December 8, 2017

 

Charles Rothberg, MD - MSSNY President
PRESIDENT’S MESSAGE

Charles Rothberg, MD
December 8, 2017
Volume 17
Number 45

 

 

 

 

 

Dear Colleagues: 

On Monday, MSSNY sent out my press statement regarding the proposed merger of Aetna and CVS. It received a lot of media coverage. I am hopeful that other groups raise similar concerns.

Without mincing words, our message was that the front door to health care should be a physician’s front door— not an insurer’s and definitely not a store. 

This merger is also bad news for hospitals, which still see millions of patients in their emergency departments and provide care for ailments that CVS and Aetna executives say could be avoided or directed to an outpatient location. How could it do this? CVS is not just drugstores. In 2006, it acquired MinuteClinic—that operates more than a thousand walk-in clinics. They are not only in their stores but also in some Target locations.

As far as these vertical mergers go, the DOJ said it would sue to block a very similar deal, between Time Warner and AT&T. It will be interesting to see their take on this proposal.

The CEO of CVS said that the merger will be a new “front door” to healthcare. His vision is out of sync. In a merger of this magnitude, the involved parties are expected show the financial benefit to shareholders, but who is looking out for the benefit of patients?

The regulators are typically less interested in vertically integrated entities than horizontal ones. For example, if physicians wanted to merge, they would have to show a benefit to consumers (e.g. clinical integration). I believe that all entities should play by the same rules. This merger has the potential to keep other health insurers from entering the market and forcing others out of business. This sort of consolidation has not been good for consumers or their doctors. Who is looking out for the thousands of community physicians across our state? Will physician practices join too many of our local pharmacies and become the ghosts of Main Street?

A physician’s purpose is to serve patients, not to sell them prescription drugs and other goods. The distinction between patient and purpose is getting very blurry. Patients should not be looked upon solely as consumers. What is wrong with this picture? At MSSNY, we are concerned about significant adverse implications for patients if this immense merger goes forward. It is troubling that patients may face even more burdensome and excessive prior authorizations along with other unnecessary barriers to needed health care.

We hope that other medical associations and individual physicians will prompt both federal and our own state regulators to take a hard look into the future as to the impact of a merger of this magnitude.

One thing we all know—when it comes to medicine, corporate consolidation is rarely better for patients and their physicians.

Sincerely,

Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


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Promo Code: MSSNY


 

 

 

 


MSSNY President Reacts to UHF Study “NY ACOs Often Exceed Cost Benchmarks”
This week the United Hospital Fund released a report that concluded that, even though New York’s Accountable Care Organization (ACOs) are providing quality care above the level of other ACOs across the nation, they still struggle to generate savings against their benchmark expenditure targets. Specifically, the study reported New York’s 32 Medicare Shared Savings Program ACOs performed better than the national average on most measures of prevention, including the management of diabetes, hypertension, and cardiovascular disease, as well as immunizations and tobacco screening and intervention.

At the same time, in 2016, only one-third (12 of 32) of the state’s ACOs generated savings against benchmark, while two-thirds (20 of 32) had expenses that exceeded their benchmarks.

In response to the report, MSSNY President Dr. Charles Rothberg issued the following statement:

“The United Hospital Fund report regarding the performance of ACOs in New York confirms a principle of which most physicians are aware – that the provision of quality patient care very often cannot be provided at a discount.

We are proud that our New York ACOs have exceeded the performance of their counterparts across the country. MSSNY has supported efforts to enable the creation of ACOs because it enabled independently practicing physicians to collaborate on resources to improve patient care, and the opportunity to secure additional funding to facilitate the investment in these patient care resources.  However, while we support efforts to assist physicians with “practice transformation” as a means to improve patient care delivery, policymakers must understand that the incentives that have been used for institutions do not transition easily to physician care delivery.  The UHF report appears to validate concerns many physicians have expressed with some “value based” payment programs imposed by public and commercial payors that payments for needed medical care could be unfairly cut based upon comparison to unrealistic cost benchmarks.”

MSSNY Joins Other Physician Advocates to Urge Congress to Prevent Cuts to Medicare and Other Health Insurance Programs
Noting that “Congress must act to prevent the loss of needed health insurance coverage for millions here in New York and across the country”, MSSNY joined with several other physician advocacy associations in a letter to New York’s Congressional delegation urging continued funding for various health insurance programs as Congress debates a spending resolution required by the end of the year as well as a massive tax restructuring proposal.  This includes continued funding for the Child Health Insurance Program (CHIP), which helps to provide coverage for over 300,000 children in New York State, and continued authorization for health insurance subsidies including for New York’s Essential Plan, which provides low-cost “first dollar” coverage to nearly 700,000 New Yorkers who earn too much to qualify for Medicaid.

Moreover, the letter urged our Congressional delegation to work to prevent potential further sequestration cuts to Medicare physician payments that could be imposed as a result of deficits potentially created through with a tax reform bill.  Others joining on to the letter to New York’s Congressional delegation included the NYS Academy of Family Physicians, NYS Academy of Pediatrics, the New York County Psychiatric Association, the Doctors’ Council/SEIU and the local affiliate of the National Medical Association.


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


MSSNY Raises Strong Concerns with CVS-Aetna Merger Proposal
Noting that “the front door to health care should be a physician’s front door – not an insurer’s and definitely not a store,” MSSNY President Dr. Charles Rothberg was quoted in a number of media outlets this week expressing strong concerns with the announcement by CVS of its intention to purchase Aetna.  Articles where he was quoted included:

Dr. Rothberg noted that physicians “are very concerned about significant adverse implications for patients if this immense merger goes forward. The possibility of even more burdensome and excessive prior authorization barriers for prescription medications needed by our patients, combined with further marginalization of many community pharmacies and community physicians that our patients depend upon is an equation for disaster.” (See Dr. Rothberg’s editorial above.)

Moreover, Assembly Insurance Committee Chair Kevin Cahill has written to the New York Department of Financial Services and Department of Health urging an investigation of this proposed transaction. To read his press release, click here.  Specifically, he noted that “CVS has been leading the lobbying effort to legalize so-called “minute clinics” in New York State, in direct competition with private practice doctors and not for profit health clinics. We have already seen the way prescription business has been steered to this giant entity, often at the expense of the neighborhood pharmacy.”

Dr. David Barbe, President of the AMA, issued the following statement in reaction to the proposal: “This proposed $69 billion transaction – one of the largest merger deals in the history of American health care – would have long-term impact on the markets for health insurance and pharmaceutical benefit management services. These markets are already dominated by few participants with large market shares, including Aetna in health insurance and CVS in pharmaceutical benefit management. The AMA is committed to reviewing all issues triggered by this proposed merger to preserve the benefits of competition, including increased access and choice, lower prices and higher quality care for patients.”

Massachusetts Medical Society Has Adopted a Neutral Position on Assisted Suicide
The Massachusetts Medical Society is no longer opposed to medical aid in dying as an end-of-life option for the terminally ill. The Massachusetts Medical Society’s governing body has voted to adopt a neutral position on the issue of medical aid in dying.   The society will now serve as a medical and scientific resource as part of legislative efforts that will support “shared decision making” between terminally ill patients and their physicians. The statewide organization says physicians shouldn’t be required to practice medical aid in dying if it violates their ethical principles.

The Massachusetts legislature is considering legislation that would allow people with incurable conditions who are likely to die within six months to request medication from their doctors that can be self-administered to bring about a peaceful death. The bill includes provisions ensuring the patient is of sound mind.  The Medical Society of the State of New York’s Bioethics Committee is in the process of developing a survey on death and dying and the physicians’ role in process.  This survey will be sent to MSSNY members and is in keeping with a 2017 resolution the passed the MSSNY House of Delegates.

HOW CAN I HELP?

Please Urge Governor Cuomo to Veto Disastrous Liability Expansion Bill and Work for Comprehensive Reform Instead
While 98 bills were delivered to Governor Cuomo this week for his consideration, not among them was legislation (S.6800/A.8516) that would significantly expand the time to bring a medical malpractice lawsuit, in circumstances based upon an “alleged negligent failure to diagnose a malignant tumor or cancer”.  It is one of 7 bills that have passed both Houses of the Legislature, but have not yet delivered to the Governor for his approval or veto.

Because it has not been paired with badly needed medical liability reforms, if signed into law this measure would likely prompt a significant increase in physician and hospital malpractice premiums at a time when New York has by far and away the highest cumulative liability costs in the country.  Please urge the Governor to veto this bill and in support of needed comprehensive medical liability reform by sending a letter to the Governor here and call 518-474-8390.

Physician leaders have been active in warning the public about the patient care access problems this bill will exacerbate if it is signed into law.  Recently, a letter to the Editor from MSSNY’s President Dr. Charles Rothberg urging a veto was published in the Albany Times-Union (letter).   Similar letters from regional and statewide physician leaders have also appeared in:

WEBINARS/SEMINARS

NYSDOH Hosts Training Session of Clinical Support for Implementation of Buprenorphine
The NYSDOH AIDS Institute will presents a training session on Clinical Support for Implementation of Buprenorphine on Saturday, December 16, 2017 from 9:30AM – 12:30PM on Long Island at the Hilton Garden Inn Stony Brook, 1 Circle Road, Shirley Kenny Room, Stony Brook, NY 11794. This free training is for physicians, nurse practitioners, and physician assistants whom have completed the required buprenorphine waiver training and would like to learn best practices with implementing buprenorphine to treat patients with an opioid use disorder. Attached is a flyer with further information, including location, online registration, and more details. Further information will be sent out to confirmed attendees. Space is limited so register fast!

Trainers:
Bruce Trigg, MD, Harm Reduction Coalition, New York, NY
Kelly Ramsey, MD, Hudson River Healthcare, Poughkeepsie, NY & Suffolk County Locations. For more information about NYSDOH buprenorphine related trainings, mentoring, coaching, technical assistance and more, please contact us at buprenorphine@health.ny.gov or 1-800-692-8528. 

Home Care Association Announces Sepsis Training Sessions
The Home Care Association (HCA) will present eight regional sepsis training sessions coming to every part of the state as part of HCA’s grant-funded sepsis initiative.   The HCA also announces that under this program there is now a website. The site includes sepsis-related news and information, tools and resources, background about our “Stop Sepsis at Home” initiative, and a calendar for upcoming training sessions that were recently announced to the membership and are again highlighted below.

Register Today for Training

Physicians are encouraged to register today for one of the eight upcoming sepsis training sessions.  The first session will be held Friday, December 15 session in the Syracuse region, followed by a December 18 session in Buffalo.   The sessions are for all home care and applicable providers on sepsis, steps for provider adoption and clinical application of the sepsis screening tool, clinical case application integration into agency procedures and records, and more.

Other sessions and regions follow in January through March.  A flyer with additional information is here.

Or register directly online for any of the sessions here.

The calendar listings at www.stopsepsisathomeny.org

With 80 to 90 percent of sepsis cases originating in the community, among other compelling data, the New York State Health Foundation (NYSHealth) has awarded HCA a major grant to support home care’s statewide adoption and use of HCA’s sepsis screening and intervention tool, which was developed and piloted in conjunction with partner organizations over the past two years.  Supported by the NYSHealth grant, HCA and sepsis leaders (including IPRO, national Sepsis Alliance, Rory Staunton Foundation for Sepsis Prevention, MSSNY and others) the training sessions are intended to create greater awareness for sepsis. Hospitals, physician practices, EMS, health plans and other community partners engaged in sepsis education, prevention, intervention and treatment are urged to attend. These sessions will include cross-sector collaboration segments to exchange critical information, best practices and other planning.

