engagement in DSRIP and SHIP.

Governor’s Budget

The Governor’s Budget this year presents several challenges to physicians.  First, there is the proposal once again to expand the terms under which retail clinics can operate in New York.  Second, there is once again an effort to eliminate the second layer of excess coverage for malpractice at a time when the legislature is consideration expanding the date of discovery and statute of limitations on filing a lawsuit for malpractice.  Third, there is a push to expand the scope of healthcare providers who can participate in the Workmen’s Compensation Board program. Finally, there is NO budgetary proposal for the establishment of a guarantee fund to address the losses in the Health Republic debacle.  

Insurer Mergers and Physician Opposition

This past week, the Physician Advocacy Institute sent a 14-page letter outlining its opposition to the merger of several large insurers in the country, highlighting the problems that such controlling entities would have in the marketplace and on the practices of physicians.  I encourage you to review this work done by an organization MSSNY helped found through the United Healthcare lawsuit settlement several years ago.

E-prescribing

Finally, it is imperative that physicians who have not as yet enrolled in the state’s e-prescribing program do so ASAP. The March 27, 2017 is looming.  A caveat–it will be impossible to complete the instructions before the deadline if you wait much longer.  We encourage you to consider the member discounted DrFirst option endorsed by MSSNY.

If you believe you qualify for a waiver, apply NOW.

Have a Happy Martin Luther King’s Day!

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Governor Andrew Cuomo Delivers Joint State of the State and Budget Message
Gov. Andrew Cuomo this week set forth his state of the state message proclaiming the accomplishments of his administration over the past five years of his term and unveiling143.6 billion budget for the coming 2016-17 fiscal year.

Many of Cuomo’s 2016 priorities have been released over the past week including plans for a massive, multi-year infrastructure investment for airports, roads and bridge construction as well as a strengthening of mass transit systems in the New York City area, and increasing the state’s minimum wage to $15 (in NYC by 2018  and by July 2021 for businesses in the rest of State) and proposing 12 weeks of paid family leave in the budget, which would be paid for with a $1 paycheck deduction for employees.

Earlier in the week, Governor Cuomo announced a $7M grant to four organizations working to control obesity, diabetes, heart disease and stroke. The funding will allow each organization to implement strategies to encourage lifestyle change and link community programs to include clinical services. Included among the four organizations awarded funding were: Albany County Department of Health ($879,880); HealtheConnections ($2M); Hudson River Healthcare ($2M) and P2 Collaborative of WNY ($2M).

Cuomo proposed divvying up more than $2 billion in settlement relief funds to a variety of areas. He wants to spend $700 million on a plan that would stabilize the Thruway Authority’s finances, $340 million for what is being term a toll “reduction” plan, $200 million on a transportation capital plan, $640 million to provide affordable housing and combat homelessness and $225 million for economic development.

Cuomo’s proposal included an increase of $1.4 B on education aid, an increase of more than 6 percent. Overall, education aid would increase by $2.1 billion over the next two years.

Components of the Governor’s tax cut for small businesses include: a reduction of the corporate tax rate for small businesses from 6.5% to 4%; increasing the exemption from 5-15% of income for tax purposes for sole proprietors and farmers; and granting a 15% exemption for partnerships and s-corps.

The Governor proposes adoption of broad new ethics measures, including limits on outside income for the Legislature. He also proposed to limit how much money lawmakers can earn in the private sector to 15 percent of their base salary. Cuomo also proposed that lawmakers end the practice of allowing single donors to give unlimited contributions through a network of limited liability companies. Cuomo also proposed public financing of political campaigns, which Senate Republicans have insisted they will not pass.

Describing the personal issues faced by his partner Sandra Lee last year, the Governor ended his presentation by proposing a $90M program in NYS for breast cancer screening and an initiative to require all health insurers to cover breast cancer screening.

In addition, the budget contains a number of initiatives—some of which we have seen previously- which will if ultimately enacted by the Legislature impact physicians and patients across NYS including the proposals listed below:

  • Limit Access to Excess Medical Malpractice Coverage. The Governor has again proposed (as he did three years ago) to significantly limit access to the second layer of medical malpractice coverage. Specifically, the proposal would require the Superintendent to, at least once every five years beginning on July 1, 2016, rank from highest to lowest each class and territory combination used for apportionment of premiums to pay for the excess coverage.  Ranking will be a function of physician primary coverage costs and “applicable” (and unspecified) excess tier factors. The proposal requires the Superintendent to grant priority for purchasing policies in descending order beginning with high risk class and territory combination until the appropriation is exhausted. This initiative will result in a $25 million reduction to the program from $127.4M to $102.4M. Three years ago, he proposed somewhat different language but his articulated goal was to limit Excess coverage to physicians with the highest risk…which would have left nearly 40% of physicians who currently have such coverage without it.
  • Authorizes Establishment of Retail Clinics. The Governor has proposed to enable the establishment of ‘limited service’ clinics which provide a limited list of services in retail stores- provided that they adhere to regulations which would among other things require them: to be accredited; accept walk ins; adhere to advertising and signage standards; disclose ownership interests; directly employ a medical director; and strengthen primary care through integration of services with the patient’s other health care providers. The justification given for this proposal is “to increase access to economical primary care services for Medicaid recipients and reduce unnecessary emergency room and inpatient visits”. This proposal is also somewhat modified from those advanced in previous years. It now would allow diagnostic and treatment centers (owned by hospitals), community health centers and federally qualified health centers to operate a limited services clinic.  The proposal would also require an establishment to ‘demonstrate a commitment’ to operate limited service clinics in medically underserved areas; and would allow the department in determining whether to approve additional limited service clinic locations, to consider whether the operator has fulfilled its commitment to operate limited services clinics in medically underserved areas of the state.
  • Makes Significant Changes to Workers Compensation program. The Governor’s proposal would expand the list of providers who are eligible to deliver (and receive payment directly form the W/C program) to include acupuncturists, nurse practitioners, physician assistants, and social workers. Currently, only chiropractors, physicians, podiatrists, psychologists and physical therapists were authorized to receive reimbursement from the workers’ compensation program. Ostensibly, NPs and PAs employed by physicians provided care but the physician’s practice was reimbursed. The proposal also eliminates need for county medical society review of physicians looking to be authorized to deliver care. The initiative would also enhance the flexibility of hearing times and enables virtual hearings for workers compensation cases. See related article.
  • Health Republic. The Governor’s proposed budget does not include language to require the creation of a Guarantee Fund or identify the use of any settlement monies or other pool of monies to address the financial plight of physicians and other providers due to the recent demise of Health Republic. MSSNY is working closely with several physician practices, the Greater New York Hospital Association and HANYS to urge enactment of legislation to reimburse providers who have incurred significant losses as a result of providing care to HR insureds.
  • Statutory Proposals to advance DSRIP/VBP. The Governor’s proposed budget did not include the statutory language changes that have been advanced by various subcommittees to the VBP Workgroup, the Governor’s State of the State message did stipulate that “in 2016, DSRIP will move to the next phase of transforming the health care delivery system in New York by implementing pilot programs to replace expensive fee-for-service payments with ‘value-base’ payments that reward providers for successful patient outcomes and help achieve one of the core DSRIP goals of reducing avoidable hospital admissions by 25 percent over five years.”
  • Additional funding ($200M) to combat AIDS. Specifically, these funds will be used to expand the availability of affordable housing and housing assistance for those living with HIV and identify undiagnosed persons, link them with treatment and facilitate access to necessary medications to keep them HIV negative to prevent spreading the disease.
  • Additional funding ($6M) to combat heroin epidemic. These funds will continue to support prevention, treatment and recovery programs targeted toward chemical dependency, residential service opportunities, and public awareness and education activities.
  • Permits certain state facilities to share patient medical records. Permits facilities, including facilities operated or licensed by the Department of Mental Hygiene, to share clinical records with managed care organizations, behavioral health organizations, health homes, and other entities authorized by the Department or Department of Health (DOH) to provide, arrange or coordinate health care services for Medicaid recipients for whom such entities are responsible.
  • Eliminates the prescriber prevails. Eliminates existing statutory prescriber prevails protections for medications for patients covered in the Medicaid program, except for atypical antipsychotic and anti-depressants. (DEARS, AUSTER, CLANCY, MCPARTLON) 

Executive Budget Seeks to Marginalize Physician Care to Injured Workers
The Governor’s proposed Budget released this week contains sweeping changes to long standing Workers’ Compensation laws to, according to the supporting memo: ensure the system provides more timely and appropriate medical and wage replacement benefits to workers; provide broader and more accessible options for medical care; make hearings more accessible through flexible scheduling and use of virtual hearings; and streamline Workers’ Compensation Board processes and administration to expedite decision making.

While these goals are obviously shared by the physician community, the proposal includes a number of seriously problematic proposals that could further discourage physician participation in the Workers’ Compensation program.  Among the proposals:

  • Removes the authority of county medical societies to recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation, which is currently an important community function provide by county medical societies;
  • Enables treatment of injured workers and direct payment for care by nurse practitioners and physician assistants, without clarity as to: how non-physicians treating patients with serious health conditions will coordinate patient care delivery with physicians; whether new funds will be allocated or whether existing fees will need to be cut to cover this expanded list of care providers; and whether a non-physician can perform an IME of an injured worker to review the care provided by a physician to an injured worker;
  • Removes the requirement for a referral by a physician for an injured worker as a pre-condition to receive psychological care;
  • Expand the circumstances when a physician or other health care provider can have their authorization removed and empowers the Board to impose a $5,000 fine on a physician or any other Board-authorized health care provider for violating a Workers Compensation rule; and
  • Prohibits an injured worker not subject to a collective bargaining agreement from seeking medical treatment from outside a Workers Compensation PPO before 120 days after his or her first visit to a preferred provider organization provider.

Of further concern, the proposal does not address any of the many excessive administrative hassles identified by physicians that have caused many physicians to choose to not participate in the Workers Compensation program.   While there have been some modestly positive actions taken by the WCB in recent years to encourage physician participation in the WC program through removal of arbitration fees and development of an electronic portal for facilitating authorizations from carrier, the Budget proposals if enacted could further chase physicians away from the program.   MSSNY has reached out to labor organizations to coordinate its advocacy in opposition to these adverse proposals. (AUSTER)


MSSNY Lobby Day Scheduled For March 8th– Physicians Urged To Attend And To Wear Your White Coats
SAVE THE DATE- MSSNY’s Physician’s Lobby Day will be held on March 8th in the Louis Swyer Theater in the Egg located on the Empire State Plaza in Albany New York.  A full slate of legislators and key staff to the Departments of Health and Financial Services has been invited to dialogue with Lobby Day participants including:

  • Donna Frescatore, Executive Director of the NYS Health Benefit Exchange
  • Troy Oechsner, Acting Executive Deputy Superintendent Of Insurance , Department of Financial Services
  • Jason HElgerson, Medicaid Director, Department of Health
  • Legislative Panel: Senate Health Chair Kemp Hannon; Assembly Health Chair Richard Gottfried; Senate Insurance Committee Chair and Assembly Insurance Chair Kevin Cahill.
  • Senate Majority Leader John Flanagan, Assembly Speaker Carl Heastie

A brief luncheon to which members of each House are invited to dine and speak with their constituents will follow the morning program. County Medical Societies will be scheduling appointments for physicians to meet with their elected representatives.
(DEARS)


Date of Discovery Liability Expansion Bill Back on Assembly Calendar; Physicians Must Contact Their Legislators to Oppose Now!
With the Legislature back in Session, all physicians must again contact their legislators to urge that they oppose legislation (A.285, Weinstein) that could drastically increase New York’s already exorbitantly high medical liability premiums by changing the medical liability Statute of limitations to a “Date of Discovery” rule.   The letter can be sent here.

With the bill having passed the Assembly in 2015, but not the Senate, it resumes a place on the Assembly Calendar, where it could be voted on by the full Assembly at any time.   The bill was brought up for initial consideration on Monday 1/11, but was “laid aside” by the Assembly Republican Conference  at MSSNY’s rquest.  While the bill currently does not have a Senate sponsor, it is likely to be introduced shortly.

MLMIC’s estimate based upon similar legislation is that this single bill could increase physician liability premiums by an untenable 15%!   New York physicians continue to pay liability premiums that are among the very highest in the country.  They also face rapidly increasing overhead costs to remain in practice such as the huge costs associated with implementing expensive and cumbersome electronic medical record systems.  At the same time, they face reduced payments from Medicare and commercial insurers, and many practices face losses of tens of thousands, hundreds of thousands and in some cases millions of dollars due to the collapse of Health Republic.  Therefore, YOU NEED TO LET YOUR LEGISLATORS KNOW THAT NO LIABILITY INCREASES CAN BE TOLERATED!

