November 15, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 15, 2019

Vol. 22  Number 43


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Colleagues:

This past week, I learned that pharmacies in the Bronx were either out of stock of opioids or on “back order.” This seemed hard to believe but one neurologist recounted his experience in trying to find a pharmacy carrying Percocet for his patient with severe paroxysms of sympathetic nerve pain. In exploring further, he had obtained a memo from a health organization suggesting that opioid manufacturers were loathe to ship supply to NY State because of the opioid excise tax recently enacted.

This particular organization suggested that the medications would be obtainable via a rather circuitous route via their own central distribution center.

This, of course, would be little help for this particular patient or for many who legitimately need narcotic analgesia. Despite the opioid crisis, pain relief is still a quality metric and pain is still the “fifth vital sign.” Measures in place, however well-intended, have put patients and physicians in a bind. Pain must be relieved but the relief is often difficult to obtain. And when the analgesics in question are out of reach, is it so hard to consider that patients might seek alternative means to relieve that pain?

Therefore never send to know for whom the bell tolls.
It tolls for thee.
John Donne

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President


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We Need Your Data
At November’s MSSNY Council meeting, Dr. Sana Block expressed concerns on behalf of physicians who are finding it difficult for patients to obtain medically needed prescriptions for pain.  He explained that pharmacies are not filling prescriptions for opioids when needed for patients with chronic pain.  Other Councilors stated that they have experienced difficulty for patients obtaining pain medications following surgery.  Anecdotal information is fine; but, to bring this to the attention of powers that might be able to address this problem, we need your data.

To help us help you, please download the MSSNY Hassle Factor Form.  Complete the form, letting us know if you have experienced difficulty in obtaining medically needed pain meds for you patients.

In Section C of the form, please indicate the name of the pharmacy.  If you have experienced problems with multiple pharmacies, please use multiple forms.  In addition, please identify the nature of the problem, such as the drug is out of stock; the pharmacy recommends a different drug, etc.  The completed form can be emailed to RxHassles@mssny.org or faxed to: 516-282-7093 or 516 282-7099 or 516-282-7098.


It’s Crunch Time – Please Make Sure Congress Adopts a Fair Solution to Surprise Medical Bills
 With just 6 weeks left in the year, Congress is continuing to have extensive discussions about legislation to address “surprise” out of network medical bills.  It is imperative that physicians continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair solution to this issue that protects patients’ access to needed care, and does not grant huge new powers to already market dominant insurers.  By clicking here, you can send a letter, and tweet at your legislators.

Please remind them of the successes of New York’s law.  In September, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.   According to a May Georgetown University report, there has not been any adverse premium impact attributable to our law.

At the same time, please remind them of the grave concerns that have been raised about insurance company friendly legislation (H.R.3630 Pallone/Walden, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.  When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not give them any more power.  Please contact your Senators and Representatives today!

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Physician Action on Key Health Care Legislation Needed
As of today, there were still 375 bills that passed both houses in 2019 that were awaiting delivery to the Governor.  But with just 6 weeks left in the year, the flurry of bill signings/vetoes has begun.  This week, MSSNY sent letters to the Governor in support of legislation to extend for 2 years the “nursing home exception” to mandatory e-prescribing (A.1034-A/S.4183) and to permit ophthalmologists to delegate administration of eye drops to assistants (S.4469-B/A.3822-D).

Physicians can quickly and easily send a letter to the Governor here on the following bills:

  • Protect Against Insurer Mid-year Formulary Changes– would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please urge the Governor to sign this bill into law.
  • Support Partial Prescription Fills– would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • Oppose Liability Expansion– two bills passed the Legislature that will further tip the scales in lawsuits against physicians and the business community generally, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please urge the Governor to veto these bills.

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NYeC: Shin-NY Reduced Healthcare Costs by Over $160 Million Annually
According to a recent preliminary analysis conducted by New York eHealth Collaborative (NYeC) use of the Statewide Health Information Network for New York (SHIN-NY) is reducing unnecessary healthcare spending in New York by $160-$195 million annually, which includes significant savings to Medicaid and Medicare.  To see NYEC’s white paper on this analysis click here.

The results of the analysis indicate that the savings are based on the current size and use of the network, using methodology developed by the Department of Health and Human Services’ (HHS) Office of the National Coordinator (ONC) for purposes with recent related federal proposals.

The report noted that, “The approximated savings and value are based and consistent with results of existing peer reviewed academic studies pointing to the value of using HIE generally. HIE has been associated with 50% reduction in rates of hospital readmission, 26% reduction in the rate of emergency department admissions, 35% reduction in the repeat of repeat imaging procedures and 10% lower 30-day readmission rate among Medicare fee-for-service beneficiaries”

The SHIN-NY is a statewide network that facilitates secure and confidential electronic sharing of patient data across the healthcare system to improve outcomes. It is comprised of and connects regional health information networks (RHIOs) that allow participating healthcare professionals, with patient consent, to quickly access and share comprehensive patient health information and medical records. Statewide, 100 percent of hospitals and over 100,000 healthcare professionals are connected to the SHIN-NY, which facilitates the exchange of health information (HIE) for patients across the state.

MSSNY representatives have been in regular communication with NYeC staff to work towards enhanced physician participation in their local RHIOs and the SHIN-NY.  They have touted HIT as a fundamental tool in positively impacting patient care and outcomes, but also have raised concerns that this technology, for many physicians, is not easily compatible with patient care delivery.  Physicians should be aware of programs such as the Data Exchange Incentive Program (DEIP) that helps subsidize the cost of connecting to your local RHIO.


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New York Is 1st State to Publicize Hospitals with C. Auris Cases
New York health officials on Nov. 13 published a list of healthcare organizations that have treated patients for the deadly fungus Candida auris, making it the first state to share this information with the public, reports The New York Times.

The list includes 64 hospitals, 103 long-term care homes, three hospice units and one long-term care hospital. It does not detail how many cases occurred at each organization.

The New York State DOH released the list in response to a rapid increase in C. auris cases. Health officials said the information is intended to boost transparency for consumers and motivate hospitals to stop C. auris from spreading further, according to NYT. The CDC has reported 836 cases of C. auris nationwide as of Aug. 31. Of these, 388 have occurred in New York.

To view the state’s full list of healthcare organizations reporting C. auris cases, click here. (Becker’s Hospital Review, Nov. 14)


Vaping Illness Leads to Lung Transplant at Henry Ford Health System
Henry Ford Health System this week announced that it performed what the health system believes is the first ever double-lung transplant for a patient with a vaping-related illness. Hassan Nemeh, who led the surgical team at Henry Ford, said the patient’s lungs were unlike anything he had seen in his 20-year career, noting that the 17-year-old patient’s lungs were scarred, rigid, inflamed, marked with dead spots. (New York Times, 11/12)


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Hospital Safety Grades
The Leapfrog Group last week released its Fall Leapfrog Hospital Safety Grades, giving about one-third of hospitals an “A,” but giving more than 40% of hospitals a “C” or lower. Leapfrog also published an infographic that looked at the rates of avoidable deaths at hospitals for each grade. (Source: HealthLeaders Media, 11/7)


CDC: Five Leading Causes of Death
U.S. residents living in rural areas of the country were more likely to die from preventable causes than those living in urban areas from 2010 to 2017, according to a CDC Morbidity and Mortality Weekly Report released last week. Overall, the researchers found heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke ranked as the five leading causes of death in the United States in 2017.


Survey Finds Many PCPs Don’t Discuss How Hair Care Can Be a Barrier to Exercise for Some Black Women
Findings published in the Journal of the American Board of Family Medicine suggests “primary care providers often don’t realize that hair care can be a barrier to regular exercise for some black women.” A survey of primary care physicians “found an overwhelming majority talk to their female African American patients about the importance of exercise. But three-quarters said they don’t talk with these patients about hair care, which can be a barrier to vigorous workouts.”


Families May Feel Better About End-Of-Life Care in ICU if Granted Simple Wishes
Researchers found in a small study that “families of dying patients may feel better about end-of-life care in the ICU if they are granted simple wishes, like letting the patient taste a favorite meal or use a blanket from home.” The findings were published in the Annals of Internal Medicine


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Hospital Price Transparency Rule Could Come Before Year’s End
CMS could release a rule by the end of 2019 on a proposal that hospitals disclose payer-specific negotiated rates, a White House adviser said. CMS is delaying action on the price transparency proposal, excluding it from the 2020 Medicare Outpatient Prospective Payment System final rule released Nov. 2.

The proposal, which CMS released July 29, includes provisions in a price transparency executive order signed this year by President Donald Trump. It would require hospitals to publish all “standard charges,” including the hospital’s gross charges and negotiated rates with payers for an item or service, online in a machine-readable format.

Under the rule, hospitals also would be required to publish the rates they negotiate with insurers for 300 services consumers are likely to shop for in a searchable and consumer-friendly manner. Hospitals that do not comply would be penalized.

The proposal builds on a current federal rule that requires hospitals to publish a list of their standard charges on the internet, but excludes negotiated rates with payers.

The American Hospital Association has come out against the proposal, saying it is “the wrong approach” and “would introduce confusion and fuel anticompetitive behavior among commercial health insurers.” Federal contends the proposal could significantly reduce healthcare costs. (Becker’s Hospital CFO Report Nov.11)


(E/M) Visit Frequently Asked Questions (FAQs) Physician Fee Schedule (PFS)
This document addresses Frequently Asked Questions (FAQs) regarding documentation and payment for evaluation and management (E/M) visits under the Medicare Physician Fee Schedule (PFS).

  1. What parts of the history can be documented by ancillary staff or the beneficiary starting in CY 2019?

The CY 2019 PFS final rule expanded current policy for office/outpatient E/M visits starting January 1, 2019 to provide that any part of the chief complaint (CC) or history that is recorded in the medical record by ancillary staff or the beneficiary does not need to be re-documented by the billing practitioner. Instead, when the information is already documented, the billing practitioner can review the information, update or supplement it as necessary, and indicate in the medical record that she or she has done so.

This is an optional approach for the billing practitioner, and applies to the chief complaint (CC) and any other part of the history (History of Present Illness (HPI), Past Family Social History (PFSH), or Review of Systems (ROS)) for new and established office/outpatient E/M visits.

To clarify terminology, we are using the term “history” broadly in the same way that the 1995 and 1997 E/M documentation guidelines use this term in describing the CC, ROS and PFSH as “components of history that can be listed separately or included in the description of HPI.” This policy does not address (and we believe never has addressed) who can independently take/perform histories or what part(s) of history they can take, but rather addresses who can document information included in a history and what supplemental documentation should be provided by the billing practitioner if someone else has already recorded the information in the medical record.


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Know Your Provider Enrollment Revalidation Due Date Today and Protect Your Bottom Line!
Revalidate before your due date to avoid a hold on your Medicare payments and deactivation of your Medicare billing privileges.

There are several ways to find your revalidation due date:

Generally, the due date will remain with the provider/supplier throughout subsequent revalidation cycles. So you will not have to wonder about the due date the next time you need to revalidate.

NOTE: Unsolicited applications received seven months prior to the revalidation due date will be returned to the provider.

Need assistance? Providers and suppliers can register for our provider enrollment webinars by either using the following links, Part A/Part B or by visiting the NGSMedicare.com website. The webinars below can be found under the Education Tab by selecting Webinars, Teleconference and Events.

  • Provider Enrollment Revalidation Overview
  • Getting Access to PECOS
  • Submitting Revalidation via PECOS Application
  • Submitting Revalidation via CMS-855A Paper Application for a Part A providers
  • Submitting Revalidation via CMS-855B Paper Application for a Part B providers
  • Submitting Revalidation via CMS-855I Paper Application for a Part B providers
  • Let’s Chat about Provider Enrollment Revalidation

PECOS: View and Manage Reassignments through Group Enrollment

Webinars

“When is the Flu not the Flu?” CME Webinar on November 20; Registration Now Open
Flu season is upon us, but there are myriad other illnesses that present similarly.  Be sure to brush up on these by signing up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
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Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*              Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                 Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                      Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: November 8, 2019 – Stop Digging

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
November 8, 2019

Vol. 22  Number 42


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Colleagues:

How did things ever get so far? This is the existential question confronting physicians every day. One of the key reasons why so many physicians report burnout or even depression is the feeling of a loss of professional autonomy. Sadly, the only group of professionals licensed to practice medicine have so little control in the way they actually practice. We are burdened by data entry, billing, coding, keeping up with new unfunded mandates, and all the while seeing their practices barely making payroll or even taking out second mortgages to keep their offices open. As said previously, it’s not about profitability anymore but about viability.

There’s an old saying – when you find yourself in a deep hole, stop digging. Going along to get along is no longer working. It’s time for a change – but how? Here’s one suggestion. Stop digging. It’s time to say, as Roberto Duran famously said, “No mas.” The decline in fortune did not start yesterday. This did not happen overnight. Therefore, the road back will not be a short one. But we must start. It will, for sure, be a long and arduous journey. But we must start. There will be bumps along the road but we must start. As the infamous Chairman put it, “A journey of a thousand miles begins with but a single step.”

So let’s take that single step. Get together. Get active. Support your fellow physicians. We need all the help we can get.

Stop digging.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President

To all physicians who served in the United States Armed Forces,
 we salute you and thank you for your service!


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Congress Finalizes 2020 Medicare Payment Rule and 2021 E&M Changes with Potentially Significant Redistributive Effects
On November 1, 2019, CMS released its 2020 Medicare Revisions to Payment Policies under Physician Fee Schedule and Other Changes to Part B Payment Policies final rule.  For a brief summary from the American Medical Association as to the highlights of the nearly 2,500 page rule, click here.

Among the highlights:

  • The Medicare Physician Fee Schedule conversion factor will be $36.09 (CY 2019 conversion factor was $36.04), which reflects a budget neutrality adjustment for reductions in relative values for individual services in 2020.
  • Geographic Adjustment Factor (GAF) Increases. Each of the 5 New York Medicare payment locality will receive a slight GAF bump for 2020 and 2021, as follows
    • Manhattan +1.3% for 2020; +2.6% for 2021
    • NYC Suburbs/Long Island +1.5% for 2020; +2.9% for 2021
    • Poughkeepsie/Northern NYC Suburbs +1.7% for 2020; +3.4% for 2021
    • Queens +1.6% for 2020; +3.3% for 2021
    • Upstate NY +0.2% for 2020; +0.4% for 2021.
  • Effective January 1, 2021, CMS will adopt the CPT guidelines to report office visits based on either medical decision making or physician time. With CMS adopting the RUC work recommendations for the office visit codes, the work value increases represent $3 billion in redistributed spending, resulting in a 3% reduction in the conversion factor.   Moreover, CMS adopted the RUC physician time recommendations. Coupled with the work value increases and some modifications in direct practice costs, these changes lead to an additional $2 billion in redistributed spending, resulting in an additional 2% across-the-board reduction.
  • CMS departed from the RUC recommendations in two ways that further intensify the specialty redistribution impact. CMS will implement an add-on payment for office visits for primary care and patients with serious or complex conditions. This proposal redistributes an additional $2.6 billion, resulting in an additional 3% reduction to the Medicare conversion factor.

CMS states that although they have no specialty restrictions on reporting new code GPC1X, they assume that the following specialties will report this add-on code with 100% of their office visits, essentially making this a bonus payment for: family medicine, general practice, internal medicine, pediatrics, geriatrics, nurse practitioner, physician assistant, endocrinology, rheumatology, hematology/oncology, urology, neurology, obstetrics/gynecology, allergy/immunology, otolaryngology, interventional pain management, cardiology, nephrology, infectious disease, psychiatry, and pulmonary disease.

It is estimated that the add-on payment for GPCIX will be approximately $18 per visit.  Therefore, while each of these specialties are expected to see sizable increases in 2021, those expected to see sizable decreases as a result of E&M changes include: anesthesiology (-7%); cardiac surgery (-8%); colon & rectal surgery (-4%); emergency medicine (-7%); gastroenterology (-4%); general surgery (-4%);  neurosurgery (-6%); ophthalmology (-10%); plastic surgery (-5%); radiology (-8%); thoracic surgery (-7%) and vascular surgery (-5%)


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Council Notes — November 7, 2019
Nancy Nankivil, AMA Director of Practice Transformation, and Kyra Cappelucci, AMA Project Administrator, Practice Transformation, presented Practice Transformation Initiative: Solutions for Increasing Joy in Medicine. The AMA has partnered with the Physicians Foundation and several state medical societies to create a practice transformation framework to reduce physician burnout by furthering research focused on evidence-based interventions; collaborate and learn from health systems committed to assessing clinician satisfaction and its correlation to workflow design; and to foster a network or organizations implementing evidence-based solutions, sharing best practices and driving change to improve the joy in medicine.

Council approved the following:

  • MSSNY will become involved in the AMA/Physician Foundation’s Practice Transformation Initiative and will seek appropriate resources for this endeavor.
  • Approval of 2020 Legislative Program
  • MSSNY will file a FOIL request for all documents from the New York Department of Health regarding ZocDoc’s business model exempted from application of NYS Education 6530 laws.

ZocDoc changed its business model to charge practices a per-patient booking fee effective April 1, 2019. The NY DOH indicated that ZocDoc can move forward with the model despite concerns of violations with referral fees; some NY DOH emails regarding ZocDoc have been redacted in a Freedom of Information Law (FOIL) request.