Coding Tip of the Week

Opioid Use, Abuse and Dependence in ICD-10-CM

By Lorna Simons, CPC Medco Consultants, Inc.

It is seldom that we go a week without seeing a new opioid linked headline in the news. As medical coders and healthcare professionals it is important to understand the nuances of coding for opioid use (prescribed or recreational), abuse and dependence. Though three separate sections of the ICD-10-CM book can be used to code patients using opioids (Chapter 21 Factors influencing health status and contact with health services (Z00-Z99); Chapter 5 Mental, Behavioral and Neurodevelopmental disorders (F01 – F99) and; Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)), we will be focusing on the difference between prescribed and recreational use, abuse and dependence (chapters 21 and 5).

Prescription use of opioids is identified in Chapter 21 of the ICD-10-CM manual. When a patient is receiving prophylactic prescription maintenance for a condition using an opioid it should be documented and coded with Z79.891 Long term (current) use of opiate analgesic. Do not use this code for patients who have addiction or are seeking treatment for addiction. The Chapter 21 Guidelines state: “This subcategory is not for use of medications for detoxification or maintenance programs to prevent withdrawal symptoms in patients with drug dependence (e.g., methadone maintenance for opiate dependence). Assign the appropriate code for the drug dependence instead.”

The codes for opioid related disorders are found in Chapter 5 under category F11. The term “use” in Chapter 5 can mean non-prescription (recreational) use or any use not documented as abuse or dependence. The distinction between use, abuse and dependence is based on clinical evaluation and documentation. As per the ICD-10-CM guidelines for coding substance use, abuse and dependence, “only one code should be assigned to identify the pattern of use based on the following hierarchy:

  • If both use and abuse are documented, assign only the code for abuse
  • If both abuse and dependence are documented, assign only the code for dependence
  • If use, abuse and dependence are all documented, assign only the code for dependence
  • If both use and dependence are documented, assign only the code for dependence.”

A patient with a history of opioid abuse or dependence should be coded with the appropriate remission code (F11.11 Opioid abuse, in remission or F11.21 Opioid dependence, in remission). ICD-10-CM does not include a code for history of opioid use.

Sources
ICD-10-CM Coding Guidelines Section C.5. Psychoactive Substance Use, Abuse and Dependence
ICD-10-CM Coding Guidelines Section C.21. Factors influencing health status and contact with health services (Z00-Z99)
ICD-10-CM Coding Guidelines Section C.19.  Injury, poisoning, and certain other consequences of external causes (S00-T88)
MEDICARE/MEDICAID

QPP Hardship Exception Application Deadline: December 31
The deadline to submit a Quality Payment Program Hardship Exception Application for the 2017 transition year is December 31. Merit-based Incentive Payment System eligible clinicians and groups may submit a hardship exception application for one of the following reasons:
• Insufficient internet connectivity
• Extreme and uncontrollable circumstances
• Lack of control over the availability of Certified Electronic Health Record Technology
For More Information:
• About Hardship Exceptions webpage
• Quality Payment Program website
• For questions, contact the Quality Payment Program Service Center at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)
Do You Want to Comment on the Workers Comp Draft Impairment Guidelines? The public comment period will remain open through December 22, 2017. Please submit to comments here.

The Case of the Patient Tattooed with “Do Not Resuscitate”
A case study published last week in the New England Journal of Medicine details the case of a 70-year-old patient with a “DO NOT RESUSCITATE” tattoo who arrived unconscious and critically ill at a Florida emergency department—but in absence of identification or guidance from next of kin, hospital staff had to determine if his tattoo counted as a legally binding request.



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RENTAL/LEASING SPACE


Space Available in North Bronx
● Medical Office for Rent
● Located on the Grand Concourse (walking distance from all major transportation)
● 2 Examination Rooms
● Large Waiting Area
● Private Doctor’s Office
● Fully equipped with new furniture
Contact info: jp@bronxheart.com // 718-584-0797


Want to Work in NYC but Live 100 Yards from the Atlantic Ocean?
Ocean views abound in this beautiful Rockaway Beach 1 family brick home. 5 bedrooms, 3 bathrooms. 60×100, detached 1 car garage, central air, sprinkler, alarm, large rear deck and heated pool. New finished basement, master bedroom on main floor and full bath. Tons of storage, solar panels. Beautiful front porch with ocean views. Located in Rockaway beach on a block 100 yards from the ocean! $1,750,000. Call 718-634-6004.

Upper East Side Plastic Surgery Office Available for Rent or Share
Beautifully equipped Plastic Surgery office available for part-time share along with Quad A-certified OR available for rent. Located in a lovely carriage house on the Upper East Side in close proximity to Lenox Hill Hospital and MEETH and conveniently located near all NYC mass transit. 1 exam room/OR and Recovery room along with large administrative space. Free WIFI. Available for full or half-days. Suits Plastic/Cosmetic Surgeons/ DERM/ ENT/or other Medical MDs. Please contact Kim at Kim@madisonps.com (212) 628-7600.

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

PHYSICIAN OPPORTUNITIES


Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next generation of primary care. If the fusion of health care and technology inspires you, please apply here.


Medical Director: Binghamton University College Physician (SL-6)
Department: Student Health ServicesLocations:   Binghamton, NYPosted: Oct 24, ’17Type:  Full-timeRef. No.: 49225The Decker Student Health Services Center at Binghamton University (The State University of New York at Binghamton) invites New York State Medical or Osteopathic Board Certified Physicians (Internal Medicine, Family Practice) to apply for a full-time, twelve-month position. This position plans, directs, supervises, and participates in the outpatient medical care of undergraduates and graduate students of a diverse student base.  The person will have excellent, primary care diagnostic skills as well as experience and proficiency in common outpatient surgical procedures, EKG and pulmonary function study interpretation, office laboratory and clinical microscopy.  This position functions as an on-site medical consultant and collaborative physician to the professional staff that includes 10 nurses, 5 nurse practitioners and 7 physicians.The individual will have five years of clinical experience after residency training and experience with staff oversight and leadership.The Medical Director provides the university campus with infectious disease direction (e.g. meningitis, measles and tuberculosis) and emergency management; participates on the Crisis Response Team; provides direction and consultation to the Dean of Students, University Counseling Center and Residential Life.  This person will be responsible for accreditation activities including; completion of internal and external benchmark studies peer chart review; completion of assessment plans, survey and risk management reports; meeting with site visitors; and following through on recommendations.Requirements: Required qualifications: NYS Board Certified Medical or Osteopathic Physicians (Internal Medicine, Family Practice) from an accredited institution; 5 years of clinical experience after residency; NYS medical license and DEA certificate that are free from special conditions or limitations. Salary: commensurate with qualifications and experience. Preferred qualifications are, but not limited to: college health familiarity; experience with diverse populations; electronic health record navigation; quality assurance, and continuous quality improvement; public health and policy experience. Payroll information can be found on our website http://www.binghamton.edu/human-resources/payroll/Cover letters may be addressed “To the Search Committee.” Postings active on the website accept applications until closure. For information on the Dual Career Program, please visit:
https://www.binghamton.edu/human-resources/dual-career-program/
Application Instructions:Deadline for Internal Applicants:  11/07/2017 Deadline for External Applicants:  Open until filled Review of applications will begin immediately and continue until the vacancy is filled.Persons interested in this position should apply online.Please submit: 1. Resume 2.Cover letter, and 3.Contact information for three professional references You may add additional files/documents after uploading your resume. After you fill out your contact information, you will be directed to the upload page. Please login to check/edit your profile or to upload additional documents: http://binghamton.interviewexchange.com/login.jsp Payroll information can be found on our website http://www.binghamton.edu/human-resources/payroll/
Additional Information:Offers of employment may be contingent upon successful completion of a pre-employment background check and verification of degree(s) and credentials.Binghamton University is a tobacco-free campus.Pursuant to Executive Order 161, no State entity, as defined by the Executive Order, is permitted to ask, or mandate, in any form, that an applicant for employment provide his or her current compensation, or any prior compensation history, until such time as the applicant is extended a conditional offer of employment with compensation.  If such information has been requested from you before such time, please contact the Governor’s Office of Employee Relations at (518) 474-6988 or via email at info@goer.ny.govEqual Opportunity/Affirmative Action Employer
The State University of New York is an Equal Opportunity/Affirmative Action Employer.  It is the policy of Binghamton University to provide for and promote equal opportunity employment, compensation, and other terms and conditions of employment without discrimination on the basis of age, race, color, religion, disability, national origin, gender, sexual orientation, veteran or military service member status, marital status, domestic violence victim status, genetic predisposition or carrier status, or arrest and/or criminal conviction record unless based upon a bona fide occupational qualification or other exception.
As required by title IX and its implementing regulations Binghamton University does not discriminate on the basis of sex in the educational programs and activities which it operates.  This requirement extends to employment and admission.  Inquiries about sex discrimination may be directed to the University Title IX Coordinator or directly to the Office of Civil Rights (OCR).  Contact information for the Title IX Coordinator and OCR, as well as the University’s complete Non-Discrimination Notice may be found here. The State University of New York is an Equal Opportunity/Affirmative Action Employer.  As required by title IX and its implementing regulations Binghamton University does not discriminate on the basis of sex in the educational programs and activities which it operates.  This requirement extends to employment and admission.  Inquiries about sex discrimination may be directed to the University Title IX Coordinator or directly to the Office of Civil Rights (OCR).  Contact information for the Title IX Coordinator and OCR, as well as the University’s complete Non-Discrimination Notice may be found here.

Medical Director – AIDS Institute
Minimum Qualifications:
Current license and registration to practice medicine in New York State and board certification AND either a Master’s Degree in Public Health or two years of experience in an HIV program or public health program.Preferred Qualifications:
Master’s Degree in Public Health.  Five years of experience including clinical service in an HIV program or clinical fellowship program (infectious diseases/HIV medicine).  Experience in quality management/quality improvement.  Knowledge of the HIV health care delivery system in New York State. Experience in/knowledge of the New York State Ending the Epidemic initiative.  Experience in STD prevention and care, drug user health, and/or LGBT health.  Experience in health policy development, analysis and evaluation.  Experience with evolving health information technologies.  Experience in health program management and administration.
Responsibilities: The Medical Director, AIDS Institute, plays a significant role in shaping HIV, hepatitis C, and STD care and services, drug user health, and LGBT health care throughout New York State.Please click the link below for more information pertaining to this position and to apply: “https://careers-healthresearch.icims.com/jobs/search?ss=1&hashed=-435829071” Affirmative Action/Equal Opportunity Employer/Qualified Individuals with Disabilities/Qualified Protected Veterans

Multiple Physician Positions with DOHMH Office of School Health
Office of School Health is the largest program of the New York City Department of Health and Mental Hygiene (DOHMH). This bureau is responsible for managing the health issues and promoting the well-being of the over 1.3 million children and adolescents enrolled in New York City’s 1700 school buildings.

Positions with the Office of School Health (OSH) combine clinical skills and public health training.

