December 21, 2018 – Billion Dollar Baby

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


MSSNY eNews
December 21, 2018
Volume 21  Number 46

MSSNYPAC Seal

Colleagues:

Governor Cuomo’s announcement this week “Let’s legalize the adult use of marijuana, once and for all” is a 180-degree turn from previous comments in early 2017. However, this “evolution” came as no surprise. In the summer, he set up a multi-agency task force to analyze the pros and cons of marijuana legalization, which then concluded the positives outweighed the negatives.   The Task Force members then went on the road to sell the idea. MSSNY and county medical society physician leaders testified at many of these meetings to state our support for marijuana decriminalization but also our strong concerns with the public health implications of the legalization of marijuana. The projected revenues the state would gain from legalization range $600M to $1.3B.  MSSNY has had meetings with the Governor’s office and key Assemblymembers to discuss how best to limit the potential significant adverse public health threats such as youth addiction and increased driving while intoxicated.

Vaping-the Next Epidemic

The U.S. Surgeon General Dr.  Jerome Adams, on Tuesday declared electronic cigarette use among America’s youth “an epidemic” and called for new restrictions on the products. The action comes a day after release of a Monitoring the Future report, which confirmed that teen vaping nearly doubled in 2018, with one in five high school seniors reporting current use of e-cigarettes. More than 3.6 million teens in the U.S. reported that they regularly used the vaping products. Recommendations in an advisory by Surgeon General Jerome Adams, MD, include banning vaping from establishments now covered by indoor smoke-free air policies, further restricting youth access to e-cigarettes in retail establishments, implementing new price policies, and banning marketing to youth.

The survey also found that many students believe they are vaping “just flavoring.” In fact, just about all brands include nicotine, and Juul, a popular, high-nicotine vaping product, that has particularly high levels of it. We all know that nicotine in any form is a tough chemical to give up.  It seems we haven’t learned much about the lure of “cool,” parent-unapproved chemicals in spite of our knowledge of addicting chemicals

Dr. Adams was joined by U.S. Health and Human Services Secretary Alex Azar and FDA Commissioner Scott Gottlieb, MD. The Monitoring the Future survey (sponsored by the National Institute on Drug Abuse) confirmed that the rise in youth e-cigarette use during 2017 and 2018 was the largest-ever single-year increase in use of a single substance ever recorded in the 43 years of the survey.

Sales of Juul increased by 600% in 2017 alone, making it the best-selling e-cigarette on the market. The e-cigarettes, which resemble USB flash drives, have high levels of nicotine — as much in a single cartridge as a pack of 20 regular cigarettes. “This is of particular concern for young people, because it could make it easier for them to initiate use of nicotine through these products and also could make it easier to progress to regular e-cigarette use and nicotine dependence,” Dr.  Adams noted.

In Tuesday’s New York Times, Jan Hoffman, in a column titled “How to Help Teenagers Quit Vaping,”   offered advice on how to get kids to quit vaping. His advice is good but I think most parents don’t even know their kids are doing it. It does not have the telltale smell of cigarette smoke.

County Health Officials Opposed to Legalization

The New York State Association of County Health Officials released a statement Tuesday outlining concerns about adverse health impacts from marijuana legalization. The association said it remains opposed to recreational marijuana legalization. But if it’s legalized, similar to MSSNY, the group called for safeguards and research as well as additional funding for local health departments for increases in workload.

The group is also opposed to e-cigarettes. According to the group, E-cigarettes accounted for an increasing proportion of combined monthly e-cigarette and cigarette exposure calls to the U.S poison centers, increasing from 0.3% in September 2010 to 41.7% in February 2014. Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the initiation of smoking among adolescents and young adults. Marketing of e-cigarettes uses cartoons, promotes fruity tobacco flavors, and providers sponsorship of events such as concerts and sporting events, all forms of advertising and marketing designed to appeal to children and young adults.  For the above discussed reasons, both MSSNY and NYSACHO find it imperative to prohibit the advertisement of tobacco products and electronic cigarettes and NY State and therefore supports corresponding legislation.

MSSNY, working together with numerous public health advocacy organizations, is also calling on the Legislature to pass a law to create a statewide minimum age of 21 to purchase tobacco and e-cigarettes.  MSSNY also supports banning the use of flavored substances in vaped products.

Altria Nears a Deal to Take 35% Stake in Juul

According to the Wall Street Journal, Altria Group is nearing a deal to take a 35% stake in e-cigarette startup Juul Labs at a roughly $38 billion valuation, an investment that would make Juul one of the most valuable private companies.It would more than double what Juul was valued at just a few months ago, a sign of how quickly the startup has been growing and Altria’s desire to find growth outside its shrinking cigarette business.

While many groups have come together to alert the public to the health threats of nicotine, the developments around expanded use of e-cigarettes and marijuana show just how vigilant we need to continue to be.

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

Thomas J. Madejski, MD
MSSNY President


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eNews

New York Exchange Enrollment Continues to Rise
As talks of health care reform continue to swirl in Albany and across the country, enrollment in New York’s Health Insurance Exchange continues to accelerate.  Even with the federal removal of the individual coverage mandate – an act widely expected to lead to a decrease in enrollment – this year is actually outpacing last year in New York.

According to the NY State of Health, more than 1 million New Yorkers had enrolled in non-Medicaid coverage in the Exchange through December 15, representing an increase of about 83,000 people over last year. New York’s uninsured rate is currently under 6%, with about three-quarters of the uninsured eligible for subsidized coverage.  Specifically, there were 247,411 enrolled in a qualified health plan; 776,481 enrolled in the Essential Plan; 413,576 enrolled in Child Health Plus, and 3,283,564 enrolled in Medicaid.

This week, as part of his “First 100 Days” Address, Governor Cuomo proposed to codify into law both New York’s Exchange as well as its “pre-existing conditions” protects for consumers.  While New York currently has a law protecting patients from being denied coverage because of a pre-existing condition, this law is tied to the federal ACA provisions that were put in doubt as a result of last Friday’s federal District Court Judge’s ruling that the ACA is unconstitutional.

In response to Judge O’Connor’s ruling, Dr. Madejski was quoted in several papers, including Newsday, Westchester Journal News, and Buffalo Business First, stating “While the ACA has many flaws that we urge Congress to work to fix, among its strongest attributes are its mechanisms to enable the purchase of health insurance coverage for millions through a variety of subsidy programs.” Amongst those flaws is the need to require exchange plans to offer out of network coverage.

With health insurance coverage through the Exchange under discussion in 2019, MSSNY will continue to push for measures to ensure patients have access to comprehensive and varied health insurance options, including out of network coverage.


Exciting Sections Meeting: Young Physicians, Residents/Fellows, Medical Students. Saturday, February 9, 2019 at the Marriott Courtyard in Westbury and MSSNY HQ. Hear national leaders in medical toxicology and social media in medicine. Read all about it here.


Judge Reviewing CVS-Aetna Orders DOJ to Respond to Community Concerns
US District Court Judge Richard Leon this week ordered the US Department of Justice to respond to numerous comments filed to it raising concerns with the proposed mega merger between CVS and Aetna.  According to media reports, this development is expected to delay approval of the merger until at least Spring 2019.

Among the comments to the US DOJ is a letter from MSSNY President Dr. Thomas Madejski summarizing MSSNY’s extensive concerns with this merger among corporate behemoths. The DOJ letter also appended testimony provided by MSSNY Immediate Past President Dr. Charles Rothberg at an October NY Department of Financial Services hearing.

The letter also summarizes the extensive concerns that had been raised by NY DFS Superintendent Maria Vullo, the American Medical Association (AMA), the American Antitrust Institute and New York State Assembly Insurance Committee Chair Kevin Cahill.

Moreover, last week, the Pharmacists United for Truth and Transparency (PUTT) and the Pharmacists Society of the State of New York (PSSNY) jointly filed a motion asking Judge Leon to stop CVS and Aetna from further integration while the Court determines the merger’s harmful effects.

The US DOJ had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition.  The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger in late November with numerous conditions.

MSSNY’s letter to the DOJ highlighted that, even though the NY DFS had approved the acquisition, it did so highlighting several problems with the merger, including that the companies had not “provided any concrete analysis that the CVS/Aetna merger would result in specific reduced costs for New York consumers, or any business plan or study of asserted improved health outcomes to benefit New Yorkers.”

Moreover, MSSNY’s letter to the DOJ reiterated the extensive concerns articulated by the AMA.  Judge Leon’s concerns about the transaction included the strong opposition by the AMA, which had argued to the DOJ that it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options.  


Physician Compare 30-Day Preview Period Extended to 1/7
On November 30, CMS opened the 30-Day Preview Period for the 2016 performance information targeted to be publicly reported on Physician Compare starting in early 2019. The preview was scheduled to end on December 31 at 8pm ET. We are extending preview through Monday, January 7 at 8pm ET (5 PM PT).

For additional assistance with accessing the Quality Payment Program website, or obtaining your EIDM user role, contact the Quality Payment Program service center at QPP@cms.hhs.gov.

If you have any questions about Physician Compare, public reporting, or the preview period, please contact us at PhysicianCompare@Westat.com.


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DFS Superintendent Vullo to Depart in February
New York Superintendent of Financial Services Maria Vullo announced this week that she would be stepping down from the position on February 1, 2019.  The many important activities engaged in by Superintendent Vullo include her close scrutiny and criticism of the defects of the many health care mega mergers such as the proposed Anthem acquisition of Cigna, and the proposed CVS acquisition of Aetna. In her statement announcing her departure she noted that “I am especially proud to have led DFS in cybersecurity, having promulgated a final regulation in March 2017 that is now the national standard for the protection of our nation’s financial markets.  I also am tremendously proud of our work to protect women’s rights in the face of federal assaults, by mandating insurance coverage of contraceptives and abortions without cost-sharing, providing essential coverage for women suffering from maternal depression, providing a special health care open enrollment period for victims of domestic violence, and implementing New York’s Paid Family Leave law.”


Assemblywoman Crystal Peoples-Stokes Named Majority Leader of NYS Assembly; Assembly Committee Chairs Mostly to Remain the Same
Assemblywoman Crystal Peoples-Stokes (D-Buffalo) was appointed by Assembly Speaker Carl Heastie to serve as the Assembly Majority Leader. The majority leader is responsible for the day-to-day operational duties of the Assembly chamber, including overseeing the floor during debates.  She will replace Joe Morelle, who just won election to Congress in his Rochester-area seat.

“Serving alongside Crystal Peoples-Stokes, I have had the opportunity to see firsthand how hard she works for the people of Buffalo and for families across our state,” Speaker Heastie, said. “Crystal is a trusted colleague who I have known for many years, and her experience and dedication to improving the lives of all New Yorkers is why I know she will make an ideal partner in leading the Assembly Majority. Crystal is widely respected by her colleagues and I am proud to appoint her as the next Majority Leader of the People’s House.”

Speaker Heastie also announced Assembly Committee Chairs for the 2019-2020 Session this week.  Many of the Chairs of Committees of strong interest to physicians and patients will remain the same.  The Assembly Health Committee Chair will continue to be Richard Gottfried.  The Insurance Committee Chair will continue to be Kevin Cahill.  The Higher Education Committee Chair will continue to be Deborah Glick.  The Assembly Judiciary Committee Chair will continue to be Jeffery Dinowitz.  The Codes Committee Chair will continue to be Joseph Lentol and the Ways and Means Committee will continue to be led by Helene Weinstein.   Assemblyman Marcos Crespo has been appointed chairman of the Committee on Labor, replacing Michele Titus.


Physicians File Class Action Suit Against ABIM
A class action lawsuit against the American Board of Internal Medicine (ABIM) was filed in a Pennsylvania federal court on December 6.  The plaintiffs include several physicians board certified in internal medicine who allege that the ABIM maintenance of certification (MOC)

requirements violate the federal anti-trust laws.  The physician plaintiffs allege that initially board certified internists have lost hospital privileges if they do not obtain MOC. It is also alleged that initially board certified internists have been removed from the list of “preferred physicians” by health insurers if they do not maintain MOC.  A similar action had been brought in an Illinois federal court by the American Association of Physicians and Surgeons (AAPS), but was dismissed on the basis that the complaint merely made general conclusions, and failed to provide sufficient specific details.



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U.S. FDA Panel Votes for Prescribing Naloxone with Opioids
On Dec 18, an advisory panel to the U.S. Food and Drug Administration recommended prescribing the opioid overdose reversal drug, naloxone, with addictive painkillers.

The panel, which concluded a two-day discussion on ways to make the potentially life-saving drug readily available, voted 12-11 in favor of labeling changes for opioids that recommend co-prescribing the overdose antidote.


Surgeon General Declares E-Cigarettes a Youth Epidemic
The US Surgeon General on Tuesday declared electronic cigarette use among America’s youth “an epidemic” and called for new restrictions on the products.

The action comes a day after release of a Monitoring the Future report, which confirmed that teen vaping nearly doubled in 2018, with one in five high school seniors reporting current use of e-cigarettes. More than 3.6 million teens in the U.S. reported that they regularly used the vaping products.

Recommendations in an advisory by Surgeon General Jerome Adams, MD, include banning vaping from establishments now covered by indoor smoke-free air policies, further restricting youth access to e-cigarettes in retail establishments, implementing new price policies, and banning marketing to youth. In his advisory, the Surgeon General singled out the new generation of e-cigarettes that have e-liquid contained in a cartridge, such as the brand Juul, as posing a particular risk to youth.

He added that despite these risks, approximately two-thirds of Juul users between the ages of 15 and 24 in one survey did not know that Juul always contains nicotine. (See Dr. Madejski’s comments in the introduction.)