  • MSSNY will seek legislation to create a physician-led healthcare cooperative in New York as one pathway for achieving legally permissible state supervised collective negotiation rights for physicians.
  • Strategies to Improve NYS Immunization Rates in Children: MSSNY will urge that New York State provide incentives to parents/guardians who vaccinate their children as a strategy to improve vaccine uptake in school-aged children and advocate that New York State develop programs to pay stipends to community health workers as a strategy to improve vaccine uptake in school-aged children.
  • Healthcare Cooperative Act: MSSNY will seek legislation to create a physician-led healthcare cooperative in New York as one pathway for achieving legally permissible state supervised collective negotiation rights for physicians.
  • Physician Owned Distributorships: MSSNY supports the concept of Physician Owned Distributorships (PODs), provided that they are operated consistently with generally accepted principles of physician ethical conduct (such as the AMA Code of Medical Ethics), including assuring that patients and other potential contractors are sufficiently notified of the physician’s financial interest in such POD.
  • Study of State and National Health Service Corps Needs: MSSNY will advocate for the expansion of the Doctors Across New York Physician Loan Repayment Program, support the development of State funded loan forgiveness and repayment programs for physicians, and advocate for scholarships/grants for medical students who plan to work in the state.
  • Manpower Assistance for Medical Students: MSSNY supports the concept of continuing federal manpower financial assistance, including grants and long term, low interest loans for medical students.
  • Patient-Driven Groupings Model (PDGM): MSSNY will work with the AMA to monitor implementation of the PDGM methodology to determine whether this new program will impose additional administrative burdens on physicians and/or impede patients from receiving needed home care services. Should it be determined that this new model is creating these issues, these concerns will be conveyed to CMS and Congress for remediation.

Complaints Re Pharmacies Not Honoring Scripts: WE NEED YOUR DATA
At yesterday’s MSSNY Council, Dr. Sana Block expressed concerns on behalf of physicians who are finding it difficult for patients to obtain medically needed prescriptions for pain.  He explained that pharmacies are not filling prescriptions for opioids when needed for patients with chronic pain.  Other Councilors stated that they have experienced difficulty for patients obtaining pain medications following surgery.  Anecdotal information is fine; but, to bring this to the attention of powers that might be able to address this problem, we need your data.  To help us help you, please download the MSSNY Hassle Factor Form. Complete the form, letting us know if you have experienced difficulty in obtaining medically needed pain meds for your patients.

In Section C of the form, please indicate the name of the pharmacy.  If you have experienced problems with multiple pharmacies, please use multiple forms.  In addition, please identify the nature of the problem, such as the drug is out of stock; the pharmacy recommends a different drug, etc.  The completed form can be emailed to comments@mssny.org or faxed to: 516-282-7093 or 516 282-7099 or 516-282-7098.


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Gov. Signs Law: Death Certificates to Specify Opioid-Involved Overdose
Following Governor Cuomo’s press release on November 5, 2019, the EDRS Team would like to reinforce the importance of complete and accurate Cause of Death data on all death certificates, including those deaths related to opioid overdose. See the Governor’s press release here. Capturing this data assists State and federal government agencies analyze and pinpoint community impacts and work toward combatting epidemics, such as the opioid crisis.

The EDRS Team would like to take this opportunity to let you know about the recently launched self-paced online course, Mastering the Cause of Death in the 21st Century, for physicians, medical examiners, coroners, and other medical certifiers. This course provides medical data providers with tips to get the best cause of death determination, including opioid related deaths. Participants may be eligible for AMA PRA credit for completing this course and its final assessment.

According to the state Department of Health’s Opioid Annual Data Report for 2018, the rate of opioid-overdose deaths in 2016 was 15.1 per 100,000 people, about three times higher than it was in 2010.

The new law takes effect immediately. Participants may register now by visiting  https://lms.udutu.com/LMSPortal/Account/LogOn?OrgCode=EDRS and using the organization code:  EDRS and select Create New Learner Account.  If you have additional questions related to the new drug specificity requirements or the EDRS implementation, call (518) 408-0243 or kira.cramer@health.ny.gov.  For more information on registration for the course, contact Zina Adams at zina.adams@health.ny.gov or 518-474-4317. Please see the flyer here.


MSSNY President Delivers Testimony to NY State Senate on Potential Harms of Electronic Cigarettes and Vaping
MSSNY President Dr. Arthur Fougner, MD, provided testimony to the New York State Senate public hearing held to examine the safety and potential harms of electronic cigarettes and vaping, especially among school-aged youth. (View full testimony here: 1Hr and 5 mins)

Dr. Fougner praised Governor Cuomo and the New York State Health Department for its emergency executive action to ban the sale of flavored e-cigarettes in the state (http://www.mssnyenews.org/press-releases/mssny-supports-call-to-ban-menthol-flavored-e-cigarettes/).  He also noted MSSNY’s long-standing support for legislation to ban flavored tobacco products, menthol and e-cigarettes and formally codify these provisions into law.

Specifically he noted that, “While evidence exists that adult smokers who completely substitute vaping for traditional smoking reduce their exposure to many of the toxic chemicals and carcinogens present in combustible tobacco cigarettes, e-cigarettes are not risk-free and are not approved by the Food and Drug Administration (FDA) as a quit-smoking aid. The bottom line is neither smoking nor vaping is safe, and people who do not smoke or vape should not begin to do so.” 

Dr. Fougner also urged strong caution regarding proposals to legalize the recreational use of marijuana since it appears from a number of sources that the vast majority of cases of vape-related lung illness are linked to the vaping of THC. Since the FDA has launched an ongoing investigation, he urged that “any proposed adult-use cannabis program, especially with a vaporizer product, be put on hold until completion of that investigation.”


Stolen Flash Drive: U of Rochester Med Center Pays $3M HIPAA Settlement
The University of Rochester Medical Center has agreed to pay $3 million to HHS’ Office for Civil Rights to settle potential HIPAA violations, according to a Nov. 5 news release. In 2013, URMC filed a data breach report with the OCR stating that an unencrypted flash drive had been stolen. Following the notice that patients’ protected health information could have been exposed, the OCR offered technical assistance to URMC.

Then in 2017, URMC disclosed that an unencrypted laptop had been stolen. An OCR investigation found URMC failed to conduct enterprise-wide risk analysis, implement security measures sufficient to reduce risk and vulnerabilities to a reasonable and appropriate level, utilize device and media controls, and employ a mechanism to encrypt and decrypt electronic protected health information.

“Because theft and loss are constant threats, failing to encrypt mobile devices needlessly puts patient health information at risk,” said Roger Severino, OCR director. “When covered entities are warned of their deficiencies, but fail to fix the problem, they will be held fully responsible.”

Along with paying the $3 million settlement, URMC will also undergo a corrective action plan, including two years of HIPAA-compliance monitoring.


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JAMA: People Turning To Social Media Platforms for STD Diagnosis
The Reddit community r/STDs “encourages its more than 10,000 members to share stories, concerns and questions about sexually transmitted diseases – and according to a study published Tuesday, they have increasingly done so.”

The study, published in the Journal of the American Medical Association, found that “the number of posts significantly increased over time, from just eight in 2010 to 3,375 in 2018.” Investigators “focused on a random sampling of 500 posts” and found over “half – 58 percent – asked the site’s members for a diagnosis,” while “nearly a third of those included photos of the apparent STD in question.”

Medscape reports investigators conclude, “requests for crowd-diagnoses were frequent, with most receiving a reply within hours, and many of these requests were for second opinions after obtaining an original diagnosis from a health care professional.”


Workers Comp

Workers’ Compensation Formulary
The NYS Workers Compensation Board Drug Formulary (NY WC Formulary) becomes effective in four weeks (12/5/19) for new prescriptions.

Training materials related to the NY WC Formulary, as well as an updated version of the NY WC Formulary (effective 11/5/19), can be found on our webpage:

Drug Formulary Overview

Information and resources related to the Board’s Medical Portal, which is used to access the prior authorization system, could be found on the Medical Portal Overview webpage. For more information or assistance Visit http://www.wcb.ny.gov/content/ebiz/drugformulary; General Formulary questions:

Subscribe for email notifications at http://www.wcb.ny.gov/notify


 

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CDC

CDC: Preventing Adverse Childhood Experiences Can Reduce Chronic Disease Experiencing traumatic things as a child puts you at risk for lifelong health effects, according to a body of research. The CDC’s new report confirms this, finding that Americans who had experienced adverse childhood experiences or ACEs, were at higher risk of dying from five of the top 10 leading causes of death.

And those who’d been through more bad experiences — such as abuse or neglect, witnessing violence at home or growing up in a family with mental health or substance abuse problems — were at an even higher risk. According to the agency, women and minorities—like African Americans, American Indians, and Alaskan Natives—were more likely to experience four or more kinds of harm while they were kids. The conclusions were drawn from surveys taken by adults between 2015 and 2017.


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Webinars

How to Maximize Success & Maintain Full Control & Ownership of Your Practice
MSSNY invites you to tune in on Tuesday, November 12 from 7PM-8PM for a webinar featuring Roy Bejarano, Co-Founder & CEO of Scale Physician Group, and Andrew Blustein, Partner/Director and Vice Chair of Garfunkel Wild, P.C. Scale Physician Group provides expert non-clinical advisory and management services to independent and private equity owned physician groups, empowering physician leaders to build modern healthcare delivery platforms that yield better results.

Roy will share the lessons and best practices learned from his experience working with over 1,200 physicians across the country. Andrew will introduce Roy and facilitate a Q&A session following the presentation. Special thanks to Garfunkel Wild, P.C., who serves as MSSNY’s General Counsel, for bringing us this program. Access the flyer here.


“When Is the Flu Not the Flu?” CME Webinar on Nov. 20; Registration Now Open
Flu season is upon us, but there are myriad other illnesses that present similarly.  Be sure to brush up on these by signing up for Medical Matters: When is the Flu not the Flu? on November 20th at 7:30am.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.  Please click here to view the flyer for this program.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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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MSSNY President-Elect Dr. Bonnie Litvack Delivers Testimony to NY Senate on Veterans Mental Health
President-Elect Dr. Bonnie Litvack, MD provided testimony to the New York State Senate Committee on Mental Health and Developmental Disabilities at its public hearing to examine veterans’ mental health.

Dr. Litvack spoke about MSSNY’s “Veterans Matters” educational program which is a part of the Veterans Mental Health Training Initiative (VMHTI) that is funded through an appropriation in the New York State budget.  She noted that the program seeks to insure our veterans can receive the care they need and deserve in New York State. She thanked the committee for their foresight in fighting for continued funding for the program.

Dr. Litvack highlighted that roughly 1.64 million troops were deployed in Operation Enduring Freedom and Iraqi Freedom and had prolonged exposure to combat which took a toll on veterans psychologically.  Additionally she noted that “11% of New York State veterans began serving after 9/11 and this group in New York State is expected to reach 22% by 2025”. Dr. Litvack quoted a 2010 RAND survey on NYS veterans which found that 22% of post 9/11 veterans have a probable mental health diagnosis, 16% screened positive for depression and PTSD.

Dr. Litvack spoke briefly about the VMHTI program which looks to educate the community and healthcare providers on veteran specific mental health issues which includes; PTSD, depression, suicide, traumatic brain injury. Dr. Litvack emphasized the importance of asking individuals whether or not they are veterans in order to help them connect to various organizations that can help them. Dr. Litvack concluded by stating that the program is both timely and critical, emphasizing that the healthcare community needs to be educated on the importance of mental health as it relates to veterans.

MSSNY faculty have participated in numerous presentations at institutions and county medical society meetings all across the State of New York.  Please contact Mhoffman@mssny.org if you would like to have a presentation at your hospital or next county medical Society meeting.

Dr. Litvak at State Senate

MSSNY President-Elect Dr. Bonnie Litvack testified this week before the Senate Mental Health Committee regarding MSSNY’s Veterans mental health training initiative

 

Classified

RENTAL/LEASING SPACE


Park Avenue Medical Office for Sale
1100 square foot office for sale on Park Avenue in Carnegie Hill in an elegant pre-war, coop building. High ceilings complement two large consulting offices, spacious waiting room, administrative room/kitchenette and full bathroom. Enter through private, accessible street entrance or attended lobby. Currently configured for two psychiatrists, easily adaptable to any specialty with multiple exam room possibilities. Extraordinary location convenient to transportation and medical centers. Full listing available at http://ow.ly/IdA130pN5Ua. Call Robin J. Roy, Licensed Real Estate Salesperson, at 212-360-2292 or email robin.roy@corcoran.com for information and showings.

Furnished Luxury Park Avenue East 70’s Medical Office Rental Available.
Voted most beautiful block on UES. Private Entrance. Central A/C.
Dedicated consultation room, exam room, procedure room, reception and nurse areas in a multispecialty office setting. Suitable for all subspecialties.Walk to Lenox Hill Hospital and NY Cornell. Proximate to Mt Sinai Hospital. Subway 2 blocks away. Full Time/Part Time. No fee.
START SEEING PATIENTS IMMEDIATELY!!!
Please call or text 929 316-1032
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Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643

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

Part-Time Pediatrician / Family Practicitioner Wanted for Private Rochester Area Office
Looking to fill a part time position in a private pediatric office serving Rural and Urban diverse population. Pediatrician and Family Practitioner if interested please send CV to : syedmasood@frontiernet.net


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Great Career Opportunities for Clinical Physicians
Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can MAKE a difference, working with a smaller number of patients for reasonable hours.

Starting salary is $143,381 – $171,631 *Additional $20,000 geographical differential for Clinton & Franklin CF, and $10,000 for Five Points, Greene and Groveland CFs. We offer full-time, part-time & hourly/per-diem positions.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Chemung               Elmira and Southport Corrl Facilities (Gateway to the Finger Lakes)
Columbia*              Hudson Correctional Facility (antiquing, arts & collectables)
Dutchess                Green Haven Correctional Facility (Hudson River Valley Beauty)
Franklin*                Franklin & Upstate Corrl Facilities (North Country, 1 hour to Montreal)
Greene*                 Greene Correctional Facility (rural charm yet only 2 hours to NY City)
Livingston*            Groveland Correctional Facility (State Parks, hiking, fishing)
Oneida                   Mohawk Correctional Facility (Cooperstown, breweries)
Orleans                 Albion Correctional Facility (Greater Niagara Region & Canal Town Culture)
Sullivan                  Woodbourne Correctional Facility (mountains, outlets, entertainment)
Seneca*                 Five Points Correctional Facility (heart of wine country)
St. Lawrence          Riverview Correctional Facility (hiking, boating and museums)
Ulster                      Shawangunk and Wallkill Corrl Facility (Catskill Mountains, Casinos)
Washington           Great Meadow Corrl Facility (Between Vermont & Green Mountains)
Westchester           Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

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Inquire with the Facility Personnel Office regarding benefits and anticipated opportunities: http://www.doccs.ny.gov/faclist.html. Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.


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: 98point6.com/pcc/


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: October 11, 2019 – R-E-S-P-E-C-T

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
October 11, 2019

Vol. 22  Number 38


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Colleagues:

The term “provider” has bothered me for a long time. And it should bother you as well.  ACP President Dr. Robert McLean posted Defining our identity does not include the ‘P word’ for his September President’s message. The central theme is a reminder that the practice of Medicine is a profession.  Physicians have a unique relationship with patients that is considerably more than the “Cable Guy” who comes to install your TV service. Dr. McClean writes:

… Such a fundamentally unique and sacrosanct relationship as that between patient and physician is not merely “providing” a health service. And that is why the term “health care provider” is so inappropriate. The patient-physician relationship does not consist of simple transactions where we provide and patients consume. That marketplace terminology implies that health care can be conceptualized as just another commodity.

The primacy of this relationship has been eroded with the commoditization of aspects of the health care delivery system. 

Dr. McClean is not the only physician upset by “provider creep.” Washington pediatrician, Dr. Niran Al-Agba goes one step further, writing in the Kitsap Sun: The sneaky cynicism of calling your doctor a ‘provider’. She traces the history of provider as a pejorative back to 1930’s Germany:

… According to Dr. Saenger, who wrote Jewish Pediatricians in Nazi Germany: Victims of Persecution, “the 1937 issue of the Reichs Medizinal Kalender, a directory of doctors, the remaining Jewish doctors in Germany were stigmatized by a colon placed before their names. Their medical licenses were revoked in 1938. They could no longer call themselves ‘Arzt’ or ‘doctor.’ They were degraded to the term ‘Behandler’ or freely translated, ‘provider.’  

She continues:

Insulting any person on the basis of their race, ethnicity or gender is morally wrong. Using the word “provider” to describe a physician is and will always be insulting, personally and professionally; it is demeaning and devalues the education and degree conferred upon every physician. Why are physicians forced to suffer repeated use of this derogatory professional insult? And why have physicians as one professional body not risen up in anger at this injustice? 

While I would not equate those who call physicians “the P word” with the Third Reich, people should realize that Provider is insulting and demeans our noble profession.

Dr. McClean concludes:

And by the way, this terminology issue was raised through the ACP Board of Governors way back in 2008. Hence, it has been ACP policy since 2009 to eliminate use of the term “provider” and “prescriber” in lieu of “physician” in all publications and communications. Pass it on. 

I would add that this has been MSSNY policy since 2011:

Professionalism in Terminology 207.956

The leadership and staff of the Medical Society of the State of New York shall not in written or spoken word, use the term “provider” in referring to physicians

With that, I give you the inimitable Aretha Franklin.

Comments? comments@mssny.org@mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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eNews

DFS Proposes Regulation to Ensure Patients Have More Detailed Notice of New York’s Surprise Bill Law
New York Department of Financial Services (DFS) Superintendent Linda Lacewell announced this week a proposed regulation to assure patients that receive a claim for the services from a non-participating physician or a non-participating referred healthcare provider receive notice from their health plan and non-par treating physician about the protections of New York “surprise bill” law.  This action follows a recent report of a Long Island patient on “CBS This Morning” who received surprise bills totaling hundreds of thousands of dollars that weren’t covered by his healthcare plan.

“We are taking this action to strengthen the law so that New Yorkers have all the information they need to avoid surprise medical bills,” said Superintendent Lacewell. “After hearing about − and resolving – a recent issue, we know that if it could happen to one consumer; it could happen to others.”