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

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

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

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

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

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

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

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

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

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


MEDICAL EQUIPMENT


Retiring from pediatrics. I have medical equipment to donate: examining table, pediatric examining table with a scale, medical scale, examining instruments and miscellaneous office items. Forest Hills. Call 718 275-5858 or email mkolak59@gmail.com


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


September 8, 2017 – Insurers Act BADLY!


PRESIDENT’S MESSAGE
Charles Rothberg, MD
September 8, 2017
Volume 17
Number 34

Dear Colleagues:

I need to inform you of recent adverse activities on the part of a few insurers.

Emblem Health appears to have begun notifying a number of participating physicians that they will no longer be in network effective Jan 1, 2018. This is reminiscent of a campaign two years ago, when approximately 700 physicians were not renewed in an apparent attempt to narrow Emblem’s networks.   In its recent letter, Emblem explained to physicians that this non-renewal was not related to quality or performance issues and need not be reported to credentialing bodies.

A few physicians have filed appeals with the company for re-consideration of their non-renewal status. Presently, one physician had his status overturned and will remain “in network” after
January 1.

Some physicians, already renewed by Emblem’s Medicare Advantage plan, still face uncertainty regarding their Emblem Health commercial line participation.

On an unrelated insurance issue, I was made aware that Anthem health, parent of Empire Blue Cross plans in New York, have been improperly collecting personal identifying information belonging to practice employees – including Social Security numbers, birth dates, and home addresses – in conjunction with the Empire Provider Application.

In this matter, Anthem staff appear to have misapplied 42CFR 455.104. that pertains to disclosure requirements for entities that bill various plans for federal funds— such as Medicare and Medicaid.  Individual solo-practices and some physician group practices are specifically excluded from the necessity to disclose a staff member’s personal information.

As a result of a conference call between MSSNY and Anthem, the insurer agreed to revise its application forms and data collection process.   I anticipate that in short time, they will produce an amended Empire Provider Enrollment Application and that they will properly discard any improperly collected information.  In the meantime, physicians in solo and small practices should be aware that the submission of this information is not required.

MSSNY also continues to seek legislation (A.2704/S.3943 – passed the Assembly this year, but not the Senate) that would require health plans to provide physicians with appropriate due process protections before they non-renew a physician’s contract.  You can send a prepared letter to your Senator by visiting MSSNY’s Grassroots Action Center today.

Late Breaking Response to MSSNY from Emblem Health:
“We continuously review our network as it relates to our membership and to reflect our partnerships in value-base arrangements. We emphasize that this change in our network impacted less than .05% of the physicians within our network. Emblem also recommends physicians who received a non-renewal notice have the option to appeal the decision relating to their Medicare agreement.”

For further information, please call VP of Socio-Medical Economics Regina McNally at 561-488-6100 ext. 334.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org


enews large


Top New York Court Rejects Right to Physician-Assisted Suicide
On September 7, the New York Court of Appeals ruled that physician-assisted suicide is not a fundamental right, and that it would not block the New York Legislature from passing legislation banning physician-assisted death. Physician-assisted suicide is illegal in most states, but in recent years, Colorado, California, Oregon, Vermont, Washington, and the District of Columbia have approved legislation allowing people to request life-ending medication from physicians. No state court, however, has recognized assisted suicide as a fundamental right. (Wall Street Journa l9/7)

The case was brought by three people with terminal illnesses. Two have since died. The plaintiffs had argued that the state’s existing ban on assisting a suicide should not apply to those seeking merciful ends to incurable illnesses.The court disagreed, noting that while state law allows terminally ill patients to decline life-sustaining medical assistance, it does not allow anyone to assist in ending patients’ lives. “The assisted suicide statutes apply to anyone who assists an attempted or completed suicide,” the court wrote in its unanimous decision. “There are no exceptions.”

In their lawsuit, the plaintiffs argued that New York’s prohibition on assisted suicide violated guarantees of equal protection under the law. They alleged the law unlawfully discriminates between terminally ill patients who have the option of dying by declining life-sustaining medical assistance and other terminally ill patients who are unable to hasten their deaths simply by rejecting medical assistance.

MSSNY’s Bioethics Committee is working on an Aid to Dying survey to gather New York physicians’ positions on this topic.

Gov. Reduces Health Insurance Barriers to Substance Abuse Treatment Coverage
New York Governor Andrew Cuomo announced new regulatory guidance this week to better assure New Yorkers can more readily overcome insurance coverage barriers to receiving medications necessary to treat a substance abuse disorder. It was part of a series of initiatives announced this week by the Governor to facilitate new addiction treatment, recovery and support services to residents suffering from substance use disorders in underserved communities throughout New York City and Long Island.

Specifically, a new regulation was issued by the New York Department of Financial Services (DFS) that will require insurers who offer large group coverage to allow consumers to appeal coverage denials for medically necessary addiction medications when they are not on the list of covered drugs.

The regulation calls for an insurer to notify the patient and the prescribing physician within 72 hours of the request and provide coverage of the non-formulary medication for the detoxification or maintenance treatment of a substance use disorder for the duration of the prescription, including refills.  Furthermore, the regulation requires an expedited appeal process for “exigent circumstances” where notification of the determination must be provided to the patient and the prescribing physician no later than 24 hours following receipt of the request.

Moreover, DFS issued a “circular letter”  to New York insurers designed to eliminate impediments to addiction services coverage, “to prevent insurers from excessively reviewing the medical necessity of opioid treatment, and to bar the inappropriate delay of coverage.”

MSSNY Attends DOH: Future of Integrated Care in New York State Workgroup
In 2016, the NYS Department of Health announced that the Fully-Integrated Duals Advantage (FIDA) program received federal approval to be extended until the end of 2019.  The FIDA program is designed to provide managed care coverage to individuals covered by both Medicare and Medicaid.  In response, the DOH workgroup on the Future of Integrated Care in New York State has committed to mapping out a strategy that would help New York State reach its objectives of increasing integration of services, providers, payments, and delivery systems.

The planning committee kicked-off in July where the NYSDOH and CMS presented on the value of integrating Medicare and Medicaid services while sharing insights into models that other states have found success in using. This week’s workgroup focused on target populations, covered services, care coordination/management elements, and assessment and service planning requirements. The Future of Integrated Care in New York State workgroup series will continue on with three additional meetings over the fall in which MSSNY will continue to participate and provide critical input.

Topics to be discussed in these future meetings include network adequacy, payment and rate considerations, and geographic scope.  For more information on the FIDA program, click here.



Promo Code: MSSNY


Addiction Medicine Track Offered at ASAP Conference on September 17, 2017
The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) and the Alcoholism and Substance Abuse Providers of New York State (ASAP) is now offering the Addiction Medicine Track at a September 17, 2018 conference.

The conference begins on Sunday September 17, 2017 and finishes on Monday September 18, 2017 and is being held at the Buffalo Niagara Convention Center in Buffalo, New York, near Niagara Falls
.  The ASAP conference runs concurrently and will actually finish on Wednesday September 20, 2017 for those who may wish to register for and stay for that.  To register for this program please click here.
This conference track is appropriate for physicians, nurse practitioners, physician assistants and any other staff who may find the material interesting or relevant.  This live activity, Addiction Medicine Track at ASAP’s 18th Annual Conference: Building Bridges, with a beginning date of 09/17/2017, has been reviewed and is acceptable for up to 15.00 prescribed credit(s).


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


Texas Medical Society: Physicians Helping Physicians
The Texas Medical Foundation is soliciting funds to use for grants to help reestablish the delivery of patient care in physician practices in federally designated disaster areas damaged by Hurricane Harvey.

The program will help cover expenses (not covered by insurance or other sources of funding) for relocating or rehabilitating a physician’s medical office. This may include replacing equipment, aiding needed staff, rebuilding patient records, and other similar needs all towards the goal of helping affected physicians once again begin treating their patients. https://www.texmed.org/Harvey

For Members Only: Brooks Brothers Offers 15% Discount
Enroll for your complimentary Brooks Brothers Corporate Membership Card and Save 15%* on full priced merchandise at all Brooks Brothers U.S. and Canadian stores, by phone and online.
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MSSNY President to Be Honored at Harvest Moon Ball in Glen Cove
MSSNY President Charles N. Rothberg is being honored at the Brookhaven Hospital Harvest Moon Ball at the Nassau Country Club in Glen Cove (Long Island) on Saturday, October 14, 2017 from 6PM to 10PM. Dr. Rothberg will be receiving the Dr. Jacob Dranitzke Award.  For tickets, to donate or be a sponsor, please go here.

Sept. 15: 2017 MSSNY Continuing Medical Education Provider Conference
To meet the challenges facing planners, providers and participants of CME, MSSNY recognizes the need for ongoing education and training of its Accredited Providers as well as physicians and other healthcare professionals in NYS.
The conference will take place on Friday, September 15, 2017, at the Westbury Marriott
.  The program is scheduled from 7:30 AM to 3:45 PM.

This conference will inspire participants to explore and interactively address challenges such as self-directed learning for physicians and compliance with the changing accreditation criteria that clearly address practice gaps and practice-based needs while creating opportunities for measurable change in physicians and reinforcing the undeniable link between a successful CME activity and quality improvement for physicians and patients alike.

Registration links and more information are available here.  Featured speakers include Steve Singer, PhD; Vice President of Education and Outreach, Accreditation Council for Continuing Medical Education (ACCME) and Mary Kelly, Project Administrator, AMA PRA Standards and Policy.  MSSNY President Charles Rothberg, MD will deliver the welcome and opening remarks. For more information, please contact Miriam Hardin at mhardin@mssny.org. More information.

Oct. 10-14: Free Vets Health Care Training Program Conference in Niagara Falls
The Medical Society of the State of New York, the New York State Psychiatric Association, and the National Association of Social Workers – New York State Chapter are hosting a two- day conference on
Friday, 10/13 Saturday,10/14 at the Niagara Falls Conference Center, 101 Old Falls St, Niagara Falls, NY.
The conference will consist of interactive seminars and panel discussions focusing on the current and evolving healthcare needs of veterans.

MSSNY and NYSPA will be conducting three CME accredited trainings for primary care physicians and specialists. The CME programs are “Invisible Wounds of War: PTSD, TBI & Combat-Related Mental Health Issues,” “Recognition, Management and Prevention of Veteran Suicide,” and “Substance Use Disorders among Returning Veterans.”


There is no cost, but separate registration will be required for both the trainings and conference. More information will be coming shortly.


Dr. Jerome Adams Sworn in As US Surgeon General
The new Surgeon General of the US, Jerome Adams, an anesthesiologist with a master’s degree in public health, was sworn in on Tuesday, September 5.  Dr. Adams previously served as Indiana’s health commissioner.

At the ceremony Tuesday afternoon, Dr. Adams said his motto as surgeon general will be to create “better health through better partnerships” in an effort to address wide-ranging health issues, such as the opioid epidemic, mental health and childhood obesity. He said that law and healthcare must work together to tackle the opioid fight.

Vice President Pence praised Dr. Adams for his work on cutting Indiana’s infant mortality rate, addressing Ebola and helping curb an HIV outbreak stemming from injection drug use. Dr. Adams said that he is eager to start helping victims of Hurricane Harvey as the “nation’s doctor” and reaffirmed his commitment to “letting the science lead him to facilitating locally-led solutions to difficult health problems.”