MSSNY Symposium Call for Abstracts; Open through 4:00 pm Tuesday, January 22, 2019
MSSNY member residents, fellows and medical students are invited to submit abstracts for consideration for the MSSNY Symposium, to be held April 12, 2019 at the Westchester Marriott in Tarrytown. Submissions will be accepted until 4:00 pm on Tuesday January 22, 2019. See complete guidelines at http://www.mssny.org/Documents/RFS/Guidelines_2019a.pdf.

Please contact sbennett@mssny.org with any questions.

If you’d like to help score abstracts, contact sbennett@mssny.org.


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3rd and 4th District Meeting Jan 25-27 at the Mirror Lake Inn in Lake Placid.


Physician Fee Schedule Final Rule: Understanding 3 Key Topics
Here are the answers to frequently asked questions::

Topic: E/M

Q: What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?
View the response here.

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Topic: QPP

Q: How does the MIPS payment adjustment apply to clinicians, especially those who may switch practices during the performance year?

A: Below are the general rules on how the payment adjustment is applied, which is different than the legacy programs.

  1. A MIPS eligible clinician (NPI) who bills to the same TIN in the payment year as they did during the performance period will be assessed the payment adjustment under that TIN/NPI combination according to the final score earned from data submitted/collected under that TIN
  2. A MIPS eligible clinician (NPI) who bills to a (new) TIN in the payment year that they did NOT bill to during the performance period will be assessed the payment adjustment under that (new) TIN/NPI combination based on the most advantageous final score attributed to that NPI under any TIN/NPI combination for the performance period.

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Topic: Changes to MIPS Requirements

  1. Are there any changes to the data completeness requirements for the MIPS Quality performance category in 2019?
  2. No, the data completeness requirements are the same as in Year 2 (2018) even with the update to the submission terminology. Individual clinicians or groups submitting quality measure data on QCDR measures, MIPS CQMs, and eCQMs must submit data on at least 60% of the clinician or group’s patients that meet the measure’s denominator criteria, regardless of payer. Individual clinicians or groups submitting quality measure data on the Medicare Part B claims measures must submit data on at least 60% of the applicable Medicare Part B patients seen during the performance period.

Additionally, we have a fact sheet that provides additional information and scenarios on the MIPS payment adjustments.


American Board of Specialties on Continuing Board Certification: Vision for Future Commission Releases Report
The report, Draft Report for Public Comment which includes the Commission’s key findings and recommendations, will be posted on the Vision Initiative website for comment through Tuesday, January 15, 2019 at 10:00 p.m. EST.

We strongly encourage you to review the draft report and offer your comments by the January 15, 2019 deadline.

The American Board of Medical Specialties and its 24 Member Boards are committed to working with stakeholders to improve the continuing certification process so that it becomes a system that demonstrates the profession’s commitment to professional self-regulation, offers a consistent and clear understanding of what continuing certification means, and establishes a meaningful, relevant and valuable program that meets the highest standard of quality patient care. The Boards will seriously consider the Commission’s findings and recommendations once finalized, as they continue implementation of improvements and pilots currently underway.

Kristin Schleiter, JD
VP, Policy, Government Relations and Strategic Engagement
American Board of Medical Specialties
Direct 312-436-2686
Mobile 847-636-2779


AM Best Rates MLMIC A+
AM Best has assigned a Financial Strength Rating of A+ (Superior) and a Long-Term Issuer Credit Rating of “aa-” to MLMIC Insurance Company (MLMIC) (New York, NY). The outlook assigned to these Credit Ratings (ratings) is stable.

The ratings reflect MLMIC’s balance sheet strength, which AM Best categorizes as strongest, as well as its adequate operating performance, limited business profile and appropriate enterprise risk management. The ratings also benefit from the financial support provided by MLMIC’s direct parent company, National Indemnity Company, which is ultimately owned by Berkshire Hathaway Inc. [NYSE: BRK.A and BRK.B].

MLMIC’s risk-adjusted capitalization, as measured by Best’s Capital Adequacy Ratio (BCAR) is categorized as strongest and AM Best expects it to remain at a similar level in prospective years. The balance sheet strength assessment also considers the company’s track record of positive reserves development, as well as good financial flexibility provided by its publicly traded ultimate parent Berkshire Hathaway Inc.

MLMIC’s insurance portfolio is concentrated in the medical malpractice line of business. The company underwrites risks only within New York state, which represents one of the nation’s most challenging market environments. However, management has been able to operate successfully through underwriting cycles while maintaining MLMIC’s leading market position within New York.


Health Affairs: First Estimate of Physicians Telemedicine Use
The December issue of Health Affairs, using data from the AMA’s 2016 Physician Practice Benchmark Survey, provides the first nationally representative estimates of physicians’ use of telemedicine. In 2016, 15.4 percent of physicians worked in practices that used telemedicine for a wide spectrum of patient interactions, including e-visits as well as diagnoses made by radiologists who used telemedicine to store and forward data. In the same year, 11.2 percent of physicians worked in practices that used telemedicine for interactions between physicians and health care professionals. We found that in addition to specialty, larger practice size was an important correlate of telemedicine use. This suggests that despite regulatory and legislative changes to encourage the use of telemedicine, the financial burden of implementing it may be a continuing barrier for small practices.


Heart Group: Statins’ Benefits “Greatly Outweigh” Their Risks
For most patients who meet criteria for statin therapy, the benefits “greatly outweigh” the risks, according to a new scientific statement from the American Heart Association.

Here are some of the group’s conclusions, published in Arteriosclerosis, Thrombosis and Vascular Biology:

  • Statins prevent primary cardiovascular events in 5% of patients treated for 5 years (who achieve a 77-mg/dL reduction in LDL) and prevent secondary events in 10% of those treated.
  • Myopathy, including rhabdomyolysis, owing to statin use affects less than 0.1% of treated patients.
  • Severe liver toxicity occurs roughly 0.001% of the time.
  • Statins “modestly” increase the risk for diabetes, most often in patients with numerous other risk factors.

The absolute risks for additional adverse effects are listed in Table 7 of the document linked below.

AHA scientific statement in Arteriosclerosis, Thrombosis and Vascular Biology

AHA/ACC 10-year CV risk calculator


PAI Submits Comments in Response to Anti-Kickback Statute Request for Information (RFI
PAI submitted comments in response to the Anti-Kickback RFI, supporting the Department of Health and Human Services’ (HHS) efforts to modernize the Anti-Kickback Statute as well as the Beneficiary Inducement Civil Monetary Penalty Law (CMP). In its comments, PAI submitted several recommendations that would provide physicians relief from the antiquated aspects of these laws/regulation, including encouraging HHS to take the following key steps:

  • Establish clear exceptions to the Statute and CMP restrictions for payment models and demonstrations and other arrangements that promote physician-led initiatives to value-based care.
  • Allow physicians to align with other high-quality providers (clinical and non-clinical, including social support organizations) for greater coordinated care and a more holistic approach to patient care.
  • Encourage physician-patient relationships through greater patient incentives and rewards that promote and support the delivery of high-value, low-cost care and contribute towards greater coordinated care that improves outcomes.

More detailed recommendations include:

  • Permitting physicians and practices to enter into group purchasing arrangements for medical equipment and social support services on behalf of their patients.
  • Modernizing the statute to allow and provide for the infrastructure support and financial incentives necessary for value-based arrangements, for both providers and patients. The current exceptions, safe harbors, and waivers limited to certain models should be expanded to other APMs, demonstrations, and similar arrangements.
  • Strengthening physician-patient relationship by better alignment, including equipping physicians with tools that can be used to incentivize patient adherence to their care plans and help ensure medication adherence.
  • Allowing cost savings from rebates and negotiated discounts to be passed down from pharmacy benefit managers (PBMs) to patients and holding PMBs to stricter standards.
  • Creating additional safe harbors that allow physicians to establish arrangements with electronic health record vendors to further promote interoperability and health information exchange.
  • Clarifying the definitions of “value,” “risk,” and “market/market share” under the Statute and in their application to value-based payment arrangements.

CME WEBINARS

 “Public Health Preparedness 101” CME webinarJanuary 16, 2019 at 7:30am – Registration now open 

Are you prepared for a public health emergency?  And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here.  Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


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RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


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


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PHYSICIAN OPPORTUNITIES

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


December 14, 2018 – Am. Bd. of Specialties Wants Your Opinion!

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


MSSNY eNews
December 14, 2018
Volume 21  Number 45

MSSNYPAC Seal

Colleagues:

My wife Sandra and I were honored to be able to join the New York State Society of Anesthesiologists for their Annual PGA in Manhattan last weekend.  Congratulations to outgoing President Dr. David Bronheim upon completion of a successful year.  I look forward to working on a number of issues of mutual interest to MSSNY AND NYSSA with incoming president Dr. Vilma Joseph. Special thanks to Stuart Hayman and Dr. Rose Berkun for their hospitality and friendship.

NYSSA provides a robust educational program in conjunction with their PGA and I participated in a panel discussion about possible passage of single payer legislation in New York State and other potential health care financing changes.  Subsequent to that, I traveled to Washington, D.C., along with MSSNY Senior Vice President for Legislative Affairs Morris Auster to participate in a discussion convened by the AMA about the last Medicare financing reform.

Medicare and You

The federal Medicare program continues to be the major driver in physician payment in the United States.  Medicare policies (and experiments) often create care and payment changes in the commercial insurance market and in Medicaid.  Medicare payment seems to be perpetually in need of reform.  The last major change in Medicare financing occurred with the passage of MACRA in 2015. MACRA was in part an attempt to provide a solution to the ongoing problem of the Sustainable Growth Rate formula, a flawed calculation that failed to compensate physicians and others fairly, and created an ongoing crisis of potential cuts that could have crippled a physicians’ ability to provide care and maintain their practice.  MACRA traded the SGR solution for a new payment system that promised to control costs while providing higher value care.  MACRA provides a carrot of bonus payments for participation in quality activities through the MIPS program for smaller practices, or through the QPP program in a variety of forms.  Unfortunately due to budgetary constraints the bonuses occur in the context of a tournament.  The lower performers receive a stick in the form of payment reductions.  Part of the design assumed that a movement away from fee for service Medicare would improve quality and restrain cost increases.  Due to the cost of replacing the SGR, payment increases have been limited and, with the sequestration process affecting the Federal budget, inadequate for practices to keep pace with inflation, and in many cases a poor return on the investment in resources required to participate and attempt to improve care.  In fact, from 2001 to 2017 while Medicare payments to hospitals and skilled nursing facilities have increased approximately 50% (8% above inflation), Medicare physician payments adjusted for inflation dropped 36%! (6% increase minus a 42% increase in the CPI)

Incentives Are Wrong

MSSNY continues to work with our partners at the AMA, and other State and Specialty Medical Societies to improve the care of our patients, and enhance physician satisfaction and practice sustainability.  Improper payment incentives and inadequate payment systems harm patients, and retard the development of a healthcare system that improves societal health and patient outcomes.

There was a wide ranging and robust discussion about issues and opportunities to improve patient care by changing the existing Medicare payment system at the Washington meeting.  Some of the challenges we face include:

  • The overall fiscal situation of the United States:  In a country with an expanding national debt and budget deficits approaching 1 trillion dollars per year, adding additional funds to support practice sustainability will be very difficult.  Trying to redirect existing funds from other areas that have benefited from the increased value provided to the system by physicians’ activities will be politically challenging.
  • After the first 5 years of MACRA, there is a five-year freeze on the Medicare Part B conversion factor. It was anticipated that there would be further modifications to the payment system before this went into effect.  This obviously would exacerbate the inequity in update differential payment highlighted above.
  • Demonstrating to lawmakers and regulators what we believe to be true—the highest quality, and most cost effective care to a patient is provided by physicians in a non-institutional setting.
  • Creating flexibility for physicians to have a real choice as to participation in new payment models. While there is much excitement about value based care, there is limited data that demonstrates its preference to traditional fee for service Medicare.  Some specialties may be best served by preservation of a fee for service model.  One of the great difficulties in MACRA implementation is the difficulty to come up with alternate payment models for physicians to consider across the spectrum of specialties and types of practice.  A bias toward large group structure to be able to afford the management tools for population health needed in risk contracting will not work in many rural or urban settings with limited resources, geographic challenges etc.
  • Reducing the regulatory and documentation burden of practice, including assuring our EMRs are truly functional.  It’s lunacy to continue as is a system that has physicians spend two-thirds of their time on non-clinical activity to get paid and not get sued.  That’s a 21st Century cure that I’d like to see.

MSSNY, through our House of Delegates, Socio-Economic committees, Council and AMA delegation, will continue to consider, explore, and advocate for policies that improve the our patients’ lives and that of our physician members.  I’m always interested to hear policy thoughts and feedback from our members.

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

Thomas J. Madejski, MD
MSSNY President


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Measles Advisory Update – Webinar Available at MSSNY CME Website
The New York State Department of Health issued an update on Tuesday, December 11th to the Measles Health Advisory in New York State.  You can view the advisory here.  There have now been at least 130 confirmed cases in the downstate region.  MSSNY conducted a just-in-time Medical Matters webinar entitled “The Continued Public Health Threat of Measles 2018” on Wednesday.  This webinar has now been posted to https://cme.mssny.org .  Please check it out and keep yourself informed about the ongoing measles outbreak in New York State. 

MSSNY Submits Comments to Department of Justice re CVS-Aetna
As reported last week, US District Court Judge Richard Leon has considering delaying the proposed mega merger between CVS and Aetna.   He has ordered a hearing for December 18 and told the companies to present arguments by December 14 to convince him why the acquisition should be permitted.