MSSNY is working with many other groups also impacted by this legislation, including hospitals, nursing homes, other specialty societies and the Lawsuit Reform Alliance of New York, in an effort to defeat this disastrous legislation.   (AUSTER, DEARS)


Contact Your Legislators to Support a Health Republic Guarantee Fund
With the failure of the Executive Budget to include a Guarantee or other fund to cover the likely   hundreds of millions in payments due to Health Republic contracted providers, all physicians are urged to continue to contact their legislators and demand that the State Legislature take action to create such Guarantee or other fund.

Last week, MSSNY President Dr. Joseph Maldonado strongly urged key State Senators to work to enact a fund to assure that Health Republic claims are completely paid, and that this legislation be enacted in the opening weeks of the 2016 Legislative Session.   Dr. Maldonado’s statements were made as part of a Senate Health & Insurance Committees Roundtable discussion examining the demise of Health Republic, discussing solutions to minimize its adverse consequences, and working to prevent similar events in the future.  The meeting was chaired by Senate Health Committee Chair Kemp Hannon and Insurance Committee Chair James Seward.

To read Dr. Maldonado’s full written statement to the State Senate click here.

Dr. Maldonado’s comments received extensive media coverage, including in Buffalo Business First, Crain’s Health Pulse, and in an Associated Press article that was printed in papers across the country. 

Please remind your legislators that, with physicians facing so many other challenges in seeking to keep their doors open to deliver patient care, including high liability costs, expensive electronic medical record equipment, employee costs and declining payments from insurers, failure to assure payment for these claims would have serious negative consequences for your community.
(AUSTER, DEARS)


Legislation Before Assembly to Accord Due Process Rights When Physicians Are Non-Renewed By A Health Insurer
Legislation (A.1212, Lavine/S.4751, Hannon) is back before the full Assembly that would assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company can be non-renewed.  The legislation is in response to situations such as the disrespectful way by which Emblem treated 750 of its network physicians who were unceremoniously dropped from the network in October based upon specious allegation of failure to transition to value-based payments, severing patient treatments relationships for countless patients.  MSSNY has raised this issue with Department of Financial Services, Department of Health, and Attorney General, as well as the entire New York State Legislature. (See MSSNY letter to DFS here.

The legislation passed the Assembly overwhelmingly in 2015, but not the Senate.  Physicians can send a letter in support of this legislation here.  A customizable template is provided.
(AUSTER, DEARS)


Cuomo Calls for Ethics Reform
On Wednesday, Governor Cuomo introduced two freestanding Article VII Ethics reform bills in his budget proposal designed to address the public perception of Albany’s political culture quagmire.

The first bill, a smorgasbord of ethics reform, tackles: (1) closing the LLC Loophole by removing an LLC’s designation as an individual, requiring LLCs making political expenditures to register with the State of Board  of Elections, and to disclose direct and indirect LLC ownership thereby proportionally attributing such political expenditures toward individual campaign contribution limits; (2) capping outside earned income of legislators to no more than 15% of member base compensation, with exceptions for investments and capital gains accrued prior to taking office, and tying members’ ability to vote in the legislature on compliance with civil penalties up to $50,000; (3) reforming campaign finance with heightened disclosure requirements for intermediaries, and proposing a system for the public financing of campaigns; (4) reforming the Freedom of Information Law (FOIL) by statutorily making both houses of the legislature subject to FOIL requirements; (5) expanding the Joint Commission of Public Ethics (JCOPE) civil penalty jurisdiction and mandating JCOPE hold one meeting location for every meeting open to the public; and (6) requiring political consultants to register as lobbyists.

The second bill, a constitutional amendment subject to voter approval, would strip a public official of his or her pension or retirement benefits/privileges if they are convicted of a crime related to public office. The constitutional amendment would be retroactive in the sense that benefits/privileges are subject to forfeiture regardless of when such rights accrued or vested.

The ambitious and seemingly all-inclusive ethics reform bills are highly contentious in both houses, and are unlikely pass without significant changes.
(DEARS, MCPARTLON)

MSSNY and OASAS to Conduct CME Webinars on Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free,  four part webinar series on opioid prescribing.  Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing. 

Tuesday January 26, 2016,  12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation. 

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Selzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.  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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.
(CLANCY, DEARS)


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org.                                         (CLANCY)


E-Prescribing Waiver Applications Now Available from BNE
With March 27, 2016 as the date that all prescriptions must be electronically submitted, the New York Bureau of Narcotic Enforcement has announced the availability of the Electronic Prescribing Waivers (EPW) application on the Health Commerce System (HCS).

A prescriber must have a HCS account in order to file an electronic prescribing waiver.  Using the HCS account is the quickest way to file the EPW application.

This application allows an institution, medical group practice or an individual practitioner to submit a request for a waiver from the requirement to electronically prescribe. Below are links to instructions for completing the online application on the Health Commerce System, based on the type of requestor:

Institution

Medical Group Practice

Individual Practitioner

If physicians do not have an HCS account, a paper version is NOW available upon request. Please contact the BNE at 1-866-811-7957, option 1.  The paper form is available for applications for institutions, group practices and individual practices and will be sent to requestors.

If physicians experience difficulties with their HCS account,  please call:  1-866-529-1890.  If a prescriber experiences any issues with the on-line Electronic Prescribing Waiver, they should call 1-866-811-7957.                                                                 (CLANCY, DEARS) 


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations During A Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.   Registration is now open to physicians and other public health officials:

Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional programs are: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

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.

Further information or assistance in registering for any of these programs,  may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.
(CLANCY, HOFFMAN) 


NYS DOH AIDS Institute Announces HCV Provider Directory
The AIDS Institute Viral Hepatitis Section is excited to announce the launch of the NYS HCV Provider Directory.  The purpose of the directory is to provide the public and other providers with a listing of HCV care and treatment providers within the State. The directory is an expansion of the existing HIV Provider Directory re-launched last year by the AIDS Institute.

Participation in this directory is voluntary. The information is compiled through provider self-identification, and includes physicians, nurse practitioners, physician assistants, and doctors of osteopathic medicine with the experience in HCV care and treatment and who meet the NYSDOH definition of an experienced HCV provider.

For more information relating to any of the above articles, please contact the appropriate contributing staff member at the following email addresses:          

pschuh@mssny.org ldears@mssny.org            mauster@mssny.org  
pclancy@mssny.org bellman@mssny.org    


CVS Pharmacies in NY Can Sell Naloxone without Prescriptions
Yesterday, the New York State DOH announced an agreement with CVS/pharmacy to help prevent opioid overdose deaths in New York State. This agreement, which became effective January 2, authorizes 479 CVS/pharmacy locations across the State to provide naloxone to their customers without a prescription. Pharmacists are currently receiving training and ordering naloxone for their stores. Naloxone (also known as Narcan®) is a medication that reverses opioid overdose.
Although traditionally administered by emergency medical (EMS) or hospital personnel, naloxone can be administered by laypeople with minimal training. CVS pharmacists are now able to provide this training in addition to dispensing the naloxone to their customers. All individuals who are given naloxone should still go to the hospital with EMS personnel. Naloxone is effective in blocking the effects of an opioid for 30 to 90 minutes. When the naloxone has worn off, someone may slip back into a life-threatening overdose. For more information, click here.


REMINDER:  All Prescriptions Must Be Sent Electronically Beginning March 27th
With the e-prescribing mandate quickly approaching on March 27th, we at MSSNY yare concerned about the lack of preparedness expressed by New York doctors.  Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate.

We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are compliant with the law.

As a MSSNY member benefit, you qualify for a substantial discount on DrFirst’s industry-leading Rcopia® with EPCS GoldSM.  The cost is $500 for a one-year license (a $299 discount) and includes e-prescribing for both legend drugs and controlled substances, as well as the DEA-required identity proofing and two-factor authentication soft token.

If you buy now, you’ll be ready when the deadline arrives, and DrFirst will extend your software license from now until March 27, 2016 at no additional charge. To purchase online, visit www.drfirst.com/MSSNY and use coupon code MSSNY, or call the MSSNY E-prescribing Hotline at 866-980-0553.

To learn more, register for DrFirst’s educational e-prescribing webinar to help you learn more about I-STOP and the patient safety and workflow benefits of using e-prescribing.  Sign-up today using the registration links below:

1/19 @ 12:00 pm – http://www.drfirst.com/mssny/mssny-lp/#webinar


MSSNY Multi-Section Meeting February 27 for YPS, Residents and Students
MSSNY’s Young Physicians, Resident and Fellow, and Medical Students Sections will hold a joint meeting on Saturday, February 27, 2016. While the business portions will be held separately, all three sections will get together to partake in a leadership presentation* by Richard Popovic, a highly experienced consultant in the fields of physician leadership, strategy, management and patient safety.

Don’t miss this essential leadership presentation and opportunity to discuss relevant issues with your colleagues and help shape MSSNY policy. Section Governing Council elections will be held. Business meetings will take place at MSSNY offices, 865 Merrick Avenue, Westbury, and the leadership presentation at the Hilton Garden Inn (across the street). Web conferencing will be available. The Hilton is offering a corporate room rate of $164.00 for those who may wish to stay overnight (contact sbennett@mssny.org for corporate number).

YPS and RFS can register at sbennett@mssny.org. Students can register at mreyes@mssny.org.

  • YPS business 8:00 am
  • MSS business 9:00 am and after lunch as necessary
  • Presentation 10:30 am
  • Lunch noon
  • RFS business 1:00 pm

*This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Medical Society of the State of New York (MSSNY) through the joint providership of MSSNY and the Medical Educational & Scientific Foundation of New York, Inc. (MESF). MSSNY 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 1.5 AMA PRA Category 1 Creditsä. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


CDC To Provide $2M to Combat Chronic Diseases in Western NY
Buffalo Business First reports that the nonprofit organization, the P2 Collaborative of Western New York, “will receive $2 million over three years from CDC to fight chronic diseases such as obesity, diabetes, heart disease and stroke in the eight-county region. The article points out that “P2 is among four organizations across New York that will receive $7 million in all.” Recipients for the grants were “selected based on high rates of chronic disease and/or more than 40 percent minority population in the counties they serve.” The funds “will support strategies in community and care settings that promote health, support and reinforce healthful behaviors, encourage lifestyle change program participation and link community programs to clinical services.” 


Eight Marijuana Dispensaries Open throughout State
On January 7, Columbia Care opened the first medical marijuana dispensary in New York City on East 14th Street in Manhattan; other dispensaries that opened in the state were in White Plains, Syracuse, Williamsville, Albany, Kingston, Amherst, and Liverpool.


Average Age of First-Time Moms in US at All-Time High
On January 14, a report released by the Centers for Disease Control and Prevention revealed that the average age of first-time mothers is at an all-time high in the United States http://www.cdc.gov/nchs/data/databriefs/db232.htm The report put the average age at 26 years, 4 months for first-time moms in 2014. Lead author T.J. Mathews from the CDC attributed the change to the drop in teen moms. Overall, the average age of first-time moms “has been rising in every racial and ethnic group, and in every state,” but the highest average ages for first-time moms are still in the Northeast.

American Academy of Pain Medicine Meeting in February in Palm Springs
The American Academy of Pain Medicine (AAPM) 32nd Annual Meeting will be held February 18-21, 2016, in Palm Springs, CA. The theme of this year’s event is Ensuring Access to Pain Care: Engaging Pain Medicine and Primary Care Teams. Of particular connection to their work on the AMA task force, the Academy is offering a preconference session titled Opioid and Non-Opioid Medications Management: Filling in the Gaps, Prescribing for the Whole Patient. Learn more by visiting www.painmed.org/annualmeeting.


Classifieds

Office Rental 30 Central Park South
Two fully equipped exam rooms, two certified operating rooms, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468drdese@gmail.com.


Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49th Street, this ground level office is handicapped accessible. Private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581



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

January 8, 2016 – Do You Need Opioid Education?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
asset.find.us.on.facebook.lgTwitter_logo_blue1
January 8, 2015
Volume 16, Number 1

Dear Colleagues:

For several years, MSSNY has fought state legislation aimed at mandating CME for chronic pain management and opioid abuse.  The fight thus far has been successful but honestly, the odds of doing this again are slim.  How can we all help to win the battle once and for all?  The answer is: EVIDENCE that physicians are voluntarily educating themselves.  While you may have already done this through other programs, I am asking every MSSNY member to ante up their non-financial contribution by signing up for one of the webinar times listed below.  If we get sufficient numbers, we may be able to show robust evidence that we can do this voluntarily and a mandate is unnecessary.  Short of doing this voluntarily and providing the State evidence of it, mandatory CME WILL succeed because much of the public believes many of us are prescribing inappropriately and abetting many patients in becoming addicted to prescription pain medications.  Regardless of how you feel on what is the best solution, signing up will go a LONG way in our talks with legislators.

In New York, we have already reduced the incidence of doctor shopping by 86% because physicians are checking the Prescription Monitoring Program prior to prescribing a controlled substance. We have also supported legislation to increase access to naloxone to reduce deaths from overdose. We have also supported efforts to increase voluntary education and training for physicians on safe prescribing practices. Our efforts have proven successful.  According to IMS data, New York has seen substantial decreases in the number of prescriptions written for oxycodone, hydrocodone and other controlled substances. New York’s utilization rate for these medications is below other states that currently require prescriber education of opioid medications. But there’s more to do.

If we educate ourselves now voluntarily, we may be able to stave off an extensive mandatory course in the near future.

Beginning on Tuesday, January 26, at 12:30 pm
, MSSNY and the New York State Office for Alcoholism and Substance Abuse Services are presenting a free, four-part webinar series on opioid prescribing— Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain. This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing. Registration is now open here.

National experts Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN will compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health and explain the requirements of New York State laws/regulations with regard to prescribing of controlled substances.

On Wednesday, February 10, 2016 at 7:30 am
, Charles E. Argoff, MD will discuss evidence-based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

On Tuesday, February 23, 2016, 7:30 am
, Jeffrey Seltzer, MD will describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral. 

On Thursday, March 10, 2016 at  7:30 am,
Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM will recommend tools to assist in the management of patients for whom opioids are indicated and prescribed and discuss strategies to reduce risk of treating pain in patients with substance use disorders.

Registration is now open to physicians here.

Registration is now open to physicians and other prescribers in your practice here.

We are strongly urging physicians to voluntarily take these webinars; please assist us in this endeavor. If there are any questions regarding this; please call Pat Clancy at 518-465-8085 ext 311.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


MSSNY Fights for Guarantee Fund to Pay for Unpaid Health Republic Claims
MSSNY President Joseph Maldonado, MD, MSc, MBA strongly urged key State Senators this week to work to enact a Guarantee or other special fund to assure that Health Republic claims are completely paid, and that this legislation be enacted in the opening weeks of the 2016 Legislative Session.   Dr. Maldonado’s statements were made as part of a Senate Health & Insurance Committees Roundtable discussion examining the demise of Health Republic, discussing solutions to minimize its adverse consequences, and working to prevent similar events in the future.  The meeting was chaired by Senate Health Committee Chair Kemp Hannon and Insurance Committee Chair James Seward.

To read Dr. Maldonado’s full written statement, click here and to view the Senate Roundtable in its entirety click here.

In addition to Dr. Maldonado, other participants in the roundtable discussion included MSSNY member Dr. Scott Hayworth, President of the Mt. Kisco Medical Group, as well as representatives of the Greater New York Hospital Association, the Healthcare Association of New York, the New York Health Plan Association, the Conference of Blue Cross/Blue Shield Plans, the National Association of Health Underwriters, United and Health Now.   Also participating were DFS Executive Deputy Superintendent Troy Oechsner and New York State of Health Executive Director Donna Frescatore.

The roundtable discussion focused on the events leading to the collapse of Health Republic and legislative solutions to prevent against such insurer collapses in the future.  This included extensive discussions whether revisions were necessary to New York’s law requiring DFS to approve premium rates as well as whether the State should enact a special Guarantee fund to address unpaid medical claims from physicians and hospitals for care to Health Republic-insured patients.   In arguing for the necessity of a Guarantee fund, Dr. Maldonado highlighted the commitment of physicians to continue to deliver the care needed by their patients despite the knowledge that it was highly unlikely that Health Republic would able to cover these claims.  In particular, he highlighted the tens of millions of dollars in outstanding claims that are owed to medical practices across New York State.  For example, 5 medical practices in the Lower Hudson Valley alone are owed over $12 million.  Moreover, MSSNY’s survey with close to 1,000 respondents showed 42% with outstanding claims to Health Republic, of which:

  • 11% are owed $100,000 or more;
  • 20% are owed $25,000 or more; and
  • 49% are owed $5,000 or more.

Dr. Maldonado’s statement also noted that, in addition to these tangible financial consequences, there is another consequence to physicians – fear of “being burned” again in what may be viewed as risky health care initiatives.  He noted that he had heard from many physicians who are now expressing great reluctance to participate in other new health coverage initiatives, as well as reluctant to participate in other reform initiatives that hold out the promise of upside financial benefits but also could potentially put their medical practices at risk.   MSSNY’s statement included a statement from William Moorely, President & CEO of the Westchester County Association who expressed “deep concern wit the financial consequences to physician practices and patients across New York State as a result of The Collapse of Health Republic” and urged the enactment of legislatures to make physicians and hospitals whole.                      
(AUSTER, DEARS)

Senate Health Committee Moving CPH Immunity Bill and Protection for Statements Made During Peer Review
The Senate Health Committee next week will advance two bills strongly supported by MSSNY. The first bill (S. 3461A, Hannon) would clarify that the statutory liability protections offered for physician participants in the Committee for Physicians’ Health (CPH) program extend to the organization who sponsors the program as well as to the employees of the sponsoring program acting without malice and within the scope of its functions for the committee. Assemblyman Gottfried has introduced the companion bill (A.7267) in the Assembly.  Last year, the Senate passed the bill but it was never reported out of the Assembly Codes Committee.

The second bill (S.4698, Hannon) would extend the confidentiality provisions relating to discovery of testimony to apply to statements made by any person in attendance at peer-review committee that is a party to an action the subject matter of which was reviewed at such meeting. Assemblyman Gottfried has sponsored the companion bill (A.3353) in the Assembly.                           
(DEARS, AUSTER)


MSSNY and OASAS to Conduct CME Webinars on Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free,  four part webinar series on opioid prescribing.  Entitled, “Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing. 

Tuesday January 26, 2016,  12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Selzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits. 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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.
(CLANCY, DEARS) 


E-Prescribing Waiver Applications Now Available from BNE
With March 27, 2016 as the date that all prescriptions must be electronically submitted, the New York Bureau of Narcotic Enforcement has announced the availability of the Electronic Prescribing Waivers (EPW) application on the Health Commerce System (HCS).

A prescriber must have a HCS account in order to file an electronic prescribing waiver.  Using the HCS account is the quickest way to file the EPW application.

This application allows an institution, medical group practice or an individual practitioner to submit a request for a waiver from the requirement to electronically prescribe. Following are links to instructions for completing the online application on the Health Commerce System, based on the type of requestor:

Institution

Medical Group Practice

Individual Practitioner

If physicians do not have an HCS account, a paper version is NOW available upon request. Please contact the BNE at 1-866-811-7957, option 1.  The paper form is available for applications for institutions, group practices and individual practices and will be sent to requestors.

If physicians experience difficulties with their HCS account,  please call:  1-866-529-1890.

If a prescriber experiences any issues with the on-line Electronic Prescribing Waiver, they should call 1-866-811-7957.
(CLANCY, DEARS)


NYS Medical Marijuana Program Launched on January 7th
The New York State Department of Health initiated the state’s Medical Marijuana Program on January 7, 2016; this program will make approved forms of medical marijuana, available with a physician’s certification at designated dispensaries across New York State. The program provides access to medical marijuana to certified patients suffering from cancer, HIV/AIDS, ALS (Lou Gehrig’s disease), Parkinson’s disease, multiple sclerosis, intractable spasticity caused by damage to the nervous tissue of the spinal cord, epilepsy, inflammatory bowel disease, neuropathies and Huntington’s disease.

Physicians seeking to certify patients for the use of medical marijuana are required to take a four and ½  hour online educational program.   The physicians CME certificate must then be forwarded to DOH.   This course is available at TheAnswerPage, an established online medical education provider here.

The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course.

Practitioners who wish to register with the department and certify their patients for the Medical Marijuana Program must:

  • be qualified, by training or experience, to treat patients with one or more of the serious conditions eligible for medical marijuana;
  • be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law, in New York State;
  • possess a Health Commerce System (HCS) Medical Professions Account user ID and password;
  • possess an active Drug Enforcement Administration (DEA) registration number; and
  • complete the four hour Department-approved medical use of marijuana course.

The course includes the following topics, which are required in the regulations: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence.  Additional information regarding the practitioner registration process is available on the department’s Medical Marijuana Program webpage, which can easily be accessed via the this link.  The NYS Department of Health has indicated that 150 physicians have taken the course and also said that a list of physicians names, who have given their consent to the DOH for their names to be made public,  should be released shortly.

The department’s press release provided the following information:  “In order to obtain medical marijuana, a patient must receive a DOH Medical Marijuana Program certification from a registered physician.   The patient must then access DOH’s online Patient Registration System to apply for a registry identification card. Additional information regarding registration can be found here.

To apply for a registry card, certified patients will need: a valid DOH Medical Marijuana Program certification form issued and signed by a registered practitioner, photographic identification, documentation of his or her temporary or permanent New York State residency, and designated caregiver information, if applicable.  A patient who is under the age of eighteen or who is otherwise incapable of consenting must apply through a proxy.

Patients with valid registry identification cards are then eligible to purchase medical marijuana from one of the dispensing locations across the State.  DOH selected five registered organizations on July 31, 2015 to grow marijuana and manufacture it into approved forms.  Each registered organization operates a manufacturing facility and four dispensing facilities. Information on the registered organizations can be found at here.
(CLANCY)


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org.
(CLANCY)


MSSNY is Member of The AMA’s Task Force on Opioid Abuse
The Medical Society of the State of New York is participating on the American Medical Association’s (AMA) national Task Force to Reduce Opioid Abuse.  The task force, established in 2014, consists of over 20 medical national specialty organizations and MSSNY is one of the eight state medical societies on the task force.  The goals of the task force are to:

  • Increase physicians’ use of effective PMPs
  • Enhance physicians’ education on appropriate prescribing
  • Reduce the stigma of pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing.

The task force ultimate goals are to create a behavioral shift in physicians to create a sense of urgency that they are a part of the solution to the opioid epidemic and to tap into their fundamental desire to effectively help their patients and improve their patients’ health.  The task force will also urge physicians to use PMPs to have a better—realistic—perspective about patients’ use of opioids.  Dr. Frank Dowling, MSSNY Councilor and Pat Clancy, Vice President of Public Health and Education are MSSNY appointees to the task force.

MSSNY has also developed a page entitled, “Opioids: What One Doctor Can Do“  This page is located on the MSSNY website and is located in a blue box at the top of the home page:  www.mssny.org   The page provides information on the AMA Task Force, provides resources and best practices for physicians and also provides tools for physicians along with patient information.
(CLANCY)


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations During A Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.   Registration is now open to physicians and other public health officials.

Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional programs are: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

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.

Further information or assistance in registering for any of these programs,  may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.
(CLANCY, HOFFMAN) 


Legislative Advocacy Leadership Workshop for HCV Clinicians to Be Held January 15
A legislative leadership workshop will be held January 15, 2016 for HCV clinicians at Lenox Hill Hospital, 130 East 77th Street, NY, NY; Aron Board Room.  The workshop is sponsored by the Empire Liver Foundation, HepCx, and NYC Health Department.   Clinicians can learn about strategies to change policies and support legislation. The workshop will also be broadcast over WebEx.    Further information and/or to register for the conference,  please  Eric Rude at erude@health.nyc.gov
(CLANCY)

REMINDER:  All Prescriptions Must Be Sent Electronically Beginning March 27th
With the e-prescribing mandate quickly approaching on March 27th, we at MSSNY are concerned about the lack of preparedness expressed by New York doctors.  Our recent survey showed that more than 40% of responding physicians are not yet prepared to meet the e-prescribing mandate.