Plant-Based Diet As Effective As PPIs in Treating Laryngopharyngeal Reflux
Findings published online in JAMA Otolaryngology-Head & Neck Surgery reports that “a plant-based diet is just as effective as proton pump inhibitors in treating laryngopharyngeal reflux,” researchers found in a six-week study involving “85 patients with an average age of 60 treated with the P.P.I.s Nexium [esomeprazole magnesium] and Dexilant [dexlansoprazole], and 99 treated with alkaline water and the Mediterranean diet, a regimen low in meat and dairy, and rich in olive oil, nuts, fish, beans, fruits and vegetables.”

Garfunkel Wild Hosting 4th Annual Ambulatory Surgery Center Symposium
Garfunkel Wild will be hosting its 4th Annual Ambulatory Surgery Center Symposium on October 20, 2017 at the Crowne Plaza Times Square.  Speakers include representatives from major managed care organizations, CMS, state and national ASC association leaders, hospitals and management company executives, leading consultants and many more. To register or for more information, visit www.nymetroasc.com or call 516-393-2294.

According to CDC Stats, One in Three Americans Are Obese
The Trust for America’s Health and the Robert Wood Johnson Foundation released a report based on statistics from the Centers for Disease Control and Prevention that showed
one in three American adults and one in six children to be obese.
The highest obesity rates are found in West Virginia, Mississippi, Alabama, and Arkansas, although the rates of increase in some states may be stabilizing. Trust for America’s Health President and CEO John Auerbach commented, “The adult rates are showing signs of leveling off and the childhood rates are stabilizing. In our review of the policies and strategies, we found that many (states) show a lot of promise for reversing the trends and improving health if we make them a higher priority.”

The data compiled from the Behavioral Risk Factor Surveillance System, relies on self-reported weight data, “so it likely underestimates true rates.” Despite state obesity statistics leveling off, the data indicates that the nation is “at risk of poor health” if programs to address obesity lose funding, according to the Trust for America’s Health CEO.

District Court: Govt. “All But Ignored” Calls for Insurer Payment Transparency
The US District Court for the District of Columbia has ruled on a motion filed by the American College of Emergency Physicians (ACEP) in regard to its lawsuit against the federal government (ACEP v. Thomas E. Price, MD) that argued a regulation under the Affordable Care Act (ACA) violated Congressional intent.
“This is a clear step in the right direction,” said Rebecca Parker, MD, president of ACEP. “It does not invalidate the federal regulation, but
it supports ACEP’s contention that the federal agencies ignored significant concerns raised by public commenters regarding a lack of transparency by health insurance companies in determining payments.
Congress in the ACA required that reasonable amounts be paid for emergency care, based on an objective standard, when patients receive it outside of a qualified health plan’s network.”

The court remanded the case back to HHS for further explanation, saying that comments during the regulation’s development had been submitted to CMS expressing concerns “for example, that the methods it used to set payments were not transparent and could be manipulated by insurers…The Departments all but ignored these comments and proposals.”

ACEP originally filed suit in May 2016 against then-Secretary Burwell after the federal government did not address the concerns raised to CMS about out-of-network emergency physician payments, which the agency set at the “greatest of three” options: (1) Medicare (which often does not even cover providers’ costs) (2) In-network rates (set without the provider’s input) (3) “Usual and customary” (as determined by the health plans).  As written, this regulation opened the door for insurers to use non-transparent (“black box”) methods to determine these “usual and customary” payment amounts without providing any means to externally verify the data.

CMS Poster for Coding Information for Preventive Services
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html


CLASSIFIEDS



Beautiful, fully-equipped medical sweet for rent or share – Glen Oaks, NY
For Rent or Share – Glen Oaks, NY
(border of Queens & Long Island)
Available for full or half-days.
Beautiful, recently renovated office
available for part-time share
OR available for rent.
Centrally located /Close to expressways.
The practice is 5 minutes from LIJ/Northwell Hospital.
8 exam rooms/procedure rooms. Waiting room, break room and
personal office with private bathroom.
(~2500 sqft) Free WIFI.
6 parking spots for patients and 2 for doctor.
The previous tenant, a full-time primary care
physician with a part-time cardiologist coming
in turned it over to an associate a year ago
but has been here for about 10 years. He needed more space
and bought a building about 20 minutes away. Our building gets a lot of drive-by traffic and pedestrian traffic from the mall across the street. Weekly we have patients walk in inquiring about the practice.
The dental practice next door sees over 2500 patients per year and refers actively to the medical suite.

Follow the link for a video of the space (all furnishings, exam tables, chairs, oxygen, orthoscope included in lease – about $500k in value): https://youtu.be/f9gr62fKaVs

Contact Haresh at hareshshah54@hotmail.com or 516-220-3297


Upper East Side Medical Office for Rent
East 68th Street full or part-time, 1 consult room, 2 exams rooms, large waiting room, high ceilings, central A/C, carpeted throughout , window in every room, X-Ray facility in-house.  Also for Rent- Large furnished room ideal for Psychiatrist/Psychologist. Please call 212-639-1800

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

Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

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

June 16, 2017 WIN, WIN for MSSNY at AMA


PRESIDENT’S MESSAGE
Charles Rothberg, MD
June 16, 2017
Volume 17
Number 23

Dear Colleagues:

The MSSNY delegation to the annual meeting of the American Medical Association has just returned from Chicago. Our efforts on behalf of our MSSNY members are important to maintaining a presence in ongoing federal and state affairs focused on medicine. Our team of 38 delegates and alternate delegates is led by John Kennedy, MD of Schenectady.

In addition to exhaustive days dealing with more than 200 reports and resolutions, there has been a major effort to assure that New York is well represented on the AMA Councils, which provide guidance on the policies being adopted. To this end, Robert Goldberg, DO was elected to the AMA Council on Medical Education. Bob’s background as Dean at Touro in NYC makes him particularly well suited to this four-year post. Tom Donoghue, once again, worked his magic to elect another MSSNY candidate to victory in a very tough race.

In addition, Jerry Cohen, MD was re-elected to the AMA Council on Constitution and Bylaws; Meena Davaluri, MD was elected to the Resident slot on the Council on Medical Service. She will be working alongside Tom Madejski, MD who already holds a seat on that important Council.

New York is also represented by MSSNY HOD Speaker Kira Geraci, MD who is an elected member of the AMA Council on Science and Public Health and Jacqueline Bello, MD who was re-elected to her seat on the Council on Medical Education. Finally, our delegation works closely with Willy Underwood MD, a MSSNY member and urologist at Roswell Park who holds a seat on the Council on Long Range Planning and Development.

MSSNY was also well-represented on the Reference Committees by Corliss Varnum, MD who chaired the Reference Committee on Public Health and Rose Berkun, MD who worked on the Reference Committee on Medical Practice.

Chicago is truly a great city but, candidly, our MSSNY Delegation does not get to see much of it. Our New York caucus usually begins at 7am and each delegation member has specific assignments to explain New York’s position at reference committee hearings and to represent our viewpoint to colleagues in other states. Usually our position prevails.

At a time when health care issues are “front and center” in Washington, it is critical that we effectively participate in helping steer the national discussion. This we do through our continued participation with the American Medical Association. As our groups, hospitals and private practices push for RVU production and taking time away from work becomes more difficult, we all owe a special thanks to our AMA team leader John Kennedy, MD and the MSSNY delegates and alternates who work on AMA issues on our behalf.

Thanks to MSSNY staffers Laurie Mayer and Michael Reyes for their hard work before, during and after the meeting.

Sincerely,
Charles Rothberg, MD
MSSNY President

Please send your comments to comments@mssny.org



Physicians Urged to Continue to Oppose Liability Expansion Bills
We need physicians to continue to contact click here their legislators to oppose several bills poised to move in the Legislature that could drastically increase the cost of medical liability insurance at a time when no increases can be tolerated. Even if you are employed by a health system, enactment of any of these bills could prompt serious cuts to your system.  These bills include:

  • Eliminating Contingency Fee Limits (S.6738/A8644) – Would remove the long-standing statutory limits on attorney contingency fees, which would undoubtedly lead to much more litigation, higher awards in medical liability actions, and potentially taking away from an award to an injured plaintiff. Actuaries have predicted that this bill could increase your liability premiums by over 10%
  • Lengthening the Medical Liability Statute of Limitations (A.3339/S.4080) – Would substantially lengthen the statute of limitations for medical malpractice actions by making it subject to a “date of discovery” of the alleged malpractice.  If enacted this bill could increase your liability premiums by 15%.
  • Expansion of Wrongful Death Actions (A.1386/ S.411) – Would greatly expand the categories of damages which a plaintiff may recover in a wrongful death action.  Actuarial studies have predicted that this bill could increase liability premiums by over 50%.; and
  • Prohibiting Ex-Parte Interviews of Plaintiff’s Treating Physician (S.243/A.1404) – would prohibit a physician’s defense counsel in a medical liability action from conducting an interview with the plaintiff’s treating physician. This bill would present significant issues for physicians in a medical liability action by limiting the opportunity to fully examine the plaintiff’s health condition to evaluate the merit of the plaintiff’s claim.

Please let your legislators know that the timing of these bills could not be worse. We now have multiple malpractice insurance companies operating in New York State that appear to be in serious financial jeopardy which can ill-afford to absorb the substantial costs of a brand new cause of action. Moreover there is a tremendous uncertainty in the NY healthcare delivery system as a result of legislation before Congress that could profoundly restructure Medicaid spending, and trigger huge cuts to our healthcare system. 

We thank the many physicians who have taken the time to respond to MSSNY’s “Call to Action”, but far more contacts are needed. MSSNY has been working closely with hospital associations and specialty societies to demonstrate our shared concerns regarding the serious adverse consequences to our healthcare system were any of such one-sided bills to be adopted, including placing advertisements in publications such as City & State and Politico-NY click here.
(DIVISION OF GOVERNMENTAL AFFAIRS)

Senate Passes Opioid Package; Discussions Continue Regarding Legislation To Combat Opioid Crisis
The New York State Senate passed a series of bills to address the state’s opioid epidemic and the package focuses on enforcement to hold drug dealers more accountable, regulates many synthetic opioids, and calls for expansion of treatment programs.   Many of the bills put forth in the Senate package do not have an Assembly sponsor.   It is anticipated that Governor Cuomo will also introduce an omnibus bill addressing the opioid crisis that will include greater access to treatment.   In the Senate package there are two bills that concern MSSNY.  The first bill, S. 5949 would require a physician to obtain written consent from a minor’s parent or legal guardian prior to prescribing opioids.