This week, MSSNY submitted comments to the US DOJ that included testimony MSSNY Immediate Past-President Dr. Charles Rothberg delivered at the October 18 NY DFS hearing examining this transaction, as well as summarizing the extensive concerns with this merger among corporate behemoths that had been raised by NY DFS Superintendent Maria Vullo, the American Medical Association, the American Antitrust Institute and New York State Assembly Insurance Committee Chair Kevin Cahill.

The US Department of Justice (DOJ) had approved the merger in October under the condition that the companies sell Aetna’s Medicare drug plan business to preserve competition.  The acquisition of Aetna by CVS had also been signed off by every state reviewing the transaction, including New York, which approved the merger in late November with numerous conditions.

While DFS’ conditional approval agreement addressed to some degree some of the concerns raised by MSSNY over the last year, MSSNY President Dr. Thomas Madejski issued a statement noting that physicians remained very concerned about the adverse impact to the health care delivery system in New York given the enormous reach of this transaction.

MSSNY’s letter to the DOJ highlighted that, even though the NY DFS had approved the acquisition, it did so highlighting several problems with the merger, including that the companies had not “provided any concrete analysis that the CVS/Aetna merger would result in specific reduced costs for New York consumers, or any business plan or study of asserted improved health outcomes to benefit New Yorkers.”

Moreover, MSSNY’s letter to the DOJ reiterated the extensive concerns articulated by the AMA.  Judge Leon’s concerns about the transaction included the strong opposition by the AMA, which had argued to the DOJ that it would leave consumers with fewer health care choices. In addition to Medicare prescription drug plan choices, AMA also raised concerns about reduced health insurance competition and patient community pharmacy options. 

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

MSSNY, working together with the New York State Psychiatric Association and other specialty societies, had strongly supported this legislation as it passed the Legislature nearly unanimously.   The bill was delivered to the Governor on December 11, which means he has until December 22 to act. 

If signed into law by the Governor, the information collected would be analyzed and used for the preparation of a parity compliance report that would be contained within in the annual “Consumer Guide to Health Insurers” issued by the DFS (https://dfs.ny.gov/consumer/health/cg_health_2018.pdf).

Although MH/SUD parity laws have been on the books for over a decade on the federal and state level, recent Attorney General settlements note that there continue to be patterns of disparity between coverage criteria imposed on MH/SUD care and treatment as compared to other covered services.  The goal of the legislation is to better ensure compliance with these laws.


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NY DFS Approves Cigna-Express Script Merger with Several Conditions
The New York Department of Financial Services (DFS) announced late Thursday that it had approved the purchase by Cigna of PBM Express Scripts.  MSSNY had submitted to DFS a letter detailing its concerns with this transaction in connection with the hearing that had been scheduled by DFS for last Friday, December 7, but the hearing was postponed after only one other group had requested to testify.

As noted in the last week’s e-news, MSSNY’s letter urged DFS to place meaningful “guardrails…to ensure that our patients’ ability to receive the care or medication they need from the physician or pharmacy of their choice is not disrupted or made more burdensome.” Concerns included: the anticompetitive effects of a health insurer purchasing a PBM when that PBM continues to provide services to other health insurance companies; the lack of a regulatory structure in New York regarding the actions of PBMs; and the risk of even more burdensome prior authorization requirements.

While MSSNY is still reviewing the final Opinion and Decision, at first glance, many of the conditions of approval appear similar to those that were required by DFS as part of its approval of the CVS acquisition of Aetna, including:

  • Prohibiting increased health insurance rates to pay for the cost of the acquisition;
  • Prohibiting dividends to be paid by Cigna without the express prior approval of DFS for 3 years;
  • Prohibiting preferential PBM pricing of Express Scripts to any Cigna-affiliated health insurer, to better ensure insurance competitors can continue to fairly purchase PBM services from Caremark;
  • Limiting changes to Cigna’s healthcare provider networks for 3 years, including maintaining access to non-chain New York pharmacies;
  • Contributing $20 million to New York State, to support health insurance education and enrollment activities and strengthen New York health care transformation activities, which may include payments to the New York State Health Care Transformation Fund
  • Requiring an independent third-party audit to assess whether Cigna employees have accessed Confidential Information from Express Scripts in violation of firewall policies; and

Furthermore, the decision contained a requirement that the parties “agree to take no action to oppose legislation” to directly regulate PBMs in New York State.

Nevertheless, physicians remain concerned with the increasing consolidation in the health care system.  MSSNY’s letter to DFS expressing concerns with this transaction, as well as its letter to the US DOJ regarding the CVS purchase of Aetna (see related article) noted that “the efficiencies that are promoted and marketed to supposedly occur are hardly ever borne out after these transactions are consummated.  Inevitably, these mergers create market dynamics that almost always result in further administrative burdens placed on physicians seeking to assure their patients receive the care or medication they need.

MSSNY Addiction & Psychiatric Medicine Committee Paper: Medicine and Marijuana
The Medical Society of the State of New York convened its members on the Addiction and Psychiatric Medicine Committee, the Bioethics Committee and its Health Disparities Committee for comments on the possibility that New York State government may seek legalization of recreational marijuana.  Comments were also expressed by committee members on the existing marijuana program for medicinal purposes.    

American Board of Specialties on Continuing Board Certification: Vision for Future Commission Releases Report
The report, Draft Report for Public Comment which includes the Commission’s key findings and recommendations, will be posted on the Vision Initiative website for comment through Tuesday, January 15, 2019 at 10:00 p.m. EST.

We strongly encourage you to review the draft report and offer your comments by the January 15, 2019 deadline.

The American Board of Medical Specialties and its 24 Member Boards are committed to working with stakeholders to improve the continuing certification process so that it becomes a system that demonstrates the profession’s commitment to professional self-regulation, offers a consistent and clear understanding of what continuing certification means, and establishes a meaningful, relevant and valuable program that meets the highest standard of quality patient care. The Boards will seriously consider the Commission’s findings and recommendations once finalized, as they continue implementation of improvements and pilots currently underway.

Kristin Schleiter, JD
VP, Policy, Government Relations and Strategic Engagement
American Board of Medical Specialties
Direct 312-436-2686
Mobile 847-636-2779 

DFS Fines Aetna and Oscar More Than $2.5 Million For Violations Of Insurance Law
NY Department of Financial Services (DFS) Superintendent Maria Vullo announced this week DFS had imposed fines against Aetna and Oscar totaling more than $2.5 million for violations of New York Insurance Law.  According to the DFS press release, Aetna will pay a civil penalty of $1.95 million for violations including the failure to make prospective determinations, including pre-authorizations, and failure to acknowledge and respond to members’ complaints within required timeframes.  Oscar Insurance Corp. will pay a civil penalty of $576,950 for violations including the failure to adhere to deadlines for utilization reviews and failure to include detailed explanations of adverse determination notices.

Regarding Aetna, a DFS market conduct examination found that from 2012 through 2015, Aetna failed to comply with a number of consumer/provider protections, including: completing pre-authorizations determinations within three business days of receipt of all necessary information; Responding to members’ complaints within the required time frames; sending initial adverse determination letters to the insured and providers within 30 days; and making an appeal determination within 60 days of all necessary information to conduct an appeal.

Under the consent order, Aetna will review and revise all of its procedures related to utilization review, appeals, grievances and complaints to ensure that timely determinations and notifications are given to insureds, providers, and other recipients.  Moreover, Aetna will reprocess all preventive care claims where cost sharing was inappropriately applied and make overdue payments, including interest; and reprocess all claims that were inappropriately denied, and make overdue payments, including interest.

Regarding Oscar, a DFS market conduct examination found that from 2013 through 2015, Oscar failed to comply with a number consumer/provider protections, including: failing to make a determination for prospective utilization reviews within three business days; Failing to make a determination for concurrent utilization reviews within one business day; and failing to include an accurate and detailed explanation of the clinical rationale for the denials in the adverse determination notices;

Under the consent order, Oscar Insurance will be: revising EOB statements to include the appropriate forfeiture language; revising adverse determination notices to include a detailed explanation of the clinical rationale for denials; and reviewing and revising all procedures, related to utilization review to assure that timely determinations are made.

A copy of the Aetna consent order can be found here.

A copy of the Oscar Insurance Company consent order can be found here.


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Millions Expected To Drop Health Coverage in 2019 with Repeal of ACA Penalty
Kaiser Health News piece predicts that millions of Americans are likely to drop their health insurance for next year now that the ACA’s penalty for not having coverage has been eliminated. The Congressional Budget Office predicted that “the repeal of the penalty would move 4 million people to drop their health insurance next year – or not buy it in the first place – and 13 million in 2027.” The article says some consumers “who from the start hated the Affordable Care Act, or Obamacare as it is often called, will drop their coverage as a political statement,” while others will do so because of affordability.


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NY Hospitals Reach Settlement, Agree To Stop Improper Billing of Rape Survivors
A group of New York hospitals has agreed to pay restitution to rape survivors and revise billing procedures as part of a legal settlement, state Attorney General Barbara Underwood announced Nov. 29.

The settlement resolves allegations that the hospitals illegally billed at least 200 forensic exams to rape survivors, ranging from $46 to $3,000 each, according to Ms. Underwood.

Hospitals are Brookdale University Hospital Medical Center in Brooklyn; Montefiore Nyack (N.Y.) Hospital; New York Presbyterian/Brooklyn Methodist Hospital; New York-Presbyterian/Columbia University Irving Medical Center; Staten Island-based Richmond University Medical Center; and Bronx-based St. Barnabas Hospital. Columbia University, which employs physicians, is also included.

The hospitals have agreed to pay restitution to rape survivors, in addition to costs, and implement written policies to prevent rape survivors from receiving bills for their rape exams. The settlements follow an investigation of billing practices for forensic rape examinations at Brooklyn Hospital Medical Center. Ms. Underwood said the investigation resulted in an agreement with the hospital, and her office initiated a statewide investigation of billing practices for rape exams at other facilities.

New York law requires that hospitals bill rape exams to the state Office of Victim Services directly, unless the sexual assault survivor voluntarily decides to assign the costs to a private health plan. (Becker’s Hospital Review 11/30)

Free Dinner Symposium for Physicians in Independent Practice
To address the needs of physicians in independent practice, PrescRXptive Communications and E Central Medical Management are co-sponsoring the third annual Toolkit for Independence: Tips and Techniques for a Successful Medical Practice, a complimentary dinner symposium packed with insights to help independent medical practices thrive. The event will be held on Thursday, January 10, from 5:30 – 9:30 p.m. at Jewel Restaurant in Melville.

The symposium is free for physicians and office managers who are accompanied by a physician. The evening includes a cocktail hour and sit-down dinner. There are limited seats available. For additional information, call 631-606-0525. To register, visit http://toolkit-for-independence.eventbrite.com/. 

2019 ACPH Call for Abstracts Now Open through March 29, 2019
Showcase your work at the American Conference on Physician Health (ACPH)! The conference, which is being hosted by the American Medical Association, Mayo Clinic and Stanford University School of Medicine, is being held September 19-21, 2019 at the Sheraton Charlotte Hotel/Le Meridien in Charlotte, NC. Authors are invited to submit abstracts for consideration as part of the 2019 ACPH. Submissions will be accepted from December 10, 2018 to March 29, 2019.

Submit your abstract in one of two categories:

  • Research: submitted as either a poster or oral presentation
  • Workshop: submitted as an interactive session

*research and non-research workshops considered

Be sure to visit the conference website physician-wellbeing-conference.org to review important details in our “Call for Abstracts” section, as well as the instructions for submitting abstracts. Submissions for all abstracts must be made electronically via the abstract submission form, information available at the ACPH 2019 Call for Abstracts website. Please contact us at physicianhealth@ama-assn.org with any questions or requests.

CME WEBINARS

“Public Health Preparedness 101” CME webinar
January 16, 2019 at 7:30am – Registration now open

Are you prepared for a public health emergency?  And are you ready for one as well?  MSSNY’s next Medical Matters webinar is Public Health Preparedness 101 on January 16, 2019 at 7:30am.  Registration is now open for this program here.  Faculty for this program will be Kira Geraci-Ciardullo, MD, MPH and Arthur Cooper, MD, MS.

Educational Objectives:

  • Inform physicians and staff on how to prepare professionally and personally for a public health emergency.
  • Describe the importance of readiness in addition to preparedness

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

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


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DISABILITY

What Should Clinicians Know About Disability?
Approximately 1 in 5 adults reports a disability, and health care professionals play distinctive roles in defining disabilities and treating individuals with them. Better care for the great diversity of people with disabilities “requires better engagement with and reflection upon the rich and complex meaning of disability,” writes Joel Michael Reynolds, The Hastings Center’s Rice Family Fellow in Bioethics and the Humanities, in the AMA Journal of Ethics. Reynolds outlines a set of recommendations and duties clinicians have when encountering patients with disabilities, including the responsibility to recognize the authority of these people as experts about their own experiences. Read the article.