The proposed regulation would require health plans that receive a claim for the services of a non-participating physician or a non-participating referred healthcare provider that could result in a surprise bill to provide additional notice to the insured consumer.

The notice would advise that the insured consumer may receive a surprise bill based on the claim and would include a description of surprise bills and the New York Out-of-Network Law’s Independent Dispute Resolution (IDR) process for surprise bills, as well as instructions on how to submit a dispute, a copy of an assignment of benefits form, and the healthcare plan’s designated addresses for submitting the form. The notice would be included on or with the explanation of benefits.

Additionally, the proposed regulation requires health plans that determine that services billed by a healthcare provider as emergency services are not emergency services to notify the consumer that the consumers may receive a surprise bill for such services and that consumers may be protected from any such surprise bill.  The notice would include the healthcare plan’s contact information as well.  If a health plan receives an assignment of benefits form and determines that a disputed bill is not a surprise bill, they would be required to notify the consumer in writing of the procedures for filing a grievance or appeal and provide information on how to file a complaint with DFS.

It is also important to note that the proposed regulation would require non-participating physicians who bill consumers for emergency services or a surprise bill to inform the consumer of the IDR process, along with providing the claim form and assignment of benefits form which non-participating physicians already must send with surprise bills.

Click here to view a full copy of the proposed amendment, which will be published in the October 23, 2019 State Register and subject to a 30-day notice and public comment period.


MSSNY President, Dr. Fougner, Comments in Crain’s re Surprise-Billing Amendment Proposes More Requirements for Insurers and Physician
Dr. Arthur Fougner, president of the Medical Society of the State of New York, said that the society is “supportive of efforts to assure patients are notified by insurers of the limitations of their coverage, and the protections available to them under our surprise bill law,” in a statement provided to Crain’s. “We are continuing to review the new proposal and will seek to provide feedback to DFS regarding the contents of the proposed disclosure form.”


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Urge the Governor to Support Formulary Protection Legislation!
MSSNY joined AARP and over thirty various health and consumer organizations in sending a letter to urge Governor Andrew Cuomo to approve S.2849/A.2969 that would protect health plan members from increases in out-of-pocket prescription drug costs in the middle of a contract year.

In a press release by AARP, Dr. Arthur Fougner, President of MSSNY said: “MSSNY strongly urges that this formulary protection bill be signed into law as it would provide significant protection from the adverse consequences many patients face as a result of non-medical switching of prescription drugs. If a treatment is working, it should not be changed due to financial constraints. In medicine as in sports, you don’t change a winning game; it’s unreasonable to force patients to change a successful course of treatment for any reason other than medical need.”

MSSNY encourages physicians, as well as their families, friends and other sympathetic individuals to send these letters to their lawmakers.

Protect your patient’s prescriptions! Urge the governor to sign formulary protection bill into law by clicking here.

Click Here to view the full letter!


Medical Society Raises Concerns About Trump’s Order on Medicare
Although the Medical Society of the State of New York supports the goal of President Donald Trump’s executive order on Medicare, it is concerned with several policy directions the order advances, according to a statement issued Tuesday by Dr. Art Fougner, president of the society.

“In particular, we are concerned with the apparent goal to expand the Medicare managed-care program, which likely could include efforts to disincentivize continued or new enrollment in the Medicare fee-for-service program,” Fougner said. “This is especially problematic in light of multiple instances in recent years where Medicare managed-care plans dropped huge numbers of physicians from their Medicare Advantage networks. This, in turn, significantly reduces care options for our patients.”

The society also takes issue with proposals to expand “already cumbersome Medicare value-based payment programs,” Fougner said. Specifically, many smaller physician practices have reported challenges with the Medicare Merit-based Incentive Payment System, such as burnout from spending more time on health-tech systems than on treating patients “to meet well-intended but often overreaching value programs.”

Additionally, Fougner said that some proposals in the order seem to focus on expanding the scope of other types of health practitioners. The combined care of a team headed by a physician is what is best for patients, he said.

Trump’s executive order states that it is focused on empowering patients to “select and access the right care, at the right time, in the right place, from the right provider.” Another focus is to help the fiscal sustainability of the Medicare program through alternative payment methodologies linked to value, increased choice and lower regulatory burdens for providers.

Dr. Fougner said, “We look forward to working with medical associations across the country to work with the administration toward preserving and strengthening the Medicare program so that our seniors continue to have timely access to the quality care they need and deserve.” (Crain’s Health Pulse Oct 8)


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Physicians – Beware of Fake Letters Claiming to be from NYS Board for Medicine
Please should be aware that the New York State Board for Medicine has advised of a scam where physicians have received a bogus letter claiming to be from the “NY State Education Department, Office of the Professions” indicating that their license has been suspended for “Illegal Drug Trafficking Under Section 33(c) of The Aviation Drug Trafficking Control Act of 1984”.

The Board for Medicine has advised MSSNY that, should any physician receive such a letter, that they be aware that they would not receive such a letter from the NYS Board for Medicine or NYSED.


New Law Enacted to Prohibit Unconsented Pelvic Exams When Not in Ordinary Course of Care
Governor Cuomo has signed into law legislation (S.1092-E/A.6325-C) that prohibits the performance of a pelvic examination without consent on an anesthetized or unconscious patient, except when clinically warranted. Specifically, the legislation provides that “No person shall perform a pelvic examination or supervise the performance of a pelvic examination on an anesthetized or unconscious patient unless the person performing the pelvic examination is legally authorized to do so and the person supervising the performance of the pelvic examination is legally authorized to do so and:

  • the patient or the patient’s authorized representative gives prior oral or written informed consent specific to the pelvic examination;
  • the performance of a pelvic examination is within the scope of care for the surgical procedure or diagnostic examination scheduled to be performed on the patient and to which the patient has already given oral or written consent; or
  • the patient is unconscious and the pelvic examination is medically necessary for diagnostic or treatment purposes, and the patient is in immediate need of medical attention and an attempt to secure consent would result in a delay of treatment which would increase the risk to the patient’s life or health.”

Several other states have passed similar laws expressly banning this practice without clinical justification. MSSNY worked with the Legislature to ensure that this legislation was drafted in such a way as to not inappropriately interfere with the clinically appropriate delivery of needed medical care.


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Bronx Teen Is First to Die in New York from Vaping
A teenager from The Bronx became the first New Yorker to die from vaping last week, state officials said Tuesday. The 17-year-old boy treated at Montefiore Hospital is among nearly two dozen people across the nation whose deaths have been linked to the use of electronic cigarettes, officials said.

“Parents have to know, young people have to know: You are playing with your life when you play with this stuff,” Gov. Andrew Cuomo said at an unrelated news conference at his Manhattan office.

The boy was first treated for a “vaping-associated respiratory illness” early last month and was hospitalized again in late September before his Oct. 4 death, according to the Democratic governor’s office. The teen’s death was reported Tuesday to the state Department of Health, which is investigating the case, officials said.

The boy may be the 20th person in the United States to die from a vaping-related illness amid an outbreak of lung ailments linked to the habit.

The U.S. Centers for Disease Control and Prevention had confirmed 18 vaping deaths in 15 states as of Oct. 1, and another was reported in Massachusetts on Monday.

Some 110 people across the Empire State — including 21 in New York City — have come down with serious lung illnesses after using at least one vape product, according to the state health department. Officials have attributed most of those cases to black-market cannabis vape devices rather than nicotine-based e-cigarettes sold in stores.

The spate of sicknesses nonetheless spurred state authorities to ban flavored e-cigarettes, but a pending lawsuit blocked the measure from taking effect last week.


Poll: New Yorkers Back Ban on E-Cigs
A majority of New Yorkers support Gov. Andrew Cuomo’s emergency ban on flavored e-cigarettes and think vaping is a serious public health problem, according to a poll published Monday.

The Siena College Research Institute found that 78% of the more than 800 New Yorkers surveyed believe e-cigarette use and vaping represent either a very serious or somewhat serious public health problem. Nearly two-thirds (61%) of New Yorkers support banning flavored e-cigarettes, and 52% support banning the sale of all e-cigarette and vaping devices.

The poll found that 12% of New Yorkers vape on a regular basis.

The poll—which has a margin of error of 4.3 percentage points—was conducted between Sept. 22 and Oct. 1. That means the final results came in two days before a state court temporarily blocked Cuomo’s prohibition on flavored e-cigarettes in response to a lawsuit from the industry.

Health Commissioner Howard Zucker vowed after the court’s decision that the state will use “every tool at our disposal to address this crisis.” More than 1,000 people have been diagnosed with vaping-related illnesses in the U.S., with 18 reported deaths, according to data from the U.S. Centers for Disease Control and Prevention.


 

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Physicians Welcome to Provide Public Comments on DSRIP at 10/25 NYC and 10/30 Syracuse Public Forums
The New York State Department of Health (NYSDOH) will be holding Public Comment Days for New York’s 1115 waiver program on:

  • October 25th 2019 at Baruch College, 55 Lexington Ave. (Corner of 24th St. & Lexington Ave.), Room 14–220 (14thFloor), New York, NY 10010.
  • October 30th 2019 at the Oncenter’s Carrier Theater located at 421 Montgomery Street, Syracuse NY 13202.

The open comment period for both forums will be from 11am to 2pm.  In addition to public testimony, written statements may be submitted to 1115waivers@health.ny.gov through November 4, 2019. Please include “1115 Public Forum Comment” in the subject line.

Specifically, the NYS Health Department is seeking from the federal government a continuation of DSRIP for the 1-year balance of the 1115 waiver ending on March 31, 2021 and to extend an additional 3 years from April 2021 to March 31, 2024.   Click Here to view the Amendment Proposal.

Background on the DSRIP Program

The roughly $6 billion Delivery System Reform Incentive Payment (DSRIP) program provides incentives for Medicaid providers to create and sustain an integrated, high-performing health care delivery system that can effectively and efficiently meet the needs of Medicaid beneficiaries and low-income uninsured individuals in their local communities by improving the quality of care, improving the health of populations and reducing costs.

The DSRIP program promotes community-level collaboration and aims to reduce avoidable hospital use by 25% over the 5-year demonstration period. A total of 25 Performing Provider System (PPS) were established in different regions of the State to implement innovative projects across three domains: system transformation, clinical improvement and population health improvement (New York’s Prevention Agenda).

While the billions in funding to the 25 PPS have increasingly been distributed to downstream community partners such as community physician practices, some have raised concerns that not enough funding has been made available to physicians who play a key role in managing patient health to prevent avoidable hospitalization or re-hospitalization.


Hassle Factor Form Now in Easy-to-Use PDF Format
MSSNY’s Hassle Factor Form has been updated.  The updated PDF version of the form can be found at the following this link.

Anyone can access the form by clicking on the drop-down box of RESOURCES from the MSSNY home page – www.mssny.org.  Then, scroll down to Payer Relations (SME).  Now, scroll to Hassle Factor Form and click.  This is a more user friendly form.

The County Medical Societies can send it to their members and add it to their websites.  The PDF version can be used by the county medical societies to gather data/information from the membership for interacting with DFS.



Doctor Sues Kaiser Permanente over Opioid-Related Patient Satisfaction Scores
An emergency medicine physician filed a lawsuit Sept. 18 against Kaiser Permanente over its patient satisfaction scoring methodology, which she alleges incentivized overprescribing of opioids and hurt her career at the Oakland, Calif.-based health system, The News Tribune reports.

Eryn Alpert, MD, worked at Kaiser Permanente from 2012 to December 2017, when she was fired. The lawsuit alleges her dismissal stemmed from her failure to accept patient satisfaction scoring tools. It alleges these tools were structured to incentivize physicians to prescribe opioids, even when medically unnecessary. The lawsuit said this pressure was greater in the emergency department, where patients often went seeking prescriptions and would leave poor reviews if they didn’t receive them, according to the report.

In the lawsuit, Dr. Alpert alleges her resistance to prescribing unnecessary opioids created a high standard deviation in her patient scores, which in turn prevented her from gaining shareholder status three years in a row, according to the report.


CME

“Influenza 2019-2020” CME Webinar on October 16; Registration Now Open
Are you prepared for flu season?
The first of MSSNY’s 2020 Medical Matters continuing medical education (CME) webinar series is: “Influenza 2019-2020” on Wednesday, October 16, 2019 at 7:30 a.m.

William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

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

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

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.


“When Is the Flu Not the Flu?” CME Webinar on November 20 at 7:30am; Registration Now Open
.  This is a companion program to the October Medical Matters webinar: Influenza 2019-2020.  William Valenti, MD, chair of MSSNY Infectious Disease Committee and a member of the Emergency Preparedness and Disaster/Terrorism Response Committee will serve as faculty for this program. Registration is now open for this webinar here.

Educational objectives are:

  • Recognize the distinction between types of influenza and other similarly presenting illnesses
  • Describe key indicators to look for when diagnosing patients presenting with flu-like symptoms

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

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.


Health Matters for Women: Symposium on Women’s Health
LIVE CME Symposium in Queens, November 2, 2019 7:30am – 12:30pm
The Medical Society of the State of New York and the Academy of Medicine of Queens County are proud to announce a live CME symposium entitled Health Matters for Women: Symposium on Women’s Health on November 2nd from 7:30am – 12:30pm at the NYC Health + Hospitals/Queens, 82-68 164th St., A-540 Conference Room, Jamaica, NY, 11432.  Please click here to register.

Program schedule:

7:30—8:20 am:           Registration and Breakfast

8:20—8:30am:            Welcome and Opening Remarks

8:30—9:30am:            Health Matters for Women: Endometriosis *
 Faculty: Lisa Eng, DO

9:30—10:30am:         Ovarian Cancer and Genetic Risk **
Faculty: David Fishman, MD

10:30—11:30am:       Health Matters for Women: Fibromyalgia and Myalgic Encephalomyelitis *
Faculty: Florence Shum, MD

11:30—12:30pm:       Genetic Profiling of Breast Cancer and Its implication for Staging, Prognosis and Treatment **
Faculty: Louis Auguste, MD

* 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.

**The Academy of Medicine of Queens County is accredited by the Medical Society of the State of New York (MSSNY) to provide Continuing Medical Education for physicians.  

The Academy of Medicine of Queens County designates each of these live activities for a maximum of 1.0 AMA PRA Category 1 creditsä.  Physicians should only claim credit commensurate with the extent of their participation in the activity. 


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CMS

HHS Issues Opioid Tapering Guidance for Clinicians
The Department of Health and Human Services today released a guide to help clinicians who are contemplating or initiating a reduction in opioid dosage or discontinuation of long-term opioid therapy for chronic pain. Compiled from published guidelines and practices endorsed in the peer-reviewed literature, the guide reviews issues to consider when changing a patient’s chronic pain therapy. “This Guide provides more resources for clinicians to best help patients achieve the dual goals of effective pain management and reduction in the risk for addiction,” said Adm. Brett Giroir, M.D., HHS assistant secretary for health.


NGS Notice : Errors Causing Incorrect Part A and Part B Claim Denials
Date Reported: 10/9/2019
Status: Open
Provider Type(s) Impacted: Part A, Part B, HH+H
Description of Issue

National Government Services (NGS), along with all Medicare Administrative Contractors (MACs), is experiencing an issue with the Medicare eligibility contractor, resulting in incorrect claim denials. NGS is informing providers of this claims processing error involving invalid entitlement dates for all beneficiary entitlement periods. This is causing claims to incorrectly deny based on invalid beneficiary entitlement.
National Government Services Action

NGS is actively pursuing a solution to this issue which will be shared with providers as soon as possible.
Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.
Proposed Resolution/Fix Date TBD


Seal of Italian Medical SocietyCalling All Physicians of Italian Heritage: Join Morgagni Medical Society
The Morgagni Medical society of New York is comprised of physicians of Italian heritage, who meet for social, educational and professional meetings in NYC quarterly. It is a nonprofit 501c3 organization, and sponsors a medical school scholarship in conjunction with the Columbus Citizen’s Foundation. Interesting people and speakers, exceptional dinners, opera night, exclusive club and venue events.

Members can march with their families in the NYC Columbus day parade. New members, both of Italian descent as well as Italophiles, have a great opportunity to share culture and profession. Check out www.Morgagnimedicalsociety.com, email Morgagni.society@gmail.com for information and join today!


Classified

RENTAL/LEASING SPACE



Park Avenue – Private Street Entrance, Same Block as Subway
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate occupancy available.  Call James: 917-710-7643


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

Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: Watching the Detectives – September 20, 2019

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 20, 2019

Vol. 22  Number 35


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Colleagues:

On Monday, MSSNY applauded Gov. Cuomo’s emergency executive action to ban the sale of flavored e-cigarettes in the state. Flavored vaping products like “cotton candy” and “Captain Crunch” are obviously targeted to entice teens to vape. The health of our children is at stake. It’s time to address this head on before it affects an entire generation.

Vape Lung, VALI (Vaping-Associated Lung injury), Allergic Pneumonitis, Lipoid Pneumonia – these are all names for an acute and sometimes fatal lung injury which leaped into our lexicon as summer was coming to an end.  Seven deaths and over 400 cases have been reported thus far in 36 states and the US Virgin Islands. Presentation is often fulminant, yet cases with slower onset have been reported. While clinical presentation resembles lipoid pneumonia, imaging is not typical for that disorder. Reports have been associated with street level THC products.

NY’s Department of Health issued an update on September 5th:

As of September 5, 2019, the Department has received 34 reports from New York State physicians of severe pulmonary illness among patients ranging from 15 to 46 years of age who were using at least one cannabis-containing vape product before they became ill. However, all patients reported recent use of various vape products.

Laboratory test results showed very high levels of vitamin E acetate in nearly all cannabis-containing samples analyzed by the Wadsworth Center as part of this investigation. At least one vitamin E acetate containing vape product has been linked to each patient who submitted a product for testing.