  • We DO NOT expect an extension of the deadline, and urge you to ACT NOW to ensure you are compliant with the law.
  • As a MSSNY member, you qualify for a substantial discount on DrFirst’s industry-leading Rcopia® with EPCS GoldSM.  The cost is $500 for a one-year license (a $299 discount) and includes e-prescribing for both legend drugs and controlled substances, as well as the DEA-required identity proofing and two-factor authentication soft token.
  • If you buy now, you’ll be ready when the deadline arrives, and DrFirst will extend your software license from now until March 27, 2016 at no additional charge. To purchase online, visit www.drfirst.com/MSSNY and use coupon code MSSNY, or call the MSSNY E-prescribing Hotline at 866-980-0553.
  • To learn more, register for DrFirst’s educational e-prescribing webinar to help you learn more about I-STOP and the patient safety and workflow benefits of using e-prescribing.  Sign-up today using the registration link below
  • 1/19 @ 12:00 pm – http://www.drfirst.com/mssny/mssny-lp/#webinar


Longtime MSSNY Counsel Don Moy Retiring from Kern Augustine Conroy & Schoppmann
Don Moy Esq.
Kern Augustine Conroy & Schoppmann, P.C. would like to announce that as of December 31, 2015, one of its partners, the esteemed Donald (“Don”) R. Moy, Esq. has retired.  Over the past five years, the partners, attorneys, staff and clients of Kern Augustine Conroy & Schoppmann have had the honor and privilege of working with Mr. Moy, one of the most honorable, knowledgeable and respected attorneys in the world of healthcare law, and he will truly be missed.

Don Moy’s career has been dedicated to the counseling of physicians, other healthcare professionals, and medical societies and other professional associations in matters pertaining to the regulation of the profession, including state and federal regulatory issues.  Prior to working with KACS, Mr. Moy served as the Senior Vice President and General Counsel to the Medical Society of the State of New York (“MSSNY”) for 25 years.

As the firm transitions as MSSNY’s General Counsel, David Vozza and David Adelson will take over Mr. Moy’s role with MSSNY, however, Mr. Moy will also be available to the firm on a consulting Of Counsel basis to ease and bolster the transition.  Mr. Vozza and/or Mr. Adelson can be reached at 1-800-445-0954 or via email at dvozza@drlaw.com and dadelson@drlaw.com, respectively.


AG Announces Settlements to Stop Prohibited ‘Direct Access Testing’
DirectLabs and LabCorp Are Prohibited from Enabling New Yorkers to Receive Clinical Laboratory Testing Without Required Medical Provider Oversight 

Attorney General Schneiderman recently announced agreements with Direct Laboratories LLC and Laboratory Corporation of America that prevent these companies from enabling New Yorkers to undergo clinical laboratory testing without a licensed medical provider’s involvement, as required by New York State law.

DirectLabs, a Louisiana-based company, advertises “direct access” to laboratory testing, and sells requisitions directly to consumers, with no physician involvement, for over 250 different tests and testing packages, including tests for parasites, heavy metals, thyroid levels, vitamin levels, various cancer markers, and specific diseases such as celiac disease and rheumatoid arthritis.  Without a health provider overseeing the test results in the context of a person’s clinical overall presentation, these test results can give consumers a mistaken impression to the detriment of their health – particularly where tests may have a propensity for either false positives or false negatives.

“My office is committed to helping all New Yorkers take control of their health and make educated health care decisions,” Attorney General Schneiderman said. “However, enabling consumers to purchase laboratory tests for serious medical conditions without consulting a physician does not help New Yorkers control their health, but rather risks placing their health in jeopardy.  Licensed medical providers are essential to ensuring consumers undergo testing that will yield clinically useful results and that the results are properly interpreted in light of the patient’s medical condition as a whole.”

DirectLabs has been able to offer its direct testing service because of its relationship with LabCorp.  LabCorp provided DirectLabs with the technology needed to generate requisitions and receive test results, and LabCorp processed specimens based on DirectLabs’ requisitions.  As a result of DirectLabs’ and LabCorp’s actions, New Yorkers were able to undergo clinical laboratory testing without ever consulting a health care practitioner, even when New York State law requires that such testing be performed only at a licensed practitioner’s request.

The settlement with DirectLabs and LabCorp comes after an investigation by the Attorney General’s Health Care Bureau showed that DirectLabs sold requisitions for a wide range of tests, and that these requisitions were automatically generated with a licensed chiropractor’s name – who had never seen or spoken with the patients – in exchange for a $24 “access fee” payment.  Consumers could then take those requisitions to a LabCorp patient service center to have the testing performed at reduced prices negotiated between LabCorp and DirectLabs.  The chiropractor whose name appeared on the requisitions not only never met or spoke with any of the approximately 1,100 consumers whose laboratory tests he authorized, he did not follow up with any of the consumers about the test results.

Under the settlement with DirectLabs, DirectLabs will no longer operate in New York State and must refund all customers with requisitions that have not yet been presented to a laboratory for testing to be performed.  Under the settlement agreement with LabCorp, LabCorp’s patient service centers in New York will no longer accept specimens for examination pursuant to requisitions generated by DirectLabs or any similar company.  Further, LabCorp will ensure that requests for laboratory testing submitted by health care providers are within the provider’s scope of practice as set forth by the New York State Education Department and that the providers’ licenses are current.  DirectLabs is obliged to pay a $24,500 penalty, while LabCorp will pay a $225,000 penalty. 


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Resident/Fellow/Medical Student Poster Symposium Reminder
Deadline for abstract submission is 4 pm, Monday, January 25, 2016 for the Annual Poster Symposium on Friday, April 15, 2016 at the Westchester Marriott in Tarrytown, New York from 2 pm to 4:30 pm.
Click here for detailed guidelines


Holding of 2016 Date-of-Service Claims for Services Paid Under the 2016 Medicare Physician Fee Schedule
In order to implement corrections to technical errors discovered after publication of the MPFS rule and process claims correctly, Medicare Administrative Contractors will hold claims containing 2016 services paid under the MPFS for up to 14 calendar days, (i.e., Friday, January 1, 2016 through Thursday, January 14, 2016). The hold should have minimal impact on provider cash flow as, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt.
MPFS claims for services rendered on or before Thursday, December 31, 2015 are unaffected by the 2016 claims hold and will be processed and paid under normal procedures and time frames.


CMS Announces the 2015 PQRS Data Submission Timeframes

  • EHR Direct or Data Submission Vendor (QRDA I or III) – 1/1/16 – 2/29/16
  • Qualified clinical data registries (QCDRs) (QRDA III) – 1/1/16 – 2/29/16
  • Group practice reporting option (GPRO) Web Interface – 1/18/16 – 3/15/16
  • Qualified registries (Registry XML)  – 1/1/16 – 3/31/16
  • QCDRs (QCDR XML) – 1/1/16 – 3/31/16

Submission ends at 8:00 P.M. Eastern Time on the end date listed. An Enterprise Identity Management (EIDM) account with the “Submitter Role” is required for these PQRS data submission methods. Please see the EIDM System Toolkit for additional information.

Eligible Professionals who do not satisfactorily report quality measure data to meet the 2015 PQRS requirements will be subject to a negative PQRS payment adjustment on all Medicare Part B Physician Fee Schedule (PFS) services rendered in 2017.

For questions, please contact the QualityNet Help Desk 1-866-288-8912 or via email at Qnetsupport@hcqis.org from 7:00 a.m. – 7:00 p.m. Central Time. Complete information about PQRS is available at http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html.


USPSTF Releases Draft Recommendation on Who Should Use Statins
On December 21, the US Preventive Services Task Force (USPSTF) issued a draft recommendation on “who qualifies for cholesterol-lowering statins.” In the new “draft guidelines” released for public comment, the USPSTF says “the…medications will be of most benefit to some people ages 40 to 75 whose risk of cardiovascular disease over the next decade is at least 10 percent. The USPSTF concluded that people with a 10% or greater risk of heart problems in the next 10 years, based on the 2013 AHA-ACC calculator, and who have diabetes, high cholesterol, high blood pressure or who smoke, can lower their risk of having a heart attack or stroke by a ‘moderate amount’ by taking a statin.”

The draft recommendation states that USPSTF maintains that “there’s not enough evidence to recommend screening all children and teens for high cholesterol.” It remains unclear “if such screening up to age 20 reduces the risk of cardiovascular disease in adulthood.


FDA Lifts Lifetime Ban on Blood Donations from Gay Men
On December 21, 2015, the Food and Drug Administration lifted a decades-old lifetime prohibition on blood donation by gay and bisexual men. The FDA will continue to ban “men who have had sex with men in the past year, however, saying that the measure was needed to keep the blood supply safe.” Dr. Peter Marks, deputy director of the FDA’s Center for Biologics Evaluation and Research, spoke at a press conference and said that the 12-month deferral period was “supported by the best available research,” and that the newest blood tests are “highly accurate but not perfect,” which is “why the elimination of all deferrals is not feasible at this time.” However, gay rights groups consider the lifting of the life time ban, “a major stride toward ending a discriminatory national policy, but had wanted blanket bans for gay men to be removed entirely.”

Dr. Marks said the policy change is “backed by sound scientific evidence” and will “continue to protect our blood supply.” The FDA had “considered eliminating all restrictions on blood donations from gay and bisexual men, but concluded that would increase the transmission of HIV through the blood supply by 400 percent.” Dr. Marks said Monday that “an increase of that magnitude is not acceptable.” Dr. Marks wrote in a statement that the FDA “will continue to actively conduct research in this area and further revise our policies as new data emerge.”


Classifieds

Office Rental 30 Central Park South
Two fully equipped exam rooms, two certified operating rooms, bathrooms and consultation room.  Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468drdese@gmail.com.


Office Near UN for Rent
Modern, 3000 sq. ft. medical office to rent near the United Nations. Located at 340 East 49th Street, this ground level office is handicapped accessible. Private reception area; secretarial area available; 6 exam rooms. Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at uneyes@verizon.net or call 914-772-5581



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

December 18, 2015

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 18, 2015
Volume 15, Number 47

Dear Colleagues:

If you have claims outstanding with Health Republic, please take a moment to click on this link which will bring you to MSSNY’s grassroots action center and a letter which you can send to your elected State Senator and Assemblyman to call for action to assure that physicians and other healthcare stakeholders are paid for services rendered to patients of the now defunct Health Republic.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  MSSNY also continues to share with key legislators and the media our collective concerns regarding the severe consequences to physicians’ practices as a result of the collapse of Health Republic, and advocating for a special fund to assure physician claims for care provided to HR-insured patients are fully paid.

This includes sharing the results of our survey of nearly 1,000 respondents, which has generated extensive media coverage from across New York State, including the Wall Street Journal and New York Times.  Please add your voice to these efforts to better assure that physicians are not left holding the proverbial bag!

Submit All Your Claims Now!

In the meantime, you must submit all HR claims for services rendered up to and including November 30, 2015. Although we cannot project the outcome of this debacle, it is safe to report that if your claims are not filed, they will never be considered.

Send Us Your Bounced Checks!

MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds. If you have received notice from your bank that an HR check bounced, send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction.

On a related matter, if you are holding reimbursement checks from HR, they will bounce if you try to deposit it.  We urge you to send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor. Again, please email rmcnally@mssny.org.

Thank you for your patience while we continue to assist you in the process.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance



Alert from MSSNY General Counsel Don Moy:  NYS Court of Appeals Decision Exposes Physicians and Other Health Care Professionals to Liability to Non-Patient Members of the General Community
The majority’s decision in Davis v. South Nassau Communities Hospital must be viewed as alarming to physicians and other health care professionals.  Physicians who administer or prescribe medication to patients must be prepared to document that they advised the patient of the foreseeable side effects of the medication, and, in particular, if the medication could foreseeably impair the patient’s ability to safely operate an automobile. Physicians must be prepared to document that they advised the patient not to drive while taking the medication.

These are the facts in Davis v. South Nassau Communities Hospital (issued on December16, 2015): Patient W was treated by Dr. H at the ER of a hospital. As part of the treatment, the doctor intravenously administered to W an opioid narcotic painkiller and a benzodiazepine drug, and, allegedly, failed to warn W that such medication could impair her ability to safely operate an automobile. Shortly thereafter, W drove herself from the hospital and, while allegedly impaired by the medication administered to her, she crossed a double yellow line and struck a bus driven by plaintiff Davis.

The NYS Court of Appeals reversed an appellate court and held that under these facts, the doctor had a duty to warn the patient about the patient’s ability to drive safely, and the failure of the doctor to fulfill this duty to the patient could subject the doctor to liability to any member of the general community who is harmed as a result of the patient’s driving. The Court of Appeals opined that the “cost” of the duty  imposed upon physicians and hospitals is a “small one” because the “duty” requires the doctor to do no more than simply warn the patient of the dangers of driving. The Court emphasized that the doctor had no obligation to prevent the patient from driving.