CMS

QPP Tip: Avoiding 2020 MIPS Payment Adjustment – The Minimum to Report
The “test” and “partial” participation options that were available for the CY 2017 MIPS participation period are no longer available for the CY 2018 MIPS participation period. To avoid the 2020 MIPS payment adjustment, based on 2018 MIPS participation, physicians will need a minimum of 15 points across all four MIPS categories – quality, improvement activities, promoting interoperability, and cost. Potential ways to achieve the minimum 15 points include:

  • 100 percent score in improvement activities category – reporting medium/high weight activities to achieve a total of 40 points
  • Achieving 18 points out of a total of 60 points (if reporting 6 measures) for the quality category
    • Reporting six measures for at least 60 percent of applicable patients
    • Earning the maximum 10 points for a high-performance score for at least two measures, which have benchmarks and are not “topped out” measures
  • Reporting the ACI base score measures and either:
    • Reporting at least one quality measure for at least 60 percent of applicable patients
    • Reporting one improvement activity
    • Receiving a small practice bonus
    • Receiving a complex patient bonus of at least three points


For additional information, please see Step 5 of the Navigating the QPP Resource  available on PAI’s MACRA QPP Resource Center.

 


Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


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

58th Street room1 58th Street room2 58th Street room3


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


PHYSICIAN OPPORTUNITIES

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


November 30, 2018 – Single Payor Update!

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
November 30, 2018
Volume 21  Number 43

MSSNYPAC Seal

Colleagues:

The MSSNY Enews staff had some well-deserved rest during the Thanksgiving holiday.  During the holiday, I spent some time with family and friends and many of my patients.  I also spent some time on MSSNY business and reflected on all I have to be thankful for.

I’m thankful for each and every one of our members.  Your support of MSSNY allows us to continue to advance the interests of our patients, the public health of the citizens of New York State, the best practice of medicine, and stewardship of our profession.  I’m thankful for each of our MSSNY Committee members, and especially my Committee Chairs. Their devotion to creating and crafting policy to improve care, and to promote the art of science and medicine, is critical to the lifespan and health span of our fellow New Yorkers.

Thanks to the MSSNY Council members. We truly are in a new Golden Age of medicine.  Your help in prioritization and refinement of the many activities that occur under the MSSNY umbrella is invaluable to me as we work to continue to expand our reach and impact on behalf of our patients. I’m especially thankful for the thoughts and efforts of my colleagues in the Office of the President, Dr. Bonnie Litvack, Dr. Arthur Fougner, and Dr. Charles Rothberg. They provide constant feedback and assistance to me as we represent MSSNY across the state and throughout the nation.

Finally, I’m most thankful for the MSSNY staff.  Mr. Phil Schuh, our MSSNY Executive Vice President, leads a talented and devoted team that supports and enhances our efforts on behalf of our members.

I hope that each of you were able to spend time with your families and have had some time to recharge your batteries for the important work you do for the people of New York.

I also had some time to catch up on some reading and recommend to you an article in Health Affairs which discusses how “to fix” primary care.

I’ve been practicing geriatric medicine for a number of years. Experts have been trying to fix primary care from the time I entered medical school. The solutions proposed haven’t changed much. However, we are always on the lookout for new solutions in this changing climate for physicians.

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

Excelsior!

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance for Doctors


eNews

Single Payor Legislation Update
With Democrats now in control of both Houses of the State Legislature, it significantly enhances the possibility of the enactment of the New York Health Act (NYHA), legislation to establish a single payer system. NYHA would provide universal insurance coverage without copays, deductibles or premiums for all New Yorkers. It would also prohibit health insurance companies from offering similar coverage.

According to the recent RAND study it would require $139 billion in new tax revenue (a 156% increase) by 2022. The bill has passed the Assembly several times in recent years but was never voted on in the previously Republican controlled Senate. Its current incarnation is sparse – just 23 pages of text – and does not include significant details sought by many stakeholders regarding how such an enormous proposal would be implemented.

Earlier this fall, MSSNY and New York County Medical Society leadership met with Assembly Health Committee Chair Richard Gottfried (and NYHA bill sponsor) to discuss questions expressed by physicians both in opposition and in support of the NYHA bill, including:

  • How burdensome will prior authorization requirements be?
  • What will be the process for patients to appeal when recommended care has been denied?
  • How meaningful will be the right for physicians to collectively negotiate with a NYHA Board?
  • Could state budget limitations result in a grossly inadequate Medicaid-type payment structure that would make it impossible for many physicians to remain in practice in New York?
  • Should liability reform be included given the enormous medical costs arising from “defensive medicine”?

In recent days leaders in New York state government have tempered expectations following the election.  Incoming Senate Majority Leader Andrea Stewart-Cousins stated this week that “It’s a conversation we have yet to have in the Senate…I can certainly commit to having it heard.”  Governor Cuomo has stated “Conceptually I think it’s the right way to go in. I believe it’s more feasible financially on the national level. No state has been able to finance the transition costs.”  Democratic Senator Elect Alessandra Biaggi, a strong supporter of the single payer concept stated “…that’s going to mean taking some time to be thoughtful about how we’re going to pay for it.” Bill Hammond, noted health policy expert and the Empire Center’s Director of Health Policy, has repeatedly voiced concerns over the many possible negative consequences of the proposal.

Senator Gustavo Rivera, who is widely expected to take over as Chair of the Senate Health Committee in 2019, stated this week that he and Assemblyman Gottfried would soon be releasing a new version of the New York Health Act to address concerns from “stakeholders”. He did acknowledge that it is an “incredibly complicated piece of legislation”, admitting that change would be gradual and would not take place overnight, stating “If it were to pass today, it would still take two to three years to put all the regulations together that would be necessary to make the transition.”

The NYHA seemingly has a path forward this year with Democrats controlling state government, but it remains to be seen if all sides will align, configuring the details necessary to make the system actually work and gathering enough support to bring it to fruition.  One “wild card” is the fact that there will be 14 new Democratic State Senators in Albany in 2019.  With the consideration of this issue so fluid, please remain alert for further updates.

NY Comptroller Tom DiNapoli Discrepancies Show I-STOP Needs to Be Better
A new audit has found about a third of New Yorkers on Medicaid being treated for opioid addiction received a prescription for narcotic painkillers over a four-year period — highlighting a potential problem nationwide with drug monitoring systems. The New York comptroller’s audit this week said of those addicts who found a doctor to prescribe them opioids between Oct. 1, 2013, and Sept. 30, 2017, 3 percent — or nearly 19,000 people –sought medical care for an overdose within a month of filling those prescriptions. Twelve died.

The audit found that treatment programs did not always check the state’s Internet System for Tracking Over-Prescribing (I-STOP) database. The study found a sample of 25 patients from three treatment programs received more than 1,000 Medicaid opioid prescriptions while in treatment for abuse over the four-year period. New York law requires treatment programs to check the I-STOP database every time a medication-assisted opioid was prescribed for take-home use.

DiNapoli recommended that the DOH develop a method for notifying treatment programs when the database shows Medicaid recipients receive potentially dangerous prescriptions. His office also suggested the programs upload their own patient info when accessing the database, and that the DOH conduct risk assessments for individuals receiving medication-assisted treatment.



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NY DFS Approves CVS-Aetna with Several Conditions
The New York State Department of Financial Services (DFS) announced their final approval of the massive proposed acquisition of Aetna by CVS, albeit with numerous conditions, paving the way for the consolidation of two of the nation’s largest healthcare companies. New York was one of the last states to approve the transaction after it was approved by the US Department of Justice and several other states.

The full list of conditions, designed to ensure fair business practices by the merged entity, can be found here. The conditions include:

  • Prohibiting use of funds from any Aetna company or affiliate covering New Yorkers to pay for its acquisition;
  • Prohibiting costs derived from the acquisition, including executive compensation, from being passed on to any domestic or foreign Aetna New York insurer;
  • Prohibiting increased health insurance rates to pay for the cost of the acquisition;
  • Prohibiting dividends to be paid by Aetna without the express prior approval of DFS for 3 years;
  • Prohibiting preferential PBM pricing to any Aetna-affiliated health insurer licensed in New York, to better ensure insurance competitors can continue to fairly purchase PBM services from Caremark;
  • Limiting changes to Aetna’s healthcare provider networks for 3 years, including maintaining access to non-chain New York pharmacies;
  • Contributing $40 million to New York State, to support health insurance education and enrollment activities and strengthen New York health care transformation activities, which may include payments to the New York State Health Care Transformation Fund
  • Requiring an independent third-party audit to assess whether Aetna employees have accessed Confidential Information in violation of firewall policies.

Moreover, the DFS press release noted that “CVS committed at the DFS public hearing in October and as part of the approval process that CVS Health and its subsidiaries will take no action to oppose” legislation requiring a New York license for PBMs to operate.

While the conditional approval agreement addresses to some degree some of the concerns raised by MSSNY over the last year, physicians remain very concerned about the adverse impact to the health care delivery system in New York given the enormous reach of this transaction.  MSSNY President Dr. Thomas Madejski stated “We thank the DFS for their efforts to push for legislation to control the ability of PBMs to limit patient access to needed medications. We applaud the extensive review that the DFS provided to this transaction and the conditions they imposed to help minimize the enormous impact that this merger will have on our health care system.  We do remain concerned, however, that there may not be sufficient steps imposed to control the enormous power that this merged entity could use to marginalize physician-led medical homes as it expands its corporate driven healthcare model. Physicians fully expect that the merger will further reduce competition in New York’s health insurance market.  This is one more reason why physicians deserve the right to collectively bargain against corporate behemoths that seek to limit our ability to deliver needed care to patients.”

MSSNY will also be providing testimony for a December 7 DFS hearing to express its similar concerns with the proposed acquisition of PBM Express Scripts by Cigna.


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Would You Like to Share MSSNY’s The Daily with Other Professionals in your Practice?

MSSNY is ready to extend this popular member benefit to the PAs and NPs on your staff.

If you’re interested, please send the email addresses of the appropriate professionals in your office to rraia@mssny.orgso they can begin to enjoy this daily sweep of healthcare news.

 


MSSNY Raises Concern with DOH Proposal Regarding Office-Based Surgery Reports
MSSNY has written to the New York State Department of Health to express its concerns and suggested revisions to regulations proposed by the NYSDOH that would require Office-Based Surgery (“OBS”) practices to report cumulative procedural information to NYSDOH. The proposed reporting requirements were published in the New York State Register on October 17 with a 60-day comment period.

The proposed regulation would require each OBS practice to report in a “form and format specified by the Department” information including, but not limited to, practice identifiers, types of procedures, and number of each type of procedure performed in office-based surgery practices.  The proposed regulation would also set forth the manner for how adverse events are reported to DOH, as well as grant the DOH discretion to use the data gathered to develop and implement guidelines and criteria for quality improvement.

The MSSNY comments to the NYSDOH note its agreement with the goal of the proposed regulation to help place in context how frequent or rare particular adverse events are occurring in OBS settings, given the importance of quality improvement to assuring patient safety.  However, MSSNY expressed concerns with the lack of needed specificity in the proposed regulation, including the specific information OBS practices will be required to report to DOH on an ongoing basis.

Moreover, MSSNY’s comments raise concerns that some practices could find it difficult to report procedural information in a manner to be determined by DOH given that physicians are at different stages of implementing Electronic Health Record (“EHR”) systems.  Given the significant EHR implementation challenges facing many physicians, some physicians have either not implemented them or use very rudimentary systems, making a new requirement for the collection and reporting of information difficult to satisfy.  Furthermore, there were concerns with the possibility that procedures could be required to be reported by its CPT code, even though some OBS facilities do not internally track these services by CPT code (since they are not submitted to insurance).

Recognizing the goal of the regulation to facilitate quality improvement and patient safety, MSSNY has also suggested that DOH amend the regulation to permit OBS accrediting bodies to file these reports on the physician’s behalf since the information sought by DOH often overlaps with reports that many physicians are already making to their respective OBS accrediting bodies.

Physicians with comments on this proposal can send them to regsqna@health.ny.gov.


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US Life Expectancy Decreases Again, CDC Report Finds
On its front page, the Wall Street Journal (11/29) reports data from the Centers for Disease Control and Prevention show that life expectancy for Americans declined again last year by one-tenth of a year, to 78.6 years. An increase in suicides, as well as the continued effects of the opioid crisis, influenza, pneumonia, and diabetes factored into the statistics, the Journal explains.

The data “continued the longest sustained decline in expected life span at birth in a century, an appalling performance not seen in the United States since 1915 through 1918.” The report found “men could anticipate a life span of 76.1 years, down a tenth of a year from 2016,” and “life expectancy for women in 2017 was 81.1 years, unchanged from the previous year.” “Suicides and drug overdoses pushed up U.S. deaths last year, and drove a continuing decline in how long Americans are expected to live.” Dr. Robert Redfield, the director of the CDC, said, “These sobering statistics are a wake-up call that we are losing too many Americans, too early and too often, to conditions that are preventable.”


Claims Data Show Telemedicine Visits Surging in US
Woman doctor in telemedicine health conceptJAMA reported that telemedicine visits in the US “have increased sharply,” but “the vast majority of American adults still receive care from doctors in person rather than via remote technology.”

Thirty-two states had passed laws that required parity in insurance coverage and reimbursement for telemedicine by 2016, so the researchers looked at insurance claims data from OptumLabs Data Warehouse for the period from 2005 to 2017 to see how the laws affected those claims. They found telemedicine visits rose from 206 visits in 2005 to “more than 202,000 visits in 2017,” with most of the growth occurring in the last years of the study period. Those visits translated to “an average annual compound growth rate of 52 percent from 2005 to 2014 and an annual average compound growth rate of 261 percent from 2015 to 2017.”


New Online Tool Displays Cost Differences for Certain Surgical Procedures
CMS launched a new online tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers. The Procedure Price Lookup tool displays national averages for the amount Medicare pays the hospital or ambulatory surgical center and the national average copayment amount a beneficiary with no Medicare supplemental insurance would pay the provider.