MSSNY is concerned that the bill does not take into account other sections of law, such as Public Health Law 2504, which define the circumstances when a minor may make health care decisions for themselves. The second bill, S.5670, would require that the prescriber provide counseling prior to issuing a Schedule II opioid prescription.  The Medical Society believes that patient education that would be required by this legislation is already being accomplished by the requirement enacted last year to have pharmacists provide education to patients at the time of filling the prescription.   Therefore, MSSNY believes that this legislation is unnecessary and duplicates efforts. To view the Senate package, click here. As the Legislature enters the final weeks, there are on-going discussions about legislation to address the opioid crisis.
(DIVISION OF GOVERNMENTAL AFFAIRS)           

Passage of Bill to Place E-cigarettes under the Clean Indoor Air Act Pending in Both Houses
Legislation, to place e-cigarettes under the Clean Indoor Air Act (CIAA) was recently amended to include the term “vape” and is on the floor in both houses.   Assembly Bill 516A/S.2543A,  sponsored by Assemblywoman Linda Rosenthal and by Senator Kemp Hannon, would apply the same protection for e-cigarettes that currently exist for tobacco products.  Concurrently, there is also legislation that would Raise the Age for Tobacco Purchase before the NYS Legislature. S.3978/A. 273, would increase the purchasing age for tobacco products from eighteen to 21 years of age.  It is now in the Assembly Codes Committee and is pending in the Senate Finance Committee.   MSSNY supports both these measures. In the final days of the legislative session, physicians are urged to send a letter in support of both these measures from MSSNY Grassroots Action Center (GAC) or can call their Senator at 518-488-2800. To send a letter, please click here.
(CLANCY)

Physicians Urged to Support Legislation Requiring Annual Report On Compliance with MH/SUD Federal and State Parity Laws
Physicians are urged contact their legislators to urge passage S.1156-A/A.3694-A which would authorize the superintendent of Department of Financial Services and the Commissioner of Health to expand the information and data that health insurers and health plans are required to submit to include additional information and data necessary to evaluate performance with respect to the implementation of New York State and Federal Mental Health and Substance Use Disorder (MH/SUD) parity laws.

Sponsored by Senator Robert Ortt and Assemblywoman Aileen Gunther, the legislation would require that the information collected be analyzed and used for the preparation of a parity compliance report in the “Consumer Guide to Health Insurers” issued annually by Department of Financial Services, in consultation with the Department of Health. While federal and state parity laws have been on the books for approximately a decade, there continues to be examples of disparate and unequal treatment of MH/SUD in a number of areas including among others utilization reviews, prior authorizations, medical necessity and network adequacy. The enactment of this legislation is imperative for continuing efforts to achieve full implementation of the parity laws and holding insurers and health plans accountable.   Physicians are urged to send a letter by clicking here
(AUSTER, CLANCY)


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


NYS Assembly Will Consider Tanning Ban
Next week, the New York Assembly is expected to consider and vote on A. 7218A/S5585A which would remove the procedures to grant 17-18 year olds access to tanning booth and would prohibit anyone 18 years or younger from using a tanning booth.  This bill is on the calendar in the Assembly and is still pending in the Senate Health Committee.   The measure is sponsored by Assemblywoman Ellen Jaffe and Senator Phil Boyle.  MSSNY supports this measure.(CLANCY)

Physicians Urged to Oppose Retail Clinic Legislation
As the Legislature enters its final few days, big box store interests are aggressively pursuing legislation strongly opposed by MSSNY (A.958, Paulin) that would permit corporate-owned retail clinics, which would veer New York away from its long history of opposition to corporately owned care delivery. Earlier this year, the bill advanced from the Assembly Health Committee to the Assembly Codes Committee despite opposition from several members of the Committee.   Physicians are urged to send a letter in opposition click here.
(AUSTER) 

Legislation Moving to Continue to Permit Limited Antitrust Immunity for Healthcare Collaboratives
Legislation (S.5342, Hannon/A.7748, Gottfried) passed the Senate this week that would extend through 2020 the authority of the Commissioner of Health to approve a Certificate of Public Advantage (COPA) that enables various health care providers to join in collaborative arrangements that otherwise may be prevented by federal and state antitrust laws. The bill has also advanced to the Assembly floor.

COPAs are designed to facilitate the ability of health care providers to engage in arrangements such as (but not limited to) mergers and clinical integration agreements that promote improvements in access to care and quality of care. The original law was enacted in 2011, but expired at the end of 2016.  In order for a group of health care providers to be awarded a COPA, the application must be reviewed by both the Department of Health and New York Attorney General. If it is approved, the arrangement is subject to ongoing State supervision.  So far, three entities have applied for receiving a COPA designation.  To read more, click here.
(AUSTER)

Please Oppose Workers Compensation Proposals to Expand Role of Non-Physicians and Remove County Society Assistance
As the Legislature enters its final days of the 2017 Session, legislation (A.8387, Pretlow and S.6349, Alcantara) remains under discussion that could significantly impair injured workers access to care from WC-authorized physicians including giving greater discretion to the Board to penalize physicians, expanding the scope of numerous non-physicians to treat injured workers without requiring coordination with a physician, and limiting the ability of your county medical society to assist physicians in completing applications to become WC-authorized.

Moreover, the bill does nothing to address the myriad of administrative hassles that physicians have experienced with the Workers Compensation system that have forced many physicians to leave the program. Similar legislation was considered during negotiations of the State Budget, but was ultimately rejected. Please contact your legislators to oppose these bills by sending a letter click here.
(AUSTER, BELMONT) 

Legislation to Expand Collaborative Drug Therapy Management Protocols Delayed
MSSNY shared our strong concerns on legislation, S.4296 sponsored by Senator LaValle, that would greatly expand existing law to allow pharmacists to enter into collaborative drug therapy management (CDTM) protocols with physicians or nurse practitioners to manage, adjust or change the medications of patients.  When the bill popped up on a senate committee agenda, MSSNY worked with the senate sponsor to delay passing the bill to work on our concerns.  If structured properly, these programs can be helpful to managing the treatment of a patient.  The current collaborative drug therapy law was originally established with a “sunset date” in 2015, and was extended by the State Legislature to continue until 2018.

However, this proposal goes well beyond this demonstration program to allow nurse practitioners to participate in the program and would allow up to fifteen community-practice sites where pharmacists and physicians or nurse practitioners may propose to enter into collaborative arrangements. Currently, only physicians are currently permitted to enter into such protocols within the hospital.

We are concerned that there has been no demonstration within a specific care setting in New York, such as in a hospital, that nurse practitioners have the sufficient pharmacology background to successfully work with pharmacists on managing patient medications on a large scale basis as is contemplated in this proposal.  By contrast, physician-pharmacist CDTM protocols were studied extensively following the enactment of New York’s law, which led to the Legislature extending the existing program in 2015.  As such, it would be premature to now add nurse practitioners.
(BELMONT)

Physicians Must Take Pain Management Mandatory Education By July 1, 2017, Just Two Weeks Away!
The Medical Society of the State of New York Pain Management, Palliative Care and Addiction modules are now available on-line here.   These modules are being offered free of charge to all MSSNY members.  Physicians who are new users to the MSSNY CME site will be required to register as a new user. As a new user, physicians and non-physicians will be required to enter fields that include: position; name (the name should be what you want to appear on the CME certificate); email address; and then create a password.  MSSNY members who encounter a payment page or have difficulty registering, please email cme@mssny.org for technical support.  Directions for creating a new account/or logging in can be found here.   Non-MSSNY physicians will be charged $50 per module. 

The MSSNY CME is a new site and while many MSSNY members have an account with mssny.org a MSSNY member may not necessary have an account with cme.mssny.org   If in doubt, try to create an account and if it tells you that the email address is unavailable or in use,  an account exists.   Passwords can be reset if you don’t know it.  Physicians who have previously had an account at the MSSNY CME site will need to log into the site using their email and password.

The MSSNY CME site provides the ability for physicians and other prescribers to view the archived webinar at their leisure, take the required test, and download their certificate. The online program covers all eight topics required in the New York State statute. MSSNY developed the program with the NYS Office of Alcoholism and Substance Abuse Services (OASAS).  MSSNY is listed as an accrediting organization by the NYS DOH Bureau of Narcotic Enforcement.   Information on the three CME modules is available here.  Additional information or technical support may be obtained by contacting cme@mssny.org.
(CLANCY)

DOH Attestation Process for Pain Management CME Must Be Completed by July 1, 2017! Just 2 Weeks Away!
The New York State Department of Health has announced the attestation process for prescribers required to complete Pain Management CME. Prescribers must attest to the completion of the pain management, palliative care and addiction course work or training by July 1, 2017, and again every three years thereafter. The prescriber should only attest after completion of at least three hours of course work or training covering all eight topics. A prescriber with a Health Commerce System (HCS) account will attest online using the Narcotic Education Attestation Tracker (NEAT) application.  Complete the steps to access the NEAT (Narcotic Education Attestation Tracker) application in the NYS Health Commerce System (HCS):

  1. Log into the HCS
  2. Under “My Content” click on “All Applications”
  3. Click on “N”
  4. Scroll down to NEAT (Narcotic Education Attestation Tracker) and double click to open the application. You may also click on the “+” sign to add this application under “My Applications” on the left side of the Home screen.

Complete the steps to ATTEST to the completion of the education requirement.   A full set of instructions can be found here.

Prescribers that do not have access to a computer can request a paper attestation form by calling the Bureau of Narcotic Enforcement (BNE) toll-free at 1-866-811-7957. They may then complete the form and return it by mail to the address provided in the form. The Bureau of Narcotic Enforcement has also released a Frequently Asked Questions (FAQs) on the prescriber mandate.   A copy of the FAQs can be found here. 

In certain limited circumstances, the New York State Department of Health may grant an exemption to the required course work or training to an individual prescriber who clearly demonstrates to the department that there is no need to complete such training.  Exemptions will be granted only in very limited circumstances, and not solely on the basis of economic hardship, technological limitations, prescribing volume, practice area, specialty, or board certification.  Prescribers may apply for an exemption through the Health Commerce System. Further information may be obtained by contacting BNE at 1-866-811-7957 or narcotic@health.ny.gov.
(CLANCY)

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 mauster@mssny.org
pclancy@mssny.org jbelmont@mssny.org

enews large

NYU Langone: Lawsuit Goes Up Against 1199 SEIU
NYU Langone Medical Center has pitted itself against the state’s largest health care union, 1199 SEIU, four of its chief hospital competitors and a collective-bargaining unit that represents 109 nonprofit hospitals and nursing homes.

In a lawsuit filed yesterday in Manhattan at the U.S. District Court for the Southern District of New York, NYU Langone alleges that 1199 SEIU and the League of Voluntary Hospitals and Homes of New York have forced it to make about $25 million in additional payments to the 1199 Benefit Fund for Health and Human Service Employees since it withdrew from the League on March 28, 2016. The payments cover medical, dental and disability benefits.

Other defendants in the lawsuit are Montefiore Medical Center, Mount Sinai Hospital, New York-Presbyterian Hospital and Northwell Health’s Long Island Jewish Medical Center.

The medical center said in the lawsuit that the League’s actions violated federal antitrust law. After the withdrawal, the League no longer represented NYU Langone in negotiations with the union, but the health system was still bound by a 2014 agreement concerning wages and benefits and required to pay dues, according to the complaint.

In August 2016, 1199 recalculated the rate NYU Langone was required to contribute to the Benefit Fund, using the methodology for non-League members, which were typically nursing homes and other non-hospital health care providers. The contribution rate for these employers was lower but had no cap, which resulted in much higher contributions for an employer with higher-paid employees like NYU Langone.

The lawsuit argues that the penalties harm competition in the New York City hospital market. NYU Langone is paying $25 million in extra benefit contributions it could otherwise spend on technology and new facilities that help it attract patients and spur its competitors to make investments, according to the complaint. (Crains, 6/16)

Dr. William Spencer Kicks Off Meningitis B Awareness Week at Press Conference
MSSNY’s William Spencer, MD addressed a June 12 press conference to kick off Meningitis B Awareness Week. MSSNY hosted the press conference in its Westbury offices in partnership with the Kimberly Coffey Foundation to urge parents to vaccinate their children to prevent Meningitis B, a potentially deadly, but preventable disease.