At our meeting with NY State’s Commissioner of Health Dr. Howard Zucker on Tuesday, we were assured the Wadsworth Laboratory had not isolated any vitamin E acetate in any of NY’s Dispensary Medical Cannabis product.

Other investigators are not so sure Vitamin E is the only etiologic factor in vape lung, suggesting some patients have not fit the street pot Vitamin E pattern.

Curiously, the cases appear to be limited to the US and its territories. For example, Canada, despite its proximity, has reported no cases. There have been no cases thus far in the UK as well. The UK had banned certain flavored nicotine vaporizer oils because they contained diacetyl which had been linked to lung disease. Michigan and now New York have banned flavored e-cigs. We can only hope this makes a dent in the incidence of these cases.

Eerily reminiscent of the 1980’s Tylenol murders, the FDA has launched a criminal investigation. (See story below.)

For now, the take home message from WarGames applies – “The only winning move is not to play.”

We’ll all be watching the detectives.

Late-breaking news: Governor Andrew M. Cuomo and State Department of Health Commissioner Dr. Howard Zucker today re-issued a warning to New Yorkers to continue to refrain from using e-cigarette or vaping products as the number of vaping-associated illnesses sharply increases both nationally and in New York State. https://www.governor.ny.gov/news/governor-cuomo-and-health-commissioner-zucker-issue-renewed-warning-vaping-associated-illnesses

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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FDA Launches Criminal Probe as Vaping-Related Illnesses Top 500
In an update on the vaping crisis, federal health officials said today that, as of September 17, the number of confirmed and probable cases of lung injury associated with e-cigarettes and vaping products has climbed to 530 in 38 states and one territory, prompting the FDA to launch a criminal investigation into the possible causes.

“Sadly,” seven patients from six states have died as a result of their illness and “we do expect others,” Anne Schuchat, MD, principal deputy director, US Centers for Disease Control and Prevention (CDC), told reporters in a telebriefing.

She said the CDC will update case counts every Thursday going forward.

Earlier this week, the CDC activated its emergency operations center to help coordinate the investigation into the growing number of cases of severe lung illnesses linked to e-cigarette use.

The exact cause of vaping-related lung illness remains elusive. This investigation is “dynamic and complex and I wish we had more answers,” Schuchat said. “States are classifying cases and reporting them to CDC on a regular basis.”

She emphasized that “no consistent e-cigarette or vaping product, substance, additive, or brand has been identified in all cases; nor has any one product or substance been conclusively linked to lung injury.” Many patients reported using multiple types of products, some containing tetrahydrocannabinol (THC), THC plus nicotine, or nicotine only.

Based on available data, Schuchat said three quarters of the cases are males, two thirds are in people 18-34 years of age, 16% are younger than 18 years of age, and 17% are age 35 years or older. In all, more than half of the cases are under 25 years of age. Patients typically have reported cough, shortness of breath, and/or chest pain, gastrointestinal symptoms (nausea, vomiting, or diarrhea) as well as fatigue and fever.

The CDC continues to recommend that people consider not using e-cigarette products while investigations are ongoing.


Council Notes—September 19, 2019
Council approved the following:

  • MSSNY will recommend that the AMA seek legislation to ban anti-assignment provisions in health insurance plans and to support legislation requiring health insurers to issue payment directly to the physician when the patient or patient representative signs an agreement that permits payment directly to the physician.
  • MSSNY will advocate for increased payment for office based afterhours CPT Codes.
  • MSSNY will advocate for legislation and regulation requiring ALL credentialed physicians (employed and voluntary) be equally included on their hospital websites and Find-a-Doctor sites of the hospitals and other health care facilities and will recommend the AMA do the same.
  • MSSNY commends the Governor and the DOH Commissioner for their action to protect patients by banning sale of flavored e-cigarettes; recommends a moratorium on dispensing of vaporized products to new certificate holders for medical marijuana until data on long term safety is available; recommends rescheduling marijuana to Schedule II; and recommends funding in the State Budget for study of efficacy and harms of the current medical marijuana program.
  • MSSNY will create a Scope of Practice Ad Hoc Committee with the following members: Rose Berkun, MD, Co-Chair; Lisa Eng, DO, Co-Chair; Inderpal Chhabra, MD; Atul Kumar Gupta, MD; Richard Wissler, MD.
  • MSSNY will adopt the Accreditation Council for Continuing Medical Education (ACCME) Menu of New Criteria for Accreditation with Commendation. This year marks the end of a transition period in which CME providers had a choice between demonstrating the old commendation criteria and the new.  Additionally, MSSNY will adopt the revised CME Annual-Reporting Requirements for MSSNY-accredited CME providers.

Bills Signings Ramping Up – Physician Action Needed!
As of today, there were still 617 bills that passed both houses in 2019 that were awaiting delivery to the governor. In the past week alone, 59 bills were chaptered into law – the flurry of bill signings has begun. Of those 617, there are a few that stand out as priorities for MSSNY. When these bills arrive at the governor’s desk, he has to decide whether to sign them into law or to veto them and as such there is still a strong opportunity to influence the decision-making process.

Physicians can quickly and easily send a letter to the Governor here on these issues by using the MSSNY Grassroots Advocacy Center at http://tiny.cc/MSSNYGAC (direct links to these priority items are listed below). Please take a moment to voice your support/concerns on these very important issues!

  • Mid-year formulary changes – would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year.  Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please reach out to the governor and let him know how helpful this bill would be by clicking here.
  • Partial prescription fills – would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure should help to address patients’ pain while reducing the amount of leftover medication in households. Please encourage the governor to sign this legislation by clicking here.
  • Malpractice expansion – two bills passed the legislature that will further tip the scales in lawsuits against physicians and others, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please let the governor know how destructive these bills would be by clicking here.


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Please Continue the Fight for a Fair Solution to Surprise Medical Bills; NY Law a Great Success
Please continue to contact Senators Schumer and Gillibrand, as well as your local Representative in Congress, in support of a fair federal legislative solution to the issue of surprise medical bills.  By clicking here, you can send a letter, make a tweet and make a phone call to your elected officials. It only takes a few minutes and contains all of the details necessary to get our point across.

This week, the NY Department of Financial Services released a report detailing the great success of New York’s surprise bill law enacted in 2014. In particular, the report found that between 2015 and 2018, consumers over $400 million and reduced out-of-network billing by 34%, in part through a reduction in costs associated with emergency services and an increased incentive for network participation.  Moreover, it noted that there were a total of 2,595 IDR decisions reached.  With regard to IDR for out of network hospital “surprise” bills, 815 IDR decisions were rendered. Health plans prevailed in 13% of the cases, while physicians prevailed in 48% of the cases. There were split decisions in 39% of the cases.   With regard to IDR for out of network emergency care services, 43% of decisions were in favor of the health plan, 24% were in favor of the provider, and 33% were split between the health plan and provider.

While MSSNY together with physician groups across the country are working diligently to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of legislation that emulates New York’s successful model, such as H.R.3502, sponsored by Representatives Ruiz and Roe. At the same time, grave concerns have been raised about the alternative being pushed by insurance companies (H.R.3630, sponsored by Representative Pallone, and S.1895-Alexander/Murray), that would limit payment in these surprise bill situations to an insurer controlled “median contracting rate”.

When California enacted a similar law a few years ago, what followed was a 48% increase in patient access to care complaints including delays in obtaining care or securing physician appointments, inadequate selection of providers, and problems accessing facilities.

United, Empire Aetna and many of the other market dominant companies already hold enormous power over physicians and their patients to dictate the terms of care delivery.  Please do not give them any more power.  Please contact your Senators and Representatives today!


New York’s Opioid Tax Creating Concerns
Fortune (9/16) reports that New York “became the first state to place an excise tax on opioids sold to or within the state,” with supporters expecting “the tax to generate $100 million in revenue for the state, which Gov. Andrew Cuomo and his administration have said will be plowed into helping victims of the opioid crisis.”

The idea behind the tax “was to punish pharmaceutical companies for their role in the opioid epidemic,” but “the tax, which went into effect July 1, has already set off a ripple effect across the entire supply chain, as manufacturers and distributors have either stopped shipping to the state altogether or passed the tax onto each other.” Additionally, regarding the fear of social costs, health officials are concerned “the tax could drive patients to seek out opioids on the black market.”

If you have patients who are having difficulty obtaining their opioid prescriptions, MSSNY wants to hear from you so that we can ascertain how widespread this problem is. Please email mauster@mssny.org with any information you have regarding this situation.


Weill Cornell: Free for Students Who Qualify
On Monday, Weill Cornell Medicine in New York City, announced that all students who qualify for financial aid will get a full ride: All costs will be covered by scholarships, including tuition, room and board, books and other educational expenses. “Student debt has been in the national discussion for a long time, and we have been planning, strategizing and raising money,” said Dr. Augustine M.K. Choi, the dean of Weill Cornell Medicine and provost for medical affairs at Cornell University. “It’s the right time to offer debt-free medical education.”

In 2017, Columbia University announced a new endowment that it said would eliminate the need for medical students to take out loans for tuition; the neediest would also have living expenses covered. The David Geffen School of Medicine at the University of California, Los Angeles, offers full rides to about 20 percent of its entering classes, though the awards are based on merit, not need. In August 2018, the New York University School of Medicine said it would cover tuition for all its current and future students.

Of Weill Cornell’s 373 students, 52 percent qualify for need-based aid. A single year at the school — which sits in one of America’s most expensive ZIP codes, on the Upper East Side of Manhattan — costs more than $90,000, according to Weill Cornell. With need-based grants for the last academic year averaging about $38,000, students often relied on federal loans to bridge the difference. The average debt for a graduate of the program this year was $156,851. (NYT Sept.16)


Zocdoc Gets Federal OK to Book Medicare and Medicaid Visits
Zocdoc would not violate the federal anti-kickback statue by charging physicians for each Medicare or Medicaid beneficiary who books an appointment through its website, according to an advisory opinion issued by the U.S. Department of Health and Human Services’ Office of the Inspector General.

The opinion does not mention Zocdoc by name but Dr. Oliver Kharraz, Zocdoc’s CEO, wrote a blog post sharing the opinion. Kharraz said Zocdoc will restore access to its appointment-booking service for all Medicare beneficiaries and Medicaid beneficiaries in certain states including New York on Sept. 18. Zocdoc began charging doctors per new patient booking earlier this year, frustrating New York doctors who had grown accustomed to paying a flat monthly fee for access to the services. At that time, it restricted Medicare and Medicaid beneficiaries from using the service to book appointments to avoid running afoul of federal law.

It has now received guidance from the state Attorney General, state Department of Health and HHS that its pricing policy wouldn’t violate the law with certain caveats. (Crain’s Sept.17)


Most Not Screening Patients for All Five Social Needs Recommended by Feds
Researchers found that “most U.S. physician practices and hospitals are screening patients for at least one social need, but only a small percentage are screening for all five social needs recommended by the federal government.” The five social needs are: Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence.

The findings were published in JAMA.


CME

Sign Up for the Morning Briefing on October 17 in Binghamton
Strengthening Community and Health Care Provider

Resiliency to Adverse Childhood Experiences

Thursday, October 17, 2019 • 12 – 2 pm
UHS Binghamton General Hospital
Russell Community Room
10-42 Mitchell Avenue
Binghamton, NY 13903

The session will also be archived on the Department of Health website. The event is free of charge and available to all interested providers throughout New York State. Participants are eligible for 2.0 CME credits. Flyer.


MLMIC Presentation: Hot Topics in Healthcare: LIVE CME EVENT
Presenters:  MLMIC and MAGNACARE

When:           Tuesday, September 24, 2019
Time:             9:00 AM to 12:30 PM

Where:          Long Island Marriott, 101 James Doolittle Blvd. Uniondale, NY 11553 

Register online at www.mlmic.com/exclusive or e-mail your full name to pjorge@mlmic.com


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CMS

The Deadline to Submit a MIPS Targeted Review Request is 2 Weeks Away
If you participated in the Merit-based Incentive Payment System (MIPS) in 2018, your performance feedback, which includes your MIPS final score and payment adjustment factor(s), are now available for review on the Quality Payment Program website. The MIPS payment adjustment you will receive in 2020 is based on your final score. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished under the Medicare Physician Fee Schedule in 2020.

MIPS eligible clinicians or groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request for CMS to review their performance feedback and final score calculation through a process called targeted review. The deadline to submit your request is September 30, 2019 at 8:00 PM (EDT) – which is just 2 weeks away.

When to Request a Targeted Review

If you believe an error has been made in your 2020 MIPS payment adjustment factor(s) calculation, you can request a targeted review until September 30, 2019 at 8:00 PM (EDT). The following are examples of circumstances in which you may wish to request a targeted review:

Errors or data quality issues for the measures and activities you submitted

Eligibility and special status issues (e.g., you fall below the low-volume threshold and should not have received a payment adjustment)

Being erroneously excluded from the APM participation list and not being scored under the APM scoring standard

Note: This is not a comprehensive list of circumstances. CMS encourages you to contact the Quality Payment Program if you believe a targeted review of your MIPS payment adjustment (or additional MIPS payment adjustment) is warranted. We’ll help you to determine if you need to submit a targeted review request.

How to Request a Targeted Review

You can access your MIPS final score and performance feedback and request a targeted review by going to the Quality Payment Program website


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Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
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Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643


Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers.

 With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES


Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: September 13, 2019 – MSSNY Responds to Washington Post OpEd

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 13, 2019

Vol. 22  Number 34


MSSNYPAC Seal


Colleagues:

The following letter to the editor was submitted to the Washington Post on September 6, 2019.

To the Editor:

Physicians agree with the goal of legislation before Congress to protect patients from “surprise” medical bills.  It is unfortunate Dr. Ezekiel (Re “No One Likes Surprise Medical Bills…”, 9/5/19) failed to recognize the need for a balanced solution. Instead, he promotes the interests of the health insurance industry.

In 2014, New York physicians worked with state regulators and patient groups to enact a law protecting patients from surprise medical bills and established a balanced approach to determine fair payment.  When an insurer and physician cannot agree, the solution is decided through a low cost, simplified dispute resolution system. The arbitrator chooses the side that is more reasonable based upon a number of factors.  New York’s system has discouraged unreasonable billing and encourages negotiated compromises between physicians and insurers.

Importantly, New York’s law also addressed a key factor often leading to surprise medical bills – new rules to protect against narrow insurer networks. Legislation before Congress (HR 3502-Ruiz-Roe) would emulate New York’s acclaimed system.  It would take patients out of the middle while employing a simplified dispute resolution system.

We are very concerned with Congressional approaches that give insurers unilateral control to determine payment for surprise bills. It would undoubtedly be manipulated by market-dominant insurers to reduce their physician networks.  Worse, it could produce shortages in hospital emergency departments, a concern New York sought to prevent.

This is a serious problem that requires a thoughtful solution—not a one-sided giveaway to the insurance industry.

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



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eNews

Assemblyman Walter Mosley Campaign Event

Dr. Moore, Council Leader Cumbo, Dr. Sweeney at the Assemblyman Walter Mosley Campaign Event

Dr. Donald Moore, Council Leader Laurie Cumbo, Dr. Monica Sweeney

Drs. Moore, Sweeney and Assemblyman Mosley at the Walter Mosley Campaign Event

Drs. Donald Moore, Monica Sweeney, and Assemblyman Walter Mosley


New York War on E-Cigarettes Breaks Out
Local state and now federal officials have declared war on e-cigarettes amid an outbreak of respiratory illnesses tied to vaping, but with little data to go on, it’s unclear regulatory efforts will stymie the health problems that have captured the public’s attention. In New York, the health complications from vaping are associated with cannabis oil, Health Commissioner Howard Zucker said, during a press conference Monday where Gov. Andrew Cuomo called for legislation banning flavored pods. Cannabis oil, and other recreational marijuana products, remain black-market items and would not be affected by curbing the availability of over-the-counter e-cigarettes and flavored pods.  (Politico New York Health Sept. 12)


NYCDOHMH: Nearly 15% of Middle School Students Used E Cigs
The New York City Health Department “revealed alarming new information Tuesday about the use of electronic cigarettes among New York adolescents and teens, and pushed the city to crack down on the device’s availability to the youth.” Last year, “about 13,000 middle school students, roughly 6.7%, reported using e-cigarettes and 29,000 students, about 14.4%, said they had tried them. Health Commissioner Dr. Oxiris Barbot said the numbers are concerning, particularly in light of recent studies that have shown that e-cig use leads to long term health problems.”


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DFS: Insurance Cannot Be Canceled for Carrying a Script for Naxalone
The state’s top insurance regulator said on September 6 that it’s illegal for insurance companies to deny life, disability income or long-term care insurance to applicants based solely on whether they carry a prescription for naloxone, a drug that reverses opioid overdoses.

The updated guidance from the state Department of Financial Services comes four months after Gov. Andrew Cuomo directed an investigation into reports that nurses and other first responders were being denied life insurance because they had a prescription for the drug known by the brand name Narcan.

Many had prescriptions as a preventative measure — in case they encountered someone in the field who overdosed and needed to be revived. But the department’s investigation found that insurers’ underwriting practices and guidelines did not distinguish between circumstances where an applicant had naloxone for their own use, or when they had naloxone for encounters with other individuals at risk of overdose.

The distinction is important, at least with insurance law, because companies are prohibited from discriminating against people of the same class and of “equal expectation of life” when approving coverage and setting rates. Carrying naloxone to prevent your own overdose could be seen as an indicator of shorter life expectancy, but carrying it to protect others would not.

“In the midst of a national opioid crisis, it is common sense for our nurses and first responders who work every day to keep New Yorkers safe to carry naloxone,” Cuomo said. “Denying them insurance coverage for doing their job to save lives is unacceptable, and today we correct this discriminatory practice.”

And it’s not just medical professionals who have taken to carrying it. Family members and friends of people struggling with addiction are also increasingly seeking prescriptions for naloxone as a way to keep their loved ones safe. In some cases, a prescription is not needed if individuals request it from a pharmacist or other official who has a “standing order” to dispense it without a prescription.