“Price transparency in health care is a priority for the Trump Administration. Working with their clinicians, the Procedure Price Lookup will help patients with Medicare consider potential cost differences when choosing where to have a medical procedure that best meets their needs,” said CMS Administrator Seema Verma.

The Procedure Price Lookup tool is launching as required by Congress in the 21st Century Cures Act. Medicare’s statutes require that CMS maintain separate payment systems for different types of healthcare providers, meaning both CMS and patients may pay different amounts for the same service, depending on the site of care.

Procedure Price Lookup, part of the agency’s eMedicare initiative, joins other patient-oriented transparency tools, including an overhauled version of the agency’s drug pricing and spending dashboards, which provide patients with Medicare and Medicaid spending information for thousands more drugs than ever before and, for the first time, list the prescription drug manufacturers that were responsible for price increases.

CMS recently launched the eMedicare initiative to empower beneficiaries with cost and quality information. This announcement included the launch of an enhanced interactive online decision support feature to help people better understand and evaluate their Medicare coverage options. eMedicare also offers a mobile-optimized out-of-pocket cost calculator to provide beneficiaries with information on overall plan costs and prescription drug costs.

For a blog post on the Procedure Price Lookup took by Administrator Verma, please go here.

The Procedure Price Lookup tool is available here.


Dr. First Banner


Boston Partners Mandates Flu shots for All 74K employees
Boston-based Partners HealthCare is requiring all 74,000 employees to receive flu shots for the first time, reports The Boston Globe.

Under the mandatory flu shot policy, employees who don’t get vaccinated or provide a valid reason for skipping the flu shot could lose their jobs. The policy applies to all hospital-based workers, as well as thousands of employees who work at Partners’ corporate office in Somerville, Mass.

“If you are able and remain unwilling to protect yourself and protect our patients [from the flu], you probably should not be working in healthcare,” Gregg S. Meyer, MD, Partners’ chief clinical officer, told The Boston Globe. “My sincere hope is that absolutely no one will lose their job over it. … We will do everything we can to convince people.”

The policy took effect this fall. So far, 99 percent of employees have received a flu shot or an exemption for religious or medical reasons, Partners officials told The Boston Globe.

Partners modeled the system wide policy on a mandatory vaccination policy Boston-based Brigham and Women’s implemented in 2017.

Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, has notified parents that if their children are not vaccinated, or if they follow an alternative vaccination schedule, that they will be denied medical services. They also notified parents that they will not honor Florida State law that allows for religious exemptions to vaccines.


Unitedhealth Group to Buy Seattle Primary Care Clinic
UnitedHealth Group will acquire a controlling stake in Polyclinic, a large physician-owned primary and specialty care clinic in Seattle — the latest move in the company’s push to expand its direct patient care business, according to The Seattle Times. Under the deal, Polyclinic’s 210-physician practice would merge with Optum Health, a subsidiary of UnitedHealth. The Optum business manages physician groups around the country.

Polyclinic was founded in 1917 by six Seattle physicians and has grown to become one of the largest multispecialty groups in the nation. Despite its ability to scale in size, the practice found it hard to compete with other Seattle area healthcare providers such as Swedish Medical Center and the University of Washington Medical Center.

By merging with Optum, Polyclinic will be able to tackle “the things that you just need to be big enough to afford to do,” UnitedHealth Group CEO David Wichmann told investors during a meeting in New York, according to the Times.

The deal also will expand the clinic’s access to technologies and other physician groups within Optum. The acquisition needs approval from the Federal Trade Commission and would supplement a separate deal with DaVita Medical Group to acquire the 500-physician Everett Clinic, a primary and specialty clinic based in Seattle, and Northwest Physicians Network, a 1,000-plus physician practice in Pierce County, Wash.


Romaine Lettuce

It’s OK to Eat Some Romaine Lettuce Again;
Just Check the Label
The FDA narrowed its blanket warning from last week, when it said people shouldn’t eat any romaine because of an E.coli outbreak. The agency reported on November 26 that the romaine linked to the outbreak appears to be from the California’s Central Coast region. It said romaine from elsewhere should soon be labeled with harvest dates and regions, so people know it is good to eat.

Consumers should not eat romaine that doesn’t have the label information, the FDA said. For romaine that doesn’t come in packaging, grocers and retailers are being asked to post the information by the register.

Romaine harvesting recently began shifting from California’s Central Coast to winter growing areas, primarily Arizona, Florida, Mexico and California’s Imperial Valley. Those winter regions weren’t yet shipping when the illnesses began. The FDA also noted that hydroponically grown romaine and romaine grown in greenhouses aren’t implicated in the outbreak.

The labeling arrangement was worked out as the produce industry called on the FDA to quickly narrow the scope of its warning so it would not have to waste freshly harvested romaine. Consumers can expect to start seeing labels as early as this week. It noted that the labels are voluntary and that it will monitor whether to expand the measure to other leafy greens and produce.

The FDA said the industry committed to making the labeling standard for romaine and is considering longer-term labeling options for other leafy greens.


CME WEBINARS

“Evidence-Based Treatment for Tobacco Dependence”
WEBINAR December 4th
REGISTRATION NOW OPEN 

Register now for “Evidence-Based Treatment for Tobacco Dependence” webinar on, December 4, 2018 at 7:30 a.m.   This program is being jointly sponsored by St. Peter’s Health Partners Community Health Programs; the Medical Society of the State of New York and Glens Falls Hospital Health Promotion Center.

Michael B. Steinberg, MD, MPH, FACP, Director of Rutgers Robert Wood Johnson Medical School Tobacco Dependence Program will serve as faculty for this program.  The objectives are for physicians to: 1) Increase their knowledge of seven FDA-approved tobacco treatment pharmacotherapies. 2) Counsel smokers by prescribing tobacco treatment pharmacotherapy to improve their tobacco cessation attempt outcomes including the use of combination therapy. 3) Increase their knowledge in regard to public insurance plans that cover NRTs.  4) Understand the importance of implementing a tobacco dependence treatment policy within their practice which includes the 5As.

This program can be attended either via Webex or at a remote site in the North Country. View the flyer and register here.

This activity has been planned and implemented in accordance with the Accreditation Requirements and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Medical Society of the State of New York (MSSNY) and St. Peters Health Partners.  MSSNY is accredited by the ACCME to provide continuing medical education for physicians.

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Additional information or assistance with registration may be obtained by contacting Community Health Programs for Webex assistance: (518) 459-2550 – or- for remote site registration contact Shannon Morrison-Gaczol at smorrison-gaczol@glensfallshosp.org.


The Continued Public Health Threat of Measles: 2018 CME Webinar
December 12, 2018 at 7:30am – Registration now open

In response to the recent and expanding measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 roster.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program.  Registration is now open for this program here.

Educational Objectives:

  • Increase physician’s awareness of the role of measles as a re-emerging infection.
  • Discuss strategies to improve vaccination rates.
  • Explore herd immunity and the role it plays in recent measles outbreaks.

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

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


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Classified

RENTAL/LEASING SPACE

Beautiful Medical Office Suite Available for Sublease in Rockville Centre
Well-appointed medical office building with enclosed private parking. Large waiting room and reception area with adjacent kitchen. Three consultation rooms and large procedure room/operating suite. Flexible availability with all mornings available or 2 full weekdays and weekends available. Perfect for plastic surgeon/dermatologist/ENT/ObGyn/podiatrist or other medical MD. Contact Harriet at harriet@plasticsurgerypc.com or 516-466-7000.


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


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

58th Street room1 58th Street room2 58th Street room3


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


PHYSICIAN OPPORTUNITIES

Physician Insights Wanted to Help Shape the Future of Primary Care
98point6 is a healthcare technology company committed to delivering more affordable, accessible, high-quality primary care. To support our mission, we need the insights of forward-thinking physicians that have opinions about the current state of primary care and are interested in the role technology can play in healthcare. Members of our exclusive Primary Care Council have no clinical responsibilities and are generally compensated for participation, which requires only a few hours per year. Interested? Learn more and apply today at www.98point6.com/pcc


Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and community partners, Send resume to neurosciencesgroup@gmail.com


Is Your Business Website Compliant with The Americans with Disabilities Act (ADA)?
If not you may be subjected to legal action! We can do a free audit of your website and let you know what corrections are needed.
Call 516-830-1973 or visit tinyurl.com/ADAWebsiteHelp for more information.


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

November 16, 2018 – WSJ, AMA and Wild Fires

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
November 16, 2018
Volume 21  Number 42

MSSNYPAC Seal

Colleagues:

I spent last weekend in National Harbor, Maryland, at the Interim AMA Meeting with our hard working delegation. I am a member of the Council on Medical Service and at our meeting, the following item was discussed:

AMA’s CMS Report 4 addresses Site of Service Differential. The AMA supports Medicare payment for the same service routinely and safely provided in multiple outpatient settings (Office, HOPDs and ASCs) that are based on sufficient data regarding the actual cost in each setting. The AMA approved an amendment to its existing policy so that outpatient services are site neutral without lowering Medicare payments. 

Other major directives discussed are:

  • Physicians again forcefully spoke out on gun-violence policy as AMA delegates adopted policy calling for a better background-check system for firearms purchases, a ban on 3D-printed firearms, and “gun violence restraining orders” for people arrested or convicted of domestic violence or stalking.

The AMA’s actions stem from comprehensive policy adopted in previous House of Delegates meetings to stem the deadly toll of firearm violence.

  • Better data needed to guide suicide prevention efforts among physicians and medical students. Citing the high rate of suicide completion among medical professionals when compared with the general population and work-related stress as a risk factor for doctors, delegates want a better understanding of patterns linked to physician and medical student suicide. Long work hours are commonly cited as a reason for the prevalence of mental illness and burnout among physicians and medical students, but additional institutional factors can contribute to suicide.

  • Sex education should include age-appropriate content on bullying, consent. More than 11 percent of high-school girls are victims of forced sex, along with 3.5 percent of high-school boys, says a 2017 Centers for Disease Control and Prevention survey. To encourage this approach, delegates directed the AMA to “support state legislation mandating that public middle and high school health education programs include age-appropriate information on sexual assault education and prevention, including but not limited to topics of consent and sexual bullying.”

  • Help homeless people get the government ID cards often needed to access medical care. More than 3.5 million Americans will experience homelessness at some point in a given year—and nearly 80,000 are chronically homeless. Lack of government-issued identification remains a major barrier to seeking medical care. Delegates adopted new policy to: Recognize that among the homeless population, lack of identification serves as a barrier to accessing medical care and fundamental services that support health. Support legislative and policy changes that streamline, simplify and reduce or eliminate the cost of obtaining identification cards for the homeless population.

Other important issues:

  • Prescription-drug importation from Canada.
  • Improved access to preventive care.
  • Rural health disparities.

California Doctors

Our hearts go out to all those who have suffered tremendous losses in the California wild fires. Past President of the California Medical Association President Dick Thorpe, lost his house in Paradise, where his internal medicine practice is also located. They have kept their doors open by temporarily moving it to Chico. You can help our friends in California at their website.

Wall Street Journal and Marijuana

Finally, I made it into the Wall Street Journal. It was not for the usual reasons, but they actually published my letter to the editor regarding MSSNY’s stance on marijuana in response to an editorial from former Speaker of the House of Representatives, John Boehner, a consultant to the marijuana industry.

Contact me at comments@mssny.org.

Thomas J. Madejski, MD
MSSNY President


MLMIC Insurance for Doctors


 

eNews

NYU Langone to Open New Medical School on Long Island by September 2019
NYU Langone plans to open a new medical school on Long Island by September 2019 that would exclusively train primary care physicians, NYU President Andrew Hamilton announced at a University Senate meeting on Thursday.

“We have the opportunity to create a new medical school that would focus exclusively on primary care physicians,” Hamilton said. “It will be a three-year program focused on training physicians to become practicing doctors in primary care in communities.”

Over the last two years, Langone has merged with Winthrop Hospital on Long Island, and this would be the site of the new medical school. Hamilton mentioned an existing infrastructure of dormitories and educational facilities at Winthrop Hospital, which would make a transition into a full-blown medical school easier. There are several steps still to go before the medical school could be deemed official, such as receiving state approval. If approved, the school would enroll 40 students per semester, potentially by as early as September 2019 according to Hamilton.


FDA Increasing Scrutiny of Drug Manufacturing Processes In Light of Recalls
FDA Commissioner Scott Gottlieb, M.D., announced “the agency is increasing its focus on drug quality to guard against impurities such as the potentially cancer-causing chemicals that have been found in three commonly prescribed blood pressure medications.” Following the recall of valsartan, irbesartan, and losartan, Dr. Gottlieb said the FDA has recruited “dozens of chemists to review pharmaceutical companies and monitor for any changes in manufacturing techniques” to help “prevent drug impurities that may be harmful to consumers.” The article points out that the agency is currently “investigating the scope of the manufacturing problem that led to the recalls.” USA Today (11/14)


Older Age and Lack of Experience with Transgender May Hinder Caring
Findings published in the Annals of Family Medicine.(11/12,Subscription Publication) reports, “Older age and lack of personal experience with transgender individuals may correlate inversely with a clinician’s willingness to care for transgender patients,” The authors of an accompanying editorial write that transgender people often report feeling stigmatized or misunderstood by healthcare” professionals. The editorialists “use a hypothetical case scenario to show how physicians and their office staff can communicate with transgender patients in sensitive and respectful ways.”