Both the New York State Senate and the New York Assembly recently declared June 12-16 Meningitis B Awareness Week. “The importance of vaccines begins in infancy and continues right through adulthood and MSSNY is committed to ensuring that all individuals receive immunizations,” said Dr. Spencer, a Pediatric Otolaryngologist and Suffolk County Legislator (18th District). “In 2015, MSSNY helped to successfully advocate for a law that required children entering 7th and 12th grades in all public and private schools in New York State be fully vaccinated against meningococcal disease types A, C, W and Y in order to attend school. The law does not require immunization of the Serogroup B meningococcal vaccine, but this vaccine is available for teens and young adults.”

Teen Girls: Fastest Rising Number of Torn Ligament Procedures
Jama Pediatrics reports a growing number of US athletes are getting operations to repair torn knee ligaments in a recently published in JAMA Pediatrics http://bit.ly/2ro9RlM The article suggests that  injury rates are “highest and rising fastest among teen girls.” The research on “private insurance data for 148 million US residents found that overall, the average annual” anterior cruciate ligament (ACL) “surgery rate climbed 22 percent from 2002 to 2014, when it reached 75 procedures for every 100,000 people.” But, “for teen girls…the average annual knee surgery rate rose by 59 percent during the study period to 269 procedures for every 100,000 people.” 

Five Ways for Physicians to Get Ready for New Medicare Cards
Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now.   CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

Based on feedback from healthcare professionals, practice managers and other stakeholders, CMS is developing capabilities whereby doctors will be able to look up the new MBI through a secure tool at the point of service. To make this change easier, there is a 21-month transition period where all healthcare providers will be able to use either the MBI or the HICN for billing purposes.

Therefore, even though your systems will need to be able to accept the new MBI format by April 2018, you can continue to bill and file healthcare claims using a patient’s HICN during the transition period. We encourage you to work with your billing vendor to make sure that your system will be updated to reflect these changes as well.

Beginning in April 2018, Medicare patients will come to your office with new cards in hand. CMS is committed to giving you information you need to help your office get ready for new Medicare cards and MBIs.

Here are 5 steps you can take today to help your office or healthcare facility get ready:

  1. Go to the CMS provider website and sign-up for the weekly MLN Connects® newsletter.
  2. Attend quarterly calls to get more information. We’ll let you know when calls are scheduled in the MLN Connects newsletter.
  3. Verify all of your Medicare patients’ addresses. If the addresses you have on file are different than the Medicare address you get on electronic eligibility transactions, ask your patients to contact Social Security and update their Medicare records.
  4. Work with us to help your Medicare patients adjust to their new Medicare card. When available later this fall, you can display helpful information about the new Medicare cards. Hang posters about the change in your offices to help us spread the word.
  5. Test your system changes and work with your billing office staff to be sure your office is ready to use the new MBI format.


Important Modification on E&M Exam Expectations for Expanded Problem Focused and Detailed Levels of E&M
The originally planned differentiation in examination requirements for Expanded Problem Focused (2-5) and Detailed (6-7) levels of service will no longer be considered mandatory for providers as of 7/1/2017. NGS developed  these suggestions in response to multiple provider queries on the original levels (both EPF and Detailed at 2-7), and has received strong provider support for delineating the two levels as a means of more accurately coding a service.

We will not, however, mandate the changes as previously announced; all medical records reviewed will be subject to the original standard of 2-7 or the newly suggested levels of 2-5 and 6-7, in whatever manner is more beneficial to our providers. These suggestions apply to services coded as per the CMS 1995 Documentation Guidelines for Evaluation and Management Services; suggestions do not apply to services coded as per the CMS 1997 Documentation Guidelines for Evaluation and Management Services.

The posted NGS Evaluation & Management Documentation Training Tool reflects the 2-7 exam component standard for both coding levels, and will remain unchanged.

EmblemHealth Backlog Update
There will be delays for a short period of time in processing claims and responding to inquiries. EmblemHealth has hired additional staff to work on backlogs. As required by statute, claims processed past the prompt pay time frame will be paid applicable interest. You should see marked improvement within 60-90 days.  We apologize for this inconvenience.

One of the efficiency measures EmblemHealth has put in place is a change to the radiopharmaceutical claims process. Notification letters were sent to affected providers on February 28, 2017. Starting with claims for dates of service on or after June 1, 2017, you will no longer need to send an invoice for your GHI PPO/EPO claims to be paid when billing radiopharmaceutical codes. This change should allow your new claims to process faster and accurately.  If your staff is not already sending in these claims electronically, they will now be able to do so.

For radiopharmaceuticals, defined by Health Common Procedure Coding System (HCPCS) codes below,

EmblemHealth will pay health care professionals at Average Sales Pricing (ASP) plus 15%. If ASP pricing is not available, then the reimbursement rate is Average Wholesale Pricing (AWP) minus 15%:

  • A9500-A9700
  • A4641-A4647
  • Q9949-Q9969

If you have questions, please contact EmblemHealth’s Provider Call Center at 1-866-447-9717.


CMS Accepts Future Measures/Activities for 3 MIPS Categories until June 30
The Centers for Medicare & Medicaid Services� (CMS) Annual Call for Measures and Activities for the Merit-based Incentive Payment System (MIPS) track of the Quality Payment Program (QPP) is open until June 30, 2017.

CMS encourages clinicians, measure stewards, organizations, and other stakeholders to identify and submit measures and activities to be considered for the Quality, Advancing Care Information, and Improvement Activities performance categories of MIPS in future years.

Submission Details

Measures and activities should be relevant, reliable, and valid at the individual clinician level. To be considered, proposals must include measure specifications, related research, and background.

A final list of measures and activities for MIPS clinicians will be published in the Federal Register no later than November 1 of the year prior to the first day of the performance period. Please note that some Advancing Care Information measures finalized in the 2018 final rule may not take effect until 2020, depending on the functionalities and workflow changes needed for implementation.

For More Information Remember to review the Annual Call for Measures and Activities fact sheet to learn more and understand the process for submitting measures and activities for the MIPS performance categories. Please direct any questions on measure and activity submissions to the QPP Service Center at QPP@cms.hhs.gov.


CLASSIFIEDS


Office Space Available within Beautiful Medical Spa in Woodbury NY
Seeking an MD that is looking to rent space in Woodbury, NY within a beautiful, state-of-the-art Medical Spa. Located in the Woodbury Common with high profile brands such as Soul Cycle, Athleta, Chop’t and more, this area is exclusive, elite and high-traffic. Rental space can include from 1 – 4 rooms with office space, shared reception and retail area. Size of area and price are negotiable. Great opportunity to share like-minded patients. ssoni@becomemedspa.com.

Manhasset Suite
Medical Suite to share- located at 1201 Northern Blvd, Manhasset. The medical space includes 4 exam rooms and consultation rooms. Direct access to office-  NO STEPS. Conveniently located between St.Francis Hospital and NS/LIJ Hospitals. For more information, please call 516-365-4616 or email RSwe777@aol.com

Medical Practice for Sale in Upscale Westchester Community
Successful well established (1984) and actively growing Internal Medicine/ Primary Care Practice conveniently located only 45 minutes from midtown Manhattan. Great Opportunity for established physician to expand his patient base or for entrepreneurial new graduate.  Lease assignable with option to renew.

Facilities / Business Details

Well known Professional Building with convenient free parking; ground/first floor location, handicap accessible. Contemporary office recently built and painted. Two large exam rooms; one consultation room/doctor’s office, lab, spacious receptionist area and large waiting room. As an independent practice, it provides an extremely appealing option for the patient that does not want to go to a huge impersonal multi-specialty group. Approximately 80% commercial payers; 20% Medicare. Doctor retiring but willing to stay on to introduce new physician to patients and assist in transition.

Asking Price: 
$175,000

Contact: rpcdb51@yahoo.com


Want to Sell Your Medical Practice? Do You Have Medical Office Space to Sell or Share?
Clineeds is a new online platform designed to help medical providers sell their practice or buy, sell and share medical office space. Listing is FREE! No contracts. No commitments. No fees. Sign up today at http://www.clineeds.com/sign-up

Physician Opportunities


Position Available for Critical Care Physician to Join Established Practice in Nassau County, Long Island, NY.
The Physician will join our existing team of Board-Eligible/Board-Certified Intensivists. This is a PT/FT position including both nocturnal and daytime responsibilities. The Physician will work with a dedicated group of highly trained mid-level practitioners, respiratory therapists and nurses to provide Critical Care at St. Francis Hospital in Roslyn, NY. St. Francis was ranked one of the top 10 hospitals in the nation for Cardiac Care and is top rated nationally in seven other adult specialties.
We are expanding our Intensivist Program and are expecting to add an Intensivist to our group.
Nassau Chest Physicians, P.C. was established in 1978 to provide state-of-the-art care to patients with pulmonary diseases on Long Island. We have expanded our practice to include 8 Intensivist/Pulmonologists and 5 pure Intensivists. Since 2006, we have assumed management of Critical Care services at St. Francis Hospital-The Heart Center in Roslyn, NY.
St. Francis Hospital is New York State’s only specialty designated cardiac center and is a nationally recognized leader in cardiology and heart surgery, ear-nose-throat, gastroenterology and GI surgery, geriatrics, neurology and neurosurgery. More cardiac procedures are performed at St. Francis than at any other hospital in New York State. The hospital is located on the North Shore of Long Island; approximately 30 minutes from Manhattan. The hospital combines unrivaled expertise in cardiovascular medicine with top-ranged nursing (AACN Magnet Award) to provide the very best in patient care.
In addition, St. Francis offers excellent Thoracic, Vascular, Oncologic, Neurosurgical, and Orthopedic Surgical Programs. We have a very active Emergency Department. The hospital offers the latest in technologies such as Therapeutic Temperature Modification, Impella, ECMO and LVAD. Our excellent and experienced medical staff supports strong medical and surgical subspecialty programs.

Aside from Certified Critical Care Nurses, many who have more than 20 years of experience and are expert at caring for this complex patient population, we have a growing pool of Intensivist mid-level practitioners who work hand in hand with our Intensivist physicians to coordinate the care of the critically ill patient, minister to them and perform procedures.

Of course, a New York License is required. J1 or H1 VISAS accepted.
Additional Salary Information: Salary and benefits are competitive and commensurate with experience. Interested applicants, send resume to: dr.sorett@nassauchest.com


Paging Primary Care MDs Who Love Technology
98point6 is a Seattle startup who wants your input. We’re seeking practicing physicians to join our council and help shape the next generation of primary care. If the fusion of health care and technology inspires you, please apply here.

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

February 3, 2017 – DSRIP Not Trickling Funds Down to Doctors

Dr. Reid - MSSNY President
PRESIDENT’S MESSAGE
Dr. Malcolm Reid
February 3, 2017
Volume 17
Number 5

mssny_enews_dividend

Dear Colleagues:

The Delivery System Reform Incentive Payment program, better known as DSRIP, was designed to overhaul Medicaid. NY State released its NYS DSRIP Mid-Point Assessment Final Reports for all 25 PPSs (Performing Provider Systems) throughout the state on January 3, 2017. The reports are extensive.  In case you want to take a look at it, click here.