In guidance published, however, Deputy Superintendent for Insurance James Regalbuto instructed any insurer who has improperly denied coverage to “immediately reach out” to the rejected applicants to provide them with an opportunity to reapply for coverage. He also instructed insurers to “correct or remove” any record or report that may have been made to a third-party consumer reporting agency regarding an improper insurance denial.

First responders who have been denied coverage should contact the Department of Financial Services via its consumer complaint website (www.dfs.ny.gov/complaint) or by phone at 212-480-6400 or toll-free at 1-800-342-3736.


Altfest_eNews-Banner

 


FDA Experts Warn Medical Devices Are Vulnerable to Hacking, Errors
Experts attending a meeting of the FDA’s Patient Engagement Advisory Committee on Sept. 10 warned medical devices like insulin pumps and pacemakers can be prone to hacking and errors. At least two speakers at the meeting “described how easy it was to hack their own medical devices by reverse-engineering them.” Committee members also “repeatedly said that many devices and the instructions that come with them are cumbersome and difficult to understand.” One attendee also stated that the “fact that it is impossible to predict which types of cybersecurity risks can affect a given medical device can make it more difficult for healthcare providers to have meaningful conversations about risks and benefits.” Medscape (9/12)


Webinars

Health Matters for Women: Endometriosis

REGISTRATION NOW OPEN

The Medical Society of the State of New York will host a live continuing medical education (CME) webinar on women’s health topics entitled “Health Matters for Women: Endometriosison Friday, September 20th, 2019 from 7:30 AM to 8:30 AM.

To register for “Health Matters for Women: Endometriosis, please click here.  The faculty will be Lisa Eng, DO.   The educational objectives are: 1) Review potential causes of pelvic pain and discuss how to identify endometriosis. 2) Discuss the benefits and risks as well as the efficacy and limitations of available medical therapies for long-term treatment of endometriosis. 3) Discuss implementation of individualized endometriosis treatment plans and options.

For assistance in registering or any other questions, please contact Melissa Hoffman at mhoffman@mssny.org or call (518) 465-8085.

The Medical Society for 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 credit TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.



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CMS

CMS-1500 Resources: Video Available and Q&A Webinars Next Week
The Workers’ Compensation Board is offering new resources to assist in the transition to Form CMS-1500, which will streamline medical billing and reduce the paperwork requirements currently in the workers’ compensation system. To help you prepare, the Board has developed a training video to show health care providers, and all others who will be using Form CMS-1500, how to use the form and the required narrative reports to bill for their services to workers ‘compensation patients.

Next week, the Board is also holding two follow-up Q&A webinars so that you can get answers to any questions you may have after viewing the training video and reading the CMS-1500 FAQ’s on the Board’s website.

With that in mind, we encourage you to view the training video before attending one of the webinars. As you view the training video, take note of questions that come up so that you’ll be prepared for the Q&A webinar. This will enable you to take full advantage of both resources.

To view the training video, follow this link: CMS-1500 Training Video

The webinars will be held next week on:

In the meantime, please see CMS-1500 Initiative and the CMS-1500 FAQ for information. Please direct questions to CMS1500@wcb.ny.gov

Revalidate before your due date to avoid a hold on your Medicare payments and deactivation of your Medicare billing privileges.

There are several ways to find your revalidation due date:

Centers for Medicare & Medicaid Services (CMS) Revalidation List Tool

Search by National Provider Identifier (NPI) or name.

A due date of “TBD” (to be determined) means a revalidation due date has not been assigned by CMS.

You can access the YouTube video, “How to use the CMS Medicare Revalidation Tool

Revalidation notice mailed by National Government Services

Mailed in yellow envelope

Internet-Based Provider Enrollment, Chain and Ownership System (PECOS)

Sign in with user ID and password.

Generally, the due date will remain with the provider/supplier throughout subsequent revalidation cycles. So you will not have to wonder about the due date the next time you need to revalidate.

NOTE: Unsolicited applications received seven months prior to the revalidation due date will be returned to the provider.

Need assistance? Providers and suppliers can register for our provider enrollment webinars by either using the following links, Part A/Part B or by visiting the NGSMedicare.com website. The webinars below can be found under the Education Tab by selecting Webinars, Teleconference and Events.

Provider Enrollment Revalidation Overview
Getting Connected to PECOS
Submitting Revalidation via PECOS Application
Submitting Revalidation via CMS-855A Paper Application for a Part A providers
Submitting Revalidation via CMS-855B Paper Application for a Part B providers
Submitting Revalidation via CMS-855I Paper Application for a Part B providers
Let’s Chat about Provider Enrollment Revalidation
PECOS: View and Manage Reassignments through Group Enrollment


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Conferences / Events

Public Health Impact of Legalizing Cannabis
You are invited to join the New York State Public Health Association and the New York State Association of County Health Officials for the “Public Health Impact of Legalizing Cannabis.” Program content will address implications for public health, cannabis policy and health equity resulting from a legalized program. As New York State considers the passage of policy to establish an adult-use cannabis program, it is imperative that public health stakeholders unite to prepare for potential implications and learn about policy, regulatory and governance aspects related to legalization.

When:     17 Oct. 2019
TIME:      8:30 AM – 4:00 PM
WHERE: Hilton Westchester

Hear from nationally-recognized experts in partnership with your colleagues in the public health sector. Throughout this meeting, there will be plenty of opportunities for networking with professionals representing local health departments; academia; clinical care settings; community-based organizations and others who value the health and safety of communities in New York. For more information and to register, please click here.


2019 AIM: Advocacy in Medicine Conference

Sunday, September 22, 2019

Time:     8:30AM-4:00PM

Venue:   New York Academy of Medicine, 1216 Fifth Avenue &103rd Street, NYC             

Cost : Free for medical students and health professionals with current ID; advance online registration is required. REGISTER

The second annual Advocacy in Medicine (AIM) Conference will bring together healthcare advocates and trainees from various local academic institutions interested in health advocacy for full day of talks, interactive panels, breakout sessions and networking. The conference opens with keynote speakers addressing the role of physician advocacy followed by an interactive Q&A panel discussion with physicians on advocacy, activism, and their personal career trajectories. The afternoon will be dedicated to small workgroups with the opportunity to focus on skill-building and topic-focused content.


4th Annual U of Buffalo DoctHERS Symposium; A Time of Urgency: Health Care Leaders Needed

When: Saturday, September 21, 2019

Time    8:00 am – 12:00 pm

Where: The Westin Buffalo, 250 Delaware Avenue, Buffalo, NY 14202

Join us for a morning of networking, empowerment, and education about
leadership development for women in health care professions.

Cost: $25 for General Alumni and Non-Alumni Guests; free for Students/Residents

More Details: The Jacobs School of Medicine and Biomedical Sciences’ Medical Alumni Association is proud to present the 4th Annual DoctHERS Symposium, featuring keynote speaker Dr. Susan R. Bailey, President-Elect, American Medical Association. We hope you will join us for a morning of networking, information, enrichment and resources for pay, promotions and equity in the workplace and support for females in the healthcare profession. MSSNYPAC Co-Chair Rose Berkun, MD is Chair of the event.

For more information on schedule and speaker biographies, please visit www.medicine.buffalo.edu/docthersnow


Classified

RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room



Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643


Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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


Are You Trying to Lease Your Medical Office or Sell Your Medical Practice? Trying to Sell New or Used Medical Equipment?
Clineeds, the new online platform designed for medical providers.

 With Clineeds you can lease your medical officeshared your office spacebuy and sell used medical equipment, or post healthcare job opportunities. LISTING IS FREE! Why wait? Click here to sign-up: www.clineeds.com/sign-up

PHYSICIAN OPPORTUNITIES


Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Council – September 19, 2019

AGENDA
MSSNY Council Meeting
Thursday, September 19, 2019, 9:00 a.m.
Courtyard Marriott, Westbury Long Island
1800 Privado Road
Westbury, NY  11590

A.  Call to Order and Roll Call

B.  APPROVAL of the Council Minutes of May 30, 2019

C.  New Business (All Action & Informational Items)

    1. President’s Report
     a. Creation of Scope of Practice AD HOC Committee (For Council Approval)

Rose Berkun, MD, Co-Chair
Lisa Eng, DO, Co-Chair
Inderpal Chhabra, MD, Member
Atul Kumar Gupta, MD, Member
Julie Vieth, MD, Member
Richard Wissler, MD, Member

b. AMA Resolutions submitted by Dr. Michael Brisman
(For Council Approval)

  • Resolution 1&2 – AMA Position on Payment Provisions in Health Insurance Policies
  • Resolution 4 – AMA Should Provide a Summary of Its Advocacy Efforts on Surprise Medical Bills
  • Resolution 21 – AMA Will Specifically Seek to Improve the Current Medicare Fee Schedule for Physicians

2.  Board of Trustees Report – Dr. Sam Unterricht will present the report (handout)

3.  Secretary’s Report – Dr. Frank Dowling will present the report

4.  MLMIC Update  –  Dr. John Lombardo will present a verbal report

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

6.  MSSNYPAC Report – Dr. Thomas Lee will present the report (handout)

7.  MESF Update – Dr. Thomas Madejski will present the report

8.  County Federation Report – Dr. Aaron Kumar will present the report

9. Commissioners/Councilors (Action Items – (For Council Approval)

a. Commissioner of Socio Medical Economics, Howard H. Huang, MD
Committee on Health Insurance Resolutions

          Resolution 2019-255 Urgent Care in the Doctor’s Office
          Resolution 2019-266 Medicare Plan Survey for Patients

Committee on Workers’ Compensation & No Fault Resolution
(For Council Approval)

Resolution 2019-271 Shortage of Specialists in Workers’ Compensation System

b. Organized Medical Staff Section Resolution (For Council Approval)
Presented by:  Stephen Coccaro, MD, OMSS Councilor
Resolution SC 1 (AMA I-19) Hospital Website Voluntary Physician Inclusion

10. PresentationDr. Mitchell Katz, President and CEO of NYC Health & Hospitals
Verbal update on the following two topics:

  • Update on Physician Wellness
  • Update on the Health & Hospitals Access Program

D. Reports of Officers (Verbal Reports)

1. Office of the President – Arthur C. Fougner, MD
2. Office of the President-Elect – Bonnie L. Litvack, MD
3. Office of the Vice-President – Joseph R. Sellers, MD
4. Office of the Treasurer – Mark J. Adams, MD – Financial Statement for the period
(For Council Approval)

5. Office of the Speaker – William R. Latreille, Jr., MD
6. Report of the Immediate Past-President – Thomas J. Madejski, MD – MSSNY Committee Goals

E.  Reports of Councilors (Informational)

  1. Kings & Richmond Report – Adolph B. Meyer, MD
  2. Manhattan & Bronx Report – Joshua M. Cohen, MD
  3. Nassau County Report – Paul A. Pipia, MD
  4. Queens County Report – Saulius J. Skeivys, MD
    (no written report submitted)
  5. Suffolk County Report Linda S. Efferen, 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
        (no written report submitted)
  10. Seventh District Branch Report – Janine L. Fogarty, MD
         (no written report submitted)
  11. Eighth District Branch Report – Edward Kelly Bartels, M
  12. Ninth District Branch Report  – Thomas T. Lee, MD
  13. Medical Student Section Report – Peter Joo
  14. Organized Medical Staff Section – Stephen F. Coccaro, MD
  15. Resident & Fellow Section Report – Catherine E. Steger, DO
         (no written report submitted)
  16. Young Physician Section Report – L. Carlos Zapata, MD

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

2.Commissioner of Continuing Medical Education, Mark J. Adams, MD
Presented by Dr. Paul Pipia (on behalf of Dr. Mark Adams)

a. Report from the Office of CME (For Council Information)
b. MSSNY’s Annual Reporting Policy for MSSNY Accredited CME Providers
(For Council Approval)
c. Annual Fee for MSSNY Accredited Providers
(For Council Information – Discussed at the MSSNY BOT Meeting)
d. ACCME’s Menu of New Criteria for Accreditation with Commendation
(For Council Approval)

3. Commissioner of Governmental Relations, Gregory Pinto, MD
   a. Division of Governmental Affairs 2019 Legislative Summary

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

 5. Commissioner of Science & Public Health, Joshua M. Cohen, MD
   a. Committee on Emergency Preparedness & Disaster/Terrorism Minutes 6/27/19
     b. Task Force on End of Life Care Minutes 7/19/19

   6. Commissioner of Socio Medical Economics, Howard H. Huang, MD 
                (No written report submitted)

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

H. Report of the General Counsel, Barry Cepelewicz, MD, Esq. Garfunkel Wild, P.C.
(No written report submitted)

I. Report of the Alliance, Helena Mirza, Co-President
Alliance Report

J. Other Information/Announcements
1. MACRA Sign-on Letter
2. 2019 PDMP Update
3. Surprise Bill Sign-On Letter

4. The Physicians Foundation Board Meeting, August 2019
5. Accreditation Council for CME Letter & Highlights
6. AMA Letter – Nondiscrimination in Health & Health Education Programs or Activities
7. Coalition of State Medical Societies Letter – Request for Comment on Consumer Inflation Measures Produced by Federal Statistical Agencies
8. Amicus Brief Regarding Public Charge Rule

9. MSSNY Letter re IHA Anesthesia policy to DFS
10. Buffalo News – Another Voice: Protect against surprise medical bills, but preserve access, too, by Dr. Fougner
11.MSSNY Surprise Bill Letter to Senators Alexander & Murry

K. Adjournment

 

 

 

 

MSSNY eNews: September 6, 2019 – Consent of the Governed

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
September 6, 2019

Vol. 22  Number 33


MSSNYPAC Seal


Colleagues:

“To secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed.” Thomas Jefferson, “Declaration of Independence”

Credit my colleague from the Great White North, Dr. Shawn Whatley, for this piece. Your Medical Society is your membership organization. While those in leadership may be quite learned in many ways, we are not you. We may think we know what you need but only you truly know what you need. From time to time, we all must reflect on what matters in our day to day lives. Views from 30,000 feet are never quite the same as they are on the ground.

In 1911, Robert Michels coined the Iron Law of Oligarchyall forms of organization, regardless of how democratic they may be at the start, will eventually and inevitably develop oligarchic tendencies. Over time, motivation shifts from that which is good for the members to that which is good for the preservation of the organization. Much of the time, motivation is in sync. However, some of the time, it is not. This is how organizations fail. Service organizations all too easily forget whom they serve. Leadership may be far more knowledgeable at the organizational level, yet deaf, dumb and blind to members’ daily lives.

Next week, we begin fashioning the MSSNY Legislative Agenda for 2020. So here is your opportunity to weigh in. What are YOUR asks – positive and negative? Please weigh in. What matters to you matters to us all. We may be your voice but we need your vibe.

So what say you?

  • Surprise Billing Interview: Dr. Ira Nash recently interviewed me on the subject of surprise billing for his radio program, Well Said with Dr. Ira Nash. Tune into WRHU 88.7FM this coming Monday, September 9 at 4 pm to listen to the program. 

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President



MLMIC Insurance Ad

eNews

Physician Advocacy Urged on Priority Bills Awaiting Governor’s Signature
As we move into fall, bills that passed during the 2019 session will begin to make their way to the Governor’s desk for action – to either be vetoed or signed into law. Currently, a few priority items for MSSNY that passed both houses this year are awaiting delivery to the. Physicians can quickly and easily send a letter to the Governor here on these issues by using the MSSNY Grassroots Advocacy Center here (direct links to these priority items are listed below):

  • Mid-year formulary changes – would prohibit a health insurer from removing a prescription drug from a formulary during the patient’s policy year. Moreover, if the plan’s drug formulary has two or more tiers of drug benefits with different deductibles, copayments or coinsurance, the plan may not move a drug to a tier with higher patient cost sharing during the policy year. It also prohibits the plan from adding new or additional formulary restrictions during the policy year. Please reach out to the governor and let him know how helpful this bill would be for patients by clicking here.
  • Partial prescription fills – would allow prescribers, in consultation with their patients, to prescribe up to a 30-day supply of a controlled substance with a notation to the pharmacist that they should only dispense the amount agreed to by patient and prescriber. Each partial fill would be dispensed and recorded in the same manner as a normal refill and the aggregate quantity dispensed across partial fillings may not exceed the overall total quantity prescribed. This measure would help to reduce unnecessary accumulation of leftover medication in households, and prevent diversion. Please encourage the governor to sign this legislation by clicking here. 
  • Malpractice expansion – two bills passed the legislature that will further tip the scales in lawsuits against physicians and others, adding costs and potentially increasing your liability premiums while doing nothing to reform the current broken system. One would force physician defendants into making a “blind gamble” in cases involving multiple defendants where one defendant settles prior to trial and would enable in many cases the total payout to a plaintiff to actually exceed a jury’s award. The other would allow plaintiffs to collect a judgment from a third party that is not a direct party to the lawsuit in question. The bill would permit this to occur even though the plaintiff had not sued or perhaps could not have sued the third-party defendant in the first instance. Please let the governor know how harmful these bills would be by clicking here.
  • Surprise Billing Legislation Poised to Move: Physician Action Urgently Needed!
  • With Congress set to return to DC, all eyes are on the competing pieces of surprise billing legislation that are up for debate. Rhetoric is heating up with insurance company hit pieces being posted in national media outlets such as the Washington Post in support of legislation to pad their bottom lines while potentially harming patient access to care through network terminations and inadequate specialty coverage in hospitals. It is imperative that physicians send a letter to Senators Schumer and Gillibrand, as well as their local Representative in Congress here. This link allows you to participate in a grassroots campaign that sends a message to your elected officials, through a letter, tweet and phone call. It only takes a few minutes and contains all of the details necessary to get our point across.
  • While MSSNY is working diligently with partners to refute the lies and half-truths expressed by the insurance lobby, more physician advocacy is urgently needed. MSSNY leadership and physician advocates have been meeting with key members of Congress to advocate for passage of the effective, sensible and bipartisan bill H.R.3502, sponsored by Representatives Ruiz and Roe. Further, grave concerns have been raised about the alternative being pushed by insurance companies (H.R.3630, sponsored by Representative Pallone, and S.1895-Alexander/Murray).
  •         New York’s acclaimed system is clearly working, with patients being removed from the fight, while physicians and insurance companies work payment out fairly via an independent dispute resolution process. This process is closely mirrored by H.R.3502, which is why MSSNY and physician groups across the nation support this legislation. Conversely, H.R.3630 is similar to California’s disastrous benchmarking system that has resulted in significant physician network terminations and reduced on-call specialty care access in emergency departments.
  • Moreover, this week a study was released attacking the Congressional Budget Office’s dubious claim about the savings that would accrue through disastrous proposals like HR 3630/S.1895
  • In particular, the report notes that the savings will not be what CBO has projected due to a) increased health system costs arising from an acceleration of hospital purchase of physician practices b) decreased tax revenue from physician practices and c) the premise of savings resulting decreased corporate health insurance premiums being faulty.
  • For more about the intense advocacy on this issue, please read this article in The Hill.
  • Please contact your Senators and Representatives today! 