The Court further held that its ruling does not create a new obligation on doctors because a doctor who administers prescribed medication already has a duty to advise the patient of the foreseeable side effects of the medication.  Rather, stated the Court, the ruling “merely extends” the scope of persons who may sue the doctor for failing to fulfill that responsibility to the patient.

The Court sought to limit the reach of its decision by stating that this decision should not be construed as an erosion of judicial precedent that courts need to proceed cautiously and carefully in recognizing a new “duty of care”.  Judge Leslie Stein issued a scathing dissenting opinion  and rebuked the majority decision  as  “precipitous” and contrary to the firmly established judicial precedent of the state that, in general, a physician’s duty is to the patient, and the corresponding liability may be extended to a non-patient only in rare and narrow circumstances, such as to an immediate family  member  where the physician knew or should have known  that treatment provided to the patient  could create risk of harm to immediate family members. To her knowledge, stated Judge Stein, there has been no precedent in the state that has held that a physician’s medical treatment of a patient could expose the physician to liability to an unidentified class of members of the general community.

Judge Stein stated that despite the majority’s attempt to limit the reach of its decision, she feared a “slippery slope” and that the decision could be precedent to expand liability to doctors in other areas of treatment. 


Congress Passes Year End Spending, Tax Relief Bills that Includes “Cadillac Tax” Delay, Extension of 9/11 Responder Health Coverage, and MU Hardship Provisions
The US House and Senate passed two massive legislative packages, an omnibus appropriations bill and tax revision bill, before Congress adjourned for the holidays.  Importantly, among the provisions is a 2-year delay of the so-called “Cadillac Tax” on benefit-rich health insurance plans enacted as part of the ACA that was to become effective in 2018.  Since this tax would strongly discourage employers from offering comprehensive health insurance coverage to their employees, the MSSNY House of Delegates adopted policy calling for this tax to be repealed.

The $1.1 trillion FY2016 omnibus appropriations package will fund federal agencies and programs through September 30, 2016. Many of the earlier debated policy riders, such as the proposal to “defund” Planned Parenthood, were omitted from the bill. In addition to the delay of the “Cadillac tax”, some of the other health-related provisions include the following:

  • Funds for the 9/11 emergency responder health care benefits were reauthorized and expanded;
  • A one-year delay of the health insurance tax (for 2017)
  • IPAB operational funding was cut by $15B (although the panel has never actually been established)
  • Requiring the HHS Secretary to implement an education campaign to inform breast cancer patients about the availability and coverage of breast reconstruction and other available alternatives post-mastectomy.
  • Breast cancer screening recommendations issued by the USPTF were blocked for 2 years
  • AHRQ funding was cut by $30M (earlier House version had zeroed out agency funding)
  • Funding for NIH was increased by $2B
  • Additional funds were provided for opioid prescription drug overdose prevention
  • $20M was provided for the National Diabetes Prevention Program
  • The annual ban on using CDC funding for gun violence epidemiological research was extended

A second $650B package extends a broad range of tax-related polices, including a two-year moratorium on the Medical Device Tax, also enacted as part of the ACA.

Moreover, there was a “last second” bill passed by Congress that grants CMS the authority to expedite applications for exemptions from Meaningful Use Stage 2 requirements for the 2015 calendar year through a more streamlined process, alleviating burdensome administrative issues for both providers and the agency.  In order to avoid a penalty under the meaningful use program, eligible professionals must attest that they met the requirements for meaningful use Stage 2 for a period of 90 consecutive days during calendar year 2015.  However, CMS did not publish the Modifications Rule for Stage 2 of meaningful use until Oct. 16. As a result, eligible professionals were not informed of the revised program requirements until fewer than the 90 required days remained in the calendar year.  The legislation is designed to address this flaw.

Click here for a more detailed summary from the AMA on Congress’ action.


State Supreme Court Justice Ruled Child Flu Vaccination Not Mandatory in NYC
State Supreme Court Justice Manuel Mendez ruled Thursday that the New York City Department of Health and Mental Hygiene (DOHMH) may not require that children receive a flu vaccination to attend “city-licensed preschools and day care centers, striking down one of the more ambitious public health initiatives of the Bloomberg administration.” Justice Mendez ruled that “the city had exceeded its authority” and if the city wants to require flu vaccines, the Legislature would have to vote to add it to the list. 

Physicians Dropped from Emblem Should Contact Their State and Federal Legislators To Supplement MSSNY’s Advocacy


Physicians who have been unfairly dropped from Emblem’s participating physician network are urged to contact their state and federal legislators from MSSNY’s Grassroots Action Site here and ask for them to take action to push Emblem to reverse its decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services, as well as the NYS Department of Health and Attorney General’s office.

Moreover, MSSNY has written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.   MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Importantly, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani last week to ask for “further clarity on this issue.”   Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.     


MSSNY and OASAS To Conduct CME Webinars On Opioid Use; Registration Now Open
The Medical Society of the State of New York and New York State Office for Alcoholism and Substance Abuse Services are pleased to present a free, four part webinar series on opioid prescribing.  Entitled,Revisiting the Role of Opioid Analgesics for Simple and Complex Patients with Chronic Pain”, the series will begin on Tuesday, January 26, 2016.

Registration is now open at here.

A copy of the flyer can be found here.

Opioid abuse is a national epidemic that physicians and other prescribers have the power to help prevent.  This series will provide information on managing pain, understanding the potential for patient addiction, and determining best practices for safe, responsible opioid prescribing.

Tuesday January 26, 2016, 12:30 p.m.

Faculty: Charles Morgan, MD, FASAM, FAAFP, DABAM and Patricia Bruckenthal PhD, APRN-BC, ANP, FAAN

Educational Objectives:

  • Compare and contrast the dual epidemics of chronic pain and opioid abuse and the implications on public health
  • Understand requirements of New York State laws/regulations with regard to prescribing of controlled substances.

Wednesday, February 10, 2016, 7:30 a.m.

Faculty:  Charles E. Argoff, MD

Educational Objective:

  • Discuss evidence based best practice recommendations for opioid therapy for chronic pain, patient risk assessment and documentation.

Tuesday, February 23, 2016, 7:30 a.m.

Faculty:  Jeffrey Seltzer, MD

Educational Objective:

  • Describe potential for patient addiction, screening, diagnosis and subsequent treatment or referral.  

Thursday, March 10, 2016, 7:30 a.m.

Faculty: Charles E. Argoff, MD and Charles Morgan, MD, FASAM, FAAFP, DABAM

Educational Objectives:

  • Recommend tools to assist in the management of patients for whom opioids are indicated and prescribed.
  • Discuss strategies to reduce risk of treating pain in patients with substance use disorders

Physicians and other prescribers can take one or all of the webinars; each webinar has been accredited for one hour of continuing medical education credits.

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.

For further information or assistance in registering for the program, please contact Pat Clancy at pclancy@mssny.org or Terri Holmes at tholmes@mssny.org.


MSSNY Is Member of AMA’s Task Force On Opioid Abuse
The Medical Society of the State of New York is participating on the American Medical Association’s (AMA) national Task Force to Reduce Opioid Abuse.  The task force, established in 2014, consists of over 20 medical national specialty organizations and MSSNY is one of the eight state medical societies on the task force.  The goals of the task force are to:

  • Increase physicians’ use of effective PMPs
  • Enhance physicians’ education on appropriate prescribing
  • Reduce the stigma of pain and promote comprehensive assessment and treatment
  • Reduce the stigma of substance use disorder and enhance access to treatment
  • Expand access to naloxone in the community and through co-prescribing.

The task force ultimate goals are to create a behavioral shift in physicians to create a sense of urgency that they are a part of the solution to the opioid epidemic and to tap into their fundamental desire to effectively help their patients and improve their patients’ health.  The task force will also urge physicians to use PMPs to have a better—realistic—perspective about patients’ use of opioids.  Dr. Frank Dowling, MSSNY Councilor and Pat Clancy, Vice President of Public Health and Education are MSSNY appointees to the task force.

MSSNY has also developed a page entitled, “Opioids: What One Doctor Can Do.“  This page is located on the MSSNY website and is located in a blue box at the top of the home page:  www.mssny.org   The page provides information on the AMA Task Force, provides resources and best practices for physicians and also provides tools for physicians along with patient information.


NYS Connects with Other Prescription Monitoring Programs; Allows Prescribers to Assist In Reducing Doctor Shopping Across State Lines
New York State has announced that it has joined the National Association of Boards of Pharmacy PMP InterConnect hub which will allow participating states to share information from prescription monitoring programs to prevent consumers from “doctor shopping” for prescription drugs over state lines.  The New York’s Prescription Monitoring Program, (PMP) is an electronic system allows prescribers and pharmacists statewide to ensure patients do not obtain multiple prescriptions for dangerous controlled substances.  New York prescribers are required to check patient information on the PMP prior to issuing controlled substances, and this requirement was implemented under the ISTOP law.  New Jersey and Connecticut are both on the NABP PMP Interconnet hub, though other neighboring states, including Massachusetts, Pennsylvania and Vermont, are not.  MSSNY strongly supports this move and believes it will give important information to physicians about their patients.


MSSNY E-Prescribing Webinar Now Available on MSSNY CME Site
MSSNY e-prescribing webinar, entitled, “NYS Requirement for E-prescribing ALL Substances” is now available at MSSNY Continuing Medical Education site at http://cme.mssny.org/  Faculty for this program is Sandra Knapp, Manager, Official Prescription Program, NYS Department of Health, Bureau of Narcotic Enforcement.    The requirement to e-prescribe all substances will become effective on March 27, 2016.   The Medical Society of the State of New York designates this enduring activity for a maximum of 1.0 AMA/PRA Category 1 credit™. New registrants to the site will have to register and create a username and password, which should be retained and be used for continued access to the site. Once registered and logged into the site, physicians will be taken to an instruction page.   Click on the menu on “My training page” to view and take the e-prescribing course.  There are over 50 free courses that are also available.  Further information on all these programs may be obtained by contacting Pat Clancy at pclancy@mssny.org 


Tomorrow Is Last Day to Submit PQRS Status Questions
If you have any questions regarding the status of your 2014 PQRS reporting or are concerned about potentially receiving the PQRS negative payment adjustment in 2016, please do not hesitate to submit an informal review request. CMS will be in contact with every individual eligible professional (EP) or PQRS group practice that submits a request for an informal review of their 2014 PQRS data. Additionally, revised 2014 Annual Quality and Resource Use Reports (QRURs) are now available via the CMS Enterprise Portal.  All informal review requests must be submitted electronically via the Quality Reporting Communication Support Page (CSP) which is available now through December 16, 2015 at 11:59 p.m. Eastern Time. 

Follow these steps to submit an informal review request:

  1. Go to the Quality Reporting Communication Support Page (CSP)
  2. In the upper left-hand corner of the page, under “Related Links,” select “Communication Support Page”
  3. Select “Informal Review Request”
  4. Select “PQRS Informal Review”
  5. A new page will open
  6. Enter Billing/Primary Taxpayer Identification Number (TIN), Individual Rendering National Provider Identifier (NPI), OR Practice Site ID # and select “submit”
  7. Complete the mandatory fields in the online form, including the appropriate justification for the request to be deemed valid. Failure to complete the form in full will result in the inability to have the informal review request analyzed. CMS or the QualityNet Help Desk may contact the requestor for additional information if necessary.

For additional questions regarding the informal review process, contact the Quality Net Help Desk at 1-866-288-8912 (TTY 1-877-715-6222) or Qnetsupport@hcqis.org Monday-Friday from 7:00 a.m. to 7:00 p.m. Central Time. To avoid security violations, do not include personal identifying information.


MSSNY Teams with CA, FL and TX Medical Societies to Urge Meaningful Use Reforms
With uncertainty surrounding whether Congress would be able agree to changes to the overly burdensome meaningful use requirements, MSSNY teamed with the medical associations of California, Florida and Texas on a letter this week to CMS Acting Administrator Andy Slavitt urging needed reforms.  In particular, the letter notes that “Physicians across this country are uniformly frustrated, angry, and demoralized by these difficult regulations.  Most physicians are working hard to meet the requirements and cannot because of the lack of specialty measures, the all-or-nothing approach, vendor problems, the lack of interoperability or other issues beyond their control.  Many physicians have been early adopters of technology and are enthusiastic about using EHR as means to improve workflow, patient care and quality outcomes.  However, the EHR incentive program must have feasible and attainable requirements to help physicians achieve these goals rather than act as a burden and hindrance to EHR use by physicians”.