NY Rx Card Banner


Workers with Highest Suicide Rates Have Construction, Mining, and Drilling Jobs
On November 16, The Centers for Disease Control and Prevention published in their Morbidity and Mortality Weekly Report that “workers with the highest suicide rates have construction, mining and drilling jobs.”  The findings corrected “an earlier study that mistakenly said farmers, lumberjacks and fishermen killed themselves most often.” In arriving at these conclusions, investigators examined data on “22,000 people who died of suicide in 2012 and 2015, and what jobs they held.”


SAVE THE DATE for the MSSNY Sections Annual Meeting: Young Physicians, Residents and Fellows, and Medical Students. Saturday, February 9, 2019. Contact sbennett@mssny.org

SYMPOSIUM/CME

Cybersecurity: A Daily Threat for Healthcare” CME webinar RESCHEDULED

November 28, 2018 at 7:30am Registration now openThe originally scheduled Medical Matters free CME webinar: Cybersecurity: A Daily Threat for Healthcare was unexpectedly cancelled owing to insurmountable weather and traffic conditions in the Capital District on November 14, 2018.

There were multiple road closures leading into Albany from every direction, preventing MSSNY staff and program faculty from reaching the MSSNY offices.  This was additionally compounded by technical difficulties that prevented MSSNY staff from accessing email remotely.

MSSNY has rescheduled this program for November 28th at 7:30am.  Register here for Medical Matters: Cybersecurity: A Daily Threat for Healthcare.  Mahesh Nattanmai, Deborah Sottolano, PhD of New York State Department of Health and Peter Bloniarz of the New York State Cyber Security Advisory Board will serve as faculty for this program.

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.

Educational objectives are:

  • Describe vulnerabilities within medical practices, hospitals and daily life
  • Identify methods to increase protection from cyberattacks
  • Review methods for reporting and responding to a cybersecurity incident

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

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


“The Continued Public Health Threat of Measles 2018” CME webinar
December 12, 2018 at 7:30am – Registration now open

In lieu of the recent measles outbreaks in New York State, MSSNY has added a just-in-time Medical Matters webinar to our 2018-19 schedule.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program.  Registration is now open for this program here.

Educational Objectives:

  • Increase physician’s awareness of the role of measles as re-emerging infection.
  • Discuss strategies to improve vaccination rates.
  • Explore herd immunity and the role it plays in recent measles outbreaks.

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

The Medical Society of the State of New York designates this live activity for a maximum of 1.0 AMA/PRA Category 1 credits™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity. 


Alzheimer’s Disease Research Symposium at Stonybrook on November 19
Learn from key experts about the important research being conducted at Stony Brook Medicine in the field of Alzheimer’s disease. The Stony Brook Center of Excellence for Alzheimer’s Disease will present a symposium on Monday, November 19, from 12 pm to 2 pm in the Health Sciences Tower, Galleria, Level 3.

No registration is required. For more information, email Daphne.Perry@stonybrookmedicine.edu or call (631) 632-3074.


Garfunkel Ad


FDA

FDA Approved Supplemental Application for Gardasil 9
The US Food and Drug Administration (FDA) has approved a supplemental application for Merck’s 9-valent human papillomavirus vaccine (Gardasil 9) to include women and men aged 27 through 45 years.

The CDC has stated that HPV vaccination prior to becoming infected with the HPV types covered by the vaccine has the potential to prevent more than 90% of these cancers, or 31,200 cases every year, from ever developing. The CDC estimates that every year about 14 million Americans become infected with HPV. About 12,000 women are diagnosed with cervical cancer and about 4000 women die from cervical cancer caused by certain HPV viruses. HPV is also associated with several other forms of cancer affecting men and women.

In 2014, the FDA approved Gardasil 9, which covers the same four HPV types as Gardasil as well as five additional types (31, 33, 45, 52, and 58). Gardasil 9 was first approved for use in males and females aged 9 through 26 years.

According to the FDA, in a study in roughly 3200 women aged between 27 and 45 years followed for an average of 3.5 years, Gardasil was 88% effective in preventing the combined endpoint of persistent infection, genital warts, vulvar and vaginal precancerous lesions, cervical precancerous lesions, and cervical cancer related to HPV types covered by the vaccine.

The safety of Gardasil 9 was evaluated in a total of about 13,000 males and females. The most commonly reported adverse reactions were injection-site pain, swelling, redness, and headaches.

The FDA granted the Gardasil 9 application priority review status, a program that facilitates and expedites the review of medical products that address a serious or life-threatening condition.


Dr. First Banner


NYS Mediciad

Continuous Recruitment for NYS DUR Board Membership
Federal legislation requires States to maintain a DUR program and establish a Drug Utilization Review (DUR) Board.  The NYS Medicaid DUR Board provides recommendations to the Health Department associated with establishing clinical standards for Medicaid’s pharmacy program. The composition of the DUR Board can be found on pages 1 & 2 of the General Operating Procedures.

Responsibilities of the DURB include:

  • The establishment and implementation of medical standards and criteria for the retrospective and prospective DUR program.
  • The development, selection, application, and assessment of educational interventions for physicians, pharmacists and recipients that improve care.
  • The collaboration with managed care organizations to address drug utilization concerns and to implement consistent management strategies across the fee-for-service and managed care pharmacy benefits.
  • The review of therapeutic classes subject to the Preferred Drug Program.

CVs associated with interest in becoming a DUR Board member are accepted continuously and can be submitted to the DUR Board mail-box at dur@health.ny.gov. If no vacancies exist, CVs will be kept on file for consideration once a position becomes available. Questions on membership and candidacy can be directed to the DUR Board Member Liaison, Robert Sheehan, at dur@health.ny.gov or 518-486-3209.

For more information about the NYS Medicaid DUR Board please go here.


 


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Classified

RENTAL/LEASING SPACE


For Rent or Share – Woodbury, Long Island
Beautiful recently renovated Plastic Surgery Class C-M AAAA-certified Operating Room available for part-time share and available for rent. Centrally located on Long Island. Close to expressways.
1 exam room /OR. Waiting room & break room. Available for full or half-days. Free WIFI. Suits Plastic/Cosmetic Surgeons/Derm/ENT/ObGyn/Podiatry or other Medical MDs. Contact Kendra at Kendra@drmadnani.com or 516-226-1080


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

58th Street room1 58th Street room2 58th Street room3


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


PHYSICIAN OPPORTUNITIES

Internal Medicine Physician and Nurse Practitioner Wanted – Syracuse Area
Syracuse primary care practice recruiting for a highly motivated Internal Medicine Physician and Nurse Practitioner. Candidates should be interested in working closely with patients, care teams, and

community partners, Send resume to neurosciencesgroup@gmail.com


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


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Council – November 1, 2018

AGENDA
MSSNY Council Meeting
Thursday, November 1, 2018 9:00 a.m.
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590

A. Call to Order and Roll Call

C. New Business (All Informational/Action Items)

1. President’s Report
b. Dr. Madejski’s Letter to Assemblyman Gottfried regarding questions and concerns about single payor system in New York State. Assemblyman Gottfried’s response to MSSNY’s questions & comments. (For Council Information)
c. Letter to Governor Andrew Cuomo regarding legalization of regulated marijuana.(For Council Information)
d. MSSNY Strategic Planning Document (For Council Information)
e. Telemedicine Update – To be presented by Eunice Skelly (verbal)
    (For Council Information)

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

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

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

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

6. MSSNYPAC Report –  Dr. Joseph Sellers will present the report (handout)

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

8. CME Update – Dr. Mark Adams will present the report

9. Commissioners/Councilors Action Items
          Commissioner of Governmental Relations, Gregory Pinto, MD, Commissioner
1. Legislative & Physician Advocacy Committee, Paul A. Pipia, MD, Chair
 FOR COUNCIL APPROVAL
b. Resolution 66 – Life Threatening Complications with HIP Replacements
c. Resolution 115 – Chiropractor (D.C.) Scope of Practice

D. Reports of Officers
1. Office of the President  – Thomas J. Madejski, MD
2. Office of the President Elect – Arthur C. Fougner, MD
3. Office of the Vice President –  Bonnie L. Litvack, MD
4. Office of the Treasurer – Joseph R. Sellers, MD
    Financial Statement for the period 1/1/18 – 9/30/18
5. Office of the Secretary – Frank G. Dowling, MD,
AMA Letters expressing  concerns regarding the new Walmart corporate policy on Opioid prescriptions
6. Office of the Speaker – Kira A. Geraci-Ciradullo, MD

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

F.  Commissioners (Committee Informational Items)
1. Commissioner of Communications, Maria A. Basile, MD, MBA
    a. Report from the Division of Communications

2. Commissioner of Governmental Relations, Gregory Pinto, MD
a. HIT Committee Minutes, October 12, 2018
b. Long-Term Care Committee Minutes, September 30, 2018

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

4.    Commissioner of Science & Public Health, Joshua M. Cohen, MD
        (No written report submitted)
5.    Commissioner of Socio-Medical Economics, Howard H. Huang, MD
       a. Workers Compensation & No-Fault Insurance Committee re: EMG & NCS

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

H. Report of the General Counsel, Garfunkel Wild, P.C. , Donald R. Moy, Esq.
    (No written report submitted)

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

J.  Other Information/Announcements
1. Physicians Advocacy Institute Letter – RE: Medicare and State Health Care Programs: Fraud and Abuse; Request for Information (RFI) Regarding the Anti-Kickback Statute and Beneficiary Inducements CMP.
2. The Physicians Foundation 2018 Physician Survey (handout)
    the 2018 New York State Fair.
4. Blog Post Regarding MLMIC-Berkshire Hathaway
    https://www.mlmic.com/blog/physicians/mlmic-joins-berkshire-hathaway

K. Adjournment

MSSNYeNews: Medical Marijuana & You

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

Thomas J. Madejski, MD
MSSNY President


MSSNY eNews
June 22, 2018
Number 23

MSSNYPAC

Dear Colleagues:

This week, the New York State Department of Health Commissioner Howard Zucker, MD, announced that the department will develop a regulatory amendment to add opioid use as a qualifying condition for medical marijuana.  The proposed regulations would join 12 other qualifying conditions under the state’s Medical Marijuana Program, which also were recently updated to include chronic pain and post-traumatic stress disorder.

At the same time, the New York State Legislature passed Senate Bill 8987/A.11011, sponsored by Senator George Amedore and Assemblyman Richard Gottfried, that would allow physicians to certify patients to obtain medical marijuana for “pain that degrades health and functional capability where the use of medical marijuana is an alternative to opioid use, substance use disorder.” The Medical Society of the State of New York has opposed this measure because there is limited evidence to support the recommendation of marijuana as an alternative to opioid pain medications for pain and no data on opioid use or opioid use disorder.

On a personal basis, I practice palliative medicine and deal with a number of patients with chronic pain issues, and comorbidities including substance use disorders and mental health issues.  I have had many discussions with my patients regarding marijuana as an alternative to opioid and other non-narcotic pain medicines.   We have explored their use in reducing or obviating their need for opioids.  My anecdotal, uncontrolled experience is that marijuana may be helpful in a subset of patients.  While I am open to further exploration of marijuana as an additional tool in my armamentarium for easing my patients’ suffering, I am troubled by the promotion of this complicated medication with many variations in dosage form, composition and other poorly studied parameters as a panacea without more robust study and data on the long term consequences of use.

Marijuana for 12 Indications Should Be Measured

This DOH proposal seems to be an attempt to reduce risk or harms when engaging in dangerous behavior, and while this may be an argument to be made for using medical marijuana as a harm reduction strategy, the state should be clear that this is the case.   At this time, there are no established guidelines for treatment of acute pain.  In addition, there is insufficient evidence to support the recommendation of marijuana as an alternative to opioid pain medications for pain.  Furthermore, there is insufficient evidence to support marijuana as an alternative to other treatments for acute pain, including in patients with opioid use disorder. Instead of medical marijuana, MSSNY believes that placing a patient on Medication Assisted Treatment (MAT) for opioid use disorder may be a more appropriate option for treating pain when an alternative opioid pain medication may not be appropriate for those patients that suffer from opioid use disorder.  Any action by New York State to use marijuana for the treatment of any of the 12 indications must be measured, including this one.

MSSNY has always expressed concerns about federal prosecution against a physician who certified a patient for the use of marijuana.  Action by US Attorney General Jeffrey Sessions may allow federal prosecutors to more aggressively enforce marijuana laws—a nuance that we are concerned is not being sufficiently considered.

In addition to medical marijuana, this week, Commissioner Zucker, MD said that a state-commissioned study will recommend allowing recreational use of marijuana.  The report is not yet public, but the commissioner indicated that the report’s authors reached their conclusion after a review of the legal, medical and social implication of legalization.  MSSNY looks forward to further information and will comment when we have had an opportunity to review the data and conclusions.

“Not Yes or No, But How?”

When questioned about Dr. Zucker’s comments, Gov. Andrew Cuomo said the state will at some point legalize recreational use of marijuana, but not this year. What’s more, he said, there are still many details to work out. “It’s not a yes or no, it’s the how,” Cuomo told reporters during an unrelated conference call. “The devil is in the details. What ages, what amounts, what tax rate, where do you sell it, how do you police it?”

George Santayana opined,” those who cannot remember the past are condemned to repeat it.”  Twenty years ago there were many entities which promoted opioids for more widespread usage based on limited data, which subsequently were noted to be flawed, contributing to our current desperate situation with prescription and non-prescription drug abuse.

Earlier this year, I applauded Governor Cuomo for his cautious approach to the complicated question of medicinal and recreational use of cannabinoids. History sometimes does repeat itself.  Unfortunately, it is often cunningly disguised and not recognized until the damage is done.  Truly, the devil is in the details, not only for the recreational use of marijuana but for clinical use as well.  MSSNY is concerned with additional uses for medical marijuana being legislated without adequate clinical evidence to support its use, and little knowledge of the consequences of chronic use on our patients and throughout society.