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Responding to Physician Pushback, ABIM Announces New Option for MOC
Physicians certified by the American Board of Internal Medicine (ABIM) will soon have a new option that takes some of the pain out of maintaining their certification. In a letter sent to its diplomates, the ABIM board of directors announced that it plans to add a longitudinal assessment option for Maintenance of Certification (MOC) that will allow physicians to take shorter, more frequent tests online.

“As a result, the ABIM board in August committed to providing a longitudinal assessment option that will allow physicians to take tests online to maintain their board certification.

“We recognize that some physicians may prefer a more continuous process that easily integrates into their lives and allows them to engage seamlessly at their preferred pace while being able to access the resources they use in practice,” Marianne Green, M.D., chair of the board of directors, and Richard Baron, M.D., president and CEO said.

The American Board of Medical Specialties (ABMS), made up of 24 medical specialty boards including ABIM, has faced a backlash in recent years from physicians over tougher requirements and costs of MOC. That prompted changes in the process by those certifying boards, including the ability to take the exam online as well as allowing doctors to use clinical references to answer questions as they do in practice.

The ABIM said it is developing the new option, and, in the meantime, its current MOC program with the choice of its two-year “knowledge check-in” and traditional long-form exam physicians take every 10 years will remain in effect. The board, which certifies internal medicine doctors to practice in the specialty, said more details about the new option will be revealed in the months ahead as it looks for physicians to play an active role in providing feedback.

The ABMS said other boards have developed a longitudinal assessment option including the American Board of Colon and Rectal Surgery, the American Board of Dermatology, the American Board of Medical Genetics and Genomics, the American Board of Nuclear Medicine, the American Board of Otolaryngology-Head and Neck Surgery, the American Board of Pathology and the American Board of Physical Medicine and Rehabilitation.

The longitudinal assessment option will offer “a self-paced pathway for physicians to acquire and demonstrate ongoing knowledge,” said Green and Baron. However, the traditional long-form assessment will remain an option as some physicians prefer a point-in-time exam taken less frequently.

With the new option, physicians will be able to answer a question and receive immediate feedback as to whether it was correct, along with rationale and links to educational material. “By engaging in such a pathway, physicians can assure their medical knowledge is up to date and utilize—in real time—learning activities to address gaps,” they said.

The ABIM said it developed the new option based on feedback from internal medicine physicians including focus groups and interviews as well as information from other ABMS boards.

The ABMS said its member boards are exploring and piloting longitudinal assessment as part of their continuing certification programs. Longitudinal assessment draws on the principles of adult learning combined with modern technology to promote learning, retention and transfer of information, the group said. (Fierce Healthcare)


NY AG Leading Coalition to Allow Stays for Immigrants in Extreme Medical Need
New York Attorney General Letitia James is leading a coalition of 19 attorneys general in calling on the U.S. Citizenship and Immigration Services and U.S. Immigration and Customs Enforcement to provide answers regarding the status and oversight of the federal medical deferred action program, which has allowed immigrants to apply to remain in the United States if they are in extreme medical need. The attorneys general wrote a letter to the acting directors of the agencies that they are “deeply concerned by USCIS’s apparent decision to stop considering requests for medical deferred action.”




Garfunkel Wild Offers Discount to MSSNY Members for Nov. Symposium in NYC
Garfunkel Wild is pleased to offer a discount to members of the Medical Society of the State of New York to attend Garfunkel Wild’s 6th Annual ASC and Healthcare Management Symposium on November 1, 2019 in NYC.  This has been a highly successful program and over the years it has grown in content, attendees and sponsors.  The agenda includes speakers from New York, Connecticut and New Jersey who will present timely and important topics that should be of great interest to your members.

For more information, please see the flyer. MSSNY members will receive a discount ($285) if you register before September 15! After September 15, the cost is $350.


New York Law Ends Religious Exemptions to Vaccinations
Opponents challenging the constitutionality of a New York law that ends religious exemptions to school vaccination requirements hit another roadblock this week as a state appellate court rejected their request to block the repeal. A four-judge panel of the State Supreme Court Appellate Division’s Third Judicial Department on Thursday denied Attorneys Michael Sussman and Robert F. Kennedy Jr.’s motion for a preliminary injunction in the case.

The New York Times (9/3) reports that as the new school year begins this week in New York, the parents of about 26,000 children “who previously had obtained religious exemptions to vaccinations, are facing a moment of reckoning.” A state law, “enacted amid a measles outbreak…ended religious exemptions to vaccinations for children in all schools and child care centers.”


 

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Physicians More Likely to Prescribe Opioids Later in the Day or Running Late
study published in JAMA Network Open on August 30 reveals that physicians were more likely to prescribe opioids later in the day and when appointments were running behind schedule.

The study utilized claims and electronic health data in 2017 for 678,319 patients with new pain who saw 5,603 physicians at health care clinics. The patients’ complaints ranged from back pain and headaches to muscle and joint aches. The researchers looked at the order of appointments and whether an appointment started at its scheduled time. Opioid prescriptions were compared to prescriptions of non-steroidal anti-inflammatory drugs and physical therapy.

Overall, physicians were 33% more likely to prescribe opioids later in the day and 17% more likely to do so if the appointment was running later than its scheduled time. NSAIDs and physical therapy prescribing did not change throughout the day.

When working with patients in pain who want opioids, offering them alternative therapies such as NSAIDs or physical therapy can require time-consuming discussions, Neprash said. “Prescribing opioids may be the quick fix when they do not have enough time to discuss non-opioid options.”

In 2017 there were six times the number of opioid related deaths compared to 1999. While much of the opioid epidemic is due to illicit drug use, prescription opioids still play a large role. The authors note that if prescribing practices remained constant throughout the day, 4,459 opioid prescriptions would not have been written in 2017.

Dr. Mark Linzer, director of the Office of Professional Worklife at Hennepin Healthcare in Minneapolis, “I suspect this is the tip of the iceberg: that time pressure has numerous adverse consequences…The conversation that avoids narcotics just takes time,” he said.


Feds Eyeing Unauthorized Vaping Products in Outbreak of Severe Lung Disease
Health officials are warning against the use of black market or unauthorized products for vaping as they investigate at least 215 cases of pulmonary illness potentially related to e-cigarette use. The Washington Post reports that authorities are investigating whether contaminants may be involved.

Officials also caution against using e-cigarettes in ways that are not intended by the makers, like dripping or dabbing. For dripping, users drop e-cigarette solvents onto the hot coils of the e-cigarette, resulting in more concentrated compounds. For dabbing, substances containing high levels of tetrahydrocannabinol (THC) or cannabidiol (CBD) are superheated in the device. THC and CBD use has been reported in many, but not all, cases.

Some patients who have developed pulmonary disease improved with corticosteroids. Antibiotics have not demonstrated a consistent effect. Several patients were diagnosed with lipoid pneumonia.

The CDC is recommending that clinicians:

      • Ask all patients who have used e-cigarettes in the past 90 days about whether they have had pulmonary illness.
      • Obtain a detailed history — including the substance, device, and methods used, and where products were purchased — in cases of severe pulmonary disease where e-cigarette use is suspected.
      • Coordinate testing with the appropriate health department if e-cigarette products are available for testing.

FDA MedWatch safety alert; CDC health advisory


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Surgeon General Warns About Marijuana’s Effects on Young Brains
U.S. Surgeon General Jerome Adams is warning about the dangers that marijuana poses to the developing brains of youth and fetuses. In an advisory released Thursday, he writes: “No amount of marijuana use during pregnancy or adolescence is known to be safe.

Until and unless more is known about the long-term impact, the safest choice for pregnant women and adolescents is not to use marijuana. “The percentage of pregnant women who said they had used marijuana in the past month doubled between 2002 and 2017 (from 3.4% to 7%). In 2017, over 9 million young people aged 12 to 25 said they had used marijuana in the past month. The Surgeon General says that frequent marijuana use during adolescence is tied to brain changes related to memory, attention, decision-making, and motivation. Fetal exposure is linked to disruption of the endocannabinoid system and lower birth weight. Surgeon General’s advisory HHS news release; Background: NEJM Journal Watch Women’s Health coverage of marijuana use in pregnancy


3500 Kidneys Discarded Every Year Due to Intense Regulations
There are 93,000 people in the United States waiting for a kidney transplant, and kidney disease kills about 5,000 U.S. residents on the kidney waiting list annually. Yet, a study published last week in JAMA Internal Medicine estimated the United States throws away at least 3,500 donated kidneys every year, mainly because of the “intense regulatory scrutiny of U.S. transplant programs.”


AMA Releases 2020 CPT Code Set
Updates to medicine’s common language reflect tech-enabled patient services

The AMA announced the release of the 2020 Current Procedural Terminology (CPT®) code set containing identifiers and descriptors assigned to each medical, surgical, and diagnostic services available to patients. There are 394 code changes in the 2020 CPT code set, including 248 new codes, 71 deletions, and 75 revisions. In making these updates, the CPT Editorial Panel considered broad input from physicians, medical specialty societies and the greater health care community.

Among this year’s important additions to CPT are new medical services sparked by novel digital communication tools, such as patient portals, that allow health care professionals to more efficiently connect with patients at home and exchange information. CPT has responded by adding six new codes to report online digital evaluation services, or e-visits. These codes describe patient-initiated digital communications provided by physician or other qualified health care professional (99421, 99422, 99423), or a non-physician health care professional (98970, 98971, 98972).

Additional CPT changes for 2020 include the new codes for health and behavior assessment and intervention services (96156, 96158, 96164, 96167, 96170 and add-on codes 96159, 96165, 96168, 96171). These codes replace six older codes to more accurately reflect current clinical practice that increasingly emphasizes interdisciplinary care coordination and teamwork with physicians in primary care and specialty settings.

New CPT category I codes are effective for reporting as of Jan. 1, 2020. To assist the health care system in an orderly annual transition to a new CPT code set, the AMA releases each new edition four months ahead of the Jan. 1 operational date and develops an insider’s view with detailed information on the new code changes.

The 2020 CPT codes and descriptors can be imported straight into existing claims and billing software using the downloadable CPT 2020 Data File.


Med Students: Learn How to be a Physician Advocate at AIM Conference in NYC
The second annual Advocacy in Medicine (AIM) Conference will bring together healthcare advocates and trainees from various academic institutions interested in health advocacy for a full day of talks, interactive panels, breakout sessions and networking. The conference opens with keynote speakers addressing the role of physician advocacy followed by an interactive Q&A panel discussion with physicians on advocacy, activism, and their personal career trajectories. The afternoon will be dedicated to small workgroups with the opportunity to focus on skill-building and topic-focused content.

When:  Sunday, September 22, 2019

Where: New York Academy of Medicine, 1216 Fifth Avenue, NY, NY 10029

Time:    8:30 am-4:00 pm

For more information and a full list of speakers, click here. Admission is free for medical students and health professionals with a current ID.


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RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room



Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643


Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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


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


PHYSICIAN OPPORTUNITIES

Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: August 23, 2019 – Death Be Not Proud

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
August 23, 2019

Vol. 22  Number 32


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Colleagues:

I think suicide is sort of like cancer was 50 years ago. People don’t want to talk about it, they don’t want to know about it. People are frightened of it, and they don’t understand, when actually these issues are medically treatable. – Judy Collins

NYPD suicides have dominated the news cycle. This from the NY Post:

… The recent spate of suicides is devastating, but not shocking. Whereas 13 out of every 100,000 people will die by suicide in the general population, that number climbs to 17 in 100,000 for police officers, according to a 2018 report by the Ruderman Family Foundation, a disability advocacy nonprofit. Furthermore, the report found, officers are more likely to kill themselves than to be killed on the job — a result, experts believe, of high stress and traumatic encounters in their line of work.

“… Even when cops do seek therapy, they’ll often go to great lengths to make sure it’s off the books,” says Petrullo, an NYPD retiree. His volunteer group of retired cops man a 24-7 hotline (800-599-1085) and can confidentially refer police officers to professional psychologists or psychiatrists.

“… Some of them are so concerned, they’ll self-pay [instead of going through their insurance],” says Petrullo. “And then there are some people who think no matter who they go to, someone is going to find out.

Do you know who else has a suicide problem? Well, there’s this: One doctor commits suicide in the U.S. every day — the highest suicide rate of any profession. And the number of doctor suicides — 28 to 40 per 100,000 — is more than twice that of the general population, new research shows. The rate in the general population is 12.3 per 100,000.

You could rewrite the Post story, substituting “Doctor” for “Police Officer” and it would be eerily similar. Your Medical Society is working on a Peer to Peer Program to try to head some of these off at the pass, so to speak.

Fingers crossed and stay tuned.

Comments? comments@mssny.org; @mssnytweet; @sonodoc99

Arthur Fougner, MD
MSSNY President 



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eNews


Urgent Activism Requested on Federal Surprise Billing Legislation
Physicians are urged to continue advocating for a fair and common sense solution to the surprise billing issue. With federal legislators on summer recess, the time is now to set up meetings to discuss how the current bills winding through Congress (S1895/HR3630) will hurt access to care for our patients through narrower insurer networks and exacerbating shortages in needed specialty care in our hospital emergency departments.

Instead of these well-meaning but seriously misguided proposals, Congress should advance legislation that addresses out of network “surprise” bills through a balanced dispute resolution system like HR3502. This bill is similar to New York’s law which has proven to be cost-effective, fair and successful at reducing the burden of surprise bills on patients.

To understand why this legislation would be so harmful, please visit one of these articles which explains the issue in detail Congress, Don’t Harm Patients With The Wrong Surprise Medical Bills Solution & Congress Is About to Give Health Insurance Companies the Nuclear Weapon. While S1895 and HR 3630 would not immediately impact state-regulated plans in New York (it would only apply to ERISA-regulated plans), employer-sponsored plans make up a relatively large percentage of plans in NY. Further, it represents a startling precedent that the insurance lobby in New York would certainly attempt to capitalize upon. As such, it is extremely vital that physicians advocate for legislation that uses IDR instead of a benchmark that would create a downward spiral of fees for doctors and narrower networks for patients.

While they are on break from Washington, D.C., please reach out to your member of Congress’s (and any others that you may be acquainted with) district office to sit down and discuss this issue. You may also take direct action by utilizing the following tool that allows you to take quick action a variety of ways, including social media and phone calls https://www.freeroots.com/campaign/mssny-end-surprise-billing.

Additionally, physicians are requested to retweet MSSNY President Dr. Art Fougner’s message to members of Congress in NY and in leadership positions relevant to this issue. Please take a moment to retweet all 6 of these so that we can have our message heard en masse (links below).

http://tiny.cc/Tweet1  http://tiny.cc/Tweet2  http://tiny.cc/Tweet3

http://tiny.cc/Tweet4  http://tiny.cc/Tweet5  http://tiny.cc/Tweet6


Now Is the Time to Urge Your Members of Congress to Support Medicare Payment Increases
The American Medical Association has sent out a grassroots alert to physicians urging them to write your members of Congress today and support improvements to the Medicare Access and CHIP Reauthorization Act (MACRA), noting that when Congress returns to DC in September one item on their plate will be improving the MACRA.

After a 15 year fight to replace the flawed Sustainable Growth Rate (SGR) update system for Medicare reimbursement rates, Congress finally acted, and passed the MACRA law in 2015. Since its enactment, physician organizations have worked closely with both Congress and CMS to promote a smooth implementation of key components of the law.

Unfortunately, it has become clear that further refinements are needed to improve the program and ensure physicians can be successful moving forward. During the first five years, the law had provided for modest payment increases, but payment rates still have not kept up with inflation. To make matters worse, the statute calls for a 0% per year payment update for years 2020-2025.  Among the improvements being fought for by organized medicine:

  • Implementing positive payment adjustments for physicians in lieu of a payment freeze over the next six years;
  • Extending the Advanced Alternative Payment Models (APM) bonus payments for an additional six years, and;
  • Implementing additional technical improvements to MACRA

This problem is real and if Congress doesn’t act when they return, many physicians who see Medicare patients will be negatively affected.  This is even more important this year, given the significant shifts in Medicare physician payment (up and down) being proposed by CMS.

Please contact your members of Congress here.


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DOH Issues Emergency Regulations for Granting Medical Exemptions from Immunizations
Last Friday, the New York State Department of Health issued emergency regulations to strengthen and clarify the process by which physicians can grant medical exemptions under the new state law which repealed non-medical exemptions for children attending school or daycare.