Reforms to the MU program urged in the letter include: delaying implementation of MU Stage 3; giving physicians proportional credit for the measures that are successfully completed, instead of the existing “all or nothing” approach; and expanding the hardship exemptions to recognize physicians who are victims of hacking or other disruptive technology problems related to their vendors, as well as physicians who are close to retirement.


PTSD and TBI in Returning Veterans: Identification and Treatment
Live CME Seminar at Southampton Hospital
Date and time:
January 7, 8-9 AM Live at Southampton Hospital

Presenter:        Dr. Frank Dowling

Program Summary: A look into the two most common disorders facing returning veterans today, from symptoms and diagnosis to treatment and recovery, and how to overcome the unique challenges posed by military culture.

For any questions, contact: Greg Elperin at gelperin@mssny.org

For more information, please read our flyer.

Please register here. 


New York Ties for Top Score in Preventing and Responding to Disease Outbreaks
A December study from Trust for America’s Health (TFAH) states that New York is “tied for top billing in terms of preventing, diagnosing and responding to disease outbreaks.” The TFAH used data from the Centers for Disease Control and Prevention to create a “scoring system with metrics such as flu vaccination rates, food safety and HIV/AIDS surveillance – and then evaluated each of the 50 states to see how they stacked up.” New York is among the five states that “maxed out at 8/10 points.” Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states—Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah—tied for the lowest score at three out of 10.

The report, from TFAH and the Robert Wood Johnson Foundation (RWJF), concluded that the United States must redouble efforts to better protect the country from new infectious disease threats, such as MERS-CoV and antibiotic-resistant superbugs, and resurging illnesses like whooping cough, tuberculosis and gonorrhea. 


Fight for Healthcare in Rural Communities

By Congressman Tom Reed (NY-23)

I care deeply about protecting access to health care and ensuring residents in rural areas have the resources and services they need. It is only fair that rural residents have equal access to quality primary and pediatric care as those living in urban areas. That is why we fought to secure funding for new health care access points across upstate New York.

Earlier this year, we introduced the Rural Hospital Access Act, which protects access to care by providing enhanced levels of Medicare funding to rural hospitals. This legislation makes permanent both the Medicare-dependent hospital program and the enhanced low-volume Medicare adjustment, which enable rural hospitals to offer the same medical services as are provided by hospitals in large cities. This is critically important because it allows seniors, veterans, and individuals with disabilities to receive quality health care right in their own communities.

The enhanced reimbursements provided by these Medicare programs have a direct impact on rural hospitals across upstate New York. An example is St. James Mercy Hospital, a central access point for residents in Steuben County. This hospital is currently undergoing a major restructuring, as part of a new vision for health care in their community. The enhanced reimbursements are critically important because they provide not only a crucial source of revenue, but also a sense of certainty and stability. This will allow rural hospitals like St. James to effectively serve local residents now and for generations to come.

Many of us depend on rural hospitals and medical facilities for health care, from pediatrics to inpatient and maternity services. It is only right we protect these services by supporting rural hospitals. We will continue fighting to ensure seniors, veterans, and individuals with disabilities have access to the care and services they need, regardless of where they live.

Congressman Tom Reed (NY-23)

2437 Rayburn House Office Building

Washington, D.C. 20515

(202)225-3161


Rep. Sarbanes:  Bill to Allow Retired Doctors to Retrain for Community Health
Rep. John Sarbanes (D-Md.) has reintroduced a bill that would allow physicians who have ceased practicing medicine to receive grants to become retrained if they pledge to work at a community health center, school health clinic or Veterans Affairs medical center for two years. This legislation would establish a grant program for medical schools, hospitals and non-profit organizations to create or expand their physician reentry programs which give physicians a streamlined process for credentialing and continuing medical education to return to medical practice after an absence. Funding could also be used to assist with credentialing fees, loan repayments and salaries. In return for this assistance, these physicians would serve at community health centers, VA medical centers or school-based health centers to help fill the shortage of primary care doctors. Participating physicians would be able to practice on a full- or part-time basis and would be covered under the Federal Tort Claims Act, which provides physicians with medical liability protection. 


MSSNY Announces 2016 Medical Matters Schedule
The Medical Society of the State of New York will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled Immunizations During a Disaster, with Dr. William Valenti as faculty.  All programs will begin at 7:30 a.m.   Registration is now open to physicians and other public health officials here. Go to training session and upcoming sessions tab.

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional programs are: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.   Further information on these programs can be found here.

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.

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


MSSNY Adult Immunization Podcast Now Available
William Valenti, MD, chair of MSSNY’s Infectious Disease Committee and Monica Sweeney, MD, MPH, vice chair of MSSNY Committee to Eliminate Health Care Disparities, discuss adult immunization in an effort to educate and inform patients and physicians in New York State about the importance of adult immunization.   The audio podcast can be accessed here. 


CDC Issuing Guidelines Urging Primary Care Physicians to Monitor Opioids
In a research letter in JAMA Internal Medicine, investigators “examined Medicare claims from 2013 to see which doctors prescribed opioids and how many prescriptions they filled.” The analysis revealed that “the drugs are prescribed by a broad cross-section of medical professionals – including doctors, nurse practitioners, physicians’ assistants and dentists – rather than concentrated among a small group of practitioners.”

Moreover, the analysis also revealed that on a “doctor-by-doctor level, pain management specialists and anesthesiologists handed out the most prescriptions for opioids,” but because there are more family physicians than specialists, as a group, “their number of painkiller prescriptions was higher than for any other category of health care worker.

In light of the findings, the Centers for Disease Control and Prevention issued new guidelines on December 14, urging primary-care physicians to closely monitor their patients’ use of opioids and take a more “conservative approach” to prescriptions in order to mitigate “a crippling epidemic of addiction to the powerful narcotics.”

Written comments must be received on or before January 13, 2016. You may submit comments, identified by Docket No. CDC-2015-0112 by any of the following methods:

  • Federal eRulemaking Portal: http://www.regulations.gov. Follow the instructions for submitting comments.
  • Mail:National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE., Mailstop F-63, Atlanta, GA 30341, Attn: Docket CDC-2015-0112.

Instructions: All submissions received must include the agency name and Docket Number. All relevant comments received will be posted without change to http://regulations.gov, including any personal information provided. For access to the docket to read background documents or comments received, go to http://www.regulations.gov.


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742

 



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

December 11, 2015 – MSSNY Aids Physicians in Taking Control of Their Practices

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 11, 2015
Volume 15, Number 46

Dear Colleagues:

First of all, Happy Chanukah to all who are celebrating the miracle of the holiday.

This year, the MSSNY HOD called for the creation of a Task Force that would explore and recommend options to assist MSSNY’s physicians in independent practice to remain viable in that environment. After a call for interested MSSNY members to participate, I put together a team of physicians from various specialties and geographic locations that had an interest and/or expertise in the subject.  Some physicians have business degrees while others have engaged in entrepreneurial projects transforming how they deliver health and wellness care to the residents of New York.  I selected Drs. Tom Lee and Paul Lograno to lead the effort.  To date, the group has had two meetings and has begun developing various options to help a broad spectrum of physicians in different practice environments. In the next few months, you will be hearing more about options available to you that many of your colleagues have embarked on that have helped them be happier physicians thriving in the turbulent environment of healthcare reform.

In addition to this effort, I have asked a group of MSSNY Councilors to develop guidelines that will guide how we collaborate with other groups of physicians who are seeking to remain out of network or who wish to engage in advocacy that relates specifically to their specialty practice. A Task Force to address physician burnout and stress will begin its deliberations in January under the leadership of Dr. Michael Privetera from the University of Rochester.

Tipping Point

The recent events concerning disenrollment of physicians from Emblem Health and United Healthcare as well as the Health Republic fiasco have become the tipping point.  WE WILL NOT SIT BACK AND TAKE THIS ANY LONGER.  If we cannot get collective negotiation or be assured that the private practice model will be supported by government legislative and regulatory reforms, then we must take matters into our own hands and develop mechanisms for group survival/individual survival.  For some, it will mean creating new physician-owned-and-run groups or IPAs.  For others, it will mean dropping out of many insurance products and establishing direct care practices. For others, there may be other models that some of you have developed.  MSSNY is working on highlighting successful options to opt out of the madness being foisted upon us.

Do you have an interest in getting involved?  Do you have a successful alternative model of delivering healthcare that is working for you?  Have you changed how you practice and become a happier and less stressed out physician while remaining in private practice?  Are you a young physician engaged in an innovative practice model?  We want you to get involved in our grassroots led effort.  Let us know.  We are bringing together talented and successful colleagues who have been quietly engaging successful strategies.

Contact Eunice skelly @ eskelly@mssny.org

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


Senate Health Committee Chair Urges Emblem to Reconsider Dropped Physicians
Noting that he has “heard from a number of physicians as well as the Medical Society of the State of New York” regarding Emblem’s decision to not renew contracts with approximately 750 physicians, New York State Senate Health Committee Chair Kemp Hannon wrote to Emblem CEO Karen Ignani this week to ask for “further clarity on this issue.”   MSSNY had written to the entire State Legislature to share the extensive media coverage of this issue affecting continuity of care for patients, and urging legislators’ assistance in reversing Emblem’s arbitrary and unfair decision.

As has been widely reported, Emblem is dropping these physicians reportedly as part of its efforts to increase the use of value-based payment arrangements.   Because of extensive physician outrage over these arbitrary and unfair actions, MSSNY has asked for an investigation by the New York Department of Financial Services in addition to contacting the State Legislature.

Senator Hannon’s letter to Emblem notes that “further information must be made available to enable the physicians you have chosen to drop from your network to properly be reconsidered.”  In particular, Senator Hannon expressed concern whether these 750 physicians “were granted an opportunity to enter value-based payment arrangements prior to them being dropped from Emblem’s network of providers” and “whether the providers will be favorably reconsidered if they are capable and willing to enter such arrangements in a timely manner, or what other factors may be taken into account upon reconsideration. “

MSSNY’s request to state legislators asked them to a) urge the New York Department of Financial Services to prevent Emblem from taking its action to drop the contracts of these 750 physicians; b)  urging the State Legislature to enact legislation (A.1212, Lavine/S.4751, Hannon) that passed the Assembly in 2015 that would provide physicians and other health care practitioners with necessary due process protections where health insurers seek to terminate a physician from its network by failing to renew the physician’s contract; and c) urging the adoption of legislation that would better assure more comprehensive physician networks by preventing health insurance companies from dropping physicians from its network based upon an inability to enter into a value-based payment arrangement.

Physicians can send a letter to their legislators urging their efforts to reverse Emblem’s action from here.

Please continue to let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.

If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount. We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


Western New York Congressman Presses CMS to Assure That HR Claims Are Paid
Noting the several physicians he has heard from, Representative Chris Collins (R-Western New York) pressed CMS Acting Administrator Andy Slavitt this week to identify what steps the federal government could take to assure physicians and other health care providers are fully paid for the care that they have provided to their patients insured by collapsed co-op health insurer Health Republic.  The questioning occurred as part of a US House of Representatives Energy & Commerce Committee hearing into the functioning of state Exchanges.  MSSNY had written to the entire New York Congressional delegation late last week to share with them the numerous articles from papers in nearly every region across New York State highlighting the consequences of the collapse of Health Republic, and asking for their assistance to assure, once the full accounting and distribution of the assets of the Health Republic is completed, that health care providers are made whole.

MSSNY continues to have regular communication with key state officials regarding how the wind-down of Health Republic will occur, and at what level and when payment can expect to be received.  Physicians can send a letter to their state legislators and Governor Cuomo to urge that steps are taken, including the creation of a special state fund, to assure that these claims are fully paid.

Moreover, this week, the New York State Association of Health Underwriters announced its support for a special fund to assure Health Republic claims are paid.