Excelsior!

Please send your thoughts to comments@mssny.org.

Thomas J. Madejski, MD 
MSSNY President


MLMIC Insurance

Capital Update

Legislature Completes Session with Public Health Victories
With the New York State Senate gaveling out at 2 AM early Thursday morning, the scheduled portion of the 2018 Legislative Session came to a close.  Despite the political deadlock in the NYS Senate, working together with the many specialty societies, patient advocacy groups and other allies, the Session produced a number of public health victories for physicians and their patients, and the defeat of hundreds upon hundreds of adverse pieces of legislation that would have added new mandates, new costs, and harmed patient access to needed care.

Among the measures adopted by the Legislature supported by MSSNY:

  • Creating a statewide drug “take back” program for the safe disposal of medications,
  • Requiring health insurers to provide data to the DFS for public reporting purposes regarding how insurers are complying with the mental health parity/substance abuse coverage requirements
  • Expanded insurance coverage for prostate cancer screening without cost-sharing
  • Prohibiting use of tanning facilities for those under 18
  • Provisions to extend MSSNY’s Committee for Physicians’ Health confidentiality and liability  until 2023

Moreover, numerous adverse proposals that had been under serious consideration in the final weeks of Session were defeated or had objectionable provisions removed.  Though there are far too many to list off here, some of the more notable proposals would have:

  • Required physicians to report certain patients to the Department of Motor Vehicles
  • Required physicians to inquire and document the school attended by their school age patients
  • Required physicians to co-prescribe naloxone for patients for whom an opioid medication is prescribed
  • Reduced to 3 days the time frame for a physician to write an initial prescription for an opioid medication for a patient with acute pain
  • Expanded religious exemptions for otherwise required child immunizations
  • Expanded the scope of practice for naturopaths, podiatrists, dieticians, estheticians, psychologists and many other non-physicians
  • Reduced the role of county medical societies in approving physicians to become authorized under Workers Compensation
  • Expanded liability against physicians through expansion of wrongful death awards, removal of contingency fee limits and prohibiting ex-parte interviews.

We thank all the physicians who took the time to communicate and/or visit with their legislators.   With a few unfinished items (not related to health care) it is still possible for the Legislature to return to Albany later in the year where various bills effecting health care delivery could be brought up again. 

Legislation Passes to Require Public Reporting of Health Insurers’ Compliance with Mental Health & Substance Use Disorder Parity Laws;
The Senate and Assembly completed passage of legislation (S.1156-C, Ortt/A.3694-C, Gunther) which directs the Superintendent of the Department of Financial Services (DFS) to collect certain key data points and elements from health insurers in order to scrutinize and analyze if they are in compliance with the federal and state mental health and substance use (MH/SUD) disorder parity laws.   MSSNY working together with the New York State Psychiatric Association and other specialty societies had strongly supported this legislation, and many physicians weighed in with their legislators in support. 

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

Bill to Establish a Statewide Drug Takeback Program Passes the NYS Legislature
Senate Bill 9100/ A9576-B, which would establish a drug takeback program, passed the New York State Legislature this week and will now go before the governor.   This measure, sponsored by Senator Kemp Hannon and Assemblymember Aileen Gunther, would require manufacturers of a covered drug to either submit, individually or jointly, a drug take back program for approval to the New York State Department or to enter into an agreement with the Department to operate a drug take back program on its behalf.  Under the bill’s provisions, manufacturers are responsible for all administrative and operational fees associated with their take back program, including the cost of collecting, transporting and disposing of covered drugs from pharmacies and other authorized collectors and the recycling or disposal, or both, of packing collected with the covered drug. This bill further requires chain pharmacies and mail-order pharmacies to provide for the collection of covered drugs by providing consumers with on-site collection, prepaid mail-back envelopes or other Drug Enforcement Agency (DEA) approved methods.  The program would accept all types of any medication in any form including prescription and nonprescription drugs, drugs in medical devices and combination products, brand and generic drugs and drugs for veterinary use.

The Medical Society of the State of New York House of Delegates had adopted policy calling for a program to allow daily access to safe, convenient, and environmentally sound medication return for sites unwanted prescription medications.  The HOD policy also calls for MSSNY to support a medication disposal program that’s fully funded by the pharmaceutical manufacturers, including costs for collection, transport and disposal of these materials as hazardous waste.                       (CLANCY)

Legislature Passes Measure to Eliminate Patient Cost-Sharing for Prostate Cancer Screening
The Senate and Assembly passed legislation this week (S.6882-A, Tedisco/A.8683-A, Gottfried) to ensure that health insurers provide coverage for diagnostic testing for prostate cancer for men 40 and over with a family history, and men 50 and over who are asymptomatic, without such care being subject to annual deductibles or coinsurance.  The bill would also require the inclusion of information regarding the availability of insurance coverage for prostate cancer screening without cost sharing in the standardized written summary prepared by the Commissioner of Health.  New York has for many years required insurance coverage for these tests, but were subject to cost-sharing.  If signed into law, this legislation would provide coverage without patient cost-sharing to a greater cohort of men for necessary prostate cancer screening than what has been recommended by the US Preventative Services Task Force.                                                                            (AUSTER, CLANCY)

Tanning Bill Prohibition For Children Under 18 Passes NYS Legislature
Legislation that would prohibit the use of tanning booths for children under 18, has passed in the NYS Legislature.  The measure, Assembly Bill 7218A/Senate Bill 8858A, is sponsored by Assemblywoman Ellen Jaffe and Senator Phil Boyle.  The Medical Society of the State of New York and several public health organizations, such as the American Cancer Society, were unanimous in their support of this measure and worked together to obtain passage of this important public health measure.   Currently, the law allows children between the ages of 17-18 years of age to use tanning booths with parental permission.  According to the American Cancer Society, skin cancer is the most diagnosed cancer in the United States. About 95,400 invasive skin cancers will be diagnosed in the US, and more than 87,000 of these will be of melanoma, the most serious form.  The bill now goes to the Governor for his consideration.                                                                              (CLANCY)

Legislation to Expand Non-Physician Care in Workers’ Compensation Does Not Pass
The Legislature left Albany without taking action on legislation (S.8812-A/A.8387-C) that would have expanded the list of eligible health care professionals allowed to treat injured workers, including acupuncturists, nurse practitioners, social workers, and physician’s assistants.  While each of these professionals can play an important role in the delivery of care to patients, MSSNY raised concerns with the possibility of care being provided to injured workers without the coordination of a physician including assessing the injured worker’s level of disability and determining causation of a patient’s injury.

MSSNY had also expressed concern over another component of the legislation that would have modified the process of how county medical societies recommend physicians to serve as treating providers or independent medical examiners under Workers Compensation.  While the provision had been improved over earlier versions, MSSNY was concerned that the phrasing of the proposal could be interpreted to enable the WCB to bypass the county medical society in approving physicians to be authorized to treat or provide IMEs under Workers’ Compensation.

Discussion on this proposal will likely continue over the year and into next year.  The legislative proposal was part of a series of WCB initiatives to expand care access to injured workers, which also included a separate WCB regulatory proposal to provide a 5% increase to the Workers Compensation medical fee schedule effective October 1.                          (AUSTER, BELMONT)

Raising the Tobacco Purchase Age Not Acted On By NYS Legislature
Legislation to increase the purchase age for tobacco products from 18 to 21, failed to be acted upon this year in the New York State Legislature.  The bill made it to the Assembly Calendar, but was not voted upon.   It had not moved from the Senate Finance Committee.  Assembly Bill 273/ Senate Bill 3978, sponsored by Assemblywoman Linda Rosenthal and Senator Diane Savino, would have allowed New York State to increase the purchase age for tobacco products from 18 to 21 years of age—there are currently 22 municipalities and counties that have increased the purchase age.  The Medical Society of the State of New York worked with  other public health associations to try to enact this legislation into law.                                                                                                        (CLANCY)

Legislation To Allow Enhanced Religious Exemptions for School Based Immunizations Defeated
Senate Bill 6141D and A. 8123B, sponsored by Senator Martin Golden and Assemblymember Richard Gottfried, which would have allowed the admission of certain unvaccinated students to public schools, did not pass the Legislature.   MSSNY opposed this measure and it worked with other public health associations and medical groups to urge that this measure not be acted upon.  There were many physicians that also sent letters to their legislators and/or made calls.   The bill did move from the NYS Senate’s Education Committee and this was the first time that this bill has been voted on by members of any Senate committee.

The bill amends the Education Law to provide the procedure for religious exemptions from vaccination requirements.  Under the bill, a parent or guardian would complete a religious beliefs vaccination exemption form to ensure a public school district does not deny admission to their unvaccinated child.  A religious exemption is currently allowable under NY State law, but the exemption allows the school institution to make a decision on whether the student should be exempt from vaccination.   This bill, if it had been passed by the Legislature, would have forced schools to accept the form and allow unvaccinated students to enter the school.                                                     (CLANCY)

Legislature Passes Bill to Call for DMV to Require Examination of Certain Patients; Does Not Contain Physician Reporting Mandate
As a result of advocacy by several patient advocacy groups along with MSSNY, the Legislature did not pass legislation (S. 3569, Young / A.10094, Carroll) that would have required a licensed physician, physician assistant or nurse practitioner to report patients that have a chronic condition which cause or may cause unconsciousness or unawareness to the Department of Motor Vehicles.  The legislation had advanced to the Senate floor, but moved no further.  In addition to MSSNY, that bill had been opposed by the Epilepsy Foundation and American Diabetes Association. 

Instead, the Legislature passed a different bill (S.8990, Young/A.11121, Carroll) which would authorize the Department of Motor Vehicles (DMV) to require driver’s license holders to submit to a DMV re-examination of their fitness to drive if the licensee experienced a loss of consciousness and was involved in a reportable accident while driving and DMV receives evidence that the loss of consciousness caused or contributed to the accident.  The bill also directs the DMV, in consultation with the Department of Health and the Division of State Police, to review its notification process by physicians to DMV including identifying the impediments of physicians, police officers and others to reporting certain patients to DMV, and report back to the Legislature within one year of enactment of this bill.                                                                                                                        (BELMONT, AUSTER)

Legislation To Mandate Collection of School Information Does Not Pass
The Senate and Assembly left Albany without taking action on legislation (S. 2113-A, Felder/A.352-A, Perry) which would have required physicians and hospitals to inquire and document the name of the school attended by school-aged patients and to include this information in their admission registration forms.    In addition to MSSNY, the bill had also been opposed by the Healthcare Association of New York State and the NYC Health and Hospitals Corporation.

The bill was on the “Debate List” on the floor of the Assembly the last 2 weeks of Session, as well as on the floor of the Senate.     However, considerable grassroots activism from physicians, as well as significant advocacy in Albany by various groups, resulted in several Senators and Assemblymembers objecting to the legislation.  MSSNY had raised concerns that New York Public Health Law Section 2101 already requires physicians to report immediately to the local health officer regarding the presence of any communicable disease. The health officer is then charged with the responsibility to investigate cases of communicable disease, to ascertain sources of infection, to seek out contacts, and to take other steps to reduce the spread of the disease.  MSSNY also raised concerns that increasing mandates take more and more time away from the ability to deliver the timely care patients expect to receive.                                                                                (AUSTER, BELMONT)

NYS Assembly Passes Single Payor Legislation; Bill Not Taken Up in the Senate
Last week, the New York State Assembly passed by a 94-46 vote legislation that would have created a single payor health care system in New York State.   The bill, which has passed the Assembly each year since 2015, was not taken up by the NYS Senate prior to leaving Albany.  While there are many physicians who support a single payor system, MSSNY has repeatedly advised legislators that it has a long-standing policy position opposing the creation of a single payor system, a policy position which was re-affirmed in the fall of 2017.

To view how each Assemblymember voted on this bill, click here.  The view the 2½ hour Assembly debate on this legislation from June 14, click here (starting at about the 1:00 mark).   (AUSTER) 

Bill to Allow Newborn Standing Orders Passes New York State Legislature
Legislation, which would authorize hospital standing orders for the care of newborns, has passed the New York State Legislature.   S. 8774B/A. 9950B, sponsored by Senator Kemp Hannon and Assemblyman Richard Gottfried, will allow a hospital to establish standing orders for the care of newborns.  The bill also allows the ability of a nurse to depart from the standing order and does require that the attending nurse shall advise the attending practitioner if the nurse becomes aware of circumstances that reasonably indicate a need to depart from the standing order.  MSSNY expressed concern that the legislation then goes on give the nurse discretion to deviate from the protocol without authorization from the attending practitioner, provided that they act within their scope of practice.

The order must also provide that the attending practitioner shall review and acknowledge in writing the care provided under the standing order.   MSSNY indicated that the tests and getting a newborn ready for admittance into a nursery pertains to a “healthy” newborn and that there is no need to deviate from the standing order.   MSSNY also indicated that if there is a medical issue that arises between the delivery room to the nursery with a “healthy” newborn then emergency protocols would be in effect and consults with a physician would be required.  However, the NYS AAP (American Academy of Pediatrics) supported this measure and the NYS Chapter, American College of Obstetricians and Gynecologists, (ACOG), District II, took no position on the measure.  The bill will now go to the Governor for his consideration.                                                                            (CLANCY)

AMA Announces Formal Opposition to CVS Takeover of Aetna
The American Medical Association (AMA) announced this week that, after conducting an exhaustive analysis on the proposed acquisition of Aetna by CVS Health, it would urge federal and state regulators to block the merger. The announcement was made by AMA President Dr. Barbara McAneny, in testimony on the proposed CVS-Aetna deal at a hearing held by the California Department of Insurance.  Earlier in the year, the AMA had presented strong concerns about the merger during a hearing of the US House of Representatives Judiciary Committee, but had stopped short of calling for an outright rejection.