The new regulations are effective immediately and provide clear, evidenced based guidance to physicians on appropriate issuance of medical exemptions.  The Department, in collaboration with the Office of Children and Family Services and the State Education Department, has issued a series of Frequently Asked Questions (FAQ) on the new law FAQ issue August 16, 2019.

Effective immediately, physicians who issue medical exemptions will be required to complete the applicable medical exemption form approved by the New York State Department of Health or New York City Department of Education, which specifically outlines the medical reason(s) that prevent a child from being vaccinated. Additionally, the regulations require physicians to outline specific justifications for each required vaccine in order to be able to grant an exemption.

Previously, regulations allowed for a physician to submit a signed statement to schools without having to document on an approved form stating why immunization may be detrimental to the child’s health. The emergency regulations apply to all children statewide, and they continue to require that medical exemptions must be reissued annually. By providing clear, evidence-based guidance to physicians regarding when immunization may be detrimental to a child’s health, this emergency regulation will help prevent medical exemptions from being issued for inappropriate reasons.

Public Health Law §2164, as amended by Chapter 35 of the Laws of 2019, applies to students attending all schools as defined in Public Health Law §2164 to include any public, private or parochial child-caring center, day nursery, day care agency, nursery school, kindergarten, elementary, intermediate, or secondary school. The NYS Department of Health encourages parents and guardians of all children who do not have their required immunizations to receive the first dose in each immunization series as soon as possible.

The deadline for obtaining first dose vaccinations in each immunization series for children attending school in the fall is 14 days from the first day of school or enrollment in child day care. Within 30 days of the first day of school, parents and guardians of such children must show that they have scheduled appointments for all required follow-up doses.

As of August 16, 2019, there were 1,044 cases of measles in New York State.   Measles is a reportable disease and physicians are encouraged to seek further information on the New York City Department of Health/Mental Hygiene website here or at the New York State Department of Health website here.

MSSNY has a free CME program on measles is available here.  Users new to the site will have to establish an account; all others will need to just log into the website and access the program entitled: The Continued Public Health Threat of Measles 2018.


Med Students: Learn How to be a Physician Advocate at AIM Conference in NYC
The second annual Advocacy in Medicine (AIM) Conference will bring
together healthcare advocates and trainees from various academic institutions interested in health advocacy for a full day of talks, interactive panels, breakout sessions and networking. The conference opens with keynote speakers addressing the role of physician advocacy followed by an interactive Q&A panel discussion with physicians on advocacy, activism, and their personal career trajectories. The afternoon will be dedicated to small workgroups with the opportunity to focus on skill-building and topic-focused content.

The conference will be held on Sunday, September 22, 2019 from 8:30 am-4:00 pm at The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029. For more information and a full list of speakers, click here. Admission is free for medical students and health professionals with a current ID.



Our State Fair Is a Great State Fair!
Once again, the Onondaga County Medical Society is staffing the Medical Society of the State of New York/New York State Society of Anesthesiologists booth at the state fair with volunteer Medical Society physician members. The state fair runs through September 2.

Doctors and Phil Schuh at the State Fair

(left to right) Onondaga County Medical Society Director of Finance Debbie Colvin; Dawn Nendza, LPN; MSSNY Executive Vice President Philip A. Schuh, C.P.A., M.S.; and former MSSNY Councilor Jef Sneider, MD at the Medical Society of the State of New York/New York State Society of Anesthesiologists booth at the New York state fair.

Phil Schuh at the State Fair

MSSNY Executive Vice President Philip A. Schuh, C.P.A., M.S. utilizes the services provided to fair goers at the Medical Society of the State of New York/New York State Society of Anesthesiologists booth at the New York state fair.


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New Study Finds that Levels of Marijuana Use Disorder Continue to Rise
This week, the Substance Abuse and Mental Health Services Administration released the 2018 Annual National Survey on Drug Use and Health (NSDUH). According to the survey, 45,000 more teenagers are regularly using pot, marijuana users are more likely to abuse opioids than non-users, and levels of marijuana use disorder continue to rise.
The study found that an average of 8,400 Americans aged 12 or older tried marijuana for the first time each day in 2018. This is an increase of 100 users per day from last year’s study. Furthermore, the majority of people in 2018 who reported first time marijuana use were between the ages of 12-25.

Approximately 4.4 million people aged 12 and older had a marijuana use disorder in the last year. Breaking this out further, 2.1 percent of youths aged 12-17, 5.9 percent of young adults aged 18-25, and 0.9 percent of adults 26 and older suffered from a marijuana use disorder. The percentage of young adults with a marijuana use disorder is significantly higher than last year and is the highest it has been since 2004. Read more here.


Have You Visited MSSNY’s Podcast Site Yet?
MSSNY proudly announces the addition of two new podcasts to our podcast site here.  You will find podcasts on a variety of timely and relevant topics from the current measles outbreak to emergency preparedness to veteran’s matters and adult immunizations.  Our latest podcast productions include The Mental Health Needs of Women in the Military and Health Matters for Women: Endometriosis.  Go here and check out all of the podcast MSSNY has on offer.


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WCB – New Injured Worker Prescriptions Must Be Consistent with Formulary by December 5
The NYS Workers Compensation Board recently issued a Bulletin reminding physicians and other care providers that, pursuant to the recently-adopted WCB Drug Formulary, as of December 5, 2019, any newly prescribed medication to their injured worker patient must be for a medication listed on the Drug Formulary, unless the physician obtains prior authorization for the non-formulary medication.

On or after June 5, 2020, all refills or renewals of prescriptions must use a Drug Formulary medication unless prior authorization has been obtained before the date of the refill or renewal.

  • A refill means any subsequent fill of a prescription when the number of refills is explicitly included in the original prescription.
  • A renewal means a prescription that the injured worker has been taking but for which there are no available refills.

Insurers, self-insured employers and third-party administrators must notify medical providers and injured workers by December 5, 2019, that a currently prescribed drug is not included on the Drug Formulary.

With regard to opioid medications, the bulletin also notes that the Drug Formulary does not include narcotics/opioids after the first 30 days following an injury (except in the immediate pre- and post-operative period).  It also notes the following:

  • On or after December 5, 2019, during the 30 days following an injury, narcotics/opioids may not exceed a single seven-day supply; and,
  • Prior to June 5, 2020, medical providers and injured workers must plan for a transition to a Drug Formulary medication. If such a transition is not medically appropriate, the medical provider must obtain prior authorization for a refill or renewal of a non-formulary narcotic/opioid well in advance of June 5, 2020.

Some Hospitals Use Text Messaging For Communication With Patients
Modern Healthcare reports on the use of text messaging for clinicians to communicate with patients. The article highlights the experience at Goshen Health in Indiana where clinicians use secure messaging apps to communicate with patients. The article quotes clinicians from Goshen offering advice for hospitals considering similar moves.


New DOH Report on Cigarette Smoking Among Adults in New York State
The New York State Department of Health announced this week the release of a new report on Cigarette Smoking among adults in New York State. The report is based on data from New York’s Behavioral Risk Factor Surveillance System and found that an estimated 2 million adults, or 14.1% of the state’s adult population aged 18 years and older, are current smokers. Between 2011 and 2017 the prevalence of adult smoking decreased 22%. Since 2014, however, the prevalence of adult smoking has remained relatively unchanged.

Rates of smoking remain highest among adults reporting frequent mental distress, defined as adults who report problems with stress, depression, or emotions on at least 14 of the previous 30 days (formerly referred to as poor mental health) (25.5%); adults enrolled in Medicaid (22.1%); adults who are unemployed (22.0%); adults living with disability (21.6%); adults with less than a high school education (20.0%); and adults with an annual household income of less than $25,000 (19.7%). The full report can be accessed here.


Classified

RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room



Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643


Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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


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


PHYSICIAN OPPORTUNITIES

Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNY eNews: August 16, 2019 – There They Go Again

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
August 16, 2019

Vol. 22  Number 31


MSSNYPAC Seal


Colleagues:

Divide et impera.” Julius Caesar

CMS has proposed a new fee schedule. True to form, some physicians will see an increase in Medicare payments. However, some will see a pay cut. Not unexpectedly, I received a call from an ophthalmologist about his 10% pay cut. He also noted that his colleagues in Endocrinology would receive a 10% increase and wondered if the Diabetologists would be splitting the difference for those patients with cataracts and retinal disease caused by their diabetes.

No matter where in this equation your particular practice is located, whether a “winner” or a “loser,” realize that in truth we are all losers. Echoing my comments from last week, when others are able to pit physician against physician, colleague against colleague, physicians lose. For many years now, this trend has made the practice of medicine less about profitability and more about viability. Rather than grumbling about whose slice of the pie is larger, we should be demanding (yes, demanding) a bigger pie.

For over a decade, Medicare payments have not kept up with inflation. It appears that Medicine has the dubious distinction of being an American endeavor which annually is treated to a cost of living decrease.

We need to stop being Only a Pawn In Their Game.

What say you? Please feel free to address your comments to: afougner@mssny.org.

And do follow me on Twitter: @sonodoc99

Arthur Fougner, MD
MSSNY President 



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eNews


New York Approves Increased Rate for Individual Insurance Market
Crain’s New York Business (8/9) reported that New York’s “state Department of Financial Services said Friday it would allow insurers selling health plans to individuals to raise their rates by 6.8% on average for 2020, a reduction of about one-quarter from the 9.2% insurers requested from the state in May.”

The proposed reduction “represented a less drastic cut than the state levied last year, when it cut insurers’ requests by about two-thirds and granted an average increase of 8.6% in the individual insurance market.” The article added, “The 6.8% increase for 2020 will be the lowest since 2015.”


Nursing Home Associations Call for State Payment Reforms
New York’s nonprofit nursing homes say action from state lawmakers is needed to slow the transfer of facilities to for-profit chains. An analysis Crain’s last week showed 48 nonprofit nursing homes were sold to for-profit operators between 2014 and 2018. It noted that the attorney general’s office was increasing its scrutiny of such sales in light of the trend.

Leaders of two of the largest nonprofit nursing home associations, the Continuing Care Leadership Coalition and LeadingAge New York, told Crain’s they believe the state must go further. “The attorney general’s laudable efforts must be part of a multipronged approach involving the highest levels of New York state leadership to prevent further sales and closures of mission-driven, not-for-profit nursing homes,” wrote Scott Amrhein, president of CCLC, and James Clyne Jr., president and CEO of LeadingAge.

Amrhein and Clyne recommended increasing Medicaid payments to nursing homes, noting that a study commissioned last year found payment rates resulted in a $64 per-patient shortfall.

They also said Medicaid nursing home payments should return to a fee-for-service model administered by the state rather than the managed-care approach that has been adopted. Similarly, the restoration of a $246 million cut in the state budget, which lowered Medicaid rate adjustments based on residents’ acuity, also could boost nonprofits. (Crain’s Health Pulse, Aug 8)


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USPSTF Proposes Screening All Adults for Illicit Drug Use
On  August 13, the U.S. Preventive Services Task Force (USPSTF) issued a draft recommendation that providers screen all adult patients for illicit drug use, marking the first time the task force has proposed such a recommendation. According to STAT News, the draft recommendation is intended to help combat the U.S. opioid epidemic. A federal survey in 2017 found one in 10 U.S. residents older than age 18 reported using drugs or prescription drugs illicitly, and other research has shown more than 70,000 U.S. residents in 2017 died from a drug overdose, STAT News reports. USPSTF in 2008 had concluded that there was insufficient evidence to recommend that providers screen all adult patients for illicit drug use.

However, based on new evidence, USPSTF on August 13 proposed that providers screen all patients ages 18 and older for illicit drug use if the providers can offer or refer patients to services to accurately diagnose and effectively treat substance use disorders. USPSTF in the draft recommendation defined illicit drug use as the use of illicit drugs or prescription drugs in amounts and for durations or frequencies other than prescribed.

Recommend Questions Not Drug Tests

According to the draft recommendation, USPSTF found new evidence showing screening tools can allow providers to detect whether a patient is using drugs illicitly and whether a patient might need to be assessed further. However, Karina Davidson, co-chair of USPSTF, noted that the task force is not recommending providers use drug tests to screen their patients. Instead, USPTF said providers could ask their patients a series of questions to determine whether they are using drugs illicitly.

Based on the evidence, USPSTF concluded “with moderate certainty” that screening adult patients for illicit drug use has a moderate net benefit when providers can offer or refer patients to services to diagnose and treat substance use disorders. USPSTF did not endorse a particular screening tool or treatment, which means providers who follow the recommendations can decide how they will screen and treat their patients.

USPSTF gave a “B” grade to the draft recommendation. Under the Affordable Care Act, insurers are required to cover preventive services that receive a “B” grade or higher from USPSTF without cost sharing.


USPSTF Draft Did Not Extend to Adolescent Patients between the of 12 and 17
The task force said there was insufficient evidence to determine whether screening tools and treatments are safe and effective for adolescents. According to STAT News, the long-term effects of certain treatments on the developing brains of adolescents are unknown, which is why treatments such as buprenorphine are approved only for use among patients 16 and older. USPSTF in the draft recommendation called for additional research on screening tools and treatments for adolescents who use drugs illicitly.



AMA Speaks Against Pres. Trump’s Proposal to End Sexual Orientation Protections
On Monday, August 12, the American Medical Association (AMA) spoke out against the Trump administration’s misguided proposal to remove anti-discrimination protections related to sexual orientation, gender identity, and the termination of pregnancy across a wide variety of health care programs and insurance plans.

The AMA noted that the proposal perverts the nondiscrimination provisions included in the Affordable Care Act by drastically limiting coverage protections despite decades of case law recognizing these protections. The letter said: “This proposal marks the rare occasion in which a federal agency seeks to remove civil rights protections. It legitimizes unequal treatment of patients by not only providers, health care organizations, and insurers, but also by the government itself—and it will harm patients. Such policy should not be permitted by the U.S. government, let alone proposed by it.” The letter concludes: “HHS should not finalize the proposed rule, but rather should redirect their efforts toward advancing health care access and equity for all. The AMA remains ready to assist with such efforts.”

The full text of the letter can be downloaded here.


Garfunkel Wild Offers Discount to MSSNY Members for Nov. Symposium in NYC
Garfunkel Wild is pleased to offer a discount to members of the Medical Society of the State of New York to attend Garfunkel Wild’s 6th Annual ASC and Healthcare Management Symposium on November 1, 2019 in NYC.  This has been a highly successful program and over the years it has grown in content, attendees and sponsors.  The agenda includes speakers from New York, Connecticut and New Jersey who will present timely and important topics that should be of great interest to your members.

Please see the attached flyer which we hope you can market to your members.  Please note this discount (off the normal $350 registration fee) is only effective until September 15, 2019.


Medical Groups Raise Outcry Over New Immigration Rule
The Trump Administration’s new “public charge” rule released Monday could keep noncitizen immigrants from seeking necessary medical care, according to healthcare experts.

Under the rule (clocking in at 837 pages), immigrants’ financial status and past use of public assistance programs will be taken into account in deciding whether to approve applications for permanent residency (“green cards”) and visa renewals. Those with low incomes or little education, and who have used benefits such as Medicaid, food stamps, and housing vouchers, may be turned down because they’d be seen as more likely to need future government assistance.

The rule quickly came under attack.

“Today’s changes to how ‘public charges’ are classified will discourage noncitizen immigrants from seeking the care and other services they need and to which they are legally entitled,” said David Skorton, MD, president and CEO of the Association of American Medical Colleges.

The administration’s actions could worsen health disparities, Skorton said: “The consequences of this action will be to potentially exacerbate illnesses and increase the costs of care when their condition becomes too severe to ignore.”

The final rule expands the definition of “public charge” to include the use of non-cash programs that previously had been excluded, according to Samantha Artiga, director of the Disparities Policy Project for the Kaiser Family Foundation. Even before the rule was finalized, Artiga said anecdotal reports came from providers that immigrant families were not enrolling in certain public programs, despite being eligible. Providers said they also noticed women dropping out from the Women Infants and Children (WIC) supplemental nutrition program, even though that program isn’t included under the rule, she noted.

According to Ken Cuccinelli, acting director of the U.S. Citizenship and Immigration Services (USCIS), during a press briefing Monday, Cuccinelli said “self-reliance” has been a “core principle” of America for decades. He said his family came to the U.S. from Italy and “worked together to ensure that they could provide for their own needs and they never expected the government to do it for them.”

Public benefits that are part of the rule would include “general assistance,” such as supplemental security income, Supplemental Nutrition Assistance Program (SNAP, a.k.a. food stamps), most forms of Medicaid, and certain subsidized housing programs…The rule will apply prospectively to applications and petitions received starting on Oct. 15, 2019 of this year, Cuccinelli noted.

“Make no mistake — this rule is a threat to the health of immigrant children and families,” said Mark Del Monte, JD, CEO and interim executive vice president for the American Academy of Pediatrics. “The rule considers the use of public programs like Medicaid, SNAP, and housing assistance in this definition, forcing immigrant families into an impossible choice: keep your family healthy but risk being separated, or forgo vital services so your family can remain together in this country. This is really not a choice at all,” Del Monte said.

“The public charge rule further intimidates these families and expands on the chilling effects pediatricians have seen across the country ever since the proposed rule was issued, with families disenrolling from or avoiding critical health programs and services they are eligible for,” Del Monte added. (Medpage, August 12)


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How Anthem, UnitedHealth + 4 Other Payers Fared in Q2
Anthem, Centene, Cigna, Humana and UnitedHealth Group all reported higher profits in the second quarter of fiscal year 2019, while Molina Healthcare saw profits decline.