MSSNY also continues to hear from dozens of physicians that reimbursement checks issued by Health Republic have been returned by the bank for insufficient funds.   If you have received notice from your bank that an HR check bounced, please let us know by sending an email to rmcnally@mssny.org


Cadillac Tax, Meaningful Use Relief Under Consideration in Year End Congressional Budget Talks
As Congress scrambles to pass a year end Budget bill, a number of health care issues of great importance to physicians continue to be under strong consideration for incorporation into the package.  This includes additional provisions that could provide some needed hardship exceptions to overly burdensome meaningful use requirements, as well as a delay in the implementation of the so-called “Cadillac Tax” on comprehensive health insurance coverage scheduled to go into effect in 2018.  The Cadillac Tax, a component of the ACA, imposes a 40% excise tax on group health plan premiums that exceed $10,200 for single coverage and $27,500 for family coverage.  It would undoubtedly have a greater impact in higher cost states such as New York, and would further discourage employers form offering comprehensive health insurance policies to their employees.   MSSNY adopted policy at its 2013 House of Delegates meeting calling for legislation to repeal this tax.  Please remain alert for further updates on these items. 


Take this AMA Survey re Meaningful Use
In the AMA’s ongoing efforts to improve EHRs and interoperability of EHRs, the AMA is assisting the Office of the National Coordinator (ONC) with gathering information to improve the summary of care document that is produced to meet the Transfer of Care objective in Stage 2 of Meaningful Use. The following is a link to a 5-10 minute survey that will help ONC create a new standard that will reduce the number of pages in the summary of care, thus making it easier to find relevant information.  Please share the link with your members and encourage them to take the survey. The Office of the National Coordinator (ONC) has extended the survey deadline to December 23. Survey link http://goo.gl/forms/0fjoUxZwsS 


BNE Sends Letter Reminding You of E-Prescribing Requirement that Becomes Effective on March 27, 2016
The New York State Department of Health’s Bureau of Narcotic Enforcement has emailedl a letter to about 110,000 prescribers, through the Health Commerce System, reminding practitioners about the e-prescribing mandate that will take effect on March 27, 2016.  The letter encourages practitioners to begin E-prescribing if they have already implemented an E-prescribing software application or to begin the process to acquire an E-prescribing software application if they have not started the process.   A copy of that letter can be found here. BNE has also developed a patient brochure on e-prescribing and it can be found on BNE’s website.

New York State’s e-prescribing requirements for non-controlled and controlled substances will go into effect on March 27, 2016.   The NYS Department of Health’s Bureau of Narcotic Enforcement has provided information to physicians and other prescribers to assist them in their transition to electronic prescribing.   Practitioners should continue their efforts to become compliant with the law, including working with their software vendors to implement the additional security requirements needed for e-prescribing of controlled substances (EPCS), and registering their certified software applications with the Bureau of Narcotic Enforcement.   According to state officials, over 35,000 prescribers have registered their systems with DOH.   This represents only about 1/3 of the prescribers in New York State.

For physicians who prescribe controlled substances, there are additional steps to complete in order to electronically prescribe controlled substances.  These include the following:

  • First, the software you currently use must meet all the federal security requirements for EPCS, which can be found on the Drug Enforcement Agency’s (DEA) web page. http://www.deadiversion.usdoj.gov/ecomm/e_rx/

Note that federal security requirements include a third party audit or DEA certification of the software.

  • Second, you must complete the identity proofing process as defined in the federal requirements.
  • Third, you must obtain a two-factor authentication as defined in the federal requirements.
  • Fourth, you must register your DEA certified EPCS software with the Bureau of Narcotic Enforcement (BNE). Registration instructions are included in the FAQs.

A copy of the BNE’s Frequently Asked Questions (FAQs) can be found here.

EPCS systems must be registered through the ROPES system.  ROPES stands for: Registration for Official Prescriptions and E-Prescribing Systems. To access ROPES, use the following steps:

  • Login to the Health Commerce System (HCS) at https://commerce.health.state.ny.us
  • Under “My Content” click on “All Applications”
  • Click on “R”
  • Scroll down to ROPES and double click to open the application. You may also click on the “+” sign to add the application “ROPES” under “My Applications” on the left side of the screen.

EPCS became permissible in New York State and over 90% of the pharmacies can now accept e-prescribing for controlled substances, according to officials from BNE.

DrFirst and MSSNY have partnered to bring MSSNY members the industry’s leading e-prescribing solution at a special discounted price and information on this program can be found here. There are additional venders that now have software available to e-prescribe both non-controlled and controlled substances and information on these can be found at this link.

There will be a waiver process for those physicians who experience technological or financial issues, however, DOH has not yet released this process, but it is expected to do so shortly. The waiver process will be electronic. Waivers will be provided for a facility, a large medical practice or an individual physician. The law provides that physicians may apply for a waiver of this e-prescribing requirement as a result of a) economic hardship b) technological limitations that are not reasonably within the control of the physician, or c) other exceptional circumstance.  DOH has indicated that more information on the waiver process will be available shortly.

E-prescribing of non-controlled substances is also required under the law; however, registering of this system with the state is not necessary. 


Bureau of Narcotic Enforcement’s Physician Info on Medical Marijuana Program
The New York State Department of Health’s Bureau of Narcotic Enforcement announces the availability of the required four hour medical use of marijuana course.  Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must complete this course. The Compassionate Care Act, signed into law on July 5, 2014, authorized the Department of Health to implement a Medical Marijuana Program in New York State. Practitioners who wish to register with the Department and certify their patients for the Medical Marijuana Program must:

  • be qualified, by training or experience, to treat patients with one or more of the serious conditions eligible for medical marijuana;
  • be licensed, in good standing as a physician and practicing medicine, as defined in article one hundred thirty one of the Education Law, in New York State;
  • possess a Health Commerce System (HCS) Medical Professions Account user ID and password;
  • possess an active Drug Enforcement Administration (DEA) registration number; and
  • complete the four hour Department-approved medical use of marijuana course.

Departmental officials anticipate that the four hour department approved online course is available to practitioners through the  TheAnswerPage, an established online medical education provider here.

The course will include the following topics, which are required in the regulations: the pharmacology of marijuana; contraindications; side effects; adverse reactions; overdose prevention; drug interactions; dosing; routes of administration; risks and benefits; warnings and precautions; and abuse and dependence.  The cost to take the course is $249, and practitioners will earn 4.5 hours of CME credit upon successful completion of the course. Additional information regarding the practitioner registration process is available on the Department’s Medical Marijuana Program webpage, which can easily be accessed via the following link.

It is also expected that DOH will announce the process that physicians may be able to “certify” patients for receiving marijuana under the medical marijuana program.   It is anticipated that this process will be through the Health Commerce System.

Please monitor this webpage frequently for updates and the department may be contacted with any questions:New York State Department of Health, Bureau of Narcotic Enforcement,

Medical Marijuana Program, Riverview Center,50 Broadway,Albany, NY 12204

Call 866-811-7957 or email mmp@health.ny.gov


Letter Re E-Prescribing from Director of Bureau of Narcotic Enforcement

Dear Prescriber:

Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.  This mandate does not apply to veterinarians.  Electronic prescribing of both controlled and non-controlled substances is currently permissible in New York. 

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements.  Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health (DOH), Bureau of Narcotic Enforcement (BNE). 

Please be aware that implementation timelines for EPCS software vary and may be lengthy.  If you have not already begun this process, BNE strongly recommends that you begin immediately.   

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper, to allow for time to resolve technical or workflow issues prior to the mandate’s effective date. 

Useful information related to electronic prescribing, including frequently asked questions, information regarding the EPCS registration process, and a downloadable patient-centered brochure to help your patients better understand electronic prescribing can be found on our website at www.health.ny.gov/professionals/narcotic. 

If you have any questions about the electronic prescribing mandate, please call 1-866-811-7957, option 1.

Joshua Vinciguerra
Director
Bureau of Narcotic Enforcement


The NY Society of Addiction Medicine to Host 12th Annual Conference Feb. 5 & 6
The NY Society of Addiction Medicine (NYSAM) will host its annual conference February 5 and 6 at the Crowne Plaza Times Square Hotel, 1605 Broadway, NYC. The conference entitled, “Critical Role of Addiction Medicine in Healthcare Reform: Best Practices,” is designed for physicians, medical students/residents, and addiction professionals.  Registration is required and the cost is as follows: Full conference price—Before January 15, 2016  NYSAM Member Rate: $350 Non-Member Rate: $425 Non Physician Rate: $225.  Residents/Fellows/Medical Students are free. Registration may be made by visiting the NYSAM website here or by contacting Elisabeth Kranson at (518) 689-0142 or via email: ekranson@asapnys.org 


Adelphi University MBA Program for Suffolk/Nassau County Medical Societies
The Nassau and Suffolk Medical Societies cordially invite all physicians to attend one of the MBA Information Sessions to learn more about how an MBA degree can give you the tools necessary to be an effective leader, critical thinker, negotiator and problem solver. Mark your calendar now and plan to attend.

Where: Suffolk County Medical Society, 1767-14 Veterans Highway, Islandia

  • Tuesday, December 8, 2015
  • Tuesday, December 15, 2015
  • Friday, December 18, 2015

Come in between 4:00 pm to 6:00 pm

Where: Adelphi University, 55 Kennedy Drive, Hauppauge- 11788

  • Monday, December 7, 2015
  • Wednesday, December 9, 2015
  • Monday, December 14, 2015

Come in between 8:00 am to 3:00 pm

Don’t miss out on this opportunity to learn more about how you can successfully position yourself in today’s healthcare system.

RSVP Maureen Leslie at 516 237-8607 or leslie@adelphi.edu or SCMS at 631 851-1400.


Consumers Warned About Raw Milk Listeria Risk in Allegany County
Food Safety News (12/11) reports “consumers in New York’s Allegany County and surrounding area were told not to consume ‘unpasteurized’ raw milk from the Gerald E. Snyder Farm due to possible Listeria contamination.” The notice “came from the New York Department of Agriculture and Markets.”

The public health warning came from the New York Department of Agriculture and Markets.The Gerald E. Snyder Farm is located at RD#1, 1444 Randolph Rd., Alfred Station, NY. The department has not yet associated any illnesses with the product that is subject of the public health warning.


Classifieds


Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org


Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742

 



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

December 4, 2015 – Are Your Health Republic Checks Bouncing?

drmaldonado PRESIDENT’S MESSAGE
 Dr. Joseph R. Maldonado
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December 4, 2015
Volume 15, Number 45

Dear Colleagues:

As was reported in several media outlets this week, including Crains’ Health Pulse, Politico New York and WNYC, MSSNY has heard from many physicians outraged regarding the decision of EmblemHealth to drop hundreds of physicians from its network reportedly as part of its efforts to increase the use of value-based payments. However, at first glance, it appears that many of the recipients of these non-renewal letters were physicians in smaller practices who did not receive any advance notice by Emblem of its desire to migrate their payment structure to a value-based methodology.

Last week, the New York County Medical Society issued a press release warning of disruptions to long-standing patient-physician relationships, followed up by multiple MSSNY letters to the NYS Department of Financial Services (DFS) urging an investigation into how these actions by Emblem will affect its network adequacy and whether these physicians and their patients were truly given adequate notice.

We have been advised by DFS staff that they have initiated a review of Emblem’s action, and hope to have some answers to our questions next week.  Among the questions we have posed to DFS:

  • Were these 750 physicians dropped by Emblem given any advance notice of Emblem’s intention to drop them for any reasons including because they chose to deliver care to patients in a smaller practice setting?
  • Were any of these 750 physicians dropped by Emblem given the opportunity to enter into the value-based contracts espoused by Emblem to stay within Emblem’s physician network?
  • How many patients are impacted by Emblem dropping these 750 physicians from its network?  What is the total number of patient encounters with Emblem insureds that these 750 physicians provided over the last year?
  • What is the specialty of the physicians being dropped?  What are their hospital affiliations? Has DFS or DOH reviewed whether the dropping of these physicians will create shortages in any specialty or in any particular community served by Emblem?
  • How does the timing of the notice to these dropped physicians intersect with employer open enrollment periods?  For example, it was reported that the open enrollment date for New York City employees ends on October 31, just three days after patients received notice of these physicians being dropped. Were patients of these physicians given fair notice so that they could shop around for coverage for a health plan that includes their treating physicians?

Please let us know if you have been impacted by these actions.  MSSNY and county medical societies are seeking to further identify physicians who have been impacted, as well as patients who may be willing to share their stories.  With assistance from MSSNY’s General Counsel, we have drafted a template “Dear Patient” letter for impacted physicians to customize to use for their discussions with their patients.