At our January 19 Council Meeting, a summary of the report was given to the Councilors. The bad news is that DSRIP is not trickling down to physicians as we had anticipated. In the reports, you need to review the DSRIP fund’s flow charts. See them here.

What is quite telling is that the funds are not flowing to physicians. We see that the larger entities are taking their slice of the pie and keeping it for themselves.

On our brief review of the fund flow charts, we see the following:

  • Advocate Community Providers, Inc. has the highest percentage of funds to physicians – 40.8% to PCPs and 6.1% to non-PCPs.
  • Sisters of Charity Hospital of Buffalo, New York is next with 15.53% to PCPs and 1.20% to non-PCPs.
  • Next is Alliance for Better Health Care, LLC at 9.3% to PCPs and appears to have no non-PCPs.
  • Montefiore is next at 6.26% for PCPs and 1.4% to non-PCPs.

Regrettably, the remaining PPSs shared less with the participating physicians.

Based on a statement of the OMIG and the DOH, DSRIP funds are distributed among the participating providers to incentivize providers to reach DSRIP performance goals.

I strongly advise all physicians who are participating in Performing Provider Systems (PPSs) to speak to the administrator of their PPS and question when they will receive their fair share.

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

Save the Date:
MSSNY Physician Advocacy Day in Albany March 8!

Please send your comments to comments@mssny.org



Please Contact Your Legislators to Express Concerns with Several State Budget Proposals
Physicians are urged to contact their elected officials regarding a number of State Budget proposals listed below.   While the proposed Executive Budget contains a number of positive provisions, it also includes several proposals that could have an adverse impact on physician care delivery.  Physicians are urged to contact their legislators to ask that these adverse provisions be removed from the Budget or, where appropriate, additional allocations be made.  For example,

  • We appreciate that funding for the Excess Medical Malpractice Insurance program is proposed to be continued at previous years’ funding levels.  However, physicians would be required to receive a “tax clearance” as a pre-condition, potentially a cumbersome requirement that could unnecessarily endanger coverage for some physicians.  To send a letter to your legislators, click here.
  • Pharmacists would be permitted to enter into “comprehensive medication management protocols” with physicians or nurse practitioners to manage, adjust and change the medications of patients with a chronic disease or diseases who have not met clinical goals of therapy, are or at risk for hospitalization.  While similar “collaborative drug therapy” programs exist within the hospital environment, only physicians are currently permitted to enter into such protocols.  To send a letter to the Legislature, click here.
  • “Prescriber prevails” protections that currently exist in Medicaid and Medicaid Managed Care would be eliminated, except for atypical antipsychotic and anti-depressant medications, forcing physicians to go through even more burdensome prior authorization requirements.  To send a letter to your legislators, click here.
  • The State Budget fails to include a specific allocation to address the likely shortcoming in payments due physicians arising from the financial collapse of liquidated insurer Health Republic. To send a letter to your legislators urging funding in the Budget to address this shortfall, click here. 
  • The Budget would establish a 25 member “Healthcare Regulation Modernization Team” to look at developing numerous health care delivery change proposals including: “Modernizing the Certificate of Need laws, and changing scope of practice for non-physician.” Of significant concern, the language would permit state agencies to implement demonstration programs without the need for legislative approval. 

Other Items of Note in the State Budget

  • Funding for MSSNY’s Committee for Physicians Health would be continued at past levels;
  • Re-appropriating $300,000 for MSSNY’s Veterans Health Care Initiative.
  • E-cigarettes would be taxed in the same manner as tobacco cigarettes.
  • Requiring the registration and regulation of Pharmaceutical Benefit Manager (PBMs)
  • Making the “inappropriate prescribing of opioids” an unacceptable provider practice in the Medicaid program, giving the state discretion to remove a physician or other prescriber from the program.
  • Reducing prescription drug costs by making drug companies pay a surcharge when costs exceed a certain benchmark to be determined by a Drug Utilization Review Board within the NYS Department of Health;
  • Requiring the testing of public water systems every three years for contaminants.

MSSNY will testify at the state Senate and Assembly public hearing on February 16, 2017 on the proposed NYS health budget.  (DIVISION OF GOVERNMENTAL AFFAIRS)

MSSNY Lobby Day Just a Few Weeks Away – March 8th – Physicians Urged to Attend and Wear Your White Lab Coats
Please make your plans now to to come to Albany Wednesday March 8 for MSSNY’s “Physician Advocacy Day”, which will be held at the Lewis Swyer Theatre in the Egg located at the Empire State Plaza in Albany.  Please register here.

The morning program will begin at 8 AM.   A full slate of legislators and key policymakers have been invited and/or confirmed to participate including:

  • Jason Helgerson, NYS Medicaid Director;
  • 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 informal luncheon to which legislators are invited to speak with their constituents will follow the morning program.   County medical societies will be scheduling appointments for physicians to meet with their elected representatives.

Come meet with your legislators to urge that they:

  • Reject burdensome new impediments to obtaining Excess Medical liability insurance coverage contained in the proposed State Budget;
  • Reject inappropriate scope of practice expansions such as the proposal contained in the proposed State Budget that would permit pharmacists to enter into medication management protocols with nurse practitioners;
  • Reject changes to increase physician prior authorization requirements contained in the proposed State Budget;
  • Support legislation to reduce prior authorization hassles including legislation to permit physicians to collectively negotiate contract terms with health insurers;
  • Support legislation to reduce the extraordinary cost of medical liability insurance in New York and reject legislation that would drive up these costs; and
  • Reject legislation that would impose costly and time consuming mandates on physician practices.

Do not leave it to the “other guy”.  Please plan to come to Albany to advocate on behalf of your profession, your community and your patients!                     
(DIVISION OF GOVERNMENTAL AFFAIRS)

Medical Liability Bills Re-Introduced
Legislation, A.3339 and S.4080,  have been re-introduced that would substantially lengthen the statute of limitations for medical malpractice actions and lead to enormous increases in the cost of liability insurance for physicians and hospitals.  If enacted, this bill could increase liability premiums by 15% at a time when no premium increases can be tolerated.

MSSNY continues to oppose expansion of liability provisions that would have drastic consequences on York’s health care system.  MSSNY will continue to push for comprehensive liability reform to preserve access to care for patients, not one-sided proposals that would further reduce access.

As we go into Super Bowl weekend, it is a good reminder that little can be done sitting on the sidelines.  Physicians are urged to contact their legislators by writing letters, making phone calls and meeting with their elected officials.  Physicians can send a letter from here.     (BELMONT)


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


Collective Negotiation Bill Introduced
One of MSSNY’s priority pieces of legislation was re-introduced this week.  Legislation, A.4472, Gottfried and S.3663, Hannon, would allow physicians to communicate with each other and jointly negotiate with health maintenance organizations (HMOs).  The bill divides the matters subject to being collectively negotiated into two major areas.

The first issue area involves non‐fee related matters such as utilization review, coverage provisions, benefits and exclusions definition of medical necessity, risk transfer, referral provisions, burdensome pre‐authorization procedures, limited drug formularies and access where necessary to out‐of‐network specialists.

The second issue area which can be negotiated involves fee‐related matters. These can be negotiated, however, only if the health care plan has substantial market share in the service area in which the physicians are practicing.  Strikes are expressly prohibited.

As many health insurers continue to expand their market share, shrink networks and impose more and more administrative burdens that interfere with patient care delivery, enactment of this legislation is essential to preserving the ability of a physician to advocate to assure their patients can get the care they need.   (Belmont) 

Assembly Health Committee Advances Legislation to Protect Physician Due Process Rights with Health Insurers
Legislation, A2704, Lavine, to assure physicians are accorded a fair peer review appeals mechanism before their participation contract with a health insurance company is non-renewed was favorably reported from the Assembly Health Committee to the Codes Committee this week.   MSSNY strongly supports this legislation.

The legislation is designed to protect existing patient-physician treatment relationships from being severed due to arbitrary health plan decisions to shrink their networks.  For example, in late 2015, hundreds of physicians were unfairly dropped from the networks of one large NYC-based insurer, allegedly because of these physicians’ failure to transition to value-based payments. Moreover, a recent MSSNY survey showed that more than 25% of the respondents indicated that they had been dropped from an insurer’s network in recent years.  Identical legislation (S.3943, Hannon) has been introduced in the New York State Senate.
(AUSTER)

Assembly Health Committee Agenda Next Week: Physicians Urged to Oppose Corporate-Owned Retail Clinic Bill
There are several bills of note on the Assembly Health Committee agenda next week, some supported by MSSNY, and some we oppose.  These include:

  • Legislation (A.958, Paulin) strongly opposed by MSSNY which would authorize the establishment of clinics in corporate-owned retail stores. To send a letter in opposition, click here:
  • Legislation (A.2539, Gottfried) strongly supported by MSSNY that would prohibit a health insurer from denying care unless it is reviewed by a physician in the same or similar specialty, and licensed in New York State; and
  • Legislation (A.2703, Gottfried) strongly supported by MSSNY that would clarify that the statutory liability protections offered for physician participants in MSSNY’s Committee for Physicians’ Health (CPH) program extend to the organization who sponsors the program as well as its employees.
    (AUSTER)

MSSNY Fights for Funding to Attract and Retain Physicians in NYS
MSSNY paired up with other health care advocates as part of the Workforce Advisory Group Lobby Day in hopes of gaining support in their efforts to address the shortage of primary physicians in underserved regions in New York State.

Among the notable issues was the request of legislative support for additional funding for Doctors Across New York (DANY).  DANY is a state funded program that was launched in 2008 to train and place physicians in areas of New York State where that specialty is most needed.  After seeing success in recruitment and retention rates in the previous cycles, the Workforce Advisory Group asked for an additional investment of $2 million dollars to award 50 more physicians.  The group also advocated for the expansion of the Take a Look Program – which introduces medical students and residents practicing in NYC to Upstate New York and the opportunities available in medicine.
(Harring, Belmont)

Blue Cross/Blue Shield of WNY Announces Reducing Prior Authorization Burdens for Many Services
As reported in the Buffalo News and on radio station WBFO, Blue Cross/Blue Shield of Western New York will be dropping prior authorization http://(http://buffalonews.com/2017/02/01/insurer-policy-shift-drops-preapproval-requirement-many-services/requirements for over 200 medical services.  To review the list of services that will no longer require prior authorization, click here.