Here’s how the six payers fared in the three-month period ended June 30:

  1. Anthem reported total revenues of $25.5 billion, up 11 percent from $22.9 billion recorded in the same period a year prior. Anthem ended the second quarter with a $1.1 billion profit, up 8.1 percent year over year.
  2. Centene posted total revenues of $18.4 billion in the second quarter of this year, up 29.4 percent from $14.2 billion reported in the same period last year. Centene ended the quarter with a $495 million profit, up 65 percent from $300 million reported in the same period in 2018.
  3. Cigna saw its total revenues climb 238 percent year over year to $38.8 billion, compared to $11.5 billion in the year prior. Cigna ended the second quarter with net income of $1.4 billion, compared to $808 million reported in the same period a year prior.
  4. Humana saw its total revenues climb to $16.2 billion, up 13.9 percent from $14.3 billion recorded in the same period a year prior. The payer boosted its net income 387 percent in the second quarter of this year to $940 million, up from $193 million in the same period a year prior.
  5. Molina Healthcare‘s total revenue fell 14.1 percent to $4.2 billion, compared to $4.9 billion in the same quarter a year prior. Molina ended the quarter with net income of $196 million, down 3 percent from $202 million reported in the same period a year prior.
    6. UnitedHealth Group recorded total revenues of $60.6 billion, up 8 percent from $56.1 billion in the same quarter a year prior. After accounting for expenses, UnitedHealth ended the second quarter with net income of $3.3 billion, up 12.7 percent from $2.9 billion recorded in the same quarter of 2018. (Becker’s Payer Issues, Aug. 13)

21 companies affected by AMCA breach
Three more health care companies have notified patients that their personal information might have been exposed in a data breach at the American Medical Collection Agency. The companies’ announcements bring the total number of health care companies known to have been affected by the data breach to 21, and the total number of patients potentially affected by the breach to at least 24.4 million. (HIPAA Journal, 8/8)


Physicians Invited to DoctHERS 4th Annual Symposium in Buffalo on 9/21
The Jacobs School of Medicine and Biomedical Sciences’ Medical Alumni Association is proud to present the 4th Annual DoctHERS Symposium.

When;             Saturday, September 21, 2019
What time?     8:00 a.m. – 12:00 p.m.

Where?           The Westin Buffalo, 250 Delaware Avenue, Buffalo, NY 14202
Cost:               $25 general admissions; students and residents are free

Join us for a morning of networking, information, enrichment and resources for pay, promotions and equity in the workplace and support for females in the healthcare profession.

Dr. Rose Berkun, Co-Chair of MSSNYPAC, is the Chair of DoctHERS and is a Clinical Assistant Professor of Anesthesiology Jacobs School of Medicine and Biomedical Sciences.

2019 Symposium Registration
Registration is now open or the 2019 DoctHERS Symposium!

Learn more about DoctHERS here.

Keynote Speaker
 Susan Bailey MD Keynote Speaker

Susan R. Bailey, MD
President-Elect, American Medical Association
Allergist in private practice, Fort Worth, TX
Distinguished Fellow of the American College of
Allergy, Asthma, and Immunology

 

 

 


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RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room



Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643

Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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


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


PHYSICIAN OPPORTUNITIES

Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MSSNYeNews: August 9, 2019 – House of Medicine Divided Cannot Stand

Arthur Fougner MSSNY Presiident

PRESIDENT’S MESSAGE
Arthur Fougner, MD
MSSNY President

MSSNY eNews
August 9, 2019

Vol. 22  Number 30


MSSNYPAC Seal


Colleagues:

“We must indeed all hang together, or most assuredly, we shall all hang separately.”
Benjamin Franklin

This week, famed physician-author Dr. Eric Topol generated quite a buzz with a piece in The New Yorker entitled “Why Doctors Should Organize.” Beginning with the recent #ThisIsOurLane pushback against a snarky NRA piece, Dr. Topol outlines past history of successes achieved when doctors organized. He rightly notes the rise of physician burnout engendered in no small part by electronic medical records which reduce caring professionals to data-entry clerks. The severing of the patient-physician relationship is also noted, thanks to the efforts of Regulators and Managed Care. Physicians, if organized, could be a powerful force but “the profession is balkanized.”

Where Dr. Topol and I part company is his assertion that Medical Societies should not be concerned with “protecting the interests of doctors.” While he is correct in recommending that a medical organization should promote the interests of the public, he’s somehow missed the history of, for example, the AMA post-Sunbeam. Eric, Medical Societies can and should do both. I’ll simply say that if physicians don’t stand up for ourselves and represent, who will?

So Dr. Topol, I am happy to continue this dialogue because you have clearly diagnosed the illness and the cure IS organizing. We must tear down the silos. We agree more than we disagree and I feel we can all work together for the good of our noble profession. We must. Our patients are counting on it.

Or, as Billy Joel put it, we will all go down together.

Arthur Fougner, MD
MSSNY President 

Comments? comments@mssny.org; @mssnytweet; @sonodoc99



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eNews

Physicians Must Make Their Voices Heard on Surprise Billing Proposals
Discussions are still ongoing regarding a national solution to surprise bills and the current incarnation winding its way through Congress would use a disastrous benchmarking system that would leave all of the power in insurers’ hands. Legislation such as S1895 and HR3630 would allow insurers to create an artificial ceiling for payment, giving market dominant insurers new incentives to drop physicians from their networks (as they have in California) and potentially limiting patient access to needed specialty care in in hospital emergency departments.

Given these threats, please take the time to send a letter to your members of Congress by going here. The letter is pre-populated and allows you to get the message to the right individuals in just a few short minutes.  Please also work with your local county medical society to arrange to meet with your Representative of Congress, as legislators are now home in their districts until the end of September.  To find your representative, go here, where you can find their contact information including phone number and Twitter handle. Please speak with their staffs and if possible, request a meeting to discuss the issue in more detail.

For more information about why this legislation is worrisome, check out the following articles. Congress is About to Give Health Insurance Companies the Nuclear Weapon discusses how it would control surprise billing mediation for any patient in an ERISA-regulated health plan and why that would likely lead to a massive cut in physician compensation. Congress, Don’t Harm Patients With The Wrong Surprise Medical Bills Solution also provides a strong overview of the topic.

MSSNY supports an approach such as HR 3502 (Ruiz-Roe-Morelle) that is modeled after New York’s acclaimed law which has shown to be remarkably effective and fair.   It mandates use of an independent dispute resolution system similar to New York’s instead of utilizing an insurer-determined benchmark.

Please do not let Congress give insurers even more ability to implement abusive tactics that interfere with needed patient care.


Five Measles Cases Reported in Mennonite Community in Wyoming County
Health officials say they’ve confirmed five cases of measles in a Mennonite community in western New York. The DOH says Thursday the cases were recorded in Wyoming County. The department has issued an advisory to notify regional health care providers of the potential for exposure.

Amid the nation’s worst measles outbreak in decades, Gov. Cuomo in June signed a law ending all non-medical exemptions for vaccines required for children to attend school in the state. The CDC Control has counted nearly 1,200 cases of measles in 30 states so far this year. About three-quarters of the cases are linked to outbreaks in New York.



FDA Investigating 127 Cases of Seizures After Vaping
The Food and Drug Administration is investigating 127 cases of people suffering from seizures after vaping, the agency announced Wednesday.

The agency received about 92 new reports of people, especially kids and young adults, experiencing seizures after using e-cigarettes since it first announced its investigation into the issue in April. The FDA said it’s unclear whether e-cigarettes caused the seizures and cautioned these cases occurred over a 10-year period.

When the FDA announced its investigation in the spring, it asked for people to let the agency know if they had ever experienced this. The FDA on Wednesday again encouraged people to report if they had seizures after vaping.

“We appreciate the public response to our initial call for reports, and we strongly encourage the public to submit new or follow-up reports with as much detail as possible,” acting FDA Commissioner Ned Sharpless said in a statement.

“Additional reports or more detailed information about these incidents are vital to help inform our analysis and may help us identify common risk factors and determine whether any specific e-cigarette product attributes, such as nicotine content or formulation, may be more likely to contribute to seizures,” he added.


Veterans’ Care Claims Inappropriately Denied
Veteran Affairs (VA) claims processors inappropriately processed claims for emergency care received at non-VA hospitals, resulting in denied or rejected claims for tens of thousands of veterans, according to a VA Office of Inspector General (OIG) report released this week. VA’s OIG noted that denied or rejected claims can leave veterans on the hook for the total costs of their care.



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Play Ball! Baseball Players May Live Longer than Other Pros and American Men
Professional baseball players may live longer than other professional athletes or American men overall, study indicates the New York Times (8/7) reports on a study published in JAMA Internal Medicine, in which researchers found that professional baseball players may have greater life expectancy than other professional athletes “and American men in general.”

The researchers also found that professional baseball players with long careers are less likely to die from cardiovascular disease and certain other diseases, but more likely to die from cancer, especially lung and skin cancer.


New Apps Give Updates to Waiting Family Members During Surgery
The Wall Street Journal (8/6) reports that startups and large healthcare companies are developing tools designed to give family members updates on the status of their relatives during surgery or hospital stays.


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USPSTF Recommends Against Pancreatic Cancer Screening
Reaffirming its 2004 statement, the U.S. Preventive Services Task Force (USPSTF) has issued a ‘D’ recommendation against screening for pancreatic cancer in low-risk adults with no signs or symptoms of this lethal disease.” The USPSTF authors wrote in their recommendation statement  published online in JAMA that “the USPSTF found no new substantial evidence that would change its recommendation and therefore reaffirms its recommendation against screening for pancreatic cancer in asymptomatic adults.”

The task force “concluded that screening has the potential for significant harm owing to the low prevalence of pancreatic cancer (12.9 cases per 100,00 person-years), the poor outcomes of treatment (5-year survival rate of only 9.3%), the limited accuracy of screening tests, and the invasive nature of diagnostic tests.”


Review Suggests Chronic Hepatitis Can Be Eliminated Globally
MedPage Today reports that “chronic hepatitis is a major public health challenge that can be eliminated globally, according to an infectious disease expert” who conducted a review study. The review study found that “although progress has been made in the prevention and treatment of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infections, challenges remain.”

The author suggests one step to achieving elimination of hepatitis is that, “all patients with risk factors should be tested for HCV and HBV and all persons born between 1945 and 1965 should be routinely tested for HCV to prevent liver disease and hepatitis transmission.” Moreover, the researcher “advised that ‘all who are positive for HBsAg or HCV should be evaluated for treatment and those susceptible to HBV or HAV should be vaccinated.’” The findings were published in the New England Journal of Medicine. https://bit.ly/2OMkY8h


CMS Releases Proposed 2020 Medicare Rule; Significant Up & Down Specialty Impacts
CMS recently released a 1700-page proposed rule for the 2020 Medicare physician fee schedule (PFS). CMS notes that “with the budget neutrality adjustment to account for changes in RVUs, as required by law, the proposed CY 2020 PFS conversion factor is $36.09, a slight increase above the CY 2019 PFS conversion factor of $36.04.

On a positive note, the 3-year review of Medicare GPCIs would produce a slight upward adjustment to the Geographic Adjustment Factors for the 5 New York Medicare payment localities.

However, it should be noted that the proposed changes to Medicare payment proposed in this rule could produce some significant upward and downward adjustments to Medicare physician payment, based upon specialty, if CMS finalizes the proposal without modification. Please see Table 111 on pp.1187-1188 of the proposed rule for a possible specialty by specialty impact.

For example, it predicts an overall +16% increase for Endocrinology, +15% for Rheumatology, +12% for Family Practice and Hematology/Oncology, +8% for Urology and Neurology, and +7% for Ob-GYN and Allergy/Immunology.  On the other hand, it predicts an overall -10% decrease for ophthalmology, -8% for Radiology and Cardiac Surgery, and -7% for Anesthesiology, Emergency Medicine and Thoracic Surgery.  The AMA notes that this impact table “should be viewed with caution” as they believe it may contain some errors.

For more information from CMS on the proposed rule, click here.  For a comprehensive AMA summary of the proposed rule, click here.

The AMA provided state medical societies with an overview of 2 of the key components of this rule:

Changes to E&M Coding and the MIPS Program

  • Office Visits – Evaluation and Management – While retaining the important modifications to reduce documentation burden, CMS will implement coding and payment modifications in 2021 that are based on the resources required to perform various levels of office visits. This will ensure that physicians treating the sickest patients are not unfairly penalized, while providing simpler solutions to coding and documentation.

Following CMS’ proposal last year to collapse payment for office visits, the AMA coordinated a response from 170 national medical specialty societies and state medical associations urging a different solution. The CPT Editorial Panel and AMA/Specialty Society RVS Update Committee (RUC) convened a Workgroup, that adopted changes in February 2019, to document office visits on either medical decision making or time spent on the date of the encounter.  According to AMA, CMS accepted most of the CPT framework and RUC recommendations.  Among the key aspects of the Office Visit Proposed Rule:

  • Effective January 1, 2021, CMS will adopt the CPT guidelines to report office visits based on either medical decision making or physician time.
  • CMS adopted the RUC work recommendations for the office visit codes. The work value increases represent $3 billion in redistributed spending, resulting in a 3% reduction in the conversion factor.
  • CMS adopted the RUC physician time recommendations. Coupled with the work value increases and some modifications in direct practice costs, these changes lead to an additional $2 billion in redistributed spending, resulting in an additional 2% across-the-board reduction.
  • Two departures from the CPT and RUC recommendations that we will need to be addressed:
    • CMS would implement an add-on payment for office visits for primary care and patients with serious or complex conditions. This proposal redistributes an additional $2 billion, resulting in an additional 2% reduction to the Medicare conversion factor.
    • Although the surgical specialties participated in the RUC survey and their data and vignettes were incorporated into the RUC recommendations, CMS proposes not to apply the office visit increases to the global surgery packages.
  • Merit-based Incentive Payment System (MIPS) – The AMA noted that it is encouraged by results showing 95% of eligible clinicians successfully participated in MIPS in 2017, increasing to 98% in 2018 based on initial results. However, many physicians report that the current program is too costly and requires reporting for reporting’s sake, diverting time from patient care.

The AMA noted that, in the 2020 proposed rule, CMS embraced the AMA’s proposed concept for streamlining MIPS. The agency outlined a high-level framework and seeks feedback on an episode-based approach to MIPS, which it is calling the MIPS Value Pathways (MVP). The attached MVP diagram is included in the rule.

In the AMA’s view, an MVP-type approach could be a turning point for the program because an option that ties MIPS to episodes of care has the potential to be more clinically relevant, less burdensome, and a stepping stone to alternative payment models.  The AMA does have concerns with several specific aspects of MVP that CMS has proposed, such as a return to the use of controversial population health administrative claims measures that the AMA successfully fought to eliminate from the initial MIPS program.  CMS does not plan initial implementation of an MVP approach until 2021.

 

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RENTAL/LEASING SPACE

Shared NYC Medical Space *Prime Flatiron Location* 17th Street and 5th Ave
Fantastic offering for shared sublease. Perfect for physician, physical therapist, psychotherapist, chiropractor, acupuncture, massage therapist, etcCentral HVAC system /High ceiling / Waiting area / Full-time use of the room /24/7 access and security. Up to 4 rooms for rent (for treatment or consultation) in shared medical office at prime NYC location. Telephone and Internet ready. Perfect for any medical professional. Included are: * Large reception area, fully equipped *Shared common areas *All utilities –electric, water, heat and A/C $ 4500 per month Part-time rates available Available September 1, 2019 Contact Information: jillian3335@gmail.com
Location: New York, NY, United States
17th Street and 5th Ave Main Lobby and Waiting Room


Ground Floor Office with Private Street Entrance in Luxury Park Avenue Building
Rental includes: two consultation rooms, private office, private bathroom.  Common waiting room, back office filing space and reception desks included.  Affordable rent.  Location East 60s between Park and Lexington.  Easy distance to Lenox Hill Hospital and New York Cornell.  Subway access within 1 block. Immediate 
occupancy available.  Call James: 917-710-7643

Fully Renovated Office Space for Part-Time Lease in Hauppauge
Available Tuesdays/Fridays, $450 half session, $750 full session. Elegant office space, beautiful waiting room with new stone and granite reception desk, custom molding, large windows, abundant natural light, TV, and refreshment counter.  Four new exam rooms and dictation room.  New stainless and granite kitchenette.  State-of-the-art network infrastructure meets HIPPA & PCI DSS compliance standards.  Digital X-ray room with PACS in each exam room available as an option.  Located in close proximity to LIE, Northern State Pkwy, and Vets Memorial Hwy. Contact us at (631) 486-8855;  Please see our listing
: https://www.loopnet.com/Listing/517-Route-111-Hauppauge-NY/15298633/



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


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


PHYSICIAN OPPORTUNITIES

Great Career Opportunities for Clinical Physicians
The NYS Department of Corrections and Community Supervision has great career opportunities for Clinical Physicians. You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary is $143,381 – $171,631 *(Additional $10,000 or $20,000). Benefits include comprehensive health insurance, NYS retirement system, deferred compensation plan, flexible spending plan, and paid time off.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*                  Clinton Correctional Facility (sporting and recreational outlets)
Dutchess                 Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin*                 Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene*                  Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                    Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan                   Woodbourne Correctional Facility (mountains, outlets, casinos and entertainment)
Seneca*                  Five Points Correctional Facility (heart of wine country)
St. Lawrence           Riverview Correctional Facility (hiking, boating and museums)
Washington             Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester            Bedford Hills Correctional Facility (Less than 1 Hour to NYC)

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

View of a doctor's office waiting area View of a doctor's office lobby

View of a doctor's office


 


Nurse, RN Utilization Review Full-Time-Westbury, NY (In-office position only)
Excellent opportunity for a RN who is seeking a position performing utilization review.  We require 1-2 years recent experience in hospital and/or insurer utilization review and experience using Interqual criteria and/or MCG Guidelines. Data entry/PC skills a plus. Benefits include 401(k), paid vacation and holidays. Send resume and salary requirements to: Empire State Medical Scientific and Educational Foundation, Inc. Human Resource Department e-mail: chunt@mssny.org  Fax: (1-516) 833-4760 Equal Oppty Employer M/F


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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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