Joseph Maldonado, M.D, MSc, MBA, DipEBHC
MSSNY President

Please send your comments to comments@mssny.org


MLMIC Physianns Insurance


MSSNY’S Advocacy Matters CME Series Webinar On December 8th
Jason Helgerson, NYS Medicaid Director to Discuss Delivery System Reform Incentive Payment Program (DSRIP) and the Move to Value Based Payment

Jason Helgerson, New York’s Medicaid Director, will present on the State’s Delivery System Reform Incentive Program (DSRIP) and on the move to value based payment on MSSNY’s December 8th Advocacy Matters program. The program will run from 12:30- 1:30PM.

DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Up to $6.42 billion dollars are allocated to this program with payouts based upon achieving predefined results in system transformation, clinical management and population health.

To read our flyer, please click here.

Calling All Doctors Who Have Been Terminated by Emblem
MSSNY is trying to collect data on the physicians who have been terminated by Emblem health. We cannot help you if we do not who you are. We are in constant contact with The Department of Financial Services in an effort to assist New York State physicians who have received these notices from Emblem.

Please email our VP of Socio-Medical Economics Division Regina McNally at rmcnally@mssny.org with your name and contact information. 


Banks Returning Health Republic Checks Due to Insufficient Funds
As you know by now, Health Republic (HR), the NYS Co-Op, closed on November 30, 2015.  MSSNY has received notices from several physicians that reimbursement checks issued by HR have been returned by the bank for insufficient funds.  We, MSSNY, would like to know how widespread this issue is.  If you have received notice from your bank that an HR check bounced, please let us know.  Please send an email to rmcnally@mssny.org  If you can scan the check into an email that would be helpful.  If not, your email should include the date the HR check was issued, the amount of the check and whether the bank charged a fee for the transaction. Note: Please do not include patient information in your email.

On a related matter, if you have a reimbursement check from HR, it would most likely bounce if you try to deposit it.  It is urged that you send us an email indicating the number of checks, the date (s), and the amount.  We will share this information with the HR monitor.  Again, please email rmcnally@mssny.org.Thank you for your patience while we continue to work to assist you in the process.


File by Dec. 16 to Avoid Medicare Pay Cut of 2-4 %
Practices that may have thought they were safe from Medicare payment penalties next year could be in for an unpleasant surprise if they don’t take action now.

Problems with how the Centers for Medicare & Medicaid Services (CMS) has been collecting and analyzing data related to the Physician Quality Reporting System (PQRS) and the value-based payment modifier are leading to inappropriate penalties of 2-4 percent of Medicare payments for thousands of physicians.

How to avoid the penalty: File an informal review request with CMS before midnight EST on Dec. 16. CMS has said it will verify incentive eligibility and payment adjustment determinations for practices that file such a request.

Additional information about the process and contact information for questions is available in CMS’ informal review fact sheet.

Note: CMS has said the informal review system will be down Dec. 3-7 and unable to accept requests during that time.


Register Now For Final 2015 E-Prescribing CME Webinar on Dec. 9
MSSNY will host its final 2015 free continuing medical education webinar on E-prescribing on December 9 at 7:30 a.m. for MSSNY members. Registration is now open to MSSNY physicians by clicking here.

The program, entitled, “New York State Requirement for E-prescribing of All Substances,” includes the following educational objectives:

  • Describe the e-prescribing mandate, to whom it applies, when it becomes effective, and how physicians can comply with its requirements.
  • Describe the practitioner electronic prescribing of controlled substances registration process, to whom it pertains, and the information required to be provided by physicians in order to register eRX software with the Bureau of Narcotics Enforcement.
  •  Describe the exceptions to the e-prescribing mandate and any additional requirements associated with those exceptions.
  • Describe the application process and criteria for a waiver from the e-prescribing mandate.
  • Describe what rules pertain to physicians who only prescribe non-controlled substances

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.

Further information can be obtained by contacting Terri Holmes at tholmes@mssny.org.

E-prescribing of all substances will be required in New York State by March 27, 2016.   The ISTOP legislation enacted in 2012 required e-prescribing of ALL substances. Regulations pertaining to the E-prescribing requirements were adopted on March 27, 2013. The Medical Society of the State of New York was successful in obtaining a delay in the e-prescribing requirements for all substances to March 27, 2016.  


US Senate Passes Controversial Bill to Revise ACA and Defund Planned Parenthood
By a 52-47 vote, the United States Senate passed legislation (HR 3762) on Thursday that would repeal significant components of the Affordable Care Act.  Specifically, the bill would repeal the taxes on medical devices and the so-called “Cadillac” tax on comprehensive health insurance policies (slated to go into effect in 2018).  It would also reduce funding for the Public Health and Prevention fund created under the ACA and repeal the expansion of Medicaid contained in the ACA.  Furthermore, it would set at $0 the fines for individuals who fail to purchase health insurance coverage and large employers who fail to provide coverage to their employees, essentially repealing these mandates.  Of greatest controversy, the legislation would also defund Planned Parenthood for one year.

While the bill is expected to be passed by the House of Representatives, it is almost certainly going to be vetoed by President Obama, and there are insufficient votes for an override.    The significance, however, is that it is likely to be the first time a bill repealing large sections of the ACA has been approved by the entire Congress.  New York’s Senators Charles Schumer and Kirsten Gillibrand voted against the bill.


Revitalizing MSSNY’s Organized Medical Staff Section – Get Involved!
MSSNY members are invited to get involved in the reestablishment of our OMSS. OMSS is a viable entity to advance the interests of your medical staff, your group practice or your institution, and to air and have MSSNY help address your issues.

OMSS also offers a prime opportunity for leadership development.

We would like to invite you to participate in an online meeting at which candidates for office will introduce themselves, and elections will be held. A slate of previously nominated candidates will be presented, and nominations will be accepted from the floor. Even if you are not running for office, please join to have your vote counted. The webinar (telephone only option also available) will take place on Saturday, December 12, 2015 at 8:00 am and should last no more than two hours.

Kindly email eskelly@mssny.org at your earliest convenience to let us know if you will be participating.


Opportunity for Physician Peer Reviewers
The Empire State Medical, Scientific and Educational Foundation, Inc. (ESMSEF) would like to invite you to participate in physician peer review with our organization.  We have a need for physician reviewers who are board certified and in active practice.  We have an urgent need for physicians in all specialties.

ESMSEF is a subsidiary of the Medical Society of the State of New York (MSSNY) and has been performing independent medical peer review since 1984.  The Foundation currently has several contracts in New York State to perform medical peer review services.  The reviews to be performed are retrospective in nature and are time sensitive.  We generally allow approximately 10 days for completion of the physician review.  Reviews may be sent to your home or office or may be performed in our offices in either Westbury or Camillus (Syracuse).  Issues to be reviewed include medical necessity, diagnosis assignment and/or quality of care issues.

If you are interested in participating in peer review, please contact Jane Steinman, Physician Reviewer Coordinator at 1-800-437-2234 or via email at jsteinman@esmsef.com to request an application. Or, you may download our application from the “Careers” section of the Foundation website at www.esmsef.com


MSSNY Announces 2016 Medical Matters Schedule for 2016
MSSNY will begin its 2016 Medical Matters webinars on January 20, 2016 with a program entitled “Immunizations During a Disaster,” with Dr. William Valenti as faculty.  All programs will begin at 7:30am.

Registration is now open to physicians and other public health officials:

https://mssny.webex.com/mw3000/mywebex/default.do?siteurl=mssny

  • Go to training session and upcoming sessions tab

Educational objectives for the January 20 program are:

  • Review recommendations for immunizations during disasters
  • Review recommendations for immunizations for responders
  • Describe best practices to avoid vaccine preventable diseases (VPD) during disasters
  • Describe the importance of herd immunity

Additional program include: Public Health Preparedness 101 on February 17, 2016 and Radiological Emergencies on March 16, 2016.

Further information on these programs can be found here

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. 

Further information or assistance in registering for any of these programs, may be obtained by contact Melissa Hoffman at mhoffman@mssny.org.


Senate Finance Report on Solvadi Pricing: Profits over People
Gilead Sciences prioritized maximizing its revenue over recouping research and development costs and ensuring patient access when pricing its breakthrough hepatitis C treatment, Sovaldi, according to a Senate Finance Committee report released yesterday.

“Gilead pursued a calculated scheme for pricing and marketing its Hepatitis C drug based on one primary goal, maximizing revenue, regardless of the human consequences. There was no concrete evidence in emails, meeting minutes or presentations that basic financial matters such as R&D costs or the multi-billion dollar acquisition of Pharmasset, the drug’s first developer, factored into how Gilead set the price. Gilead knew these prices would put treatment out of the reach of millions and cause extraordinary problems for Medicare and Medicaid, but still the company went ahead,” stated the report. The drug costs $1,000 per pill or $84,000 per patient for a 12-week course of treatment. According to the report, fewer than 3% of eligible Medicaid beneficiaries received the treatment last year because of the drug’s high price. Gilead says it disagrees with the report’s findings, noting that it provides financial assistance for the treatment to uninsured individuals. (Wall Street Journal 12/1)


Mandatory Electronic Prescribing in New York State
Effective March 27, 2016, electronic prescribing for both controlled and non-controlled substances will be required in New York State.

In order to process electronic prescriptions for controlled substances (EPCS), a prescriber must select and use a certified electronic prescribing computer application that meets all federal requirements. Each unique certified computer application used to electronically prescribe controlled substances must first be registered by the practitioner with the New York State Department of Health, Bureau of Narcotic Enforcement (BNE).

Prescribers who have certified EPCS software and have completed the registration process are highly encouraged to begin electronically prescribing instead of using paper. This will allow for time to resolve technical or workflow issues prior to the mandate’s effective date.

Please be aware that implementation timelines for EPCS software vary and may be lengthy. If you have not already begun this process, it is recommended that you begin immediately.

The laws regarding issuing and dispensing prescriptions for controlled substances, from paper to the electronic method, have not changed. Only the format has changed.

Useful information related to electronic prescribing, including frequently asked questions and information regarding the EPCS registration process, can be found on BNE’s website here.


ACEP: Under New Reg, Plans Not Required To Pay Fairly for Emergency Care
A new regulation issued by the Department of the Treasury, the Department of Labor and the Department of Health and Human Services last week stated that health insurance companies can pay doctors in emergency departments essentially whatever they like, opening the door to the possibility of reimbursements that do not even cover the costs of care.  The American College of Emergency Physicians (ACEP) expressed astonishment at the ruling, given the feedback emergency physicians have given to CMS over several years, as well as the timing.  Dr. Jay Kaplan, president of ACEP, said that the organization was considering legal action.

“This new ruling will significantly benefit health insurance companies at the expense of physicians, because they know hospital emergency departments have a federal mandate to care for everyone, regardless of ability to pay,” said Dr. Jay Kaplan.  “They will continue to shift costs onto patients and medical providers, as well as shrink the number of doctors available in plans.  Instead of requiring health plans to pay fairly, this ruling guarantees that insurance companies can pay whatever they want for emergency care.  If history tells us anything it’s that insurance companies prefer to pay as close to nothing as possible, while building their war chest for profits and litigation.”

“This is a scary environment for patients,” said Dr. Kaplan.  “Insurance companies are alleging that doctors are charging too much, rather than admitting they are paying too little.  This ruling by CMS unfortunately suggests that the federal government is on the side of Big Insurance rather than patients and their physicians.”


Classifieds

Office Space–Sutton Place
Newly renovated medical office. Windows in every room look out to a park like setting on the plaza level. 2-4 exam rooms/offices available, possible procedure room or gym. Separate reception and waiting area, use of 3 bathrooms and a shower.  Central air and wireless. All specialties welcome. Public transportation nearby. Please call 212-772-6011 or email:  advocate@medicalpassport.org

Modern 3000 sq. ft. medical office to rent near the United Nations.
Handicapped accessible; private reception area; secretarial area available; 6 exam rooms.  Ideal for ophthalmologist/optometrist. Could suit other specialties. Available for full or part time. $1300 per month for one day per week. Please contact Dr. Weissman at  uneyes@verizon.net or call 914-772-5581.

Office Rental 30 Central Park South
Two fully equipped exam, two certified operating, bathrooms and consultation room. Shared secretarial and waiting rooms.  Elegantly decorated, central a/c, hardwood floors. Next to Park Lane and Plaza hotels. $1250 for four days a month. Available full or part-time. 212.371.0468 / drdese@gmail.com.


Midtown Office- Rockefeller Center
Sunny, upscale office. Furnished or unfurnished. Tranquil Ambience, waterfall, well maintained building. MUST BE SEEN. If interested in renting please call 646-242-4742



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

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