These articles note that the action by BCBSWNY followed a report issued last week by the AMA noting the overwhelming burden to physician practices of prior authorization requirements, and the recommendation of several principles that health insurers should follow to reduce these burdens.     MSSNY was one of a handful of state medical societies to work with the AMA in developing these principles.  It also follows strong and sustained advocacy by leaders of the Erie County Medical Society to BCBSWNY and other regional health insurers regarding the need to reduce the administrative burdens that are interfering with patient care delivery.  Review of the list of services is ongoing, and suggestions may be made to expand this list of services not requiring PA.
(AUSTER)

NY State of Department  of Health Announces More Than 3.6 Million New Yorkers Secure Health Coverage
The NY State Department of Health reported this week that it saw a sharp influx of enrollees bringing the total number of people who receive coverage through New York’s Exchange to over 3.6 million – a 29% increase since the end of Open Enrollment in 2016.  While most continue to be enrolled in Medicaid, 1.2 million are enrolled in non-Medicaid plans.  242,880 are enrolled in a non-qualified health plan, with almost 60% of new enrollees entitled to federal tax credits to reduce the cost of monthly premiums.  The “Essential Plan”, which covers individuals with income between 138-200% FPL, saw a 75% upsurge in enrollment, bringing the total number receiving coverage to almost 670,000 New Yorkers.    In addition, 299,214 children are enrolled in Child Health Plus.
(HARRING, AUSTER)

MIPS Educational Webinar Program Available from MSSNY MACRA Webpage
Over 120 physicians and/or their staff participated in a January 26 webinar hosted by MSSNY to learn about key aspects of the new Medicare Merit Based Incentive Payment System (MIPS) that went into effect on January 1, 2017.  The MIPS program was enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and will have a significant impact on physician care delivery and billing for Medicare.  MSSNY thanks Frank Winter, Partnership Manager for the New York Regional Office for CMS, for taking the time to present important information about this new program for physicians and their staffs, and answering their questions.

To listen to a re-broadcast of this one-hour program, please go to the “MACRA” section of the MSSNY website or click here:  (Members only).
(AUSTER)

DOH Commissioner Medical Grand Rounds to be Held on Feb. 8th
The third session of the 2016-2017 Commissioner’s Medical Grand Rounds series will be held on February 8, 2017 from 6-8 p.m.   The session, “Technology Changes Our Connection: Physician and Patient Communication” will take place in Manhattan at the Borough of Manhattan Community College. The flyer for this session is here.

The session will also be streamed as a live webcast for those unable to attend in-person and will also be offered on our webpage as an archived webinar afterwards. Participants are eligible for CME credits whether they view in-person, via the live webcast, or the archived webcast.   The session will be hosted by NYS DOH Commissioner Howard Zucker, MD.  Presenters are: Richard M Frankel, PhD; Professor of Medicine and Geriatrics, Indiana University School of Medicine Senior Scientist, VA HSR&D Center for Health Information and Communication and Joseph C Kvedar, MD, Vice President, Connected Health, Partners HealthCare Associate Professor, Dermatology, Harvard Medical School.(CLANCY)

Register Now for Upcoming Medical Matters 2017 CME Webinar Series
The Medical Society of the State of New York encourages you to register for its next Medical Matters webinar on Wednesday, February 15, 2017 at 7:30 a.m. with The Mental Health Impact of Active Shooter/Bombing on the Healthcare Team.  Faculty for this program is Craig Katz, MD, member of MSSNY’s Emergency Preparedness and Disaster/Terrorism Response Committee.  Registration is now open for this webinar here just click on “Upcoming”.

The educational Objectives are: 1) Describe the psychological problems and stress symptoms that can result from an active shooter/bombing event in the healthcare setting.  2) Identify means by which members of the healthcare team can address stress before, during and after an active shooter/bombing event.  3) Review resources and methodologies available to address the mental health impact of an active shooter/bombing on the healthcare team.

The Medical Matters program for March 15, 2017 at 7:30 a.m. is Exercise Response to Novel Influenza Strains.  Faculty for this program is Pat Anders, MS, MEP, Manager, Health Emergency Preparedness Exercises, New York State Department of Health, Office of Health Emergency Preparedness.

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

Medical Matters is a series of CME webinars sponsored by MSSNY’s Committee on Emergency Preparedness and Disaster/Terrorism Response. 

The Medical Society of the State of New York (MSSNY) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

MSSNY 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.                               (CLANCY, HOFFMAN)

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 mauster@mssny.org         pclancy@mssny.org   jbelmont@mssny.org

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AMA to Homeland Security: Concern re IMGs Who Have Visas to Train/Practice in US
The American Medical Association entered the immigration debate Wednesday with a letter to the U.S. Department of Homeland Security asking the agency to clarify how the Trump Administration’s executive order applies to health workers trained abroad, to those seeking to train in the U.S. and to patients needing care. MSSNY has the same concerns as the AMA as we have a higher percentage of IMGs in New York than other states. The Association of American Medical Colleges said 260 medical students from the seven countries are applying to residency programs in the United States.

It is “vitally important” that this process not impede patients’ access to timely treatment or restrict doctors and international medical graduates “who have been granted visas to train, practice, or attend medical conferences” in the U.S., ” the AMA’s chief executive officer, Dr. James L. Madara, wrote in a letter to Homeland Security Secretary John F. Kelly.

Dr. Madara noted that the order could block entry to foreign medical graduates who have applied for or who have been granted visas to come to the U.S. to train and provide care in poor and underserved communities to “some of our most vulnerable patients,” many of whom live in rural and low-income areas. “One of every four physicians practicing in the United States is an [international medical graduate],” he said, noting that they meet the same stringent licensing requirements as US graduates, but they are more likely to practice in underserved and poor communities, and to fill training positions in primary care and other specialties that face significant workforce shortages.

The letter requests rapid action, because the order places into limbo foreign medical school graduates whose residency assignments will be decided next month. He also expressed concerns about how the order might affect medical school applicants granted temporary work permits under an Obama Administration program that allows certain undocumented immigrants who entered the U.S. as minors to remain for at least two years.

Erie County Suing Pharmaceuticals for Promoting Opioids to Doctors/Patients
Erie County Executive Mark Poloncarz is suing several pharmaceutical companies alleging that the companies misled doctors and patients into thinking that their highly addictive medications were safe. The lawsuit, filed in State Supreme Court, names 11 major companies- including Purdue, Hanssen, and Endo. Read the Buffalo News story here.

MSSNY Members ONLY: Free Service to Resolve Your Insurance Problems
The Division of Socio-Medical Economics (SME) is responsible for addressing health insurance-related issues and developments affecting the physician community. SME is here to help you and your staff with problems relating to insurance reimbursement for care you render to your patients. We receive thousands of calls each year regarding Medicare, Medicaid, Workers’ Comp (WC), No-Fault Auto (NFA), managed care, traditional indemnity plans, etc. Sometimes we help our members by explaining insurer requirements, diagnosis and procedure coding questions, Medicare/Medicaid Crossover issues, National Provider Identifier (NPI) matters, WC/NFA questions, private-pay arrangements, etc.  This is a FREE SERVICE for MEMBERS ONLY.

In other cases, we may argue with a health plan on behalf of our members for policy clarification or proper payment of a bill or claim. In 2016, our Ombudsman Program recovered $89,815.79 for our members

Please contact the SME staff if you have questions or problems with which you think we can help at 516-488-6100 ext. 334.

Regina McNally, Vice-President


SAVE THE DATE
Physician Lobby Day in Albany
Wednesday, March 8th, 2017
YOU NEED TO TAKE A DAY AWAY FROM YOUR PRACTICE
Call Your County Medical Society for Details


MSSNYPAC – The Political Voice for New York’s
PhysiciansFace-to-face relationship-building with those who will be deciding policies which impact our ability to provide care to our patients is of great importance to all physicians.  MSSNYPAC provides opportunities for physicians to support and encounter physician-friendly candidates.  Every individual physician, resident, medical student and Alliance member is essential to strengthen these relationships. Join or increase your support and participation today at www.mssnypac.org/contribute

Open Payments System Is Now Available
The Open Payments system is now available, enabling physicians and teaching hospitals to register. Physicians and teaching hospitals must register first in order to review any payments and other transfers of value attributed to them. If physicians and teaching hospitals registered last year, they do not need to register again.

If it has been over 180 days since a physician or teaching hospital has logged onto the Enterprise Identity Management System (EIDM), the account has been deactivated for security purposes. If an account must be reactivated, physicians and teaching hospitals can contact the Help Desk. Beginning today, the Help Desk has extended hours from 7:30 a.m. – 6:30 p.m. (EST).

The review and dispute period is targeted to start in April 2017, following the close of data submission (the Program Year 2016 data submission window begins on February 1, 2017 and ends on March 31, 2017).

You can learn more about the Open Payments system enhancements by viewing the Open Payments Overview and Enhancements presentation. Additional updated resources are located here.

Questions—Contact Live Help Desk
For more information about Open Payments, please visit the Open Payments website. If you have any questions, you can submit an email to the Help Desk at openpayments@cms.hhs.gov..

Live Help Desk support is available by calling 1-855-326-8366, Monday through Friday, from 7:30 a.m. to 6:30 p.m. (EST), excluding Federal holidays.

Please be aware that other critical deadlines for the House of Delegates meeting remain ahead of us.

Resolutions Have Two DeadlinesFebruary 17 and March 17!
We tried this last year and it worked well.  Please try to submit any resolutions that are ready by FEBRUARY 17.  This gives staff adequate time to review and contact you or the author with questions or clarifications.

The final deadline for receipt of resolutions is MARCH 17 at 5 PM.  This deadline was selected so that any issues which might arise as a result of Physician Advocacy Day participation can still be addressed.  Anything received after Friday March 17th will be considered LATE and referred to the House Committee on Rules, Credentials and Order of Business.  That committee meets on Thursday April 20, 2017 at 2 PM and the author of that late resolution must be present to discuss the reasons for the lateness of the resolution.

Resolutions must be submitted as word documents (each resolution as a separate document) with the proper formatting, necessary research and policy citations noted.  Resolution titles should be succinct and reflect the broad topic of the resolution.  Guidelines for constructing resolutions and proper formatting are installed on the MSSNY website.  Please research your resolutions to establish whether there is already existing policy on your topic.  The Policy and Position Statements are on the MSSNY website and have been updated through the January Council meeting.

Join us for ARTMED INSIGHT’s February Workshop at the MET Museum! 

THE ART OF SEEING: ART IN CLINICAL PRACTICE 

Expanding Point of View and Creative Thinking Skills
February 17, 2017, from 6 to 8.30 pm and February 18, 2017 from 5 to 7.30 pm

Boost your perceptual and communication skills and strengthen your clinical practice! 

Open to all physicians, physician assistants, psychiatrists, residents, nurses, medicals students, and healthcare professionals across disciplines. 

Expanding Point of View: February 17 from 6 to 8.30 pm

Participants explore art works in order to uncover their perceptual habits and move beyond them. Multiplying perspectives, participants learn how to access new data and ways of seeing. Issues of bias and context are also considered and their relevance to medical practice and patient communication explored.

Enhancing Creative Thinking Skills: February 18 from 5 to 7.30 pm

In part 2 of this workshop, participants investigate art works and develop perceptual tools to “reframe” their looking. This serves to stimulate participants’ creativity and capacity for creative problem solving. Challenges regarding ambiguity and premature closure are also examined and explored.      

Cost: $285 (includes 1/17/17 and 1/18/17 + museum entrance fee) $185 for students

Art experience is welcome but not necessary–Location: The MET Museum in NYC.

Space is limited to insure interactivity! For more information check out our website www.artmedinsight.org and to register go here.


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Modern/High End Office (Upper East Side)
Large and Modern office to share.  Located on the ground floor.  2+ treatment/exam rooms, large waiting room, private office, storage.  Price is negotiable for 1-3 day/week.  Call Dr. Austin 5189284819 or email ian@caneandaustin.com No broker fee.  Craig Austin, M.D. 120 East 64th Street, NYC 10065



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

Physician Opportunities


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

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

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