According to the press release, the AMA position in opposition is based on evidence indicating the merger’s likely anticompetitive effects on Medicare Part D, pharmacy benefit management services, health insurance, retail pharmacy, and specialty pharmacy, including:

  • An expected increase in premiums due to a substantial increase in market concentration in 30 of 34 Medicare Part D regional markets.
  • An anticipated increase in drug spending and out-of-pocket costs for patients as Aetna and CVS fortify their dominant positions in the health insurance, pharmaceutical benefit management, retail and specialty pharmacy markets that already lack competition.
  • A reduction in competition in health insurance markets that will ultimately adversely affect patients with higher premiums and a reduction in the quality of insurance.
  • A foreseeable failure to realize proposed efficiencies and benefits because the merger faces enormous implementation challenges, and those efficiencies have a questionable evidence base.

Earlier this month, Immediate MSSNY Past President Dr. Charles Rothberg expressed MSSNY’s opposition to this proposed acquisition during a New York State Assembly Insurance-Health Committee hearing on this topic. Strong concerns were also expressed by consumer and pharmacy groups.

Following the conclusion of the NY Assembly hearing, Assembly Insurance Committee Chair Kevin Cahill noted, “Our State must be proactive in responding to such drastic potential changes in our health care delivery systems. The past has taught us that reactive approaches to challenges in health care could have devastating effects on consumers and our health care system. This acquisition poses serious questions for the long-term stability of the State’s insurance markets and access to health care products”.

Assembly Health Committee Chair Richard Gottfried added: “It should be of great concern to have what economists call ‘vertical integration’ – in this case a major health care provider and a major health insurer sharing the same bottom line – with dramatic effect on consumers and others in the market. It’s critical that State and Federal regulators assess and understand the potential impact on patients, insurance networks, and drug purchasing and dispensing processes.”

The AMA will file a post-hearing memorandum outlining its concerns later this month.  (AUSTER)

Legislature Rejects Scope of Practice Changes
The State Legislature left Albany this week without taking an action on a plethora of bills opposed by MSSNY together with many specialty societies which would have created or expanded the scope of practice of numerous non-physician health care providers.   Some of these bills include: 

  • Certification of Certified Registered Nurse Anesthetists  – A.442 / S.1385
  • Broadening the scope of practice of dentistry -A.4543 / S.3551
  • Expand the ability of podiatrists to provide wound care – A.1880/S.4734
  • Statutory recognition to naturopaths – 5913/S.4297
  • Psychologists Prescribing – 2851 / S.4498                          
  • Expand scope of dieticians to order lab tests – 2231-C/A.8504-B
  • Allow PAs to Operate Fluoroscopy Imaging Technology – 4716/S.8165
  • Permitting estheticians and others to do laser hair removal with limited physician oversight – S.6088-A/A.7977-A

            (DIVISION OF GOVERNMENTAL AFFAIRS)                                                                                                                                       

MSSNY Participates in New York State Lyme and Tick-Borne Disease Summit
Governor Cuomo has called upon the Department of Health, Department of Environmental Conservation, and the Office of Parks, Recreation and Historic Preservation to collaborate in order to target priority counties and public lands with the highest risk of tick exposure and Lyme disease.  On Tuesday, both public and private stakeholders met to discuss the goals of the collaboration at the New York State Lyme and Tick-Borne Disease Summit.

The goal of the working group on Lyme and other tick-borne diseases is to review New York State’s current initiatives and make policy recommendations on actions that New York State can take in the next one to three years to advance prevention, diagnostics, and other best practices. The Statewide Tick-Borne Pathogen Surveillance Initiative has been actively surveying lands across New York State and has recently launched a website displaying their findings. To view their research, click here. Tick season has started in many areas of the state and will continue through November.  To learn more about Lyme disease, prevention, and tick removal, click here.
(HARRING)

Medical Society of the State of New York Announces Veterans Matters Programs are Available on CME Website
Did you know that in a recent report, the New York State Health Foundation discovered that nearly HALF of veterans prefer to receive their care OUTSIDE of the VA system, and less than 3% of physicians outside of the VA are fully prepared to help veterans?

The Medical Society has created a free CME program series entitled Veterans Matters to assist New York State physicians in recognizing the unique health problems faced by veterans and the best way to provide care to veterans.  These programs are all available at https://cme.mssny.org 

Veterans Matters: PTSD & TBI in Veterans

Faculty: Emerald Lin, MD

Educational Objectives:

  • Identify signs and symptoms of PTSD & TBI
  • Examine evidence-based treatment modalities for PTSD & TBI
  • Explore military culture and methods to overcome unique barriers to treatment intrinsic to military culture. 

Veterans Matters: Substance Use Disorders in Veterans

Faculty: Frank Dowling, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention, and treatment options
  • Identify barriers to identification and treatment in military culture and methods to overcome them 

Veterans Matters: Suicide in Veterans

Faculty: Jack McIntyre, MD

Educational Objectives:

  • Address the causes and warning signs of suicide and suicidal behavior among veterans
  • Explore evidence-based diagnostic, intervention and treatment options
  • Identify barriers to identification and treatment and methods to overcome them

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

Additional information or assistance with registration may be obtained by contacting Melissa Hoffman at mhoffman@mssny.org.                                                                        (HOFFMAN)

Medical Society of the State of New York Encourages You to Check out CME Website
The Medical Society of the State of New York has recently added several new emergency preparedness and Medical Matters CME programs to our CME website. You can earn FREE CME credits on a myriad of topics related to Bioterrorism and Disaster/Terrorism response.  Emergency preparedness topics include our 4-part Physician’s Electronic Emergency Preparedness Toolkit, Anthrax, Smallpox as well as Ebola and numerous others.

Additionally, all of our Medical Matters programs from the past several years have been archived at https://cme.mssny.org.  Topics range from Zika Virus, Influenza and Plague to Nuclear Radiation, Disaster Triage and Mental Health as well as a variety of other timely and relevant subjects.  For assistance, or more information, please contact Melissa Hoffman at mhoffman@mssny.org or call (518) 465-8085.                                                (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
charring@mssny.org

eNews

Group Health Insurance Survey
Do you have a moment to take a brief survey? MSSNY is exploring the possibility of developing a cost-effective health plan for our members, their dependents, and their employees (not an associated health plan [AHP]).

Our ability to move forward will be based on the number of members that express an interest in participating with this new group.

You can access the survey here.

Thank you for your participation.

Is It OK to Charge Patients $.75 Per Page for Their Records?
Can doctors still charge 75 cents per page? NO, not automatically.

Now, practices need to do some figuring.  Copies can be provided by paper or electronically by CD or USB stick.

Then, the practice needs to do some calculations.

HIPAA requires that the charge for paper or electronic copies must reflect actual cost.  The cost may include:

  • cost of labor to copy—but not labor to review request or search and retrieve;
  • cost of certain supplies such as paper, CD or USB flash drive;
  • postage;
  • cost of labor to prepare a summary or explanation, but only if both parties agree.

Based on the results, the practice will need to ensure that whatever cost is most favorable to the patient is what can be charged.  If all else fails [or, is too cumbersome to figure out] a maximum flat rate of $6.50 can be charged.

Please be sure to see the actual HHS guidance on this link.

Notice from MLMIC to All Endorsed Partners
A public hearing has been scheduled by the New York State Superintendent of Financial Services pursuant to Section 7307 of the New York Insurance Law, to consider the Plan of Conversion adopted by the Board of Directors of Medical Liability Mutual Insurance Company, a New York mutual insurance company (“MLMIC”) on May 31, 2018, and revised on June 15, 2018.

The public hearing will be held at the offices of the New York State Department of Financial Services, One State Street, New York, NY, 10004 (6th floor in the main hearing room), beginning at 10 a.m. EST on August 23, 2018.

To view a digital copy of the entire notice of public hearing, click here.

To view a digital copy of the Plan of Conversion, click here.

For additional information about the transaction, visit  Frequently Asked Questions or call 1-888-998-7871.

Please see MLMIC’s latest news on the Berkshire Hathaway Transaction here. MLMIC policyholders should go to this link for information or to call their BH hotline 1-888-998-7871 to speak with knowledgeable staff regarding their questions.

Nurse Pleads Guilty: $60M Fraud Allegedly Involved Accelerating Patient Deaths
A nursing supervisor for Novus, a shuttered hospice provider in Frisco, Texas, has pleaded guilty to conspiracy to commit healthcare fraud for her role in a $60 million scheme that federal prosecutors say involved fatally overdosing patients for profit, according to The Dallas Morning News. Jessica Love, RN, served as Novus’ nurse case manager and regional director before the company shut down several years ago. She was one of 16 defendants charged in the healthcare fraud scheme in February 2017.

According to court documents, Ms. Love and her co-conspirators, including Novus’ owner and CEO Bradley Harris, allegedly enrolled as many people as possible in hospice care, even patients who were not eligible for the services. Once the patients were enrolled, they were given around-the-clock care, which Medicare reimbursed at a higher rate than routine care. If hospice patients were in continuous care for too long, Novus workers allegedly overmedicated them so they would die.

Ms. Love was allegedly involved in the fatal overmedication of two patients, according to the report. Documents from Ms. Love and another Novus employee, who also pleaded guilty in the case, stated Mr. Harris instructed “nurses to intentionally overmedicate beneficiaries with medications such as hydromorphone and morphine with the intent to hasten their deaths,” according to the report.

Mr. Harris has denied any wrongdoing. “We are not aware of any evidence that shows that Mr. Harris caused, hastened or otherwise contributed to the death of the hospice patients being treated by Novus,” Chris Knox, an attorney representing Mr. Harris, told The Dallas Morning News.

WHO Releases ICD-11: 5 Things to Know
After more than a decade in the making, the 11th edition of the International Classification of Diseases has been released by the World Health Organization.

The ICD serves as a foundation for identifying global health trends and statistics and is used by health insurers whose reimbursements depend on ICD coding.

Five things to know:

  1. The new edition carries about 55,000 codes for injuries, diseases and causes of death. By comparison, the 10thedition had 14,400 codes. And for the first time, the ICD is completely electronic.
  2. The new ICD will be presented at the World Health Assembly in May 2019 for adoption by member states and will go into effect Jan. 1, 2022. “This release is an advance preview that will allow countries to plan how to use the new version, prepare translations and train health professionals all over the country,” the WHO stated.
  3. In an effort to more closely reflect progress in medicine, the codes relating to antimicrobial resistance in the new ICD are more closely aligned with the Global Antimicrobial Resistance Surveillance System.
  4. The new ICD can also better capture data regarding healthcare safety, meaning it will help identify and reduce unnecessary events that may harm health, including unsafe workflows in hospitals.
  5. This ICD has new chapters, including ones on traditional medicine and sexual health. Traditional medicine has not been classified in this system until now. The chapter on sexual health brings together conditions that were previously categorized in other ways. The WHO also added gaming disorder to the section on addictive disorders. https://www.beckershospitalreview.com/finance/who-releases-icd-11-5-things-to-know.html

FDA Approves First Generic Versions of Suboxone
On June 14, the U.S. Food and Drug Administration approved the first generic versions of Suboxone (buprenorphine and naloxone) sublingual film (applied under the tongue) for the treatment of opioid dependence.

FDA Commissioner Scott Gottlieb, M.D. said, “The FDA is also taking new steps to address the unfortunate stigma that’s sometimes associated with the use of opioid replacement therapy as a means to successfully treat addiction. Patients addicted to opioids who are eventually treated for that addiction, and successfully transition onto medicines like buprenorphine, aren’t swapping one addiction for another, as is sometimes unfortunately said. They’re able to regain control of their lives and end all of the destructive outcomes that come with being addicted to opioids. When coupled with other social, medical and psychological services, medication-assisted treatments are often the most effective approach for opioid dependence. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm610807.htm

New Shingles Vaccine in Short Supply
On Oct. 25, the CDC recommended Shingrix as the preferred vaccine for the prevention of shingles for adults aged 50 and up. The Washington Post (6/20) “To Your Health” blog reports there is a national shortage of the new shingles vaccine Shingrix, “prompting retailers to create waiting lists and the manufacturer to delay additional promotion.” The CDC now recommends Shringrix over Zostavax for people over the age of 50.

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Classified

RENTAL/LEASING SPACE

For Sale-Outpatient Mental Health Clinic
Started in 1998 and located in the NYC metro area, this multi-location business is a well-established, highly reputable, mental health clinic providing outpatient psychotherapy and counseling services.
Revenues 2017 $1.2 mil.
Profits: 2017 $326k
Asking Price: $970k
Terms are available. The clinic’s market consists of Manhattan, Bronx, Brooklyn and Queens Counties. The 25 clinician practice specializes in group, women’s and psycho-educational therapy as well as parenting groups, court mandated services, domestic violence victims groups, anger management and supervised visitation programs. There are 250+ weekly patients and the business accepts most insurances. Buyer must be a NYS licensed physician, NYS licensed mental health consultant, NYS licensed social worker, psychologist or PhD. The owner is retiring.Direct All Inquiries to:
Steve Epstein, V.P.
Gottesman Company
O: 201-750-9605
C: 201-704-8051


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


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




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


PHYSICIAN OPPORTUNITIES


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


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

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


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